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John G. Laffey - One of the best experts on this subject based on the ideXlab platform.
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comparison of the c mac Airtraq and macintosh laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization
BJA: British Journal of Anaesthesia, 2011Co-Authors: J Mcelwain, John G. LaffeyAbstract:Background We aimed at comparing the performance of the C-MAC®, Airtraq®, and Macintosh laryngoscopes when performing tracheal intubation in patients undergoing neck immobilization using manual inline axial cervical spine stabilization. Methods Ninety consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a C-MAC® (n=30), Airtraq® (n=29), or Macintosh (n=31) laryngoscope. All patients were intubated by one anaesthetist experienced in the use of each laryngoscope. Results The Airtraq® laryngoscope performed best in these patients, reducing the Intubation Difficulty Scale score, improving the Cormack and Lehane glottic view, and reducing the need for optimization manoeuvres, compared with both the Macintosh and the C-MAC®. The C-MAC® and Macintosh laryngoscopes performed similarly. There were no differences in success rates or haemodynamic profiles post-intubation between any of the devices tested. Conclusions The Airtraq® laryngoscope performed better than the C-MAC® and Macintosh laryngoscopes in patients undergoing cervical immobilization.
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comparison of the c mac Airtraq and macintosh laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization
BJA: British Journal of Anaesthesia, 2011Co-Authors: J Mcelwain, John G. LaffeyAbstract:Background. We aimed at comparing the performance of the C-MAC w , Airtraq w , and Macintosh laryngoscopes when performing tracheal intubation in patients undergoing neck immobilization using manual inline axial cervical spine stabilization. Methods. Ninety consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a C-MAC w (n¼30), Airtraq w (n¼29), or Macintosh (n¼31) laryngoscope. All patients were intubated by one anaesthetist experienced in the use of each laryngoscope. Results. The Airtraq w laryngoscope performed best in these patients, reducing the Intubation Difficulty Scale score, improving the Cormack and Lehane glottic view, and reducing the need for optimization manoeuvres, compared with both the Macintosh and the C-MAC w . The C-MAC w and Macintosh laryngoscopes performed similarly. There were
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evaluation of the Airtraq and macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation
Anaesthesia, 2008Co-Authors: C H Maharaj, B H Harte, J F Costello, John G. LaffeyAbstract:Summary The Airtraq � , a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, inpatients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
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a comparison of direct and indirect laryngoscopes and the ilma in novice users a manikin study
Anaesthesia, 2007Co-Authors: C H Maharaj, B H Harte, John G Mcdonnell, John G. LaffeyAbstract:Direct laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healthcare professionals as it is a potentially life-saving procedure. However, it is a difficult skill to acquire and maintain. Several alternative intubation devices exist that may provide a better view of the glottis and require less skill to use. We conducted a prospective, randomised trial of four different laryngoscopes and the ILMA in 30 medical students who had no prior airway management experience. The devices were tested in both normal and cervical immobilisation laryngoscopy scenarios. Following brief didactic instruction, each participant took turns performing laryngoscopy and intubation using each device under direct supervision. Each student was allowed up to three intubation attempts with each device, in each scenario. The Airtraq, McCoy, and the ILMA each demonstrated advantages over the Macintosh laryngoscope. In both the easy and difficult airway scenarios, the Airtraq, McCoy, and the ILMA reduced the number of intubation attempts, and reduced the number of optimisation manoeuvres required. The Airtraq and ILMA reduced the severity of dental trauma in both scenarios. The performance of the other devices studied was more variable. Overall, participants found that only the Airtraq was less difficult to use and they were more confident using it compared to the Macinosh laryngoscope.
