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Shobha Purohit - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Hemodynamic Responses to Orotracheal Intubation by Flexible Fibreoptic Bronchoscope, McCoy Laryngoscope and Airtraq in Presence of Rigid Cervical Collar for Traumatic Cervical Injury
2020Co-Authors: Sidhdharth Sharma, Ritika Aggarwal, Shobha PurohitAbstract:Background: Orotracheal Intubation can lead to exaggerated hemodynamic response. In cases of unstable Cervical spine placing rigid Cervical Collar for Cervical immobilization to avoid neurological injury may cause hindrance in laryngoscopic view. The aim of our study was to analogize the hemodynamic responses to intubation by flexible Fiberoptic Bronchoscope (FOB), McCoy laryngoscope and airtraq in patients posted for surgery under general anesthesia with rigid Collar simulating Cervical spine stability in the cases of traumatic Cervical injury. Method: Ninety patients in the age group 20–50 years, of American Society of Anesthesiologist grade I II, posted for surgery under general anesthesia were randomly designated into three groups according to the aid used for intubation: Group A (flexible FOB), Group B (McCoy laryngoscope) and Group C(Airtraq). Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and Heart Rate (HR) were recorded at baseline, post induction, and shortly one min, three minutes and five minutes post intubation. Statistical analysis: The categorical data was compared by Chi-square test and P value
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a comparative study of orotracheal intubation guided by airtraq and mccoy laryngoscope in patients with rigid Cervical Collar in situ simulating Cervical immobilization for traumatic Cervical spine injury
International Journal of Neural Systems, 2019Co-Authors: Akhil Diwan, Shobha PurohitAbstract:Background Immobilization of Cervical spine is of utmost importance in patients with Cervical injury, making intubation a difficult task due to the application of Cervical Collar. This study was done to assess which laryngoscope (Airtraq or McCoy) is better for intubation and prevents the deleterious effects of hypoxia by comparing the intubation time. Methods A prospective interventional randomized study was undertaken in 60 adult patients of American Society of Anesthesiologists (ASA) grade I and II, aged between 20 and 50 years, scheduled for various surgical procedures requiring tracheal intubation for anesthesia. Patients were randomly allocated to undergo intubation with either the Airtraq (Group A; n = 30) laryngoscope or McCoy (Group B; n = 30). Patients were intubated following the standard anesthetic protocol, and the differences in duration of intubation, changes in the hemodynamic parameters in response to intubation, modified intubation difficulty score, and airway complications between the Airtraq and the McCoy laryngoscope were compared. Results Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. Though the mean time required for successful intubation was less with the Airtraq (25.2 ± 5.11 seconds) than the McCoy laryngoscope (27.3 ± 4.47 seconds); it was statistically insignificant (p = 0.14). Intubation difficulty score and ease of insertion were significantly less in Airtraq laryngoscope when compared with McCoy laryngoscope. Increase in the heart rate and mean arterial pressure was significantly more just after intubation with McCoy in comparison with Airtraq laryngoscope. However, the frequencies of airway complications were similar. Conclusion Intubation time despite being lesser with the Airtraq than the McCoy laryngoscope was statistically insignificant, and overall success rates between the two devices were similar.
