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Peter Krafft - One of the best experts on this subject based on the ideXlab platform.
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Comparison of Mucosal Pressures Induced by Cuffs of Different Airway Devices
Anesthesiology, 2006Co-Authors: Herbert Ulrich-pur, Ernst Schuster, Peter Krafft, Franz Hrska, Helmut Friehs, Beatrix Wulkersdorfer, Wolfgang J. Köstler, Werner Rabitsch, Thomas Staudinger, Michael FrassAbstract:Background:High pressures exerted by balloons and cuffs of conventional endotracheal tubes, the Combitube® (Tyco Healthcare Nellcor Mallinckrodt, Pleasanton, CA), the EasyTube® (Teleflex Ruesch, Kernen, Germany), the Laryngeal Mask Airway ™ (LMA North America, San Diego, CA), the Intubating Laryngea
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Recommendation of the minimal volume technique to avoid tongue engorgement with prolonged use of the esophageal-tracheal Combitube.
Annals of emergency medicine, 2005Co-Authors: Werner Rabitsch, Wolfgang J. Köstler, Peter Krafft, Heinz Burgmann, Michael FrassAbstract:demonstrates once more that the Combitube could be used for successful ventilation over a period of 7 hours. We want to add some information on the issue of tongue engorgement. In emergency situations, the oropharyngeal balloon is filled with 85 mL of air in the 37F small adult Combitube and with 100 mL in the 41F Combitube (http://www.Combitube.org). Ovassapian 2 has observed livid discoloration of the tongue during ventilation with the Combitube in a few patients without further sequelae. We fully agree that compression of the lingual veins during prolonged use of the Combitube may be the cause of tongue engorgement and discoloration of the tongue. To avoid this possible complication, we recommend use of the minimal volume technique (ie, minimal leakage technique) as soon as the patient’s situation has stabilized. 3-5 Urtubia et al 3 first described the minimal volume technique of oropharyngeal balloon inflation. In elective surgery, the oropharyngeal balloon of the 37F small adult Combitube is filled with smaller amounts of air. After inflation of the oropharyngeal balloon with a starting volume of 50 mL, additional 10-mL increments of air are instilled until a sufficient seal is achieved, as can be observed by clinical (neck auscultation) and/or mechanical means (comparison of inspiratory and expiratory tidal volume and flow-volume curve). 3,4 Usually, 40 to 85 mL of air is sufficient to obtain a tight seal. 3 The minimal leakage technique decreases the pressure of the oropharyngeal balloon exerted against the pharyngeal mucosa, thereby reducing the stress on the tissue. 4 In addition, the study used methylene blue capsules to show that the minimal leakage technique does not result in aspiration. 3 We recommend that this technique also may be used in emergencies after the patient’s situation has stabilized and the oropharyngeal balloon has fixated behind the hard palate. Similar findings have
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Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia.
Wiener klinische Wochenschrift, 2004Co-Authors: Werner Rabitsch, Peter Krafft, Camillo Sherif, Reinhard Frenzer, Roland Hofbauer, Franz Lackner, Michael FrassAbstract:Objectives Evaluation of safety and effectiveness of the Combitube during general anaesthesia.
