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Kurt Ruetzler - One of the best experts on this subject based on the ideXlab platform.

  • Haemodynamic response at double Lumen bronchial Tube placement - Airtraq vs. MacIntosh laryngoscope, a randomised controlled trial
    Heart lung and vessels, 2020
    Co-Authors: Thomas Hamp, Kurt Ruetzler, Georg Grubhofer, Thomas Stumpner, Rainer Thell, Helmut Hager
    Abstract:

    Introduction: Tracheal intubation causes a haemodynamic response that might be harmful for patients. The Airtraq® laryngoscope has been shown to decrease the haemodynamic response to Single-Lumen Tube intubation. We hypothesised that double-Lumen bronchial Tube placement with the Double-Lumen Airtraq® laryngoscope would cause a reduced haemodynamic response and decreased catecholamine release compared with the MacIntosh laryngoscope. Methods: Forty adult patients were randomly assigned to the Airtraq® group or to the MacIntosh group. Intubation with either the Airtraq® or the MacIntosh laryngoscope was performed two minutes after standardised induction of anaesthesia. Arterial blood pressure, heart rate, catecholamine levels, bispectral index and duration of the intubation procedure were measured. Results: Mean (standard deviation [95% confidence interval]) systolic arterial blood pressure at laryngoscopy with the Airtraq® laryngoscope was 124 (34 [106 to 141]) mmHg and, with the MacIntosh laryngoscope, it was 110 (25 [99 to 122]) mmHg (p=1.0). Heart rate at laryngoscopy with the Airtraq® laryngoscope was 75 beats·min-1 (16 [67 to 83]) and, with the MacIntosh laryngoscope, it was 64 beats·min-1 (14 [58 to 71]) (p=0.71). Adrenaline levels post-intubation were 54.3 ng·l-1 (41.5) [29.3 to 79.4] in the Airtraq® group and 30.5 ng·l-1 (25.6) [15.1 to 46.0] in the MacIntosh group (p=0.016). The duration of intubation with the Airtraq® laryngoscope was 88 s (31 [72-104]) while, with the MacIntosh laryngoscope, the duration was 75 s (35 [59-92]) (p=0.26). Conclusions: The use of the Double-Lumen Airtraq® laryngoscope provides no benefit regarding stress response compared to the MacIntosh laryngoscope.

  • vivasight Single Lumen Tube as an intubation method a systematic review and meta analysis of randomised simulation trials
    Disaster and Emergency Medicine Journal, 2020
    Co-Authors: Katarzyna Karczewska, Jacek Smereka, Marek Dabrowski, Adam Lisiecki, Dawid Golik, Dominika Dunder, Szymon Bialka, Lukasz Szarpak, Kurt Ruetzler
    Abstract:

    INTRODUCTION: Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight SL Tube-mounted camera with a standard endotracheal Single-Lumen Tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL Tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression.  MATERIAL AND METHODS: We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view.  RESULTS: The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = –11.29 [–13.10, –9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for DL (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08).  CONCLUSIONS: Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

  • randomized clinical trial comparing double Lumen Tube and ez blocker for Single lung ventilation
    BJA: British Journal of Anaesthesia, 2011
    Co-Authors: Kurt Ruetzler, Georg Grubhofer, W Schmid, D Papp, Sabine Nabecker, D Hutschala, G Lang, Helmut Hager
    Abstract:

