Articles: intubation.
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Anaesth Intensive Care · Jan 2025
A simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.
A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation. ⋯ Twenty-five percent of participants required multiple attempts using the ETT method versus 5% using the SAFE airway device, which was also rated as being easier to use. This study demonstrates that the SAFE airway device was fast, effective, easy to use and acceptable to airway practitioners in a simulated manikin environment. These findings indicate that further studies of the SAFE airway device are warranted.
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Case Reports
Cervicothoracic Emphysema After Nasotracheal Intubation Attempt: A Life-Threatening Complication-A Case Report.
Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient. This case underscores the need for increased awareness and readiness for managing rare but critical complications associated with airway management techniques.
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Review Meta Analysis
Preoperative Ketamine Gargle for Prevention of Postoperative Sore Throat After Tracheal Intubation in Adults: A Meta-Analysis.
Objective: This meta-analysis aims to evaluate the impact of preoperative ketamine gargle on postoperative throat pain in patients undergoing general anesthesia with endotracheal intubation (ETI). Methods: A comprehensive search was conducted in databases including PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, ClinicalTrials.gov, and others. Data analysis was performed using RevMan 5.4 and Stata Statistical Software 18 (StataCorp., Texas., United States of America). ⋯ The results demonstrated a significant reduction in the incidence of postoperative sore throat at 0, 2, 4, 8, and 24 h after the operation (0 h: OR: 0.14; 95% CI: 0.04-0.47; p=0.002; I 2 = 67%; 2 h: OR: 0.30; 95% CI: 0.17-0.52; p < 0.0001; I 2 = 31%; 4 h: OR: 0.32; 95% CI: 0.20-0.52; p < 0.00001; I 2 = 0%; 8 h: OR: 0.40; 95% CI: 0.23-0.70; p=0.001; I 2 = 29%; 24 h: OR: 0.36; 95% CI: 0.25-0.51; p < 0.00001; I 2 = 0%) in patients who received ketamine gargle compared to those who received a placebo. In addition, our meta-analysis indicated that ketamine gargle did not result in a reduction in anesthesia time (min) (MD: -1.16; 95% CI: -6.44-4.11; p=0.67). Conclusion: Our meta-analysis demonstrated the efficacy of prophylactic ketamine gargle in reducing the incidence of POST across all studied time intervals in patients requiring tracheal intubation of general anesthesia compared to placebo.
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Multicenter Study
Association Between Neuromuscular Blocking Agents and Outcomes of Emergency Tracheal Intubation: A Secondary Analysis of Randomized Trials.
To examine the association between the neuromuscular blocking agent received (succinylcholine versus rocuronium) and the incidences of successful intubation on the first attempt and severe complications during tracheal intubation of critically ill adults in an emergency department (ED) or ICU. ⋯ Among critically ill adults undergoing tracheal intubation, the incidences of successful intubation on the first attempt and severe complications were not significantly different between patients who received succinylcholine and patients who received rocuronium.
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Randomized Controlled Trial Comparative Study
Cervical spine motion during videolaryngoscopic intubation using a Macintosh-style blade with and without the anterior piece of a cervical collar: a randomized controlled trial.
Applying a cervical collar during videolaryngoscopic intubation can increase the lifting force required to achieve adequate glottic view, potentially increasing cervical spine motion. We aimed to compared cervical spine motion during videolaryngoscopic intubation between applying only the posterior piece (posterior-only group) and applying both the anterior and posterior pieces (anterior-posterior group) in patients wearing a cervical collar. ⋯ CRIS.nih.go.kr ( KCT0008151 ); first submitted 17 January 2023.