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Evaluation of the oesophageal-tracheal double-lumen tube (Combitube) during general anaesthesia
Wiener Klinische Wochenschrift, 2004Co-Authors: Werner Rabitsch, Peter Krafft, Camillo Sherif, Franz X. Lackner, Reinhard Frenzer, Roland Hofbauer, Michael FrassAbstract:Objectives Evaluation of safety and effectiveness of the Combitube during general anaesthesia. Patients and methods 250 patients undergoing general anaesthesia were enrolled in the study. The respective types and duration of surgery, ease of insertion of the Combitube, and potential complications were recorded. Maximum ventilatory pressures and leak fraction were also evaluated in this study. Results Duration of surgery varied between 20 and 410 min. More than 96% of the blind Combitube insertions were successful at the first attempt, with a mean time of less than 18±5 seconds (range 12–24 seconds). In 99% of patients the Combitube worked well, and adequate oxygenation and ventilation was possible. All patients were haemodynamically stable during the entire duration of surgery. In all patients, pulse oximetry showed an oxygen saturation of 97±2% and an end-tidal carbon dioxide of 38±6 mm Hg. Leak fraction, calculated as a fraction of the inspired volume, did not increase to more than 5% up to a ventilation pressure of 40 cm H_2O. Superficial laceration occurred in 18 patients (7.2%) without further sequelae. No severe injuries were observed during the study period. Conclusion Ventilation via the Combitube appears to be safe and effective during general anaesthesia. Practice in elective cases is a requirement for successful use in an emergency situation. Fragestellung Evaluation auf Sicherheit und Verlässlichkeit und Wirksamkeit des Combitube (Tyco Healthcare, Brunn am Gebirge, Österreich) während Allgemeinanästhesie. Patienten und Methoden 250 Patienten, die eine Allgemeinanästhesie erhielten, wurden in die Studie eingeschlossen. Die verschiedenen Operationstypen, die Dauer der Operationen, Leichtigkeit der Einführung, und potentielle Komplikationen wurden registriert. Zudem wurden maximale Beatmungsdrücke und das Ausmaß der Leckage ermittelt. Ergebnisse Die Dauer der Operationen variierte zwischen 20 und 410 Minuten. Mehr als 96% der blinden Combitube Einführungen waren beim ersten Versuch nach einer durchschnittlichen Zeit von 18±5 Sekunden (12 bis 24 Sekunden) erfolgreich. Bei 99% der Patienten war es möglich, eine adäquate Oxygenation und Ventilation aufrecht zu erhalten. Alle Patienten waren während der Gesamtdauer der Operationen hämodynamisch stabil, mit einer pulsoximetrisch gemessenenen Sauerstoffsättigung von 97±2%. Der end-tidal gemessene Kohlendioxid-Partialdruck war 38±6 mm Hg. Die Leckage betrug auch bei Beatmungsdrücken von bis zu 40 cm H_2O nicht mehr als 5%. Bei 18 Patienten (7,2%) fanden sich oberflächliche Schleimhaut-Lazerationen ohne anhaltende Folgeschäden. Es wurden keine schwerwiegenden Komplikationen während der Studie beobachtet. Zusammenfassung Die Beatmung via Combitube während Allgemeinanästhesie erscheint sicher und effektiv. Der Einsatz des Combitube sollte jedoch in Hinblick auf einen zukünftigen Notfalleinsatz bei elektiven Eingriffen trainiert werden.
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Alternative management techniques for the difficult airway: esophageal-tracheal Combitube.
Current opinion in anaesthesiology, 2004Co-Authors: Peter Krafft, Karl SchebestaAbstract:PURPOSE OF REVIEW To summarize knowledge about the esophageal-tracheal Combitube in emergency medicine and anesthesia, with special emphasis on uncommon indications. Papers published between August 2003 and July 2004 are reviewed. RECENT FINDINGS Tracheal intubation in the field is difficult and success rates are dependent upon training level (90-98%). Therefore, the esophageal-tracheal Combitube has been recommended for emergency ventilation after failed tracheal intubation with success rates of about 90%, even when performed by emergency medical technicians. Combitube insertion is easy to learn, but practice is necessary to retain skills. Use of this device has also been recommended for ventilatory support during routine anesthesia. Combitube ventilation is successful in over 96% of patients, with minimal trauma. Since only a small percentage of American anesthesiologists are familiar with the Combitube (
Michael Frass - One of the best experts on this subject based on the ideXlab platform.
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Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions.
Canadian Journal of Emergency Medicine, 2015Co-Authors: Oliver Robak, Marco Leonardelli, Konstantin Zedtwitz-liebenstein, Kurt Rützler, Ernst Schuster, Sonia J. Vaida, Ramez M Salem, Michael FrassAbstract:Objectives: Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions. Methods: Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs. Results: Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs. Conclusion: The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.
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Comparison of Mucosal Pressures Induced by Cuffs of Different Airway Devices
Anesthesiology, 2006Co-Authors: Herbert Ulrich-pur, Ernst Schuster, Peter Krafft, Franz Hrska, Helmut Friehs, Beatrix Wulkersdorfer, Wolfgang J. Köstler, Werner Rabitsch, Thomas Staudinger, Michael FrassAbstract:Background:High pressures exerted by balloons and cuffs of conventional endotracheal tubes, the Combitube® (Tyco Healthcare Nellcor Mallinckrodt, Pleasanton, CA), the EasyTube® (Teleflex Ruesch, Kernen, Germany), the Laryngeal Mask Airway ™ (LMA North America, San Diego, CA), the Intubating Laryngea
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Comparison of mouth-to-mouth resuscitation and Combitube ventilation in a bench model.