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comparison of hemodynamic responses to orotracheal intubation by flexible fibreoptic bronchoscope mccoy laryngoscope and airtraq in presence of rigid Cervical Collar for traumatic Cervical injury
Anesthesia & Clinical Research, 2019Co-Authors: Sidhdharth Sharma, Ritika Aggarwal, Shobha PurohitAbstract:Background: Orotracheal Intubation can lead to exaggerated hemodynamic response. In cases of unstable Cervical spine placing rigid Cervical Collar for Cervical immobilization to avoid neurological injury may cause hindrance in laryngoscopic view. The aim of our study was to analogize the hemodynamic responses to intubation by flexible Fiberoptic Bronchoscope (FOB), McCoy laryngoscope and airtraq in patients posted for surgery under general anesthesia with rigid Collar simulating Cervical spine stability in the cases of traumatic Cervical injury. Method: Ninety patients in the age group 20–50 years, of American Society of Anesthesiologist grade I II, posted for surgery under general anesthesia were randomly designated into three groups according to the aid used for intubation: Group A (flexible FOB), Group B (McCoy laryngoscope) and Group C(Airtraq). Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and Heart Rate (HR) were recorded at baseline, post induction, and shortly one min, three minutes and five minutes post intubation. Statistical analysis: The categorical data was compared by Chi-square test and P value<0.05 was captured as statistically significant. To compare the quantitative data parametric test (unpaired t test) was done. Results: The difference in mean arterial pressure with mc coy, airtraq and fiberoptic bronchoscope was significant at one min, three minutes and five minutes after intubation. Similarly there was significant difference in heart rate in intubation with mc coy, airtraq and fiberoptic bronchoscope. The mean duration of intubation was (40 ± 7.28 sec) in fiberoptic group which was statistically significant compared to mc coy (27.3 ± 4.47 sec) and airtraq (25.2 ± 5.11 sec). Conclusion: Airtraq is better as an aid for orotracheal intubation in traumatic Cervical injury with rigid Collar as it consumes lesser time and provides stable hemodynamics compared to fiberoptic and mc coy.
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comparison of hemodynamic responses to intubation flexible fiberoptic bronchoscope versus mccoy laryngoscope in presence of rigid Cervical Collar simulating Cervical immobilization for traumatic Cervical spine
Anesthesia: Essays and Researches, 2015Co-Authors: Nitesh Gill, Shobha Purohit, Poonam Kalra, Tarun Lall, Avneesh KhareAbstract:Background: Intubation is known to cause an exaggerated hemodynamic response in the form of tachycardia, hypertension, and dysrhythmias. In Cervical spine instability, intubation has to be performed using Cervical immobilization to prevent exacerbation of spinal cord injuries. Application of rigid Cervical Collar may reduce Cervical spine movements, but it hinders tracheal intubation with a standard laryngoscope. The aim of this study was to compare the hemodynamic responses to fiberoptic bronchoscope (FOB) and McCoy laryngoscope in patients undergoing elective surgery under general anesthesia with rigid Cervical Collar simulating Cervical spine immobilization in the situation of Cervical trauma. Methods: Thirty-two patients in the age range 20–50 years, of American Society of Anaesthesiologist I-II, and of either sex undergoing elective surgery under general anesthesia were randomly allocated into each group. There were two groups according to the technique used for intubation: Group A (flexible FOB) and Group B (McCoy laryngoscope). Systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate (HR) were recorded at baseline, intraoperatively, immediately before and after induction, and immediately after intubation. Thereafter, every min for next 5 min. Statistical Analysis: Intergroup comparison of categorical data was done by Chi-square test. P < 0.05 was considered statistically significant. Intergroup comparison of quantitative data was done by the parametric test (unpaired t-test), and probability was considered to be significant if <0.05. Results: Due to intubation response, HR and blood pressure increased significantly (P < 0.05) above preoperative values in McCoy group as compared to the fiberoptic group. Conclusion: We suggest that the flexible FOB is an effective and better method of intubation in a situation like traumatic Cervical spine injury and provides stable hemodynamics.
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comparison of oral intubation using flexible fibreoptic bronchoscope with or without rigid Cervical Collar a clinical study
Journal of Neuroanaesthesiology and Critical Care, 2015Co-Authors: Nitesh Gill, Shobha Purohit, Mukesh GodaraAbstract:Background: Device like fibreoptic bronchoscope is gold standard for difficult intubation situations. It can be performed by both orotracheal and nasotracheal route. But, through nasal route there are more chances of nasal bleeding and pressure necrosis while through oral route there is only one problem, which is clearing of upper airway for bronchoscope. Manoeuvres like jaw thrust and chin lift are very useful in clearing upper airway for bronchoscope. The aim of this study was to compare ease of oral intubation using flexible fibreoptic bronchoscope with or without rigid Cervical Collar, in terms of need of manoeuvres: Jaw thrust and Chin lift. Materials and Methods: 25 patients in age range 20-50 years, of ASA - II, and of either sex undergoing elective surgery under general anaesthesia were randomly allocated into each group. There were two groups: Group A (Rigid Cervical Collar) and group B (Without Collar). Intubating condition was assessed in between these groups with need of manoeuvres like jaw thrust and chin lift. Quantitative data i.e. age, weight, thyromental distance and sternomental distance were presented as mean value and standard deviation. Intergroup comparison of quantitative data was done by t -test and probability was considered to be significant if less than P Results: There was significant ( P P Conclusion: We concluded that as far as the oral intubation with flexible fibreoptic bronchoscope is concerned, rigid Cervical Collar is very useful tool for making intubation easier.
