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Markus Weiss - One of the best experts on this subject based on the ideXlab platform.
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Techniques and Procedures Massive Aspiration Past the Tracheal Tube Cuff Caused by Closed Tracheal Suction System
2016Co-Authors: Mital H. Dave, Angela Frotzler, Caveh Madjdpour, Nelly Koepfer, Markus WeissAbstract:Background: Aspiration past the Tracheal Tube cuff has been recognized to be a risk factor for the development of ventilator-associated pneumonia (VAP). This study investigated the effect of closed Tracheal suctioning on aspiration of fluid past the Tracheal Tube cuff in an in vitro benchtop model.Methods: High-volume low pressure Tube cuffs of 7.5 mm internal diameter (ID) were placed in a 22 mm ID artificial trachea connected to a test lung. Positive pressure ventilation (PPV) with 15 cm H2O peak inspiratory pressure and 5 cm H2O positive end-expiratory pressure (PEEP) was used. A closed Tracheal suction system (CTSS) catheter (size 14Fr) was attached to the Tracheal Tube and suction was performed for 5, 10, 15, or 20 seconds under 200 or 300 cm H2O suction pressures. Amount of fluid (mL) aspirated along the Tube cuff and the airway pressure changes were recorded for each suction procedure. Fluid aspiration during different suction conditions was com-pared using Kruskal-Wallis and Mann-Whitney test (Bonferroni correction [a .01]). Results:During 10, 15, and 20 seconds suction, airway pressure consistently dropped down to 8 to 13 cm H2O (P <.001) from the preset level. Fluid aspiration was never observed under PPV þ PEEP but occurred always during suctioning. Aspiration along the Tube cuff was higher with 300 cm H2O than with200 cm H2O suction pressure (P <.001) and was much more during 15 and 20 seconds suction time as compared to 5seconds (P <.001). Conclusion: Massive aspiration of fluid occurs along the Tracheal Tube cuff during suction with the closed Tracheal suction system
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Tracheal Tube tip displacement in children during head neck movement a radiological assessment
BJA: British Journal of Anaesthesia, 2006Co-Authors: Markus Weiss, Walter Knirsch, Oliver Kretschmar, Alexander Dullenkopf, Maren Tomaske, Christian Balmer, K Stutz, A C Gerber, Felix BergerAbstract:Background Aims of this study were to assess the maximum displacement of Tracheal Tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the Microcuff Paediatric EndoTracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation. Methods We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients' tracheas were orally intubated and the Tracheal Tubes positioned with the intubation depth mark at the level of the vocal cords. The Tracheal Tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30° flexion, 0° neutral position and 30° extension. Results One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum Tracheal Tube-tip displacement after head-neck 30° extension and 30° flexion demonstrated a linear relationship to age [maximal upward Tube movement (mm)=0 0.71×age (yr)+9.9 (R2=0.893); maximal downward Tube movement (mm)=0.83×age (yr)+9.3 (R2=0.949)]. Maximal Tracheal Tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension. Conclusions The intubation depth marks were appropriate to avoid inadvertent Tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the Tracheal Tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer time.
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outer diameter and shape of paediatric Tracheal Tube cuffs at higher inflation pressures
Anaesthesia, 2005Co-Authors: Vera Bernet, Alexander Dullenkopf, P Maino, Markus WeissAbstract:Cuffed Tracheal Tubes are becoming increasingly popular in paediatric anaesthesia and intensive care medicine. To avoid cuff related complications and airway morbidity, a thorough understanding of cuff volume/pressure behaviour and management is required. In this study, the outer cuff diameter and form stability of the cuff at high cuff pressure were assessed in a series of different paediatric cuffed Tracheal Tubes with internal diameter of between 3.0 and 5.0 mm. The main findings were that small amounts of inflated air led to a rapid increase in cuff pressure and volume and that the outer cuff diameters increased to 2-2.5 times the age-corresponding internal Tracheal diameter following inadvertent syringe inflation. Careful cuff inflation under cuff pressure monitoring and/or automatic cuff pressure release is recommended in paediatric Tracheal Tube cuffs to prevent airway damage caused by manual inflation, pilot balloon compression and nitrous oxide diffusion.