Wiener klinische Wochenschrift, 2005Co-Authors: Camillo Sherif, Ernst Schuster, Wolfgang J. Köstler, Werner Rabitsch, Josef Erdös, Michael Sohm, Robert Schönbauer, Peter Schellongowski, Johanna Boltuch, Michael FrassAbstract:In addition to heart massage, the primary goal of cardiopulmonary resuscitation is efficient oxygenation and ventilation. To compare the ease of learning and handling of standard mouth-to-mouth resuscitation with the Combitube (Tyco Healthcare Nellcor, Pleasanton, CA) ventilation. After a 30 minute theoretical introduction and demonstration of mouth-to-mouth resuscitation and use of the Combitube in mannequins, following American Heart Association guidelines, 26 adolescent school children (15 of them 14 years old, 11 of them 10 years old) undertook two ventilation trials, each consisting of five single ventilations, with each technique. Only the second trial with each technique was evaluated. Qualitative implementation (grades: very good, good, failed) was evaluated, several procedure-related time points were recorded, and tidal volumes (ml) were measured. With mouth-to-mouth resuscitation, the time interval until start of first ventilation was 36.5 seconds shorter than with the Combitube (P < 0.001). With the Combitube, the time needed for five single ventilations was 6.4 seconds less than with mouth-to-mouth resuscitation (P < 0.001) and mean tidal volumes were higher (mouth-to-mouth resuscitation, 450 +/- 384 ml, versus Combitube, 735 +/- 358 ml; P < 0.05). Most of the school children performed both techniques to a high qualitative level. The study shows that mouth-to-mouth resuscitation and use of the Combitube have equal ease of learning, a precondition for proficient retention of skills. Tidal volumes were significantly higher with the Combitube and, not surprisingly, the time interval until the start of first ventilation was significantly shorter with mouth-to-mouth resuscitation. Regardless of the ventilation technique or device, we believe that subsequent retraining of ventilation skills is very important.
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Comparison of mouth-to-mouth resuscitation and Combitube ventilation in a bench model.
Wiener Klinische Wochenschrift, 2005Co-Authors: Camillo Sherif, Ernst Schuster, Wolfgang J. Köstler, Werner Rabitsch, Josef Erdös, Michael Sohm, Robert Schönbauer, Peter Schellongowski, Johanna Boltuch, Michael FrassAbstract:CONTEXT: In addition to heart massage, the primary goal of cardiopulmonary resuscitation is efficient oxygenation and ventilation. OBJECTIVE: To compare the ease of learning and handling of standard mouth-to-mouth resuscitation with the Combitube (Tyco Healthcare Nellcor, Pleasanton, CA) ventilation. METHODS: After a 30 minute theoretical introduction and demonstration of mouth-to-mouth resuscitation and use of the Combitube in mannequins, following American Heart Association guidelines, 26 adolescent school children (15 of them 14 years old, 11 of them 10 years old) undertook two ventilation trials, each consisting of five single ventilations, with each technique. Only the second trial with each technique was evaluated. Qualitative implementation (grades: very good, good, failed) was evaluated, several procedure-related time points were recorded, and tidal volumes (ml) were measured. RESULTS: With mouth-to-mouth resuscitation, the time interval until start of first ventilation was 36.5 seconds shorter than with the Combitube (P < 0.001). With the Combitube, the time needed for five single ventilations was 6.4 seconds less than with mouth-to-mouth resuscitation (P < 0.001) and mean tidal volumes were higher (mouth-to-mouth resuscitation, 450 ± 384 ml, versus Combitube, 735 ± 358 ml; P < 0.05). CONCLUSION: Most of the school children performed both techniques to a high qualitative level. The study shows that mouth-to-mouth resuscitation and use of the Combitube have equal ease of learning, a precondition for proficient retention of skills. Tidal volumes were significantly higher with the Combitube and, not surprisingly, the time interval until the start of first ventilation was significantly shorter with mouth-to-mouth resuscitation. Regardless of the ventilation technique or device, we believe that subsequent retraining of ventilation skills is very important.
