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Compressed Mallinckrodt w reinforced oral tracheal tube.
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... factor. Despite delivery of FI O 2 1.0, the patient began to desaturate and the tracheal tube was therefore removed. Mask ventilation was easy and the airway was subsequently resecured with a standard tracheal tube without complication. Inspection of the removed reinforced tracheal tube clearly demonstrated the cause of the airway obstruction ( Fig. 1) Compression of the reinforcing wire coil had irreversibly nar- rowed the lumen of the tube, leading to near-occlusion. We hypothesize that this occurred as a result of the patient biting on the tube which went unrecognized during removal of the halo ...
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BACKGROUND
Airway management is of prime importance to the anaesthesiologists. Unanticipated difficult laryngoscopy and endotracheal
intubation remains a primary concern for the anaesthesiologists. The reported incidence of a difficult laryngoscopy or
endotracheal intubation varies from 1.5% to 13% in patients undergoing surgery. Failure to intubat...
Background:
Endotracheal intubation (EI) in intensive care unit (ICU) patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in expertise of operators. We aimed to compare the effect of video laryngoscopy (VL) and direct laryngoscop...
Over 400,000 Americans are intubated in emergency settings annually, with indications ranging from respiratory failure to airway obstructions to anaphylaxis. About 12.7% of emergency intubations are unsuccessful on the first attempt. Failure to intubate on the first attempt is associated with a higher likelihood of adverse events, including oxygen...
Background
Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways.
Objectives
We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requ...
Background: The haemodynamic responses to laryngoscopy and endotracheal intubation have been recognized since 1951.
Objective: To compare the efficacy of bolus administration of IV Esmolol and IV Fentanyl to suppress the pressor response during laryngoscopy and endotracheal intubation.
Methods: 75 patients of ASA physical status I & II undergoing...
Citations
... The primary inclusion criteria to participate were patients with Mallampati grades (MPG) 1, 2, and 3 [7] and Cormack-Lehane (CL) grades 1, 2a, 2b, and 3a on laryngoscopy. [8] The exclusion criteria were refusal to participate in the study, patients with an anticipated difficult airway, history of difficult airway in previous documents, head and neck pathology, and haemodynamic instability. ...
Background and Aims
Correctly holding the endotracheal tube (ETT) is essential for successful tracheal intubation. The study’s primary objective was to compare the between-the-fingers grip with the conventional pen-holding grip regarding the number of attempts required for orotracheal intubation and usage of external aids.
Methods
Three hundred patients undergoing elective surgeries under general anaesthesia were randomised according to the method to hold the ETT to Group C (conventional grip) and Group M (modified, between-the-fingers grip) during oro-tracheal intubation. A designated anaesthetist blinded to the groups performed laryngoscopy in all the patients, and difficult Cormack-Lehane grade 3b and 4 (n = 24) were excluded. Then, the group was revealed to the anaesthetist, and intubation was done accordingly; the number of attempts, use of backward upward rightward pressure (BURP), and time taken were noted. The sample size was estimated using the software G*Power version 3.1.9.2. Statistical Package for Social Sciences, version 23 (SPSS-23, IBM, Chicago, USA) was used for data analysis.
Results
Single-attempt intubation was comparable between the groups (99.3% versus 97.2%, P = 0.197). In contrast, the external assistance as BURP (0.75% versus 6.99%, P = 0.009) and the time taken for intubation ( P = 0.008) were reduced in group M significantly.
Conclusion
The between-the-fingers grip seems as effective as the standard grip to hold the ETT during intubation. However, it proved to be better as it can reduce the requirement for external assistance in BURP.
... In unconscious patients, neuromuscular blockade was induced by rocuronium (0.6 mg/kg). The difficulty of laryngoscopy was ascertained by the single advanced anaesthesiologist using the Cormack-Lehane scales with the Macintosh laryngoscope for all participants in the olfactory position (Table 1) [15]. The anaesthesiologist was not engaged in perioperative radiographic evaluations. ...
Background
Identification of difficult laryngoscopy is a frequent demand in cervical spondylosis clinical surgery. This work aims to develop a hybrid architecture for identifying difficult laryngoscopy based on new indexes.
Methods
Initially, two new indexes for identifying difficult laryngoscopy are proposed, and their efficacy for predicting difficult laryngoscopy is compared to that of two conventional indexes. Second, a hybrid adaptive architecture with convolutional layers, spatial extraction, and a vision transformer is proposed for predicting difficult laryngoscopy. The proposed adaptive hybrid architecture is then optimized by determining the optimal location for extracting spatial information.