Makoto Ozaki - One of the best experts on this subject based on the ideXlab platform.
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intubating laryngeal mask airway allows tracheal intubation when the Cervical spine is immobilized by a rigid Collar
BJA: British Journal of Anaesthesia, 2004Co-Authors: Ryu Komatsu, Katsuyuki Yamagata, Kotoe Kamata, Osamu Nagata, Daniel I Sessler, Makoto OzakiAbstract:An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid Cervical Collar. However, a Cervical Collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid Cervical Collar. In 50 Cervical spine surgery patients with a rigid Philadelphia Collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P<0.01) and Mallampati scores were significantly greater (P<0.001) in the Collared patients. ILMA insertion took longer (30 [25] vs. 22 [6] seconds), more patients required 2 insertion attempts (15 vs. 3; P<0.005), and ventilation adequacy with ILMA was worse (P<0.05) in Collared patients. However, there were no significant differences between the Collared and control patients in terms of total time required for intubation (60 [41] vs. 50 [30] seconds), number of intubation attempts, overall intubation success rate (96 vs. 98%), or the incidence of intubation complications. Blind intubation through an ILMA is thus a reasonable strategy for controlling the airway in patients who are immobilized with a rigid Cervical Collar, especially when urgency precludes a fiberoptic approach.
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Intubating laryngeal mask airway allows tracheal intubation when the Cervical spine is immobilized by a rigid Collar.
BJA: British Journal of Anaesthesia, 2004Co-Authors: Ryu Komatsu, Katsuyuki Yamagata, Kotoe Kamata, Osamu Nagata, Daniel I Sessler, Makoto OzakiAbstract:An intubating laryngeal mask airway (ILMA) facilitates tracheal intubation with the neck in neutral position, which is similar to the neck position maintained by a rigid Cervical Collar. However, a Cervical Collar virtually obliterates neck movement, even the small movements that normally facilitate airway insertion. We therefore tested the hypothesis that the ILMA facilitates tracheal intubation even in patients wearing a rigid Cervical Collar. In 50 Cervical spine surgery patients with a rigid Philadelphia Collar in place and 50 general surgery patients under general anaesthesia, we performed blind tracheal intubation via an ILMA. The time required for intubation, intubation success rate, and numbers and type of adjusting manoeuvres employed were recorded. Inter-incisor distance was significantly smaller (4.1 [0.8] cm vs. 4.6 [0.7] cm, mean [SD], P
Liselott Persson - One of the best experts on this subject based on the ideXlab platform.
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Cervical Radiculopathy. Effects of Surgery, Physiotherapy or Cervical Collar. A prospective, randomised study.
1998Co-Authors: Liselott PerssonAbstract:The efficacy of surgery, physiotherapy or a Cervical Collar in the treatment of chronic cervicobrachial pain of radicular origin was evaluated in a prospective, randomised study comprising 81 patients of both sexes, 28-64 years of age, referred for possible neurosurgical treatment. After neurological and radiological examination and giving their informed consent, they were randomised to one of the three treatments. The surgery group underwent anterior decompression and single level fusion by bovine graft. The conservatively treated groups received individual physiotherapy or a rigid Cervical Collar for three months. The effects were evaluated at three months and 12 months later with respect to pain, tender points, sensory disturbance, muscle strength, neck and shoulder joint mobility, postural control, mood and health status. All treated groups improved, although the improvement rate differed. The surgically treated group was significantly better at three months, but one year later, there was no significant difference between the three groups. The studies variables also included the patients? balance in comparison with a healthy control group and the occurrence of headache. Before treatment, the patients manifested significantly poorer postural control than sex and age- matched controls. Three months after treatment the surgery group showed a significantly improved postural performance and the Collar group showed the poorest. Forty-nine of the 81 patients were classified as having Cervical headache and 24 of these reported that their headache had improved at the three months? control. Patients with Cervical headache reported significantly more cervicobrachial pain and higher tenderness score than patients with Cervical radiculopathy with no headache. No one-year follow-up was performed concerning balance and headache. It may be concluded that pain intensity, sensory disturbance, muscle strength and health status can be expected to improve most rapidly after surgery, but a slow improvement with conservative treatments makes the one-year results about equal.