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Comparison of mouth-to-mouth resuscitation and Combitube ventilation in a bench model
Wiener klinische Wochenschrift, 2005Co-Authors: Camillo Sherif, Ernst Schuster, Wolfgang J. Köstler, Werner Rabitsch, Josef Erdös, Michael Sohm, Robert Schönbauer, Peter Schellongowski, Johanna Boltuch, Michael FrassAbstract:CONTEXT: In addition to heart massage, the primary goal of cardiopulmonary resuscitation is efficient oxygenation and ventilation. OBJECTIVE: To compare the ease of learning and handling of standard mouth-to-mouth resuscitation with the Combitube (Tyco Healthcare Nellcor, Pleasanton, CA) ventilation. METHODS: After a 30 minute theoretical introduction and demonstration of mouth-to-mouth resuscitation and use of the Combitube in mannequins, following American Heart Association guidelines, 26 adolescent school children (15 of them 14 years old, 11 of them 10 years old) undertook two ventilation trials, each consisting of five single ventilations, with each technique. Only the second trial with each technique was evaluated. Qualitative implementation (grades: very good, good, failed) was evaluated, several procedure-related time points were recorded, and tidal volumes (ml) were measured. RESULTS: With mouth-to-mouth resuscitation, the time interval until start of first ventilation was 36.5 seconds shorter than with the Combitube (P < 0.001). With the Combitube, the time needed for five single ventilations was 6.4 seconds less than with mouth-to-mouth resuscitation (P < 0.001) and mean tidal volumes were higher (mouth-to-mouth resuscitation, 450 ± 384 ml, versus Combitube, 735 ± 358 ml; P < 0.05). CONCLUSION: Most of the school children performed both techniques to a high qualitative level. The study shows that mouth-to-mouth resuscitation and use of the Combitube have equal ease of learning, a precondition for proficient retention of skills. Tidal volumes were significantly higher with the Combitube and, not surprisingly, the time interval until the start of first ventilation was significantly shorter with mouth-to-mouth resuscitation. Regardless of the ventilation technique or device, we believe that subsequent retraining of ventilation skills is very important. HINTERGRUND: Neben der Herzdruckmassage ist die effiziente Oxygenierung und Ventilation ein vorrangiges Ziel bei der Herzlungenwiederbelebung. FRAGESTELLUNG: Vergleich der Einfachheit der Anwendung und der Erlernbarkeit der Standard Mund-zu-Mund-Beatmung und der Combitube-Beatmung (Tyco Healthcare Nellcor, Brunn am Gebirge, Österreich). METHODIK: Nach einer 30-minütigen theoretischen Einführung und Demonstration der Mund-zu-Mund-Beatmung und des Combitube an der Beatmungspuppe entsprechend den Richtlinien der American Heart Association (AHA), führten 26 Jugendliche (15 von ihnen 14 Jahre alt, 11 von ihnen 10 Jahre alt) zwei Beatmungsversuche à fünf Ventilationen mit jeder Technik durch, wobei nur der zweite Versuch ausgewertet wurde. Neben der Evaluierung der qualitativen Umsetzung (Benotung: sehr gut, gut, nicht genügend) wurden definierte Zeitspannen gemessen und die Tidalvolumina (ml) bestimmt. ERGEBNISSE: Die Dauer bis zum Beginn der ersten Ventilation war bei der Mund-zu-Mund-Beatmung um 36,5 Sekunden kürzer (P
P Krafft - One of the best experts on this subject based on the ideXlab platform.