Results
The test accuracy of four indexes using simple model is 0.8320. The test accuracy of optimized hybrid architecture using four indexes is 0.8482.
Conclusion
The newly proposed two indexes, the angle between the lower margins of the second and sixth cervical spines and the vertical direction, are validated to be effective for recognizing difficult laryngoscopy. In addition, the optimized hybrid architecture employing four indexes demonstrates improved efficacy in detecting difficult laryngoscopy.
Trial registration
Ethics permission for this research was obtained from the Medical Scientific Research Ethics Committee of Peking University Third Hospital (IRB00006761-2015021) on 30 March 2015. A well-informed agreement has been received from all participants. Patients were enrolled in this research at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, identifier: ChiCTR-ROC-16008598) on 6 June 2016.
... [9] After achieving adequate neuromuscular blockade, direct laryngoscopy was attempted for tracheal intubation using an appropriately sized Macintosh blade by an experienced anaesthesiologist (with more than 3 years of experience) blinded to the upper airway ultrasound parameters. The laryngoscopic view was graded according to the Cormack-Lehane (CL) grading and was graded difficult if the CL grade was at least Grade 3, and mask ventilation was graded difficult if the Han scale was at least Grade 3. [10] The presence of at least one of the following was defined as a difficult airway: The primary outcome measure was to compare the ultrasound parameters (DSHB, DSTI and TBT) between participants with difficult airway and those without difficult airway. The secondary outcome measure was to compare the BMI between participants with difficult airway and those without difficult airway. ...
Background and Aims
Ultrasonography has emerged as a new airway assessment tool. However, its role in predicting difficult airways needs to be explored. This study aimed to evaluate the accuracy of pre-operative ultrasound assessment of the neck in predicting difficult airways in patients undergoing elective surgery under general anaesthesia.
Methods
One hundred and fourteen adult patients undergoing elective surgeries under general anaesthesia were enrolled in this study. In the pre-operative room, upper airway ultrasound measurements of the neck were obtained, namely, distance from skin to the hyoid bone, distance from skin to the thyroid isthmus and thickness of the base of the tongue. Clinical airway assessment details were noted from the pre-anaesthetic evaluation form. The airway management technique was noted. Receiver operating characteristic curves were used to assess the diagnostic value of these upper airway ultrasound measurements in predicting difficult airways.
Results
The distance from the skin to the thyroid isthmus in the difficult airway group (0.37 ± 0.133 cm) was significantly higher than in the non-difficult group ( P = 0.007). It appeared to be a better predictor of difficult airways and correlated better with clinical tests among the measured ultrasound parameters. The body mass index was significantly higher in the difficult airway group ( P = 0.009).
Conclusion
Considering the difference in means between the two groups, distance from the skin to the thyroid isthmus should be explored as a potential predictor of a difficult airway in studies with a larger sample size.
... FPS was measured when the ventilation indicators in the simulator confirmed the success of the ventilation endeavor. Secondary results include time to intubate, glottis visualization based on Cormack-Lehane classification [23], and percentage of glottis opening (POGO) score. The time to intubation was defined as starting when the laryngoscope blade was placed between the teeth and terminating until the first lung breathing occurred, as measured by the simulator's sensors. ...
Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol- generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, random- ized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView’s performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.
... The laryngeal view was classified using the Cormack-Lehane system. 11 Oxygen desaturation was included only if initial S pO 2 was > 90% and the subject had an S pO 2 < 80% observed during the procedure. Cricoid manipulation before or during intubation attempt was recorded. ...
Background:
Respiratory therapists (RTs) have historically performed safe and effective intubations, yet there are limited multi-center data assessing their intubation performance. Multi-center data can be used to compare RT intubation performance to that of other professions and identify quality improvement opportunities at hospitals where RTs perform intubation. We aimed to explore the feasibility of a multi-center collaborative to evaluate RT intubation outcomes.
Methods:
A data collection tool was developed by the authors and implemented at two institutions. Following institutional review board approval at each center and completion of data-use sharing agreements, data were collected between May 25, 2020-April 30, 2022, and combined for analysis. Descriptive statistics were used to compare overall success rate, first-attempt success rate, adverse events (AEs), and type of laryngoscopy.
