A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

Patkar, Geeta A.; Virkar, Nilam Dharma; Anusha, M. S.; Tendolkar, Bharati A

doi:10.18203/2349-3259.ijct20162238

Cited by 7 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, Shetty et al, 20 in their prospective study on 10 patients with midfacial fractures, reported a mean time of 5.9 minutes for performing Altemir's submental intubation. In a previous study by Patkar et al, 22 the time taken to perform submental intubation was 9.68 ± 1.82 minutes, which was significantly more than that in our study (2.84 minutes and 3.67 minutes in Seldinger group and Altemir group, respectively). This could be due to the fact that in the study by Patkar et al, total submental intubation time was taken from the time of induction to fixation of the ETT submentally.…”

Section: Discussioncontrasting

confidence: 70%

“…Sample Size Calculation. The sample size was calculated on the basis of a previous study by Patkar et al, 22 wherein the authors reported the mean ± standard deviation time taken to complete submental intubation (Altemir's technique) as 580.8 ± 109.2 seconds. Assuming a 15% relevant reduction (equivalent to a decrease of 87.12 seconds) in the time taken to complete the procedure as clinically important, with a power of 80%, 25 patients were required in each group.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

Bhatia

Jain

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

BACKGROUND: Submental intubation performed using the classical Altemir’s technique is a well-accepted, safe technique for providing optimal operating field to the maxillofacial surgeon, in cases where either nasotracheal or orotracheal intubation is impossible. We propose a new, percutaneous Seldinger’s technique of submental intubation as an interesting alternative to the classical Altemir’s technique, wherein a percutaneous dilatational tracheostomy kit is used to dilate the submental tract, instead of bluntly dissecting it. We hypothesized that Seldinger’s technique would be associated with reduced procedure time and minimal scar formation in patients with maxillofacial fractures. METHODS: We enrolled 60 patients scheduled to undergo maxillofacial injury fixation under general anesthesia. After consent, the cohort was randomly allocated to undergo submental intubation by either the classical Altemir’s technique or Seldinger’s technique. As our primary objective, we noted the time taken to complete the procedure of submental intubation. Our secondary objectives were the components of primary outcome, such as disconnection/apnea time, bleeding, and technical difficulties during the procedure. We also observed for complications such as presence of salivary fistula/infection at hospital discharge and scar characteristics at 1- and 3-month follow-up. RESULTS: The median time for performing submental intubation in the Seldinger group was significantly lower than that in the Altemir group (170.5 [136.5–256.0] seconds vs 220.0 [205.5–289.0] seconds; P value, .040). The median disconnection time was also significantly lower in the Seldinger group (12.0 [10.8–20.0] seconds vs 19.0 [15.0–23.0] seconds; P value, .036). Furthermore, significant bleeding was absent in nearly 53.8% of the study participants in the Seldinger group as compared to 25.9% in the Altemir group. At follow-up, there was no evidence of differences in scar characteristics between the 2 groups. CONCLUSIONS: Seldinger’s technique is associated with shorter procedure time and reduced apnea time due to easier and better tract formation, thus minimizing the effort required to exteriorize the endotracheal tube. Furthermore, as dilation reduces tissue damage, Seldinger’s technique is associated with significantly less procedural bleeding. Thus, Seldinger’s technique can be safe, easy, and faster to perform compared with the classical Altemir’s technique of submental intubation in patients with maxillofacial trauma.

show abstract

Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

Bhatia

Jain

et al. 2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…In the study of Geeta A. Patkar et al, changes in the different heamodynamic parameters during submental intubation were statistically not significant. 13 Damage of the endotracheal tube cuff was occurred in two patients during the manipulation with Magill forceps into the trachea. But we excluded those cases from the study because extra time taken during tube exchange could alter the result of the study.…”