    Background In several clinical situations, lung separation and Single-lung ventilation (SLV) is essential. In these cases, the double-Lumen Tube (DLT) is the most widely used device. Bronchial blocker such as Univent or Arndt Blocker serves as an alternative. The EZ-Blocker® (EZ; AnaesthetIQ B.V., Rotterdam, The Netherlands) is a new device promising to exceed clinical performance of DLT. The aim of this study was to assess the clinical performance of EZ in comparison with conventional left-sided DLT. Methods Forty adult patients undergoing elective thoracic surgery requiring thoracotomy and SLV were included in this study. The patients were randomly assigned to one of two groups: EZ (combined with conventional 7.5 or 8.5 mm Single-Lumen Tube) or DLT (37 or 39 Fr left-sided DLT). Time for intubation procedure and time to verification of the correct position of EZ or DLT using fibreoptic bronchoscopy (FOB) were recorded. After surgery, a thoracic surgeon rated the quality of collapse of the lung (1–3 on a three-level scale). Results Time for intubation using DLT 85.5 (54.8) s was significantly faster (P Conclusions Although time for intubation was longer with the EZ, the device proved to be an efficient and easy-to-use device. The EZ is a valuable alternative device to conventional DLT. Verification of the correct position of the EZ by FOB seems to be obligatory. This study was registered at http://www.clinicaltrials.gov (identifier: NCT01171560).

François Donati - One of the best experts on this subject based on the ideXlab platform.

  • Replacing a double-Lumen Tube with a Single-Lumen Tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled Single-blind trial
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2015
    Co-Authors: Issam Tanoubi, Pierre Drolet, Louis-philippe Fortier, François Donati
    Abstract:

    Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-Lumen Tube (DLT). In this study, the DLT was replaced with either a Single-Lumen endotracheal Tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Methods Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal™ (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed and replaced by an ETT (ETT Group), or (3) left in place (DLT Group). The primary outcome was the number of coughing episodes at extubation. Results Among 184 patients screened, 124 did not meet inclusion criteria, and two patients, both in the ETT Group, were excluded after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT, and DLT Groups, respectively. There were fewer coughing episodes (median [quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2[1-3], respectively; P = 0.01). In the DLT Group, 90% of patients coughed at least once. This incidence was not significantly different in the ETT Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group (35%; P < 0.001). No patient had oxygen desaturation during airway exchange or at extubation. The incidence and severity of hoarseness and sore throat were similar in all groups. Conclusion Coughing at extubation after thoracic surgery can be reduced if the DLT is replaced by an LMA-P before emergence. The number of patients in this trial was too small to evaluate the risks associated with exchanging the airway device. This trial was registered at ClinicalTrials.gov: NCT00925613. Contexte Les épisodes de toux surviennent fréquemment lors de l’extubation après une chirurgie thoracique, et ils pourraient être provoqués en partie par la sonde double lumière (SDL). Dans cette étude, nous avons remplacé la SDL par une sonde endotrachéale (SET) simple lumière, par un masque laryngé (ML) ou l’avons laissée en place, et nous avons comparé l’incidence de toux au réveil dans les trois groupes. Méthode Cinquante-huit adultes devant subir une chirurgie thoracique avec une SDL ont été recrutés pour cette étude. Les critères d’exclusion étaient des voies aériennes anticipées comme difficiles, l’obésité et toute contre-indication à l’utilisation d’un masque laryngé ProSeal™ (ML-P). Après la chirurgie mais avant le réveil, les patients ont été aléatoirement attribués à l’un des trois groupes suivants : (1) retrait de la SDL et remplacement par un ML-P (groupe ML-P), (2) retrait et remplacement de la SDL par une SET (groupe SET), ou (3) SDL laissée en place (groupe SDL). Le critère d’évaluation principal était le nombre d’épisodes de toux lors de l’extubation. Résultats Parmi les 184 patients évalués, 124 ne répondaient pas aux critères d’inclusion, et deux patients du groupe SET ont été exclus après la randomisation, laissant 20, 18 et 20 patients dans les groupes ML-P, SET et SDL, respectivement. Il y a eu moins d’épisodes de toux (médianes [quartiles]) dans le groupe ML-P que dans le groupe SDL (0 [0-1] vs 2 [1-3], respectivement; P = 0,01). Dans le groupe SDL, 90 % des patients ont toussé au moins une fois. Cette incidence n’était pas significativement différente dans le groupe SET (83 %; P = 0,222), mais elle était significativement réduite dans le groupe ML-P (35 %; P < 0,001). Aucun patient n’a subi de désaturation en oxygène pendant l’échange de sonde ou l’extubation. L’incidence et la gravité de l’enrouement et des maux de gorge étaient semblables dans tous les groupes. Conclusion Les épisodes de toux lors de l’extubation suivant une chirurgie thoracique peuvent être réduits si on remplace la SDL par un ML-P avant le réveil. Le nombre de patients dans cette étude était trop restreint pour évaluer les risques associés au changement de dispositif pour les voies aériennes. Cette étude est enregistrée au ClinicalTrials.gov : NCT00925613.