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endotracheal intubation in patients with cervical spine immobilization a comparison of macintosh and Airtraq laryngoscopes
Anesthesiology, 2007Co-Authors: C H Maharaj, B H Harte, Elma Buckley, John G. LaffeyAbstract:Background: The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial. Methods: Forty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n 20) or Airtraq (n 20) laryngoscope. All patients were intubated by one of four anesthesiologists experienced in the use of both laryngoscopes. Results: No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, were successfully intubated on the first attempt. The Airtraq reduced the duration of intubation attempts (mean SD: 13.2 5.5 vs. 20.3 12.2 s), the need for additional maneuvers, and the intubation difficulty scale score (0.1 0.5 vs. 2.7 2.5). Tracheal intubation with the Airtraq caused fewer alterations in blood pressure and heart rate. Conclusions: These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in patients with cervical spine immobilization.
Galarreta Sánchez, Víctor Alejandrino. - One of the best experts on this subject based on the ideXlab platform.
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Tiempo de intubación endotraqueal con laringoscopio óptico AirtraqR vs estándar Macintosh en pacientes obesos del Hospital III Suarez-Angamos : Essalud Lima.
2015Co-Authors: Galarreta Sánchez, Víctor Alejandrino.Abstract:GALARRETA Sánchez, Víctor Alejandrino. Tiempo de intubación endotraqueal con laringoscopio óptico AirtraqR vs estándar Macintosh en pacientes obesos del Hospital III Suarez-Angamos : Essalud Lima. Trabajo de Investigación (Especialista en Anestesia, Analgesia y Reanimación). Lima, Perú: Universidad Nacional Mayor de San Marcos. Facultad de Medicina Humana. Escuela de Post-Grado, 2014. 24 h.Objetivo: El manejo adecuado de la vía aérea es una responsabilidad importante para el anestesiólogo. Existen grupos de población en los que la incidencia de una vía aérea difícil es claramente más elevada. Este estudio se llevó a cabo para determinar si existe una diferencia significativa entre el tiempo de intubación endotraqueal con el laringoscopio óptico Airtraq ® vs el Macintosh en pacientes obesos. Metodología: Se realizó un estudio experimental, ensayo clínico simple ciego; con 2 grupos: Grupo 1: Pacientes obesos intubados con el laringoscopio Macintosh. Grupo 2: Pacientes obesos intubados con el laringoscopio Airtraq®. Se midió el tiempo de intubación, además se midió la aparición de desaturación, si se requirieron maniobras adicionales para realizar la intubación, y aparición de complicaciones traumáticas de la vía aérea. Se utilizó la Prueba U de Mann-Whitney, se consideró significativo si p< 0.05. Resultados: Hubo un menor tiempo de intubación estadísticamente significativo al intubar con el laringoscopio Airtraq® en comparación con el Macintosh (p
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Tiempo de intubación endotraqueal con laringoscopio óptico AirtraqR vs estándar Macintosh en pacientes obesos del Hospital III Suarez-Angamos : Essalud Lima
'Baishideng Publishing Group Inc.', 2014Co-Authors: Galarreta Sánchez, Víctor Alejandrino.Abstract:El documento digital no refiere asesorObjetivo: El manejo adecuado de la vía aérea es una responsabilidad importante para el anestesiólogo. Existen grupos de población en los que la incidencia de una vía aérea difícil es claramente más elevada. Este estudio se llevó a cabo para determinar si existe una diferencia significativa entre el tiempo de intubación endotraqueal con el laringoscopio óptico Airtraq ® vs el Macintosh en pacientes obesos. Metodología: Se realizó un estudio experimental, ensayo clínico simple ciego; con 2 grupos: Grupo 1: Pacientes obesos intubados con el laringoscopio Macintosh. Grupo 2: Pacientes obesos intubados con el laringoscopio Airtraq®. Se midió el tiempo de intubación, además se midió la aparición de desaturación, si se requirieron maniobras adicionales para realizar la intubación, y aparición de complicaciones traumáticas de la vía aérea. Se utilizó la Prueba U de Mann-Whitney, se consideró significativo si p< 0.05. Resultados: Hubo un menor tiempo de intubación estadísticamente significativo al intubar con el laringoscopio Airtraq® en comparación con el Macintosh (p
C H Maharaj - One of the best experts on this subject based on the ideXlab platform.
