Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?: A prospective observational study
The objective of this study was to compare the initial intubation in the cardiac operating room with reintubation (if required) in the ICU following cardiac surgery. DESIGN A prospective, observational study. SETTING Department of Anesthesiology and Intensive Care Medicine, Clinical Hospital of Santiago, Spain. PATIENTS With approval of the local ethics committee, over a 44-month period, we prospectively enrolled all cardiac surgical patients who were intubated in the operating room using direct laryngoscopy, and who required reintubation later in the ICU. MAIN OUTCOME MEASURES The primary endpoint was to compare first-time success rates for intubation in the operating room and ICU. Secondary endpoints were to compare the technical difficulties of intubation (modified Cormack–Lehane glottic view, operator-reported difficulty of intubation, need for support devices for direct laryngoscopy) and the incidence of complications. RESULTS A total of 122 cardiac surgical patients required reintubation in the ICU. Reintubation was associated with a lower first-time success rate than in the operating room (88.5 vs. 97.6%, P = 0.0048). Reintubation in the ICU was associated with a higher incidence of Cormack–Lehane grades IIb, III or IV views (34.5 vs. 10.7%, P
Publication date: Available online 25 January 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Patrick Schoettker, Ana Pérez Arias, Etienne Pralong, John Michael Duff, Nicolas Fournier, Istvan BathoryAbstractBackgroundFibreoptic intubation is described as the preferred technique for the non-urgent airway control in patients with an unstable cervical spine injury. Indirect laryngoscopes offer promising advantages, but their safety and impact on cervical spine movement is still discussed.AimWe compared the incidence of significant neurophysiologic modifications associated with tracheal intubation performe...
Authors: De Cassai A, Boscolo A, Rose K, Carron M, Navalesi P Abstract BACKGROUND: Airway management is a fundamental goal for the anesthesiologist. The rate of difficult laryngoscopy in patients undergoing thyroid surgery ranges from 6.8% to 9.6%. An accurate and detailed preoperative evaluation of the airway seems to be a promising tool to predict a potentially difficult airway management. We aimed to identify possible risk factors and physical findings that predict difficult intubation in thyroid surgery. METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analysed,...
CONCLUSIONS: The combination of Thyromental distance, Interincisor gap, and Forward protrusion of the mandible is the optimal assessment to predict difficult laryngoscopy in school-aged patients with microtia. PMID: 31922374 [PubMed - as supplied by publisher]
ConclusionThere is no anatomical relation between otolaryngologic surgery, the hypoglossal nerve and recurrent laryngeal branch of the vagus nerve. This Tapia’s syndrome case is possibly caused by nerve compression of the two nerves due to anaesthesia cannula. Ginkgo leaf extract, methylcobalamin and mouse nerve growth factor could be used as an alternative treatment plan in case of steroid contraindications.
CONCLUSION: We showed on a simulator that there was no statistically significant difference between the duration of the intubation between direct laryngoscopy and video laryngoscopy both in the easy and difficult airway. PMID: 31917002 [PubMed - as supplied by publisher]
CONCLUSION TFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02671877.
Conclusion: When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign.
I'll admit it. I hate the cricothyrotomy. It's not because I haven't done one for a decade or because it is a complicated procedure. Or because I dread the thought of leaving a permanent cosmetic defect on someone's neck. Or because it is a procedure performed as a last resort under extreme time pressure on a hypoxic patient who will almost assuredly die if you fail.It has something to do with the word failed, as in failed airway. That surgical airway is there because the physician could not gain effective control of the patient's airway using all of the other airway tools at his disposal. We all understand that failure...