Anaesthesia
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Randomized Controlled Trial Comparative Study
The circulatory responses to fibreoptic intubation: a comparison of oral and nasal routes.
The circulatory responses to fibreoptic intubation under general anaesthesia were studied in 60 adult female patients who were randomly assigned to receive either the oral or nasal route for insertion. Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline values), immediately after anaesthesia induction (post-induction values), at intubation and every minute for a further 5 min. The product of heart rate and systolic blood pressure (rate pressure product) at every time point was also calculated. ⋯ There were no significant differences between the two groups in blood pressure, heart rate and rate pressure product at any measuring point, or in the maximum values during observation. The time required for recovery of systolic blood pressure to the post-induction value was not significantly different between the two groups, but the time required for recovery of heart rate to post-induction value was significantly longer in the fibreoptic orotracheal intubation group than in the fibreoptic nasotracheal intubation group. It was concluded that both fibreoptic orotracheal and fibreoptic nasotracheal intubations could cause a similar magnitude of circulatory responses in general anaesthetised, female adults, but the tachycardic response to fibreoptic orotracheal intubation lasted longer than that to fibreoptic nasotracheal intubation.
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Randomized Controlled Trial Comparative Study
Tracheal intubation using the ILMA, C-Trach or McCoy laryngoscope in patients with simulated cervical spine injury.
A study of 90 patients was undertaken to compare intubation success rates of using either ILMA, C-Trach or McCoy laryngoscope in patients with simulated cervical spine injury. Insertion and intubation success rates, time taken to achieve intubation, airway complications and haemodynamic parameters were recorded. ⋯ Total intubation time was significantly longer in the ILMA (63 s, SD 36.5) group than in the C-Trach (41 s, SD 15.8) and McCoy (30 s, SD 7.4) groups (p < 0.05, p < 0.05, respectively). There were no significant differences in haemodynamic parameters among the groups at any time.
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We report the management of a patient requiring surgical laryngoscopy with a view to laser resection of an epiglottic recurrence of laryngeal cancer. Previous attempts at tracheal intubation and awake nasal fibreoptic intubation had failed. During a previous anaesthetic the patient had been both 'impossible to intubate and to ventilate'. ⋯ This was achieved using the Aintree intubation catheter as an aid to nasal fibreoptic intubation and as a tube exchanger. Novel roles of the Aintree intubation catheter and LMA Proseal in this case are discussed. Complications of transtracheal jet ventilation as well as possible methods for avoiding them are also reviewed.
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Comparative Study
Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.
Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. ⋯ In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.