  • replacing a double Lumen Tube with a Single Lumen Tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery a randomized controlled Single blind trial
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2015
    Co-Authors: Issam Tanoubi, Pierre Drolet, Louis-philippe Fortier, François Donati
    Abstract:

    Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-Lumen Tube (DLT). In this study, the DLT was replaced with either a Single-Lumen endotracheal Tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups.

Yoram Kluger - One of the best experts on this subject based on the ideXlab platform.

  • The use of VivaSight™ Single Lumen endotracheal Tube in morbidly obese patients undergoing laparoscopic sleeve gastrectomy
    BMC Anesthesiology, 2014
    Co-Authors: Michal Barak, Ahmad Assalia, Ahmad Mahajna, Bishara Bishara, Alexander Braginski, Yoram Kluger
    Abstract:

    Background The population of obese patients is progressively growing and bariatric operations are becoming increasingly common. Morbidly obese patients require special anesthetic care and are often considered to be difficult to ventilate and intubate. The VivaSight™ Single Lumen Tube is an endotracheal Tube with a camera embedded in its tip. The view from the tip appears continuously on a monitor in the anesthesiologist's vicinity. The aim of this study was to assess the VivaSight™ in comparison with conventional endotracheal Tube as an aid in the intubation and surveillance of Tube position during surgery of obese patients. Methods This is a prospective study of 72 adult obese patients who underwent laparoscopic sleeve gastrectomy. The patients were randomly assigned to be intubated by either the VivaSight™ (40 patients, test group) or a conventional endotracheal Tube (32 patients, control group). Data on the patients, the pre-operative airway evaluation, the endotracheal intubation and the post-operative outcome were collected and compared. Results The Mallampati scores were significantly higher in the test group than in the control group. Endotracheal intubation took 29 ± 10 and 24 ± 8 seconds using the VivaSight™ and a conventional Tube respectively (p = 0.02). Three of the patients in the control group, while none of those in the test group, had soft tissue injury (p 

  • the use of vivasight Single Lumen endotracheal Tube in morbidly obese patients undergoing laparoscopic sleeve gastrectomy
    BMC Anesthesiology, 2014
    Co-Authors: Michal Barak, Ahmad Assalia, Ahmad Mahajna, Bishara Bishara, Alexander Braginski, Yoram Kluger
    Abstract:

    Background: The population of obese patients is progressively growing and bariatric operations are becoming increasingly common. Morbidly obese patients require special anesthetic care and are often considered to be difficult to ventilate and intubate. The VivaSight™ Single Lumen Tube is an endotracheal Tube with a camera embedded in its tip. The view from the tip appears continuously on a monitor in the anesthesiologist's vicinity. The aim of this study was to assess the VivaSight™ in comparison with conventional endotracheal Tube as an aid in the intubation and surveillance of Tube position during surgery of obese patients. Methods: This is a prospective study of 72 adult obese patients who underwent laparoscopic sleeve gastrectomy. The patients were randomly assigned to be intubated by either the VivaSight™ (40 patients, test group) or a conventional endotracheal Tube (32 patients, control group). Data on the patients, the pre-operative airway evaluation, the endotracheal intubation and the post-operative outcome were collected and compared. Results: The Mallampati scores were significantly higher in the test group than in the control group. Endotracheal intubation took 29 ± 10 and 24 ± 8 seconds using the VivaSight™ and a conventional Tube respectively (p = 0.02). Three of the patients in the control group, while none of those in the test group, had soft tissue injury (p < 0.05). Conclusion: We found the VivaSight™ SL to be helpful in the endotracheal intubation and continuous surveillance of Tube position in morbidly obese patients undergoing laparoscopic sleeve gastrectomy.