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fit and seal characteristics of a new paediatric Tracheal Tube with high volume low pressure polyurethane cuff
Acta Anaesthesiologica Scandinavica, 2005Co-Authors: Alexander Dullenkopf, A C Gerber, Markus WeissAbstract:BACKGROUND To evaluate a new paediatric Tracheal Tube (Microcuff, Weinheim, Germany) with an ultrathin high volume-low pressure polyurethane cuff. METHODS With approval of the Hospital Ethics Committee tracheas of children undergoing general anaesthesia were intubated using a Microcuff Tube. Tube sizes were selected according to: internal diameter (mm) = age/4 + 3.5 in children aged > or = 2 years. In newborns (> or = 3 kg) < or = 1 year, ID 3.0-mm Tubes, and in children from 1 to 2 years, internal diameter 3.5-mm Tubes were used. Tubes were classified too large if no air leakage was obtained at an airway pressure of 20 cm H2O with the cuff not inflated. Sealing pressure was assessed by auscultation. Post-extubation croup requiring therapy was noted. RESULTS Five-hundred children were studied. In eight children the Tubes were too large. Sealing pressure was 9.7 +/- 2.5 cm H2O (4-20). In two patients postextubation croup required singular short-term therapy. CONCLUSIONS Microcuff paediatric Tracheal Tubes provided Tracheal sealing with cuff pressures considerably lower than usually accepted. The rate of Tube exchange was very low (1.6%), as was the rate of airway morbidity (croup requiring therapy; 0.4%).
M T Popat - One of the best experts on this subject based on the ideXlab platform.
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NasoTracheal fibreoptic intubation: A randomised controlled trial comparing the GlideRite® (Parker-Flex® Tip) nasal Tracheal Tube with a standard pre-rotated nasal RAE™ Tracheal Tube
Anaesthesia, 2011Co-Authors: S. L. Lomax, K. D. Johnston, S. Kathawaroo, S. M. Yentis, A. G. Marfin, M T PopatAbstract:In a randomised controlled study, we compared the ease of railroading a GlideRite® nasal Tracheal Tube over a fibrescope with that of a pre-rotated RAE™ nasal Tracheal Tube. We studied 110 anaesthetised patients with no known airway difficulties undergoing elective dental or maxillofacial surgery. Impingement was more common with the GlideRite Tubes (11/55 (20%)) compared with the pre-rotated RAE Tubes (3/55 (5%); p=0.02). The median (IQR [range]) time to intubation (GlideRite 7.6 (4.7-10.8 [3.0-46.2]) s; RAE 8.0 (6.2-10.7 [2.4-30.0]) s) and postoperative sore throat numerical ratings (GlideRite 2 (0-3 [0-10]); RAE 2 (0-5 [0-8])) were similar. A 90° anticlockwise pre-rotation of a standard nasal RAE Tube has a higher initial rate of successful railroading at first attempt and is therefore superior to a GlideRite nasoTracheal Tube during nasal fibreoptic intubation.
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a comparison of a flexometallic Tracheal Tube with the intubating laryngeal mask Tracheal Tube for nasoTracheal fibreoptic intubation using the two scope technique
Anaesthesia, 2009Co-Authors: S. Scott, M T Popat, A. G. Marfin, J J PanditAbstract:Summary We compared the incidence and site of impingement of a flexometallic Tracheal Tube with those of the re-usable intubating laryngeal mask (ILMA) Tube in 60 anaesthetised patients undergoing nasoTracheal fibreoptic intubation for oral surgery. A two-scope technique was used, observing the site of impingement with one scope whilst intubating with the other. The Tubes were 6.0-mm in females and 6.5-mm in males. Impingement occurred with 10 (33%) flexometallic and 2 (7%) ILMA Tubes (p < 0.032). In all but one case, the impingement was posterior to the right arytenoid cartilage. When impingement was observed, a single disempaction with a 90° anticlockwise rotational manoeuvre overcame impingement in every case except one, allowing successful intubation. We conclude that the incidence of impingement of the Tracheal Tube, and therefore of potential laryngeal trauma from nasoTracheal fibreoptic intubation, is significantly greater with the flexometallic Tube than with the ILMA Tube.
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A comparison of a flexometallic Tracheal Tube with the intubating laryngeal mask Tracheal Tube for nasoTracheal fibreoptic intubation using the two-scope technique.