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evaluation of the Airtraq and macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation
Anaesthesia, 2008Co-Authors: C H Maharaj, B H Harte, J F Costello, John G. LaffeyAbstract:Summary The Airtraq � , a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, inpatients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
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a comparison of direct and indirect laryngoscopes and the ilma in novice users a manikin study
Anaesthesia, 2007Co-Authors: C H Maharaj, B H Harte, John G Mcdonnell, John G. LaffeyAbstract:Direct laryngoscopic tracheal intubation using the Macintosh laryngoscope is taught to many healthcare professionals as it is a potentially life-saving procedure. However, it is a difficult skill to acquire and maintain. Several alternative intubation devices exist that may provide a better view of the glottis and require less skill to use. We conducted a prospective, randomised trial of four different laryngoscopes and the ILMA in 30 medical students who had no prior airway management experience. The devices were tested in both normal and cervical immobilisation laryngoscopy scenarios. Following brief didactic instruction, each participant took turns performing laryngoscopy and intubation using each device under direct supervision. Each student was allowed up to three intubation attempts with each device, in each scenario. The Airtraq, McCoy, and the ILMA each demonstrated advantages over the Macintosh laryngoscope. In both the easy and difficult airway scenarios, the Airtraq, McCoy, and the ILMA reduced the number of intubation attempts, and reduced the number of optimisation manoeuvres required. The Airtraq and ILMA reduced the severity of dental trauma in both scenarios. The performance of the other devices studied was more variable. Overall, participants found that only the Airtraq was less difficult to use and they were more confident using it compared to the Macinosh laryngoscope.
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endotracheal intubation in patients with cervical spine immobilization a comparison of macintosh and Airtraq laryngoscopes
Anesthesiology, 2007Co-Authors: C H Maharaj, B H Harte, Elma Buckley, John G. LaffeyAbstract:Background: The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial. Methods: Forty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n 20) or Airtraq (n 20) laryngoscope. All patients were intubated by one of four anesthesiologists experienced in the use of both laryngoscopes. Results: No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, were successfully intubated on the first attempt. The Airtraq reduced the duration of intubation attempts (mean SD: 13.2 5.5 vs. 20.3 12.2 s), the need for additional maneuvers, and the intubation difficulty scale score (0.1 0.5 vs. 2.7 2.5). Tracheal intubation with the Airtraq caused fewer alterations in blood pressure and heart rate. Conclusions: These findings demonstrate the utility of the Airtraq laryngoscope for tracheal intubation in patients with cervical spine immobilization.
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the Airtraq as a rescue airway device following failed direct laryngoscopy a case series
Anaesthesia, 2007Co-Authors: C H Maharaj, B H Harte, J F Costello, J G Mcdonnell, John G. LaffeyAbstract:We report the successful use of the Airtraq as a rescue device following failed direct laryngoscopy, in patients deemed at increased risk for difficult tracheal intubation. In a series of seven patients, repeated attempts at direct laryngoscopy with the Macintosh blade, and the use of manoeuvres to aid intubation, such as the gum elastic bougie placement, were unsuccessful. In contrast, with the Airtraq device, each patient's trachea was successfully intubated on the first attempt. This report underlines the utility of the Airtraq device in these patients.
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retention of tracheal intubation skills by novice personnel a comparison of the Airtraq and macintosh laryngoscopes
Anaesthesia, 2007Co-Authors: C H Maharaj, Brendan D. Higgins, B H Harte, Joseph Costello, John G. LaffeyAbstract:Direct laryngoscopic tracheal intubation is a potentially lifesaving manoeuvre, but it is a difficult skill to acquire and to maintain. These difficulties are exacerbated if the opportunities to utilise this skill are infrequent, and by the fact that the consequences of poorly performed intubation attempts may be severe. Novice users find the Airtraq laryngoscope easier to use than the conventional Macintosh laryngoscope. We therefore wished to determine whether novice users would have greater retention of intubation skills with the Airtraq rather than the Macintosh laryngoscope. Twenty medical students who had no prior airway management experience participated in this study. Following brief didactic instruction, each took turns performing laryngoscopy and intubation using the Macintosh and Airtraq devices in easy and simulated difficult laryngoscopy scenarios. The degree of success with each device, the time taken to perform intubation and the assistance required, and the potential for complications were then assessed. Six months later, the assessment process was repeated. No didactic instruction or practice attempts were provided on this latter occasion. Tracheal intubation skills declined markedly with both devices. However, the Airtraq continued to provide better intubating conditions, resulting in greater success of intubation, with fewer optimisation manoeuvres required, and reduced potential for dental trauma, particularly in the difficult laryngoscopy scenarios. The substantial decline in direct laryngoscopy skills over time emphasise the need for continued reinforcement of this complex skill.