Javier H Campos - One of the best experts on this subject based on the ideXlab platform.

  • is there a better right sided Tube for one lung ventilation a comparison of the right sided double Lumen Tube with the Single Lumen Tube with right sided enclosed bronchial blocker
    Anesthesia & Analgesia, 1998
    Co-Authors: Javier H Campos, Christopher F Massa
    Abstract:

    Anatomic variation between tracheal carina and the takeoff of the right upper bronchus often makes the use of a right-sided double-Lumen Tube (R-DLT) or a Single-Lumen Tube with right-sided enclosed bronchial blocker Tube (R-UBB) (Univent[registered sign]) undesirable. This study compared the R-DLT with the R-UBB to determine whether there was any advantage of one over the other during anesthesia with one-lung ventilation (OLV) for right-sided thoracic surgeries. Forty patients requiring right lung deflation were randomly assigned to one of two groups. Twenty patients received a right-sided BronchoCath[registered sign] double-Lumen Tube, and 20 received a Univent[registered sign] Tube with a bronchial blocker placed in the right mainstem bronchus. The following were studied: 1) time required to position each Tube until satisfactory placement was achieved; 2) number of times that fiberoptic bronchoscopy was required (including one with the patient supine and one in lateral decubitus position); 3) number of malpositions after initial confirmation of Tube placement; 4) time required until lung collapse; 5) surgical exposure; and 6) cost of Tubes per case. No differences were found with any of these variables except that the cost of acquisition overall was greater for the R-UBB than for the R-DLT. No right upper lobe collapse was observed in the postoperative period in the chest radiograph in any of the patients studied. We conclude that either Tube can be used safely and effectively for right-sided thoracic surgeries that require anesthesia for OLV. Implications: In this study, right-sided double-Lumen Tubes were compared with the Univent[registered sign] with right-sided bronchial blockers. The results indicate that either Tube can be used for right-sided thoracic surgery. (Anesth Analg 1998;86:696-700)

  • comparison of a modified double Lumen endotracheal Tube with a Single Lumen Tube with enclosed bronchial blocker
    Anesthesia & Analgesia, 1996
    Co-Authors: Javier H Campos, Daniel K Reasoner, John R Moyers
    Abstract:

    This study compared the modified BronchoCath[R] double-Lumen endotracheal Tube with the Univent[R] bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath[R] double-Lumen Tube (DLT), and 20 received a Univent[R] Tube with a bronchial blocker. The following were studied: 1) time required to position each Tube until satisfactory, placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of Tube used; and 6) cost of Tubes per case. No differences were found in: 1) time required to position each Tube (DLT 6.2 +/- 3.1 versus Univent[R] 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent[R] median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent[R] 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT [5] compared to the Univent[R] [15] (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent[R] group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent[R], once position was corrected adequate surgical exposure was provided. In the Univent[R] group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/efficacy justification for routine use of this device. (Anesth Analg 1996;83:1268-72)

Issam Tanoubi - One of the best experts on this subject based on the ideXlab platform.