Results:
There were a total of 689 intubation courses where RTs made an attempt, 363 from center A and 326 from center B. Center A captured 85% of all RT intubation courses, and center B captured 63%. Overall, RTs were successful in 98% of attempts. RTs made 86% of initial attempts. The most common indications for intubation were cardiac arrest (42%) and respiratory failure (31%). Videolaryngoscopy was used during 65% of initial attempts and was associated with higher first-attempt success rate, higher overall success rate, and fewer AEs. Airway-related adverse event rate was 8.7%; physiologic AE rate was 16%, and desaturation rate was 11%.
Conclusions:
A collaborative examining RTs intubation performance was successfully initiated at 2 separate facilities. Intubations performed by RTs had a high success rate, with AE rates comparable to published results from other types of providers.
... The standard threshold value as observed in other racial and ethnic population in predicting difficult airway may not apply to the Indian population as mentioned by Prakash et al. (2013). Another limitation of our study is the possibility of inter-observer variability in perception of Mallampati class (Karkouti et al. 2000) and the Cormack-Lehane grade (Krage et al. 2010). ...
Background
Unanticipated difficult airway remains a challenge for the anesthesiologist with no established standard criteria to predict difficulty in intubation. Our aim was to correlate the pre-anesthetic ultrasonographic (USG) airway assessment parameters with Cormack-Lehane (CL) grade at direct laryngoscopy view under general anaesthesia.
This was a prospective, observational study on 150 adult patients between 18 and 70 years with the American Society of Anesthesiologist—Physical Status 1–2 requiring general endotracheal anesthesia for elective surgery.
Results
The incidence of difficult laryngoscopy was 22.7%. The sonographic distance from anterior neck surface to epiglottis (ANS-E) > 1.67 cm was observed to be a statistically significant USG predictor of difficult laryngoscopic view with sensitivity of 64.71% and specificity of 78.45% ( p = 0.000). The sonographic distance from anterior neck surface to hyoid bone (ANS-H) or to anterior commissure (ANS-AC) did not corelate with difficult laryngoscopy. The ultrasound (US) parameters had higher negative than positive predictive value.
Conclusions
We found ANS-E distance to be the most significant predictor of difficult laryngoscopy in our study. USG is a useful tool to identify the “at-risk” patients for difficult airway.
... According to one study, using Cormack and Lehane categorization as the gold standard, the HMDR's sensitivity for predicting DL was 27.78%, specificity was 98.89%, PPV was 71.43%, and NPV was 93.19% 22 . ...
Background: To keep the airway open, a flexible plastic tube (ETT) is inserted into the trachea during tracheal intubation. Even when done correctly, tracheal intubation requires much clinical experience, and catastrophic problems can occur. Mandibular space has been estimated using hyomental distance (HMD), although HMD has only been found to provide a limited amount of diagnostic accuracy on its own. In order to determine how well the Hyomental Distance Ratio (HMDR) predicts difficult laryngoscopy, we conducted this study. Objectives: Using the Cormack and Lehane classification as the gold standard, the objective is to assess the diagnostic validity of the Hyomental Distance Ratio (HMDR) for the prediction of challenging laryngoscopy in patients undergoing surgery under general anaesthesia. Materials & Methods: The department of anesthesiology and the general surgery operating rooms at Sir Ganga Ram Hospital in Lahore conducted this cross-sectional study over the course of six months in 2015–2016. The approach of non-probability purposive sampling was applied. Informed consent was acquired, and patient demographics were recorded. The researcher herself then assessed patients for HDMR. In order to determine if a patient had a difficult or normal laryngoscopy, HDMR was determined. After that, the researcher performed a laryngoscopy on the patients. If the vocal cords were visible, the mouth was opened, and the case was assessed using the Cormack and Lehane classification (CL), with easy or difficult laryngoscopy being designated. SPSS version 20 was used to enter and analyse all of the data. Results: The patients in our study had a mean age of 43.23 11.63 years and a male to female ratio of 1.5:1. In this study, 43.91% of patients had an HDR difficult intubation. HDR's difficult intubation has a sensitivity of 95.05%, a specificity of 96.12%, and a diagnostic accuracy of 95.65% when using CL as the gold standard. Practical Implication: According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Conclusion: According to the findings of our study, the HMDR is a viable diagnostic tool for anticipating challenging laryngoscopy in patients having general anaesthesia with tracheal intubation. According to this study, this strategy can be applied accurately in other hospitals. Government should establish guidelines for using the most trustworthy techniques as the benchmark in healthcare settings. Keywords: Laryngoscopy, difficult intubation, Cormack Classification, difficult surgery
... Airway assessment was done by Copur score 9 and Cormack Lehane grading system. 10 In the operating room, standard basic monitoring devices were attached to the children including a pulse-oximeter, 3 lead ECG, and non-invasive blood pressure (NIBP). Baseline measurements of NIBP, heart rate and saturation were recorded. ...