G Dhonneur - One of the best experts on this subject based on the ideXlab platform.
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simulating face to face tracheal intubation of a trapped patient a randomized comparison of the lma fastrach the glidescope and the Airtraq laryngoscope
BJA: British Journal of Anaesthesia, 2012Co-Authors: R Amathieu, W Abdi, X Combes, J Sudrial, D Luis, H Hahouache, G DhonneurAbstract:Background We undertook a prospective randomized comparison of the LMA Fastrach™, Airtraq™ laryngoscope, and GlideScope™ used for face-to-face tracheal intubation simulated to mimic an entrapped patient. Methods Thirty senior emergency medicine physicians were trained in the use of the LMA Fastrach™, GlideScope™, and Airtraq™ laryngoscope with a standard airway trainer manikin (control). Participants were then asked to perform tracheal intubation in two difficult situations simulated on a difficult airway management manikin wearing a cervical collar. In Situation 1, the manikin was in the supine position with a difficult airway caused by stiffening the cervical spine. In Situation 2, the manikin was positioned to simulate face-to-face tracheal intubation. We measured intubation times, success rates for tracheal intubation, and the difficulty of tracheal intubation. Values are means ( sd ). Results In control and Situation 1, tracheal intubation details were similar. In Situation 2, face-to-face tracheal intubation success rate was increased with the Airtraq™ (100%), when compared with that of the GlideScope™ (70%, P P P P P P Conclusions The Airtraq™ laryngoscope was superior to both the GlideScope™ and LMA Fastrach™ during simulated face-to-face difficult tracheal intubation.
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optimising tracheal intubation success rate using the Airtraq laryngoscope
Anaesthesia, 2009Co-Authors: G Dhonneur, W Abdi, R Amathieu, S Ndoko, L TualAbstract:Summary In this study we have used a video-recording, retrospective analysis technique to evaluate the influence of the Airtraq TM laryngoscope manipulations and the resulting changes in position of the glottic opening and inter-arytenoids cleft, on the success rate of tracheal intubation. The video recordings of the internal views of 109 tracheal intubation attempts, in 50 anaesthetised patients were analysed. We demonstrated that successful tracheal intubation using the Airtraq laryngoscope require the glottic opening to be centred in the view, and positioning the inter-arytenoid cleft medially below the horizontal line in the centre of the view. We also demonstrated that repositioning of the Airtraq laryngoscope following a failed tracheal intubation attempt required the performance of a standard series of manoeuvres.