'Wiley', 2009Co-Authors: Rai Mr, M T Popat, A. G. Marfin, S. Scott, J J PanditAbstract:We compared the incidence and site of impingement of a flexometallic Tracheal Tube with those of the re-usable intubating laryngeal mask (ILMA) Tube in 60 anaesthetised patients undergoing nasoTracheal fibreoptic intubation for oral surgery. A two-scope technique was used, observing the site of impingement with one scope whilst intubating with the other. The Tubes were 6.0-mm in females and 6.5-mm in males. Impingement occurred with 10 (33%) flexometallic and 2 (7%) ILMA Tubes (p < 0.032). In all but one case, the impingement was posterior to the right arytenoid cartilage. When impingement was observed, a single disempaction with a 90 degrees anticlockwise rotational manoeuvre overcame impingement in every case except one, allowing successful intubation. We conclude that the incidence of impingement of the Tracheal Tube, and therefore of potential laryngeal trauma from nasoTracheal fibreoptic intubation, is significantly greater with the flexometallic Tube than with the ILMA Tube
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comparison of times to achieve Tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway
Anaesthesia, 2002Co-Authors: J J Pandit, K Maclachlan, R M Dravid, M T PopatAbstract:Summary We compared the times to intubate the trachea using three techniques in 60 healthy patients with normal airways: (i) fibreoptic intubation with a 6.0-mm reinforced Tracheal Tube through a standard laryngeal mask airway (laryngeal mask−fibreoptic group); (ii) fibreoptic intubation with a dedicated 7.0-mm silicone Tracheal Tube through the intubating laryngeal mask airway (intubating laryngeal mask−fibreoptic group); (iii) blind intubation with the dedicated 7.0-mm silicone Tracheal Tube through the intubating laryngeal mask airway (intubating laryngeal mask−blind group). Mean (SD) total intubation times were significantly shorter in the intubating laryngeal mask−blind group (49 (20) s) than in either of the other two groups (intubating laryngeal mask−fibreoptic 74 (21) s; laryngeal mask−fibreoptic group 75 (36) s; p < 0.001). However, intubation at the first attempt was less successful with the intubating laryngeal mask−blind technique (15/20 (75%)) than in the other two groups (intubating laryngeal mask−fibreoptic 19/20 (95%) and laryngeal mask−fibreoptic 16/20 (80%)) although these differences were not statistically significant. We conclude that in this patient group, all three techniques yield acceptable results. If there is a choice of techniques available, the intubating laryngeal mask−blind technique would result in the shortest intubation time.
Ying Cao - One of the best experts on this subject based on the ideXlab platform.
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laryngoscope and a new Tracheal Tube assist lightwand intubation in difficult airways due to unstable cervical spine
PLOS ONE, 2015Co-Authors: Jianqi Wei, Qingyun Cen, Qingxiang Cai, Huafeng Wei, Ying CaoAbstract:Purpose The WEI Jet EndoTracheal Tube (WEI JET) is a new Tracheal Tube that facilitates both oxygenation and ventilation during the process of intubation and assists Tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult Tracheal intubation due to unstable cervical spine.
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laryngoscope and a new Tracheal Tube assist lightwand intubation in difficult airways due to unstable cervical spine
PLOS ONE, 2015Co-Authors: Jianqi Wei, Qingyun Cen, Qingxiang Cai, Huafeng Wei, Ying CaoAbstract:Purpose The WEI Jet EndoTracheal Tube (WEI JET) is a new Tracheal Tube that facilitates both oxygenation and ventilation during the process of intubation and assists Tracheal intubation in patients with difficult airway. We evaluated the effectiveness and usefulness of the WEI JET in combination with lightwand under direct laryngoscopy in difficult Tracheal intubation due to unstable cervical spine. Methods Ninety patients with unstable cervical spine disorders (ASA I-III) with general anaesthesia were included and randomly assigned to three groups, based on the device used for intubation: lightwand only, lightwand under direct laryngoscopy, lightwand with WEI JET under direct laryngoscopy. Results No statistically significant differences were detected among three groups with respect to demographic characteristics and C/L grade. There were statistically significant differences between three groups for overall intubation success rate (p = 0.015) and first attempt success rate (p = 0.000). The intubation time was significantly longer in the WEI group (110.8±18.3 s) than in the LW group (63.3±27.5 s, p = 0.000) and DL group (66.7±29.4 s, p = 0.000), but the lowest SpO2 in WEI group was significantly higher than other two groups (p<0.01). The WEI JET significantly reduced successful Tracheal intubation attempts compared to the LW group (p = 0.043). The severity of sore throat was similar in three groups (p = 0.185). Conclusions The combined use of WEI JET under direct laryngoscopy helps to assist Tracheal intubation and improves oxygenation during intubation in patients with difficult airway secondary to unstable spine disorders. Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-14005141
J Brimacombe - One of the best experts on this subject based on the ideXlab platform.