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long lasting Cervical radicular pain managed with surgery physiotherapy or a Cervical Collar a prospective randomized study
Spine, 1997Co-Authors: Liselott Persson, Carlaxel Carlsson, Jane CarlssonAbstract:STUDY DESIGN: This prospective, randomized study compares the efficacy of surgical and conservative treatments in patients with long-lasting Cervical radicular pain.OBJECTIVES: To compare the effects of surgery, physiotherapy, and a Cervical Collar.SUMMARY OF BACKGROUND DATA: There are no previous controlled outcome studies that have compared surgical treatment with nonsurgical treatment of patients with Cervical radicular pain.METHODS: The study group comprised 81 patients with cervicobrachial pain of at least 3 months' duration, in whom the distribution of the arm pain corresponded to a nerve root that was significantly compressed by spondylotic encroachment with or without an additional bulging disc, as verified by magnetic resonance imaging or computed tomographic myelography. The patients were randomly allocated to surgery (Cloward technique), individually adapted physiotherapy, or a Cervical Collar. The therapeutic effects were evaluated with respect to pain intensity by the visual analogue scale, function by the Sickness Impact Profile, and mood by Mood Adjective Check List. The measurements were performed before treatment (control 1), shorter after treatment (control 2), and after a further 12 months (control 3).RESULTS: At control 1, the groups were uniform. At control 2, the surgery group reported less pain (visual analogue scale) and, like the physiotherapy group, better function (Sickness Impact Profile) than the Collar group. At control 3, there was no difference in visual analogue scale, Sickness Impact Profile, and Mood Adjective Check List measurements among the groups.CONCLUSIONS: In the treatment of patients with long-lasting Cervical radicular pain, it appears that a Cervical Collar, physiotherapy, or surgery are equally effective in the long term. (Less)
Olga Aniolek - One of the best experts on this subject based on the ideXlab platform.
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Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial
BMC Anesthesiology, 2020Co-Authors: Kurt Ruetzler, Cristian Abelairas-gomez, Hanna Misiolek, Tadeusz Plusa, Oliver Robak, Jacek Smereka, Marek Dabrowski, Szymon Bialka, Michael Frass, Olga AniolekAbstract:Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual Cervical inline stabilization, Cervical Collar stabilization, Cervical Collar stabilization and pharyngeal obstruction . Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except Cervical Collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. Trial registration clinicaltrials.gov Identifier: NCT03733158 . 7th November 2018.
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Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial.
BMC Anesthesiology, 2020Co-Authors: Kurt Ruetzler, Cristian Abelairas-gomez, Hanna Misiołek, Oliver Robak, Jacek Smereka, Marek Dabrowski, Szymon Bialka, Michael Frass, Olga AniolekAbstract:BACKGROUND: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. METHODS: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual Cervical inline stabilization, Cervical Collar stabilization, Cervical Collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. RESULTS: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except Cervical Collar stabilization. CONCLUSION: In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.
Mitchel B Harris - One of the best experts on this subject based on the ideXlab platform.
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case report nonoperative treatment of an unstable jefferson fracture using a Cervical Collar
Clinical Orthopaedics and Related Research, 2008Co-Authors: Brian M Haus, Mitchel B HarrisAbstract:The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a Cervical Collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the “rules of Spence” to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1–C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.