  • Replacing a double-Lumen Tube with a Single-Lumen Tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled Single-blind trial
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2015
    Co-Authors: Issam Tanoubi, Pierre Drolet, Louis-philippe Fortier, François Donati
    Abstract:

    Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-Lumen Tube (DLT). In this study, the DLT was replaced with either a Single-Lumen endotracheal Tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Methods Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal™ (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed and replaced by an ETT (ETT Group), or (3) left in place (DLT Group). The primary outcome was the number of coughing episodes at extubation. Results Among 184 patients screened, 124 did not meet inclusion criteria, and two patients, both in the ETT Group, were excluded after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT, and DLT Groups, respectively. There were fewer coughing episodes (median [quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2[1-3], respectively; P = 0.01). In the DLT Group, 90% of patients coughed at least once. This incidence was not significantly different in the ETT Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group (35%; P < 0.001). No patient had oxygen desaturation during airway exchange or at extubation. The incidence and severity of hoarseness and sore throat were similar in all groups. Conclusion Coughing at extubation after thoracic surgery can be reduced if the DLT is replaced by an LMA-P before emergence. The number of patients in this trial was too small to evaluate the risks associated with exchanging the airway device. This trial was registered at ClinicalTrials.gov: NCT00925613. Contexte Les épisodes de toux surviennent fréquemment lors de l’extubation après une chirurgie thoracique, et ils pourraient être provoqués en partie par la sonde double lumière (SDL). Dans cette étude, nous avons remplacé la SDL par une sonde endotrachéale (SET) simple lumière, par un masque laryngé (ML) ou l’avons laissée en place, et nous avons comparé l’incidence de toux au réveil dans les trois groupes. Méthode Cinquante-huit adultes devant subir une chirurgie thoracique avec une SDL ont été recrutés pour cette étude. Les critères d’exclusion étaient des voies aériennes anticipées comme difficiles, l’obésité et toute contre-indication à l’utilisation d’un masque laryngé ProSeal™ (ML-P). Après la chirurgie mais avant le réveil, les patients ont été aléatoirement attribués à l’un des trois groupes suivants : (1) retrait de la SDL et remplacement par un ML-P (groupe ML-P), (2) retrait et remplacement de la SDL par une SET (groupe SET), ou (3) SDL laissée en place (groupe SDL). Le critère d’évaluation principal était le nombre d’épisodes de toux lors de l’extubation. Résultats Parmi les 184 patients évalués, 124 ne répondaient pas aux critères d’inclusion, et deux patients du groupe SET ont été exclus après la randomisation, laissant 20, 18 et 20 patients dans les groupes ML-P, SET et SDL, respectivement. Il y a eu moins d’épisodes de toux (médianes [quartiles]) dans le groupe ML-P que dans le groupe SDL (0 [0-1] vs 2 [1-3], respectivement; P = 0,01). Dans le groupe SDL, 90 % des patients ont toussé au moins une fois. Cette incidence n’était pas significativement différente dans le groupe SET (83 %; P = 0,222), mais elle était significativement réduite dans le groupe ML-P (35 %; P < 0,001). Aucun patient n’a subi de désaturation en oxygène pendant l’échange de sonde ou l’extubation. L’incidence et la gravité de l’enrouement et des maux de gorge étaient semblables dans tous les groupes. Conclusion Les épisodes de toux lors de l’extubation suivant une chirurgie thoracique peuvent être réduits si on remplace la SDL par un ML-P avant le réveil. Le nombre de patients dans cette étude était trop restreint pour évaluer les risques associés au changement de dispositif pour les voies aériennes. Cette étude est enregistrée au ClinicalTrials.gov : NCT00925613.

  • replacing a double Lumen Tube with a Single Lumen Tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery a randomized controlled Single blind trial
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2015
    Co-Authors: Issam Tanoubi, Pierre Drolet, Louis-philippe Fortier, François Donati
    Abstract:

    Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-Lumen Tube (DLT). In this study, the DLT was replaced with either a Single-Lumen endotracheal Tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups.

  • replacing a double Lumen Tube with a Single Lumen Tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery a randomized controlled Single blind trial remplacement de la sonde double lumiere par une sonde aune seul
    2015
    Co-Authors: Issam Tanoubi, Pierre Drolet, Louis-philippe Fortier
    Abstract:

    Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-Lumen Tube (DLT). In this study, the DLT was replaced with either a Single-Lumen endotracheal Tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Methods Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to