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postoperative nausea vomiting airway morbidity and analgesic requirements are lower for the proseal laryngeal mask airway than the Tracheal Tube in females undergoing breast and gynaecological surgery
BJA: British Journal of Anaesthesia, 2007Co-Authors: Matthias Hohlrieder, J Brimacombe, A Von Goedecke, C KellerAbstract:Background: We test the hypothesis that the frequency of postoperative nausea and vomiting is similar for the ProSeal laryngeal mask airway (LMA) and the Tracheal Tube. Methods: Two hundred consecutive female patients (ASA I–II, 18–75 yr) undergoing routine breast and gynaecological surgery were divided into two equal-sized groups for airway management with the ProSeal LMA or Tracheal Tube. Results: Ventilation was better and airway trauma less frequent for the ProSeal LMA. For the ProSeal group, the time spent in the post-anaesthesia care unit was shorter (69 vs 88 min, P < 0.0001); fewer doses of tropisetron were required in the post-anaesthesia care unit (P ≤ 0.001) and ward (P = 0.004); morphine requirements were lower in the post-anaesthesia care unit (6.0 vs 8.1 mg, P = 0.005) and ward (6.1 vs 8.9, P = 0.004); nausea was less frequent at all times (overall: 13% vs 53%, P < 0.0001); vomiting was less frequent at 2 h (4% vs 18%, P = 0.003) and 24 h (5% vs 19%, P = 0.004); and sore throat was less frequent at all times (overall: 12% vs 38%, P < 0.0001). Conclusions: The ProSeal LMA reduced the absolute risk of postoperative nausea and vomiting by 40% (53–13%). In patients without the need for morphine, the ProSeal LMA reduced the absolute risk of postoperative nausea and vomiting by 23% (37–14%). We conclude that the frequency of postoperative nausea, vomiting, airway morbidity, and analgesic requirements is lower for the ProSeal LMA than the Tracheal Tube in females undergoing breast and gynaecological surgery.
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a study of airway management using the proseal lma laryngeal mask airway compared with the Tracheal Tube on postoperative analgesia requirements following gynaecological laparoscopic surgery
Anaesthesia, 2007Co-Authors: Matthias Hohlrieder, J Brimacombe, Stephan Eschertzhuber, Hanno Ulmer, Christian KellerAbstract:In a randomised double blind prospective study, we tested the hypothesis that postoperative pain is lower in patients who receive an ProSeal LMA™ laryngeal mask airway compared with a Tracheal Tube. One hundred consecutive female patients (ASA I–II, 18–75 years) undergoing laparoscopic gynaecological surgery were divided into two equal-sized groups for airway management with the ProSeal LMA or Tracheal Tube. Anaesthesia management was identical for both groups and included induction of anaesthesia using propofol/fentanyl, and maintenance with propofol/remifentanil, muscle relaxation with rocuronium, positive pressure ventilation, gastric Tube insertion, dexamethasone/tropisetron for anti-emetic prophylaxis, and diclofenac for pain prophylaxis. All types of postoperative pain were treated using intravenous patient-controlled analgesia (PCA) morphine. Patients and postoperative staff were unaware of the airway device used. Data were collected by a single blinded observer. We found that pain scores were lower for the ProSeal LMA at 2 h and 6 h but not at 24 h. Morphine requirements were lower for the ProSeal LMA by 30.4%, 30.6% and 23.3% at 2, 6 and 24 h, respectively. Nausea was less common with the ProSeal LMA than with the Tracheal Tube at 2 h and 6 h but not at 24 h. There were no differences in the frequency of vomiting, sore throat, dysphonia or dysphagia. We conclude that postoperative pain is lower for the ProSeal LMA than the Tracheal Tube in females undergoing gynaecological laparoscopic surgery.