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alternative management techniques for the difficult airway esophageal tracheal Combitube
Current Opinion in Anesthesiology, 2004Co-Authors: P Krafft, Karl SchebestaAbstract:PURPOSE OF REVIEW To summarize knowledge about the esophageal-tracheal Combitube in emergency medicine and anesthesia, with special emphasis on uncommon indications. Papers published between August 2003 and July 2004 are reviewed. RECENT FINDINGS Tracheal intubation in the field is difficult and success rates are dependent upon training level (90-98%). Therefore, the esophageal-tracheal Combitube has been recommended for emergency ventilation after failed tracheal intubation with success rates of about 90%, even when performed by emergency medical technicians. Combitube insertion is easy to learn, but practice is necessary to retain skills. Use of this device has also been recommended for ventilatory support during routine anesthesia. Combitube ventilation is successful in over 96% of patients, with minimal trauma. Since only a small percentage of American anesthesiologists are familiar with the Combitube (<50%), using the device in anesthesia care may improve the skills required during emergency airway management. Blood gases are in the range of those obtained during endotracheal tube ventilation and aspiration prophylaxis is at least as good as that of the laryngeal mask airway. Successful uncommon uses of the device have also been recommended, for example, Combitube ventilation in craniomaxillomandibular surgery via the submental route and insertion of the device in a burns patient with minimal mouth opening and significant tracheal stenosis after long-term ventilation. SUMMARY The esophageal-tracheal Combitube is a useful and efficient alternative airway characterized by high success rates in emergency situations. We recommend the use of a laryngoscope for insertion and strict adherence to the manufacturer's guidelines in order to maximize success and minimize potential injury.
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waste gas exposure to sevoflurane and nitrous oxide during anaesthesia using the oesophageal tracheal Combitube small adulttm
BJA: British Journal of Anaesthesia, 2001Co-Authors: K Hoerauf, T. Hartmann, S. Acimovic, A. Kopp, G. Wiesner, Burkhard Gustorff, H. Jellinek, P KrafftAbstract:Exposure to sevoflurane (SEV) and nitrous oxide during ventilation using a Combitube (37Fr) small adult (SA) was compared with waste gas exposure using conventional endotracheal tubes. Trace concentrations of SEV and nitrous oxide were assessed using a direct reading spectrometer during 40 gynaecological laparoscopic procedures under general anaesthesia. Measurements were made at the patients' mouth and in the anaesthetists' breathing zone. Mean (SD) concentrations of SEV and nitrous oxide measured at the patients' mouth were comparable in the Combitube SA (SEV 0.6 (0.2) p.p.m.; nitrous oxide 9.7 (8.5) p.p.m.) and endotracheal tube group (SEV 1.2 (0.8) p.p.m.; nitrous oxide 17.2 (10.6) p.p.m.). These values caused comparable contamination of the anaesthetists' breathing zone (SEV 0.6 (0.2) p.p.m. and nitrous oxide 4.3 (3.7) p.p.m. for the Combitube SA group, compared with SEV 0.5 (0.2) p.p.m. and nitrous oxide 4.1 (1.8) p.p.m. for the endotracheal tube group). We conclude that the use of the Combitube SA during positive pressure ventilation is not necessarily associated with increased waste gas exposure, especially when air conditioning and scavenging devices are available.
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the oesophageal tracheal Combitube small adult an alternative airway for ventilatory support during gynaecological laparoscopy
Anaesthesia, 2000Co-Authors: T. Hartmann, Jonathan L. Benumof, Claus G. Krenn, A. Zoeggeler, Klaus Hoerauf, P KrafftAbstract:Airway management during gynaecological laparoscopy is complicated by intraperitoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesophageal–tracheal Combitube 37 Fr SA™ is a suitable airway during laparoscopy. One hundred patients were randomly allocated to receive either the Combitube SA™ (n = 49) or tracheal intubation (n = 51). Oesophageal placement of the Combitube was successful at the first attempt [16 (3) s]. Peak airway pressures were 25 (5) cmH2O. An airtight seal was obtained using air volumes of 55 (13) ml (oropharyngeal balloon) and 10 (1) ml (oesophageal cuff). Significant correlations were observed between patient's height and weight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficult in three patients. The Combitube SA™ provided a patent airway during laparoscopy. Non-traumatic insertion was possible and an airtight seal was provided at airway pressures of up to 30 cmH2O.
Jonathan L. Benumof - One of the best experts on this subject based on the ideXlab platform.
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The esophageal-tracheal Combitube resistance and ventilatory pressures.