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tracheal intubation of morbidly obese patients a randomized trial comparing performance of macintosh and Airtraq laryngoscopes
BJA: British Journal of Anaesthesia, 2008Co-Authors: S Ndoko, R Amathieu, L Tual, C Polliand, W Kamoun, El L Housseini, G Champault, G DhonneurAbstract:Background The Airtraq™ laryngoscope is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. We hypothesized that this new airway device would facilitate tracheal intubation of morbidly obese patients. We compared tracheal intubation performance of standard Macintosh laryngoscope with the Airtraq™ laryngoscope in morbidly obese patients. Methods One hundred and six consecutive ASA I–III morbidly obese patients undergoing surgery were randomized to intubation with the Macintosh laryngoscope or the Airtraq™ laryngoscope. Induction of anaesthesia was standardized. If tracheal intubation failed within 120 s with the Macintosh or Airtraq™, laryngoscopes were switched. Success rate, Sp o 2, duration of tracheal intubation, and quality of airway management were evaluated and compared between the groups. Results Preoperative characteristics of the patients were similar in both groups. In the Airtraq™ group, tracheal intubation was successfully carried out in all patients within 120 s. In the Macintosh laryngoscope group, six patients required intubation with the Airtraq™ laryngoscope. The mean ( sd ) time taken for tracheal intubation was 24 (16) and 56 (23) s, respectively, with the Airtraq™ and Macintosh laryngoscopes, (P o 2 was better maintained in the Airtraq™ group than in the Macintosh laryngoscope group with one and nine patients, respectively, demonstrating drops of Spo2 to 92% or less (P Conclusions In this study, the Airtraq™ laryngoscope shortened the duration of tracheal intubation and prevented reductions in arterial oxygen saturation in morbidly obese patients.
Ranieri Júnior Dante - One of the best experts on this subject based on the ideXlab platform.
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Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq™ video laryngoscope in obese patients
Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda., 2014Co-Authors: Ranieri Júnior Dante, Schneider, Andre P., Riefel Zinelli Fabio, Geraldo Neubauer Adecir, Do Nascimento PauloAbstract:AbstractPurposethis study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq™ laryngoscopes.Methodsfrom 132 bariatric surgery patients (body mass index≥35kgm−1), cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n=64) or an Airtraq™ (n=68) laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack–Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered.Resultsintubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9+22.8s and 13.7+3.1s for the Macintosh and Airtraq™ laryngoscope groups (p
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Dados da avaliação pré‐anestésica não influenciam o tempo de intubação com o videolaringoscópio Airtraq® em pacientes obesos
Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda., 2014Co-Authors: Ranieri Júnior Dante, Riefel Zinelli Fabio, Geraldo Neubauer Adecir, Schneider P. Andre, Do Nascimento Jr PauloAbstract:ResumoObjetivoesse estudo investigou a influência de preditores anatômicos para laringoscopia e intubação orotraqueal difícil em pacientes obesos mediante a comparação dos laringoscópios Macintosh e Airtraq®.Métodosem 132 pacientes de cirurgia bariátrica foram registrados: perímetro cervical, distância esternomentoniana, distância inter‐incisivos e escore de Mallampati. Os pacientes foram randomizados em dois grupos, de acordo com o laringoscópio usado para a intubação traqueal: Macintosh (n=64) ou Airtraq® (n=68). O tempo até a intubação foi o primeiro desfecho. Também foram registrados: escore de Cormack‐Lehane, número de tentativas de intubação, lamina Macintosh usada, necessidade de compressão traqueal externa, ou uso de um bougie elástico de borracha. Também foram anotados o insucesso na intubação e as estratégias adotadas.Resultadoshouve insucesso na intubação em dois pacientes no grupo com laringoscópio de Macintosh; esses pacientes foram incluídos como o pior cenário de caso. Os tempos para intubação foram 36,9±22,8 seg e 13,7±3,1 seg para os grupos Macintosh e Airtraq® (p