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a silicone based wire reinforced Tracheal Tube with a hemispherical bevel reduces nasal morbidity for nasoTracheal intubation
Anesthesia & Analgesia, 2003Co-Authors: Shinichi Kihara, J Brimacombe, Tetsuya Komatsuzaki, Yuichi Yaguchi, Noriko Taguchi, Seiji WatanabeAbstract:We tested the hypothesis that a silicone-based wire-reinforced Tracheal Tube with a hemispherical bevel is superior to a polyvinyl chloride (PVC)-based precurved Tube with a conventional diagonal bevel for nasoTracheal intubation. Eighty anesthetized paralyzed adults (ASA physical status I–II) requiring nasoTracheal intubation for tonsillectomy were randomly allocated into two equal-sized groups for airway management with the silicone Tracheal Tube or PVC Tracheal Tube. Intubation was subdivided into three phases: 1) passage through the nose into the pharynx, 2) laryngoscope-guided passage into the glottic inlet, and 3) laryngoscope-guided passage into the trachea. A specific sequence of airway maneuvers was followed at each stage if it was unsuccessful. The number of attempts and intubation time were documented by an unblinded observer. The frequency of epistaxis and postoperative nasal complications was documented by blinded observers. There were no intubation failures. The number of attempts at pharyngeal (47 versus 56; P = 0.04) and Tracheal (43 versus 55; P = 0.005) placement was smaller for the silicone Tracheal Tube, but the number of attempts at glottic placement was more (72 versus 49; P < 0.0001). Intubation time was similar. The frequency (32% versus 80%; P < 0.0001) and severity of epistaxis were less for the silicone Tracheal Tube. The total number of postoperative nasal symptoms was smaller for the silicone Tracheal Tube (10 versus 21; P < 0.05). We conclude that the pharyngeal and Tracheal placement phases of nasoTracheal intubation require fewer attempts with the silicone Tracheal Tube than the PVC Tracheal Tube but that the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone Tracheal Tube. IMPLICATIONS: The pharyngeal and Tracheal placement phases of nasoTracheal intubation require fewer attempts with a silicone-based wire-reinforced Tracheal Tube with a hemispherical bevel than with a polyvinyl chloride-based precurved Tracheal Tube with a conventional diagonal bevel, but the glottic placement phase requires more attempts. Nasal morbidity is less common with the silicone Tracheal Tube.
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retrograde nasoTracheal intubation with a new Tracheal Tube a feasibility study
BJA: British Journal of Anaesthesia, 2000Co-Authors: Felice Eugenio Agro, J Brimacombe, D J Doyle, L Marchionni, Rita CataldoAbstract:We have assessed the feasibility of retrograde nasoTracheal intubation using a flexometallic Tracheal Tube with a detachable pilot balloon and connector in a study of 20 consecutive adult patients undergoing oropharyngeal surgery. The technique consisted of: (1) laryngoscope-guided oroTracheal intubation; (2) insertion of an 18-gauge Foley catheter through the nose and retraction into the mouth; (3) detachment of the anaesthesia circuit, pilot balloon and connector; (4) insertion of the Foley catheter tip into the proximal end of the Tracheal Tube and inflation of the Foley catheter cuff; (5) withdrawal of the Foley catheter and attached Tracheal Tube back through the nose; (6) deflation of the Foley catheter cuff; and (7) re-attachment of the pilot balloon, connector and anaesthesia circuit. The technique was successful at the first attempt in all patients. Mean time taken to insert the Foley catheter and retract it into the mouth was 19 (range 12-30) s. Mean time taken from disconnection to reconnection of the anaesthesia circuit was 8 (6-10) s. Heart rate increased after intubation, but there were no significant changes in arterial pressure. Nasal bleeding, airway problems and hypoxic events did not occur. No anatomical abnormalities or nasal trauma were detected at rhinoscopy. We conclude that retrograde nasoTracheal intubation is feasible using a flexometallic Tracheal Tube with a detachable pilot balloon and connector.