Journal of clinical anesthesia, 2005Co-Authors: Luis Gaitini, Sonia J. Vaida, Somri Mostafa, Boris Yanovski, Bruce Ben-david, Jonathan L. BenumofAbstract:Abstract Study Objective To measure resistance of the Combitube, a supraglottic ventilatory device used in the management of the patients with difficult airways, and its influence on delivered ventilatory pressures. Design Prospective study. Setting University-affiliated hospital. Patients A total of 20 patients with ASA status I or II who were scheduled for elective knee arthroscopy. Interventions (Part 2 of the study) After induction of general anesthesia and insertion of the Combitube, mechanical ventilation was initiated. Airway pressures were measured using fluid-filled pressure lines at the Y-piece ( P Y-piece ) of the breathing system and in the oropharynx ( P oropharynx ) at a position 2 cm beyond the second proximal anterior hole of the Combitube. These pressures were simultaneously recorded and the pressure curves were compared. Measurements (Part 1 of the study) Resistance of the esophageal and the tracheal lumen of the 37-F Combitube and standard endotracheal tubes (with internal diameters of 6, 7, and 8 mm) was compared ex vivo with a Datex AS/3 monitor. Ventilation conditions were kept constant at a tidal volume of 0.5 L, frequency of 10 breaths per minute, and ramp flow waveform and peak flow of 1 L/s. Main Results Resistance of standard endotracheal tubes was inversely proportional to their diameters (16, 11, and 7 cm H 2 O/L per second for the tubes with internal diameters of 6, 7, and 8 mm, respectively). The resistance of the Combitube's tracheal lumen was 12 cm H 2 O/L per second. There was a significant difference in peak respiratory pressures between P Y-piece and P oropharynx (40 ± 5 and 23 ± 5 cm H 2 O, respectively). Conclusions The Combitube has significant airflow resistance that should be considered when patients are mechanically ventilated because the delivered oropharyngeal pressure is significantly lower than the pressure measured at the anesthesia breathing system.
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Current status of the Combitube™: a review of the literature
Journal of clinical anesthesia, 2002Co-Authors: Felice Agrò, Michael Frass, Jonathan L. Benumof, Peter KrafftAbstract:The Combitube (Tyco-Healthcare-Kendall-Sheridan, Mansfield, MA) is an easily inserted and highly efficacious device to be used as an alternative airway whenever conventional ventilation fails. The Combitube allows ventilation and oxygenation whether the device locates in the esophagus (very common) or the trachea (rare). In this report, we review studies that suggest the Combitube is a valuable and effective airway in the emergency and prehospital settings, in cardiopulmonary resuscitation, in elective surgery, and in critically ill patients in the intensive care unit. Also reviewed are studies that demonstrate the superiority of the Combitube over other supraglottic ventilatory devices in resuscitation with respect to success rates with insertion and ventilation. Contrary to the Laryngeal Mask Airway, the Combitube may help in patients with limited mouth opening. The Combitube may be of special benefit in patients with massive bleeding or regurgitation, and it minimizes the risk of aspiration.
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Current Status of the Combitube™: A Review of the Literature
2002Co-Authors: Felice Agrò, Michael Frass, Jonathan L. Benumof, Peter KrafftAbstract:serted and highly efficacious device to be used as an alternative airway whenever conventional ventilation fails. The Combitube allows ventilation and oxygenation whether the device locates in the esophagus (very common) or the trachea (rare). In this report, we review studies that suggest the Combitube is a valuable and effective airway in the emergency and prehospital settings, in cardiopulmonary resuscitation, in elective surgery, and in critically ill patients in the intensive care unit. Also reviewed are studies that demonstrate the superiority of the Combitube over other supraglottic ventilatory devices in resuscitation with respect to success rates with insertion and ventilation. Contrary to the Laryngeal Mask Airway™, the Combitube may help in patients with limited mouth opening. The Combitube may be of special benefit in patients with massive bleeding or regurgitation, and it minimizes the risk of aspiration. © 2002 by Elsevier Science Inc
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The Combitube in Elective Surgery: A Report of 200 Cases
Anesthesiology, 2001Co-Authors: Luis Gaitini, Sonia J. Vaida, Somri Mostafa, Boris Yanovski, Milian Croitoru, Marisa D. Capdevila, Edmond Sabo, Bruce Ben-david, Jonathan L. BenumofAbstract:Background The Combitube has proved to be a valuable device for securing the airway in cases of difficult intubation. This study investigated the effectiveness of the Combitube in elective surgery during both mechanical and spontaneous ventilation. Methods Two hundred patients classified as American Society of Anesthesiologists physical status I and II, with normal airways, scheduled for elective surgery were randomly allocated into two groups: nonparalyzed, spontaneously breathing (n = 100); or paralyzed, mechanically ventilated (n = 100). After induction of general anesthesia and insertion of the Combitube, oxygen saturation, end-tidal carbon dioxide and isoflurane concentration, systolic and diastolic blood pressure and heart rate, as well as breath-by-breath spirometry data were obtained every 5 min. Results In 97% of patients, it was possible to maintain oxygenation, ventilation, and respiratory mechanics, as well as hemodynamic stability during either mechanical or spontaneous ventilation for the entire duration of surgery. The duration of surgery was between 15 and 155 min. Conclusions The results of this study suggest that the Combitube is an effective and safe airway device for continued management of the airway in 97% of elective surgery cases.
