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Fritz CG, Monos SD, Romeo D, Lowery A, Xu K, Atkins J, Rajasekaran K. Medico-legal liability of injuries arising from laryngoscopy. J Laryngol Otol 2024; 138:554-558. [PMID: 37982243 PMCID: PMC11063656 DOI: 10.1017/s0022215123001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy. METHODS Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted. RESULTS Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest. CONCLUSION Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.
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Affiliation(s)
- Christian G Fritz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Stylianos D Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Anne Lowery
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Katherine Xu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Joshua Atkins
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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2
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van Zundert A. C-MAC Video Laryngoscopy Is Beneficial to Avoid Palatopharyngeal Trauma Due to the Use of Rigid Stylets. Air Med J 2024; 43:74-76. [PMID: 38490786 DOI: 10.1016/j.amj.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 03/17/2024]
Affiliation(s)
- André van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia
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3
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Feng IJ, Lin JW, Lai CC, Cheng KC, Chen CM, Chao CM, Wang YT, Chiang SR, Liao KM. Comparative efficacies of various corticosteroids for preventing postextubation stridor and reintubation: a systematic review and network meta-analysis. Front Med (Lausanne) 2023; 10:1135570. [PMID: 37554508 PMCID: PMC10406286 DOI: 10.3389/fmed.2023.1135570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
Objectives We assessed the efficacies of various corticosteroid treatments for preventing postexubation stridor and reintubation in mechanically ventilated adults with planned extubation. Methods We searched the Pubmed, Embase, the Cochrane databases and ClinicalTrial.gov registration for articles published through September 29, 2022. Only randomized controlled trials (RCTs) that compared the clinical efficacies of systemic corticosteroids and other therapeutics for preventing postextubation stridor and reintubation were included. The primary outcome was postextubation stridor and the secondary outcome was reintubation. Results The 11 assessed RCTs reported 4 nodes: methylprednisolone, dexamethasone, hydrocortisone, and placebo, which yielded 3 possible pairs for comparing the risks of post extubation stridor and 3 possible pairs for comparing the risks of reintubation. The risk of postextubation stridor was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients (dexamethasone: OR = 0.39; 95% CI = 0.22-0.70; methylprednisolone: OR = 0.22; 95% CI = 0.11-0.41). The risk of postextubation stridor was significantly lower in methylprednisolone-treated patients than in hydrocortisone-treated: OR = 0.24; 95% CI = 0.08-0.67) and dexamethasone-treated patients: OR = 0.55; 95% CI = 0.24-1.26). The risk of reintubation was significantly lower in dexamethasone- and methylprednisolone-treated patients than in placebo-treated patients: (dexamethasone: OR = 0.34; 95% CI = 0.13-0.85; methylprednisolone: OR = 0.42; 95% CI = 0.25-0.70). Cluster analysis showed that dexamethasone- and methylprednisolone-treated patients had the lowest risks of stridor and reintubation. Subgroup analyses of patients with positive cuff-leak tests showed similar results. Conclusions Methylprednisolone and dexamethasone were the most effective agents against postextubation stridor and reintubation.
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Affiliation(s)
- I-Jung Feng
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jia-Wei Lin
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chen Cheng
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Safety, Health, and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chin-Ming Chen
- Departments of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan
| | - Ying-Ting Wang
- Departments of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan
| | - Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
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4
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Tufail B, Shabbir M, Majeed A, Akhtar AB, Al Malyan M. Tonsillar Trauma During Video Laryngoscopy: A Case Report. Cureus 2023; 15:e41617. [PMID: 37565098 PMCID: PMC10410289 DOI: 10.7759/cureus.41617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
Potentially difficult airways warrant the use of airway adjuncts, which, if not used with caution, can cause trauma to the oral cavity. Although most operators are familiar with modern airway adjuncts, as they are not routinely used, adverse events can occur. Since its introduction, a video laryngoscope (VL) has been lauded as a necessary instrument for airway management in and out of the operating room. This case report highlights right tonsillar tissue perforation with a GlideScope® VL (Verathon Incorporated, Bothell, Washington, USA), requiring primary closure by an otolaryngologist.