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bronchial mucus transport velocity in paralyzed anesthetized patients a comparison of the laryngeal mask airway and cuffed Tracheal Tube
Anesthesia & Analgesia, 1998Co-Authors: C Keller, J BrimacombeAbstract:We compared bronchial mucus transport velocity (BTV), an index of mucociliary clearance, between the laryngeal mask airway (LMA) and the Tracheal Tube (TT). Forty patients were studied during propofol anesthesia and muscle relaxation with rocuronium. BTV was measured 10 and 60 min after insertion of the airway device by fiberoptic observation of the movement of methylene blue dye injected onto the dorsal surface of the left main bronchus. BTV for the LMA was similar at 10 and 60 min (13.9 ± 2.0 and 13.6 ± 2.1 mm/min, respectively). BTV for the TT was significantly faster at 10 min that at 60 min (13.0 ± 1.4 vs 6.9 ± 1.2 mm/min, respectively; P < 0.00001). BTV was similar for both devices at 10 min (TT 13.0 ± 1.4 mm/min versus LMA 13.9 ± 2.0 mm/min), but was significantly faster for the LMA than for the TT at 60 min (LMA 13.6 ± 2.1 mm/min versus TT 6.9 ± 1.2 mm/min; P < 0.00001). We conclude that the LMA impedes mucociliary clearance less than the TT in anesthetized patients. This may have implications for reducing the risk of retention of secretions, atelectasis, and pulmonary infection. Implications: This study compares bronchial mucus transport velocity, an index of mucociliary clearance, in anesthetized patients between two airway devices, the cuffed Tracheal Tube and the laryngeal mask airway. We have shown that the laryngeal mask airway impairs mucociliary clearance less than the Tracheal Tube. This may have implications for reducing the risk of retention of secretions, atelectasis, and pulmonary infection.
Shigehito Sato - One of the best experts on this subject based on the ideXlab platform.
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effects of using two airway exchange catheters on laryngeal passage during change from a double lumen Tracheal Tube to a single lumen Tracheal Tube
BJA: British Journal of Anaesthesia, 2007Co-Authors: Akira Suzuki, Masahiro Uraoka, K Kimura, Shigehito SatoAbstract:Background A thin airway exchange catheter (AEC) is often used for changing from a double-lumen Tracheal Tube (DLT) to a single-lumen Tracheal Tube. However, passage of the Tube into the trachea is often difficult. The purpose of this study was to evaluate the effectiveness of using two AECs for Tracheal Tube exchange. Methods In Study 1, 30 patients were randomly allocated to two groups and one AEC was inserted into the trachea in one group, and two AECs in the other group. A Tracheal Tube was advanced into the pharynx over the AEC(s). A blinded observer assessed the difficulty of passing the Tube into the trachea. In Study 2, another group of 30 patients (whose airways had been managed with DLTs) were randomly allocated to two groups, and either one or two AECs were inserted into the DLT depending upon the group allocation. The difficulty of passing the Tube into the trachea was assessed and the time required for exchange was measured. Results The use of two AECs reduced the incidence of impingement of the Tube into the trachea during the AEC-guided Tracheal intubation (Study 1) from 93 to 33% (P sd )] for one and two AECs, respectively. Conclusion The use of two AECs reduces the incidence of impingement of the Tube into the trachea during Tracheal Tube exchange.
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the effects of Tracheal Tube tip design and Tube thickness on laryngeal pass ability during oral Tube exchange with an introducer
Anesthesia & Analgesia, 2003Co-Authors: Hiroshi Makino, Takasumi Katoh, Syunji Kobayashi, Hiromichi Bito, Shigehito SatoAbstract:UNLABELLED: We compared the ease of passage through the glottis of two different Tubes and two different sizes of Tracheal Tube exchanger (TE) during introducer-guided Tracheal intubation. One Tube was a polyvinyl chloride Tube with a standard bevel, and the other was a newly designed Tube with a hemispherical bevel. The outer diameters (OD) of the two TEs were 2.5 and 5.0 mm. After the standard induction of anesthesia, followed by vecuronium-induced paralysis, a TE was inserted into the trachea with a direct laryngoscope. By using the introducer as a guide, the Tracheal Tube was inserted into the trachea. The difficulty in passing the Tube was assessed by a blinded observer and graded with a four-point scale. The newly designed Tube was inserted more smoothly than was the conventional Tube when the 2.5-mm-OD TE was used (P < 0.01). In situations such as those occurring after one-lung anesthesia, when use of a thicker TE is not applicable, this newly designed taper-tipped Tube may be considered as an adjunct to oral Tracheal Tube exchange, using a thinner (smaller-OD) TE as the guide for Tracheal intubation. IMPLICATIONS: In situations such as after one-lung anesthesia, when use of a thicker Tube exchanger (TE) is not applicable, a newly designed taper-tipped Tube with the leading edge in the midline may be considered as an adjunct to an oral Tracheal Tube exchange, using a thinner TE as the guide for Tracheal intubation.