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The esophageal tracheal Combitube as a non-invasive alternative to endotracheal intubation. A review.
Minerva anestesiologica, 2001Co-Authors: Felice Agrò, Michael Frass, Peter Krafft, Luis Gaitini, Jonathan L. Benumof, R. M. Urtubia, I GiulianoAbstract:The esophageal tracheal Combitube (ETC) is a supraglottic airway device that functions as an effective alternative to ventilation via mask and tracheal intubation and is therefore a valuable tool in difficult and emergency airway management. The Com-bitube has proven to be a valuable tool for securing the airways and providing adequate ventilation. Its advantages are that it is easy to insert quickly, it may be inserted blindly or with the aid of a laryngoscope, and it provides adequate ventilation and oxygenation in both esophageal and tracheal position. The Combitube allows application of high ventilatory pressures and it minimises the risk of aspiration. Several guidelines including European Resuscitation Council, Ame-rican Heart Association, American Society of Anesthesiologists have included the Combitube as a primary rescue device in cannot ventilate cannot intubate situations. It has been used in elective patients as well as in emergency situations in- and out-of-hospital. The Combitube can be inserted with minimal movement of the cervical spine and is therefore indicated whenever cervical spine movement is anatomically restricted (e.g. rheumatoid arthritis) or should be functionally restricted (e.g. trauma). Since the Combitube isolates the lungs from the esophagus it is especially useful in patients at risk for aspiration (e.g., caesarean section, morbid obesity). The Combitube is available in two sizes: 37 F SA (Small Adult) and 41 F. Unfortunately, a pediatric size is not commercially available. Training in the use of the Combitube under controlled conditions is prerequisite to being expert in an emergency situation. The Combitube is another non-surgical airway in the armamentarium of the anaesthesiologist or emergency provider in case of foreseen or unforeseen difficult airways in patients who can neither be intubated or mask ventilated.
T. Hartmann - One of the best experts on this subject based on the ideXlab platform.
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Waste gas exposure to sevoflurane and nitrous oxide during anaesthesia using the oesophageal–tracheal Combitube small adultTM
British journal of anaesthesia, 2001Co-Authors: Klaus Hoerauf, T. Hartmann, S. Acimovic, A. Kopp, G. Wiesner, Burkhard Gustorff, H. Jellinek, Peter KrafftAbstract:Exposure to sevoflurane (SEV) and nitrous oxide during ventilation using a Combitube (37Fr) small adult (SA) was compared with waste gas exposure using conventional endotracheal tubes. Trace concentrations of SEV and nitrous oxide were assessed using a direct reading spectrometer during 40 gynaecological laparoscopic procedures under general anaesthesia. Measurements were made at the patients' mouth and in the anaesthetists' breathing zone. Mean (SD) concentrations of SEV and nitrous oxide measured at the patients' mouth were comparable in the Combitube SA (SEV 0.6 (0.2) p.p.m.; nitrous oxide 9.7 (8.5) p.p.m.) and endotracheal tube group (SEV 1.2 (0.8) p.p.m.; nitrous oxide 17.2 (10.6) p.p.m.). These values caused comparable contamination of the anaesthetists' breathing zone (SEV 0.6 (0.2) p.p.m. and nitrous oxide 4.3 (3.7) p.p.m. for the Combitube SA group, compared with SEV 0.5 (0.2) p.p.m. and nitrous oxide 4.1 (1.8) p.p.m. for the endotracheal tube group). We conclude that the use of the Combitube SA during positive pressure ventilation is not necessarily associated with increased waste gas exposure, especially when air conditioning and scavenging devices are available.