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Affiliation(s)
- Bilal Tufail
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Muhammad Shabbir
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Amer Majeed
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Ahmed Bilal Akhtar
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohamed Al Malyan
- Anesthesia and Critical Care, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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5
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Riveros-Perez E, Bolgla L, Yang N, Avella-Molano B, Albo C, Rocuts A. Effect of table inclination angle on videolaryngoscopy and direct laryngoscopy: Operator's muscle activation and laryngeal exposure analysis. BMC Anesthesiol 2022; 22:308. [PMID: 36192677 PMCID: PMC9528055 DOI: 10.1186/s12871-022-01849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Optimal vocal cord visualization depends on the patient's anatomical factors, characteristics of the laryngoscope, and the operator's muscle action. This study evaluated the effect of table inclination and three different laryngoscopic methods on procedural variables. The primary aim of this study is to compare differences in laryngoscopic view among clinicians based on the instrument used and table orientation. The secondary aim is to determine differences in upper extremity muscle activity based on laryngoscope use and table inclination. METHODS Fifty-five anesthesia providers with different experience levels performed intubations on a manikin using three angles of table inclination and three laryngoscopy methods. Time to intubation, use of optimization maneuvers, glottic view, operator's comfort level, and upper extremity muscle activation measured by surface electromyography were evaluated. RESULTS Table inclination of 15° and 30° significantly reduced intubation time and the need for optimization maneuvers. Fifteen degrees inclination gave the highest comfort level. Anterior deltoid muscle intensity was decreased when table inclination at 15° and 30° was compared to a flat position. CONCLUSION Table inclination of 15° reduces intubation time and the need to use optimization maneuvers and is associated with higher operator's comfort levels than 0° and 30° inclination in a simulated scenario using a manikin. Different upper extremity muscle groups are activated during laryngoscopy, with the anterior deltoid muscle exhibiting significantly higher activation levels with direct laryngoscopy at zero-degree table inclination.
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Affiliation(s)
- Efrain Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, 1120 15th street BI-2144, Augusta, GA, 30912, USA.
| | - Lori Bolgla
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Nianlan Yang
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, GA, Augusta, USA
| | - Bibiana Avella-Molano
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, GA, Augusta, USA
| | - Camila Albo
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Alexander Rocuts
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, GA, Augusta, USA
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6
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Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Jones PM, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Kovacs G. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth 2021; 68:1373-1404. [PMID: 34143394 PMCID: PMC8212585 DOI: 10.1007/s12630-021-02007-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider "exit strategy" options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a "cannot ventilate, cannot oxygenate" emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as "airway lead" to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.
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Affiliation(s)
- J. Adam Law
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Room 5452, Halifax, NS B3H 3A7 Canada
| | - Laura V. Duggan
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Mathieu Asselin
- grid.23856.3a0000 0004 1936 8390Département d’anesthésiologie et de soins intensifs, Université Laval, 2325 rue de l’Université, Québec, QC G1V 0A6 Canada ,grid.411081.d0000 0000 9471 1794Département d’anesthésie du CHU de Québec, Hôpital Enfant-Jésus, 1401 18e rue, Québec, QC G1J 1Z4 Canada
| | - Paul Baker
- grid.9654.e0000 0004 0372 3343Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Edward Crosby
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Suite CCW1401, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Andrew Downey
- grid.1055.10000000403978434Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Orlando R. Hung
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Philip M. Jones
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Rd., London, ON N6A 5A5 Canada
| | - François Lemay