There are many studies in India that have compared direct laryngoscopy and video laryngoscopy in adults but the published data regarding paediatric population which needs special consideration is limited. The present study was aimed to compare the efficacy of video laryngoscopy and direct laryngoscopy in endotracheal intubation in paediatric patients.
The present randomised controlled research was done in 64 children of one to five years that underwent pre-planned surgery. Children were divided into direct laryngoscopy and video laryngoscopy groups by randomization. The comparison of the time required for the best visualisation of glottis was the primary outcome measure. The comparison of the time to intubation and number of attempts were the secondary outcome measures. An unpaired student’s t-test and the Chi-square/ Fisher’s exact tests were used to compare the quantitative and qualitative variables respectively.
Mean time required for the best visualisation of video laryngoscopy and direct laryngoscopy was 6.1 sec and 5.3 sec respectively (p-value = 0.010). The mean time to intubation of video laryngoscopy was 15.3 sec while that of direct laryngoscopy was 13.1 sec (p-value = 0.001). The first attempt success rate was 29/32 (90.6%) in the video laryngoscopy group whereas it was 28/32 (87.5%) in the direct laryngoscopy group (p-value = 0.580).
Time required for the best visualisation of glottis and time to intubation were significantly higher in video laryngoscopy as compared to direct laryngoscopy group.
... However, it only represents one aspect of the intubation process and can be subjective in nature. [12,[15][16][17] The Intubation Difficult Scale (IDS) is the most comprehensive scale as it combines multiple parameters known to be associated with DI into a single number to give an estimate of intubation difficulty [ Table 1]. [14,18] Between the two, the IDS is more comprehensive and is a previously validated score that accounts for multiple predictors of DI. ...
Airway management in patients with obesity remains a complex and evolving topic that is becoming more pertinent given the increasing prevalence of obesity and bariatric surgery worldwide. Obesity is associated with increased morbidity and mortality secondary to anesthetic complications, especially related to airway management. Preoperative assessment is especially vital for the bariatric patient so that potential predictors for a difficult airway can be identified. There are several airway management strategies and techniques for the bariatric population that may help reduce postoperative pulmonary complications. This review aims to discuss assessment of the airway, ideal patient positioning, intubation techniques and devices, apneic oxygenation, optimal ventilation strategies, and extubation and post-anesthesia care.
... The Cormack-Lehane Classification (CL) is a grading system commonly used to describe laryngeal vision during direct laryngoscopy (5). Laryngoscopy was classified as easy (grade 1 and 2) or difficult (grade 3 and 4) (6). ...
Background: Airway management is one of the most important responsibilities of anesthesiologists, predict difficult tracheal intubation can reduce the possible complications of intubation. The aim of this study was to investigate the malocclusion classification and degree of laryngoscopy to predict the difficult intubation. Methods: A retrospective observational study was performed in Shahid Mohammadi and Shariati hospitals affiliated to Bandarabbas University of medical sciences in Iran. Over a 4-yr period from 2014 to 2018, 1080 attempts at for treatment of malocclusion were recorded. Results: According to the findings of this study, the highest percentage 49.3% (572 n), were malocclusion Class 1, and 42.1%(488n) were malocclusion Class 2 and 1.7% (20 n) were malocclusion Class 3. Findings showed that the relationship between the two variables of malocclusion and the degree of laryngoscopy in terms of age, sex, thyromental distance, malamapathy and BMI showed that between the two variables of malocclusion and the degree of laryngoscopy in ages less than 10 years, there is a significant relationship and inverse correlation(r=-0.594). Conclusion: The results of this study showed that is no significant relationship between dental malocclusion and degree of laryngoscopy, malamapathy, gender and BMI. Malocclusion only at less than 10 years of age is effective to predict difficult laryngoscopy.
