Difficult Intubation

Cossham, P.S.; Allen, MartinB.; Coe, PeterA; King, T.A.; Towey, R.M.

doi:10.1016/s0140-6736(87)92607-9

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Intubation with tracheal tube railroaded directly over the fibrescope For this method of fibrescope guided intubation, a 6.0 mm reinforced tracheal tube (Mallincrodt, Hazelwood, MO, USA), with the tube bevel facing posteriorly [14,15], was mounted on the fibrescope by the investigator. Total timing of the first intubation consisted of two timed sections: time 1 -from the participant's picking up the fibrescope to obtaining a view of the carina; and time 2 -from the start of railroading the tube into the trachea over the fibrescope, to removal of the fibrescope and delivery of a single breath.…”

Section: Methodsmentioning

confidence: 99%

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i‐gel in a manikin*

Lloyd¹,

Hodzovic

Voisey

et al. 2009

Anaesthesia

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SummaryWe compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. Each anaesthetist performed two intubations with each method via each device. The mean (SD) time for the first intubation using the tracheal tube over the fibrescope was 43 (24) s with the classic laryngeal mask airway and 22 (9) s with the i-gel (95% CI for the difference 12-30 s, p < 0.0001). The mean (SD) times for the first intubation when using the Aintree Intubation Catheter was 46 (24) s with the classic laryngeal mask airway and 37 (9) s with the i-gel (95% CI for the difference 5-12 s, p < 0.0001). We recorded five (5 ⁄ 64, 8%) oesophageal intubations when using the classic laryngeal mask airway and none when using the i-gel. The participants rated the ease of railroading of the tracheal tube and railroading the Aintree Intubation Catheter over the fibrescope to be significantly easier (p < 0.0001 and p = 0.002 respectively) when using the i-gel than when using the classic laryngeal mask airway. Furthermore, 30 ⁄ 32 (94%) of anaesthetists reported preference for the i-gel over the classic laryngeal mask airway for fibrescope guided tracheal intubation when managing a difficult airway. We conclude that the i-gel is likely to be a more appropriate conduit than the classic laryngeal mask airway for fibrescope guided intubation irrespective of the intubation method used.

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Section: Methodsmentioning

confidence: 99%

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i‐gel in a manikin*

Lloyd¹,

Hodzovic

Voisey

et al. 2009

Anaesthesia

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“…The obstruction is caused by impingement of the tube on the right vocal cord complex and arytenoids [2]. Cossham [3] described a pre-emptive 90°anti-clockwise rotation of the tube (90CCWR), the Cossham twist, as a preventive measure. This has become the standard manoeuvre to overcome the obstruction when impingement occurs.…”

mentioning

confidence: 99%

The effect of cricoid pressure on intubation facilitated by the gum elastic bougie*

et al. 2007

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SummaryTracheal tube impingement is common during gum elastic bougie facilitated intubation and a 90°a nti-clockwise rotation of the tube usually relieves it. We detail a case where this manoeuvre failed in the presence of cricoid pressure. We investigated the effect of cricoid pressure on gum elastic bougie facilitated intubation in 120 patients randomly allocated to receive sham cricoid pressure (n = 60) or 30 N cricoid pressure (n = 60). Impingement occurred in 23 ⁄ 60 (38%) with sham cricoid pressure and 36 ⁄ 60 (60%) with 30 N cricoid pressure (p < 0.025). Only females showed an increase in impingement with cricoid pressure: 29% sham cricoid pressure vs 63% 30 N cricoid pressure, p < 0.01, whereas the impingement in males was 60% in both groups. Ninety degree anti-clockwise rotation of the tube was successful in all 23 patients (100%) with sham cricoid pressure and in 32 ⁄ 36 patients (89%) with 30 N cricoid pressure. Releasing cricoid pressure relieved the obstruction in the four cases where 90°anti-clockwise rotation of the tube failed. Impingement is common and 90°anti-clockwise rotation is highly effective in both the presence and absence of cricoid pressure. In a small number of cases, cricoid pressure may cause the manoeuvre to fail.

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“…This can be explained by the direction of the bevel. When a precurved ETT is advanced over the fiberoptic scope with concavity of the tube facing the lower incisors, the bevel is always facing left and the tip of the ETT is closer to the right arytenoid than the left . Intentional rotation of the ETT 180° counterclockwise to make the bevel face right has been observed to result in impingement against the left arytenoids .…”

Section: Discussionmentioning

confidence: 99%

Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study

Choudhry

Brenn

Lutwin-Kawalec

et al. 2016

Pediatric Anesthesia

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Difficult Intubation

Cited by 4 publications

References 3 publications

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i‐gel in a manikin*

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i‐gel in a manikin*

The effect of cricoid pressure on intubation facilitated by the gum elastic bougie*

Effect of 90° counterclockwise rotation of the endotracheal tube on its advancement through the larynx during nasal fiberoptic intubation in children: a randomized and blinded study

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