Section: Discussionmentioning

confidence: 99%

A study to evaluate the efficacy of submental intubation in panfacial trauma

Banjare¹,

Ningawal²,

Nema³

et al. 2020

IJCA

View full text Add to dashboard Cite

Anaesthesia for pan-facial surgeries is challenging because the anaesthesiologist and surgeon have to share the common upper airway field. Oral and nasal routes for intubation are often not feasible. Submental intubation is alternative method to tracheostomy and other modes of intubation for management of airway during maxillofacial surgeries. Aim: To provide safe and easy airway with unobstructed intraoral surgical field without causing much morbidity. Materials and Methods: 30 ASA I and II patients who had pan-facial fracture, including Le Forte II, Le Forte III, with naso-orbital ethmoidal fracture requiring surgical correction admitted in MGM Medical College and MY Hospital Indore were selected for the study. The patients are intubated by submental route and various hemodynamic parameters were evaluated at different time interval during the surgery. In our study, we used two tube method of submental intubation in which another tube was drawn intra oral through submental incision and first tube was replaced. Result: There were no episode of desaturation and no difficulty was encountered in secondary intubation. The average duration of secondary intubation was 3-4 minute (Mean+SD = 3.45+0.95) which is less than the conventional one tube method. Conclusion: As per our experience in study and the review of literature, the submental intubation is very easy and safe method of intubation to provide the unobstructed surgical field for the Le forte II and III panfacial fracture surgeries.

show abstract

“…Submental intubation has been described as a safe and effective technique for Since 1986, several publications have attested to the efficacy and low morbidity of this technique. In a study involving 25 patients [7], two patients had endobronchial intubation, and one patient suffered infection at the submental incision site. Another study involving 13 maxillofacial surgical patients [8] reported two patients with endobronchial migration which was readily detected and corrected, as well as two patients with superficial wound infection which responded well to local treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Dislodgement was excluded with laryngoscopy and the pilot balloon was not leaking. We postulated that our problem occurred because the Fastrach™ ETT is shorter in length when compared to the Mallinkrodt reinforced tube of the same diameter, and we did not exclude coiling of the ETTintraorally before fixing the tube [7]. This resulted in the universal connector being embedded in the submental tunnel throughout surgery, rendering it difficult to remove at the end of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Submental Intubation with LMAFastrach<sup>TM</sup> Endotracheal Tube in Maxillofacial Trauma: A Case Report

Moo¹,

Lai²,

Chan³

2019

OJAnes

View full text Add to dashboard Cite

Securing a definitive airway in patients who require surgical fixation of complex maxillofacial fractures is an integral part of their perioperative management. For the ease of surgical access, an orotracheal tube is usually not preferred by surgeons. The presence of a base of skull or nasal bone fractures would also contraindicate nasotracheal intubation. Therefore, a tracheostomy may be the only option left to secure the airway in these patients who require surgical fixation. Submental intubation has been used as a safe and effective alternative method in patients who require intubation for maxillofacial reconstruction since it was first reported by Hernandez Altemir F in 1986. Many modifications to the original technique have been documented over the years, but there has been no consensus to support the use of a single method or device. In this case report, we described our experience with submental intubation using an LMAFastrach™ endotracheal tube (ETT) to facilitate the surgical fixation of bilateral Le Fort II fractures. We conclude that the LMA-Fastrach™ ETT is a suitable device for submental intubation. This technique should be included in airway workshops and courses for anaesthesia residents as it is a simple yet secure alternative to tracheostomy in the intraoperative airway management of maxillofacial trauma.

show abstract

A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

Cited by 7 publications

References 34 publications

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

A study to evaluate the efficacy of submental intubation in panfacial trauma

Submental Intubation with LMAFastrach<sup>TM</sup> Endotracheal Tube in Maxillofacial Trauma: A Case Report

Contact Info

Product

Resources

About

A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

Cited by 7 publications

References 34 publications

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

A Prospective, Randomized Comparison of the Classical Altemir’s Method With the Newer Seldinger’s Technique of Submental Intubation

A study to evaluate the efficacy of submental intubation in panfacial trauma

Submental Intubation with LMAFastrach&lt;sup&gt;TM&lt;/sup&gt; Endotracheal Tube in Maxillofacial Trauma: A Case Report

Contact Info

Product

Resources

About

Submental Intubation with LMAFastrach<sup>TM</sup> Endotracheal Tube in Maxillofacial Trauma: A Case Report