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Datos de evaluación preanestésica no influyen en el tiempo de intubación traqueal con el videolaringoscopio Airtraq® en pacientes obesos
Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda., 2014Co-Authors: Ranieri Júnior Dante, Zinelli, Fabio Riefel, Neubauer, Adecir Geraldo, Schneider, Andre P., Paulo Do NascimentoAbstract:ResumenObjetivoel objetivo de este estudio fue evaluar la influencia de los predictores anatómicos en la laringoscopia e intubación orotraqueal difíciles en pacientes obesos comparando el laringoscopio Macintosh y el videolaringoscopio Airtraq®.Métodosen 132 pacientes sometidos a cirugía bariátrica (índice de masa corporal≥35kg/m2), se registraron los valores de perímetro cervical, distancia mentoesternal, distancia interincisivos y puntuación de Mallampati. Los pacientes fueron aleatorizados en 2 grupos de acuerdo con el uso de los laringoscopios Macintosh (n=64) o Airtraq® (n=68) para intubación traqueal. El resultado primario fue el tiempo necesario para la intubación. Se registraron la puntuación de Cormack-Lehane, el número de intentos de intubación, el uso de lámina Macintosh y cualquier necesidad de compresión traqueal externa o la utilización de introductor del tubo traqueal. Las estrategias de intubación adoptadas y los fallos de las intubaciones también fueron recogidos en el informe.Resultadosen el grupo Macintosh, 2 pacientes presentaron fallo en la intubación y fueron incluidos como los peores casos de intubación. Los tiempos de intubación fueron 36,9±22,8s y 13,7±3,1s para los grupos Macintosh y Airtraq® (p
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Dados da avaliação pré-anestésica não influenciam o tempo de intubação com o videolaringoscópio Airtraq(r) em pacientes obesos
Sociedade Brasileira de Anestesiologia, 2014Co-Authors: Ranieri Júnior Dante, Zinelli, Fabio Riefel, Neubauer, Adecir Geraldo, Schneider, Andre P., Nascimento Junior, Paulo Do [unesp]Abstract:Purpose this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq™ laryngoscopes. Methods from 132 bariatric surgery patients (body mass index ≥ 35 kg m−1), cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64) or an Airtraq™ (n = 68) laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack–Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq™ laryngoscope groups (p < 0.01), respectively. Cormack–Lehane scores were also lower for the Airtraq™ group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq™. Cervical circumference (p < 0.01) and interincisor distance (p < 0.05) influenced the time required for intubation in the Macintosh group but not in the Airtraq™ group. Conclusion in obese patients despite increased neck circumference and limited mouth opening, the Airtraq™ laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails.Objetivo esse estudo investigou a influência de preditores anatômicos para laringoscopia e intubação orotraqueal difícil em pacientes obesos mediante a comparação dos laringoscópios Macintosh e Airtraq®. Métodos em 132 pacientes de cirurgia bariátrica foram registrados: perímetro cervical, distância esternomentoniana, distância inter‐incisivos e escore de Mallampati. Os pacientes foram randomizados em dois grupos, de acordo com o laringoscópio usado para a intubação traqueal: Macintosh (n = 64) ou Airtraq® (n = 68). O tempo até a intubação foi o primeiro desfecho. Também foram registrados: escore de Cormack‐Lehane, número de tentativas de intubação, lamina Macintosh usada, necessidade de compressão traqueal externa, ou uso de um bougie elástico de borracha. Também foram anotados o insucesso na intubação e as estratégias adotadas. Resultados houve insucesso na intubação em dois pacientes no grupo com laringoscópio de Macintosh; esses pacientes foram incluídos como o pior cenário de caso. Os tempos para intubação foram 36,9 ± 22,8 seg e 13,7 ± 3,1 seg para os grupos Macintosh e Airtraq® (p < 0,01), respectivamente. Os escores de Cormack‐Lehane também foram mais baixos para o grupo Airtraq®. Um paciente no grupo Macintosh com insucesso na intubação foi rapidamente intubado com o laringoscópio Airtraq®. A circunferência cervical (p < 0,01) e a distância inter‐incisivos (p < 0,05) influenciaram o tempo até a intubação no grupo Macintosh, mas não no grupo Airtraq®. Conclusão em pacientes obesos, apesar da