PurposePalpation during intubation could be used as an ancillary method of providing real-time information of the endotracheal tube (ETT) placement before manual ventilation. This study aimed to evaluate the ability to discriminate the ETT location using a modified real-time palpation method with a preloaded stylet during intubation.Patients and methodsThe examiner performing the real-time palpation method placed three fingers on the lateral sides of the trachea between the sternal notch and the thyroid cartilage to determine if endotracheal intubation was successful. Endotracheal intubation was confirmed by auscultation and quantitative carbon dioxide waveform using capnography.ResultsEighty-eight patients were enrolled in this study. The discrimination accuracy of the real-time palpation method was 98.9% (95% CI: 93.8–99.8) for identifying the location of ETT between the trachea and esophagus. There was one false negative, reported as esophageal intubation rather than tracheal intubation.ConclusionThe real-time palpation method during intubation using an ETT with a preloaded stylet is an instantly applicable technique with good discrimination ability. The addition of real-time information through this palpation method to the conventional intubation process, especially in patients with poor vocal cord visualization, would be useful to facilitate the process of safe and careful endotracheal intubation.

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In this study, we analyzed the design of a source lens for a free-electron laser (FEL) module and proposed an optimized module equipped with multiple tips using carbon nano-tube (CNT) paste. We proposed the combination of a wiggler structure and source lens structure optimized for the electron beam trajectory, using an electrostatic wiggler. The optimal configuration consisted of a circular extractor and accelerator electrodes (to reflect the tip structure) and a rectangular limiting aperture (to reflect the wiggler structure). We also investigated the use of multiple electron tips and demonstrated that the optimal configuration obtained using the CNT paste was the most efficient configuration for a FEL module. These findings provide valuable insights into the design of high-performance FEL modules.