- grid.417661.30000 0001 2190 0479Département d’anesthésiologie, CHU de Québec – Université Laval, Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, QC G1R 2J6 Canada
| | - Rudiger Noppens
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Matteo Parotto
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Interdepartmental Division of Critical Care Medicine, University of Toronto, EN 442 200 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Roanne Preston
- grid.413264.60000 0000 9878 6515Department of Anesthesia, BC Women’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Nick Sowers
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Kathryn Sparrow
- grid.25055.370000 0000 9130 6822Discipline of Anesthesia, St. Clare’s Mercy Hospital, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John’s, NL A1B V6 Canada
| | - Timothy P. Turkstra
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - David T. Wong
- grid.17063.330000 0001 2157 2938Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St, Toronto, ON M5T2S8 Canada
| | - George Kovacs
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
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7
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Marvin K, Bowman P, Keller MW, Ambrosio AA. Effectiveness of an Advanced Airway Training "Boot Camp" for Family Medicine Physician Trainees. Otolaryngol Head Neck Surg 2020; 163:204-208. [PMID: 31986975 DOI: 10.1177/0194599820902065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This course was designed to characterize the impact of a curriculum for training family medicine physicians in advanced airway techniques with respect to intubation performance and learner confidence. METHODS A training course was introduced into the curriculum in a single-group pretest-posttest model at a community family medicine residency program. Training consisted of a didactic teaching session on airway management and hands-on skill session with direct laryngoscopy (DL) and video-assisted laryngoscopy (VAL) on normal and difficult airway simulators. Participants were scored with the Intubation Difficulty Scale and completed surveys before and after the training. RESULTS Twenty-eight residents of all levels participated. The mean time to successful intubation was significantly decreased after training from 51.96 to 23.71 seconds for DL and from 27.89 to 17.07 seconds for VAL. Participant scores with the Intubation Difficulty Scale were also significantly improved for DL and VAL. All participants rated their comfort levels with both techniques as high following training. DISCUSSION Advanced airway management is a critical skill for any physician involved in caring for critically ill patients, though few trainees receive formal training. Addition of an airway training course with simulation and hands-on experience can improve trainee proficiency and comfort with advanced airway techniques. IMPLICATIONS FOR PRACTICE Training on airway management should be included in the curriculum for trainees who require the requisite skills and knowledge necessary for advanced airway interventions. This introductory project demonstrates the efficacy and feasibility of a relatively brief training as part of a family medicine residency curriculum.
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Affiliation(s)
- Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Paige Bowman
- Department of Family Medicine, Naval Hospital Camp Pendleton, Oceanside, California, USA
| | - Matthew W Keller
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, Oceanside, California, USA
| | - Art A Ambrosio
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.,Joint Tele-Critical Care Network, Indo-Pacific Virtual Medical Center, San Diego, California, USA
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8
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Aykanat VM, Graham JM. Role of playback videolaryngoscope footage in improved patient care. Anaesth Intensive Care 2019; 47:389-391. [PMID: 31423803 DOI: 10.1177/0310057x19861115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the frequency of videolaryngoscope use, to the authors’ knowledge, there are no publications exploring the role of playback video recording in real time to improve patient care. We present a patient with a difficult airway complicated by trauma during GlideScope® (Verathon Inc., Bothell, WA, USA) intubation. The injury was not recognised by any of the anaesthetic staff observing the intubation, and was only identified when playback video footage was viewed. This provided the opportunity for early ear, nose and throat surgical review prior to extubation. Airway trauma can be missed by the anaesthetist. Reviewing video playback footage at an appropriate time during the case may enable more timely recognition of airway injuries and, ultimately, improved patient care.