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waste gas exposure to sevoflurane and nitrous oxide during anaesthesia using the oesophageal tracheal Combitube small adulttm
BJA: British Journal of Anaesthesia, 2001Co-Authors: K Hoerauf, T. Hartmann, S. Acimovic, A. Kopp, G. Wiesner, Burkhard Gustorff, H. Jellinek, P KrafftAbstract:Exposure to sevoflurane (SEV) and nitrous oxide during ventilation using a Combitube (37Fr) small adult (SA) was compared with waste gas exposure using conventional endotracheal tubes. Trace concentrations of SEV and nitrous oxide were assessed using a direct reading spectrometer during 40 gynaecological laparoscopic procedures under general anaesthesia. Measurements were made at the patients' mouth and in the anaesthetists' breathing zone. Mean (SD) concentrations of SEV and nitrous oxide measured at the patients' mouth were comparable in the Combitube SA (SEV 0.6 (0.2) p.p.m.; nitrous oxide 9.7 (8.5) p.p.m.) and endotracheal tube group (SEV 1.2 (0.8) p.p.m.; nitrous oxide 17.2 (10.6) p.p.m.). These values caused comparable contamination of the anaesthetists' breathing zone (SEV 0.6 (0.2) p.p.m. and nitrous oxide 4.3 (3.7) p.p.m. for the Combitube SA group, compared with SEV 0.5 (0.2) p.p.m. and nitrous oxide 4.1 (1.8) p.p.m. for the endotracheal tube group). We conclude that the use of the Combitube SA during positive pressure ventilation is not necessarily associated with increased waste gas exposure, especially when air conditioning and scavenging devices are available.
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the oesophageal tracheal Combitube small adult an alternative airway for ventilatory support during gynaecological laparoscopy
Anaesthesia, 2000Co-Authors: T. Hartmann, Jonathan L. Benumof, Claus G. Krenn, A. Zoeggeler, Klaus Hoerauf, P KrafftAbstract:Airway management during gynaecological laparoscopy is complicated by intraperitoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesophageal–tracheal Combitube 37 Fr SA™ is a suitable airway during laparoscopy. One hundred patients were randomly allocated to receive either the Combitube SA™ (n = 49) or tracheal intubation (n = 51). Oesophageal placement of the Combitube was successful at the first attempt [16 (3) s]. Peak airway pressures were 25 (5) cmH2O. An airtight seal was obtained using air volumes of 55 (13) ml (oropharyngeal balloon) and 10 (1) ml (oesophageal cuff). Significant correlations were observed between patient's height and weight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficult in three patients. The Combitube SA™ provided a patent airway during laparoscopy. Non-traumatic insertion was possible and an airtight seal was provided at airway pressures of up to 30 cmH2O.
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The oesophageal–tracheal Combitube Small Adult™An alternative airway for ventilatory support during gynaecological laparoscopy
Anaesthesia, 2000Co-Authors: T. Hartmann, Jonathan L. Benumof, Claus G. Krenn, A. Zoeggeler, Klaus Hoerauf, Peter KrafftAbstract:Airway management during gynaecological laparoscopy is complicated by intraperitoneal carbon dioxide inflation, Trendelenburg tilt, increasing airway pressures and pulmonary aspiration risk. We investigated whether the oesophageal–tracheal Combitube 37 Fr SA™ is a suitable airway during laparoscopy. One hundred patients were randomly allocated to receive either the Combitube SA™ (n = 49) or tracheal intubation (n = 51). Oesophageal placement of the Combitube was successful at the first attempt [16 (3) s]. Peak airway pressures were 25 (5) cmH2O. An airtight seal was obtained using air volumes of 55 (13) ml (oropharyngeal balloon) and 10 (1) ml (oesophageal cuff). Significant correlations were observed between patient's height and weight and the balloon volumes necessary to produce a seal. Similar findings were recorded for the control group, with tracheal intubation being difficult in three patients. The Combitube SA™ provided a patent airway during laparoscopy. Non-traumatic insertion was possible and an airtight seal was provided at airway pressures of up to 30 cmH2O.