Articles: intubation.
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The 'cuff-leak' test, which involves demonstrating a leak around a tracheal tube with the cuff deflated, has been advocated to determine the safety of extubation in patients with upper airway obstruction. In 62 such patients we were able safely to extubate all patients with a cuff leak. ⋯ Subsequently, we extubated 10 patients who were stable on spontaneous ventilation and did not have cuff leak; three later required tracheostomy and seven were uneventfully extubated. While the presence of cuff leak demonstrates that extubation is likely to be successful, a failed cuff-leak test does not preclude uneventful extubation and if used as a criterion for extubation may lead to unnecessarily prolonged intubation or to unnecessary tracheostomy.
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We have studied the effects of phonation and posture on the Mallampati classification of view of the pharyngeal structures. Differences between observers were allowed for by the experimental design and log-linear modelling. Sixty-four patients were assessed on the ward, sitting upright, with and without phonation, by each of two observers. ⋯ Differences between observers were non-systematic but substantial. About 25% of patients phonated spontaneously. It is recommended that anaesthetists make their own assessments of Mallampati classification, with the patient in either of the postures but always either with or without phonation, and thereby gradually "calibrate" their assessments against the degree of difficulty encountered in intubation.
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Ann Fr Anesth Reanim · Jan 1992
Case Reports[Difficult intubation managed by laryngeal mask and fibroscopy].
A case is reported of a patient due to undergo a combined kidney and pancreas transplant who proved to be difficult to intubate. This diabetic hypertensive 35-year-old male patient also had ankylosing spondylitis. Mouth opening was normal (more than fingers' breadth), the chin-sternum distance was 4 cm on full cervical flexion, and cervical extension was only slightly impaired. ⋯ A paediatric fibroscope, passed through the LM tube, served as guide for the endotracheal tube. The mask was not removed, although its cushion was slightly deflated, so as not to extubate the patient. The benefits and usefulness of a laryngeal mask in predictable and unpredictable cases of difficult intubation are discussed.