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Affiliation(s)
- Verna M Aykanat
- Department of Anaesthesia, Austin Hospital, Heidelberg, Australia
| | - Jon M Graham
- Department of Anaesthesia, Austin Hospital, Heidelberg, Australia
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9
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Yoon HK, Lee HC, Oh H, Jun K, Park HP. Postoperative sore throat and subglottic injury after McGrath® MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score: a randomized controlled trial. BMC Anesthesiol 2019; 19:137. [PMID: 31366325 PMCID: PMC6668117 DOI: 10.1186/s12871-019-0811-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background A tracheal tube stylet can be used to assist successful tracheal intubation, especially during videolaryngoscopic intubation because videolaryngoscopes with a Macintosh-type blade such as McGrath® MAC videolaryngoscope have more acute angle than conventional Macintosh laryngoscope. However, the use of a stylet during tracheal intubation can raise concerns about stylet-induced postoperative airway complications, such as sore throat, subglottic injury, and hoarseness. In this study, we compared the incidence of postoperative airway complications after McGrath® MAC videolaryngoscopic intubation with versus without a stylet in patients with a high Mallampati score. Methods In 104 patients with Mallampati score III or IV and who were scheduled for lumbar or thoracic spine surgery, McGrath® MAC videolaryngoscopic intubation was performed either with a stylet (group S, n = 52) or without a stylet (group N, n = 52). The primary outcome measure was the incidences of sore throat evaluated at 1 and 24 h postoperatively. Secondary outcome measures were the incidences of subglottic injury and postoperative hoarseness. Results The incidence of CL grade III in group S and N was 3.8 and 5.8%, respectively. No patient showed CL grade IV. The incidences of sore throat at 1 (26.9 vs 19.2%, P = 0.485) and 24 h (17.3 vs 13.5%, P = 0.786, respectively) postoperatively were not significantly different between the group S and N. However, the incidence of subglottic injury was significantly higher in the group S, compared with the group N (65.4 vs 42.3%, P = 0.030). The incidence of postoperative hoarseness did not differ significantly between the two groups. Conclusions The use of a stylet during McGrath® MAC videolaryngoscopic intubation did not have a significant impact on the incidence of postoperative sore throat in patients with a high Mallampati score. Avoiding the use of a stylet during intubation with McGrath® MAC videolaryngoscope may reduce the incidence of subglottic injury in such patients. Trial registration Clinical Research Information Service (identifier: KCT0002427, date of registration: June 12, 2017).
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Affiliation(s)
- Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Kwanghoon Jun
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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10
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Lai WS, Lin YY, Chu YH, Lee JC. Accidental Intubation of the Soft Palate. EAR, NOSE & THROAT JOURNAL 2019; 99:NP86. [PMID: 31170818 DOI: 10.1177/0145561319840138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Wen-Sen Lai
- Department of Otolaryngology-Head and Neck Surgery, 38003Taichung Armed Forces General Hospital, Taichung.,Department of Otolaryngology-Head and Neck Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yuan-Yung Lin
- Department of Otolaryngology-Head and Neck Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Yueng-Hsiang Chu
- Department of Otolaryngology-Head and Neck Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Jih-Chin Lee
- Department of Otolaryngology-Head and Neck Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei
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11
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Lascarrou JB, Martin M, Reignier J. Quelle est la place des vidéolaryngoscopes pour l’intubation en réanimation ? MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Tsao M, Vargas AA, Hajduk J, Singh R, Jagannathan N. Pediatric airway management devices: an update on recent advances and future directions. Expert Rev Med Devices 2018; 15:911-927. [DOI: 10.1080/17434440.2018.1549483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angelica A. Vargas
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Renee Singh
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Pagel PS, Chapel MA, Georgeson AR, Traudt EA, Little RE, Loehrl TA, Somberg LB. An Unanticipated Airway Finding After Orotracheal Intubation With a GlideScope Videolaryngoscope. J Cardiothorac Vasc Anesth 2018; 33:873-875. [PMID: 30213637 DOI: 10.1053/j.jvca.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Paul S Pagel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
| | - Marc A Chapel
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Alexander R Georgeson
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Elizabeth A Traudt
- Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Ryan E Little
- Otolaryngology Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Todd A Loehrl
- Otolaryngology Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Lewis B Somberg
- Surgery Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Ji S, Song J, Kim SK, Kim MY, Kim S. Fiberoptic bronchoscope and C-MAC video laryngoscope assisted nasal-oral tube exchange: two case reports. J Dent Anesth Pain Med 2017; 17:219-223. [PMID: 29090253 PMCID: PMC5647822 DOI: 10.17245/jdapm.2017.17.3.219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/03/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022] Open
Abstract
In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.
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Affiliation(s)
- Sungmi Ji
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jaegyok Song
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seok Kon Kim
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Moon-Young Kim
- Department of Oral and Maxillofacial Surgery, Dankook University College of Dentistry, Cheonan, Korea
| | - Sangyun Kim
- Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine, Cheonan, Korea
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