maior circunferência cervical e da limitada abertura da boca, o laringoscópio Airtraq® possibilita uma intubação traqueal mais rápida versus laringoscópio Macintosh, podendo funcionar como alternativa, nos casos de insucesso com a laringoscopia convencional.Objetivo el objetivo de este estudio fue evaluar la influencia de los predictores anatómicos en la laringoscopia e intubación orotraqueal difíciles en pacientes obesos comparando el laringoscopio Macintosh y el videolaringoscopio Airtraq®. Métodos en 132 pacientes sometidos a cirugía bariátrica (índice de masa corporal ≥ 35 kg/m2), se registraron los valores de perímetro cervical, distancia mentoesternal, distancia interincisivos y puntuación de Mallampati. Los pacientes fueron aleatorizados en 2 grupos de acuerdo con el uso de los laringoscopios Macintosh (n = 64) o Airtraq® (n = 68) para intubación traqueal. El resultado primario fue el tiempo necesario para la intubación. Se registraron la puntuación de Cormack-Lehane, el número de intentos de intubación, el uso de lámina Macintosh y cualquier necesidad de compresión traqueal externa o la utilización de introductor del tubo traqueal. Las estrategias de intubación adoptadas y los fallos de las intubaciones también fueron recogidos en el informe. Resultados en el grupo Macintosh, 2 pacientes presentaron fallo en la intubación y fueron incluidos como los peores casos de intubación. Los tiempos de intubación fueron 36,9 ± 22,8 s y 13,7 ± 3,1 s para los grupos Macintosh y Airtraq® (p < 0,01), respectivamente. Las puntuaciones de Cormack-Lehane también fueron menores para el grupo Airtraq®. Un paciente del grupo Macintosh con fallo de intubación fue rápidamente intubado con el Airtraq®. La circunferencia cervical (p < 0,01) y la distancia interincisivos (p < 0,05) influyeron en el tiempo necesario para la intubación en el grupo Macintosh, pero no en el grupo Airtraq®. Conclusión en los pacientes obesos, a pesar del aumento de la circunferencia del cuello y de la abertura limitada de la boca, el laringoscopio Airtraq® ofrece una intubación traqueal más rápida que el laringoscopio Macintosh, pudiendo servir como una alternativa cuando la laringoscopia convencional falle
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Dados da avaliação pré-anestésica não influenciam o tempo de intubação com o videolaringoscópio Airtraq em pacientes obesos
Elsevier Editora Ltda, 2014Co-Authors: Ranieri Júnior Dante, Riefel Zinelli Fabio, Geraldo Neubauer Adecir, Schneider, Andrew Perillier, Paulo Do ,nascimento JúniorAbstract:Objetivo: esse estudo investigou a influência de preditores anatômicos para laringoscopia e intubac¸ão orotraqueal difícil em pacientes obesos mediante a comparac¸ão dos laringoscópios Macintosh e Airtraq®. Métodos: em 132 pacientes de cirurgia bariátrica foram registrados: perímetro cervical, distância esternomentoniana, distância inter-incisivos e escore de Mallampati. Os pacientes foram randomizados em dois grupos, de acordo com o laringoscópio usado para a intubac¸ão traqueal: Macintosh (n = 64) ou Airtraq® (n = 68). O tempo até a intubac¸ão foi o primeiro desfecho. Também foram registrados: escore de Cormack-Lehane, número de tentativas de intubac¸ão, lamina Macintosh usada, necessidade de compressão traqueal externa, ou uso de um bougie elástico de borracha. Também foram anotados o insucesso na intubac¸ão e as estratégias adotadas. Resultados: houve insucesso na intubac¸ão em dois pacientes no grupo com laringoscópio de Macintosh; esses pacientes foram incluídos como o pior cenário de caso. Os tempos para intubac¸ão foram 36,9 ± 22,8 seg e 13,7 ± 3,1 seg para os grupos Macintosh e Airtraq® (p < 0,01), respectivamente. Os escores de Cormack-Lehane também foram mais baixos para o grupo Airtraq®. Um paciente no grupo Macintosh com insucesso na intubac¸ão foirapidamente intubado com o laringoscópio Airtraq®. A circunferência cervical (p < 0,01) e a distância inter-incisivos (p < 0,05) influenciaram o tempo até a intubac¸ão no grupo Macintosh, mas não no grupo Airtraq®. Conclusão: em pacientes obesos, apesar da maior circunferência cervical e da limitada abertura da boca, o laringoscópio Airtraq® possibilita uma intubac¸ão traqueal mais rápida versus laringoscópio Macintosh, podendo funcionar como alternativa, nos casos de insucesso com a laringoscopia convencional