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Lin CH, Tseng KY, Su MP, Chuang WM, Hu PY, Cheng KI. Cuff inflation technique is better than Magill forceps technique to facilitate nasotracheal intubation guiding by GlideScope® video laryngoscope. Kaohsiung J Med Sci 2022; 38:796-803. [PMID: 35652136 DOI: 10.1002/kjm2.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022] Open
Abstract
Video laryngoscopy is often selected to assist nasotracheal intubation in allowing better laryngeal visualization, although there is no comparative study evaluating the effectiveness between auxiliary techniques by using Magill forceps and inflated cuff in GlideScope video laryngoscopy for nasotracheal intubation. Fifty-one of 100 patients in a Magill forceps group and 47 of 100 patients in a cuff inflation group were included in the final analysis in this randomized, single-blind, parallel, clinical trial study. Induction agents were routinely administered according to body weight, while intubation time spent, attempts, and related side effects were recorded. Compared to the Magill forceps group, the cuff inflation technique shortened the total intubation time (70.0 ± 24.5 s vs. 87.0 ± 25.0 s, p = 0.001) and the time of advancing the nasotracheal tube from oropharyngeal space into the trachea (25.9 ± 16.4 s vs. 42.3 ± 21.2 s, p < 0.001). However, the number of intubation attempts was not significantly different between groups. During tube advancement, the tube was rotated to accommodate the glottis and trachea more frequently in the cuff inflation group (p = 0.009), but the blade of the laryngoscope shifted and was adjusted to the proper position more frequently in the Magill forceps group (p < 0.001). In the Magill forceps group, the tube cuff might be clipped incidentally and the intubator might shift their gaze away from the screen during intubation, although there was no significant difference in intubation-related side effects between groups. Unlike the conventional approach, nasotracheal intubation with the GlideScope® video laryngoscope using the auxiliary technique of cuff inflation could be more suited than using Magill forceps.
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Affiliation(s)
- Chia-Heng Lin
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-Yi Tseng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Miao-Pei Su
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Ming Chuang
- Department of Anesthesiology, Qishan Hospital of the Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Ping-Yang Hu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kuo YM, Lai HY, Tan ECH, Li YS, Chiang TY, Huang SS, Huang WC, Chu YC. Cervical spine immobilization does not interfere with nasotracheal intubation performed using GlideScope videolaryngoscopy: a randomized equivalence trial. Sci Rep 2022; 12:4041. [PMID: 35260735 PMCID: PMC8904815 DOI: 10.1038/s41598-022-08035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/01/2022] [Indexed: 11/09/2022] Open
Abstract
GlideScope-assisted nasotracheal intubation (NTI) has been proposed as an alternative to difficult orotracheal intubation for critical patients or those under cervical immobilization. We evaluated the difficulty of performing NTI using GlideScope under cervical orthosis. A total of 170 patients scheduled for elective cervical spinal surgery that required NTI were randomized to receive cervical immobilization using a cervical collar (collar group) or no cervical immobilization at all (control group) before anesthetic induction (group assignment at 1:1 ratio). All NTI during anesthetic induction were performed using the GlideScope. The primary outcome was time to intubation. The secondary outcomes were ease of intubation, including the necessity of auxiliary manipulations to assist intubation, and the nasotracheal intubation difficulty scale (nasoIDS). An exploratory analysis identified morphometric parameters as predictors of time to intubation, the necessity of auxiliary manipulations, and a nasoIDS score ≥ 4. For time to intubation, the mean difference (collar group-control) was - 4.19 s, with a 95% confidence interval (CI) of - 13.9 to 5.52 that lay within our defined equivalence margin of 16 s. Multivariate regressions precluded the association of cervical immobilization with a necessity for auxiliary manipulations (adjusted odds ratio [aOR] 0.53, 95% CI [0.26-1.09], P = 0.083) and a nasoIDS ≥ 4 (aOR 0.94 [0.84-1.05], P = 0.280). Among all morphometric parameters, the upper lip bite test class was predictive of a longer time to intubation (all analyses relative to class 1, 14 s longer for class 2, P = 0.032; 24 s longer for class 3, P = 0.070), increased necessity for auxiliary manipulation (aOR 2.29 [1.06-4.94], P = 0.036 for class 2; aOR 6.12 [1.04-39.94], P = 0.045 for class 3), and nasoIDS ≥ 4 (aOR 1.46 [1.14-1.89], P = 0.003 for class 3).The present study demonstrated that GlideScope achieved NTI in patients with or without cervical immobilization equivalently with respect to intubation time and ease.
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Affiliation(s)
- Yi-Min Kuo
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Hsien-Yung Lai
- Department of Anesthesiology, Mennonite Christian Hospital, Hualien, 970, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, 11217, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Yi-Shiuan Li
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Ting-Yun Chiang
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, 40201, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, 40201, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, 11217, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Beitou Dist., Taipei, 11217, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
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Gupta A, Gupta N. Airway management of patients undergoing oral cancer surgery: It is time to replace conventional Macintosh with videolaryngoscopes. J Anaesthesiol Clin Pharmacol 2022; 38:494-495. [PMID: 36505183 PMCID: PMC9728455 DOI: 10.4103/joacp.joacp_298_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/18/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anju Gupta
- Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Onco-Anesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, Delhi, India,Address for correspondence: Dr. Nishkarsh Gupta, Room No. 139, First Floor, DRBRAIRCH, AIIMS, Delhi - 110 029, India. E-mail:
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Syal R, Kumar R, Chhabra S, Kamal M. Cuff inflation technique: A saviour in the double lumen tube placement. J Clin Anesth 2021; 74:110364. [PMID: 34147930 DOI: 10.1016/j.jclinane.2021.110364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Rashmi Syal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Rakesh Kumar
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Swati Chhabra
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, India.
| | - Manoj Kamal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, India.
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Kumar A, Gupta N, Kumar V, Bhargava T. Total control introducer-aided nasotracheal intubation using a videolaryngoscope in an anticipated difficult airway: a novel technique. BMJ Case Rep 2020; 13:13/12/e236118. [PMID: 33318264 PMCID: PMC7737032 DOI: 10.1136/bcr-2020-236118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Nasotracheal intubation can be challenging due to undesirable incidence of nasal bleeding and soft tissue injuries. The bleeding can obscure glottis visualisation, increase the total intubation time, the risk of aspiration and oxygen desaturation. Total control introducer is a new airway adjunct with a flexible shaft, articulating tip and an intuitive depth control system, which can be used in difficult airway scenarios to improve the success of nasal intubations.
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Affiliation(s)
- Abhishek Kumar
- Onco-Anaesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nishkarsh Gupta
- Onco-Anaesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vinod Kumar
- Onco-Anaesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Tanvi Bhargava
- Anaesthesiology, Dr RML Hospital and PGIMER, New Delhi, Delhi, India
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