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Intubation Conditions (intubation + condition)

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Medical Sciences	100%

Selected Abstracts

Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2001
M. Eikermann
Background: To define the rocuronium doses which would provide 50%, 90%, and 95% probability of ,acceptable' intubation conditions during light sevoflurane anaesthesia, we studied 60 children aged 2,7 years in a prospective, randomised, assessor blinded study. Methods: After mask ventilation with 1 MAC sevoflurane/N2O for 17±1 (x̌±SD) min we administered rocuronium (either 0.15, 0.22, 0.3, 0.5, or 1.0 mg ,· ,kg,1) or placebo, and quantified the evoked force of the adductor pollicis muscle. Intubation conditions were assessed before and 2 min after injection of the test drug. Results: Intubation conditions were improved significantly with rocuronium and scored ,acceptable' in 70%, 90%, and 100% of the children after injection of rocuronium 0.15, 0.22, and 0.3 mg ,· ,kg,1, respectively. In parallel, twitch tension decreased to 53% (6,100), 26% (11,100), and 11% (0,19) of baseline (median (range)). Recovery of train-of-four ratio to 0.8 was achieved 13 (7,19), 16 (8,28), and 27 (23,44) min after injection of the respective rocuronium doses. Higher rocuronium doses did not further improve intubation conditions but only prolonged time of neuromuscular recovery. Logistic regression analysis revealed that rocuronium 0.11 (CI 0.05,0.16), 0.21 (0.14,0.28), and 0.25 (0.15,0.34) mg ,· ,kg,1 provides a 50%, 90%, and 95% probability of ,acceptable' intubation conditions in children during 1 MAC sevoflurane/N2O anaesthesia, respectively. Furthermore, we calculated that force depression of adductor pollicis muscle to 81% (CI 72,90), 58% (42,74), and 50% (29,71) of baseline is associated with 50%, 90%, and 95% probability of ,acceptable' intubation conditions. Conclusions: Submaximal depression of muscle force with low dose rocuronium improves intubation conditions in children during light sevoflurane anaesthesia while allowing rapid recovery of neuromuscular function. However, when using low dose rocuronium neuromuscular monitoring may be helpful to detect children with inadequate response to the relaxant so as to avoid an unsuccessful intubation attempt. [source]

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010
A. G. JENSEN
Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1,1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia. [source]

Evaluation of the Video Intubation Unit in morbid obese patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
I. BATHORY
Background: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. Methods: We studied 40 MO patients (body mass index >35 kg/m2) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO2 achieved during the procedure, were measured. Results: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO2 post-intubation. Conclusion: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions. [source]

Probability of acceptable intubation conditions with low dose rocuronium during light sevoflurane anaesthesia in children

Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways,

PEDIATRIC ANESTHESIA, Issue 11 2009
MICHELLE WHITE MB ChB DCH FRCA
Summary Aim:, To evaluate the new pediatric Glidescope® (Cobalt GVL® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope® would perform as well as conventional laryngoscopy. Background:, A new pediatric Glidescope® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. Methods:, We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. Results:, We found no difference in time taken to tracheal intubation using the Glidescope® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope®, respectively. However, only 34% of participants said that they would definitely use the Glidescope® in an emergency compared with 66% who would be willing to use the Miller laryngoscope. Conclusions:, The new Glidescope® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions. [source]

A comparison of the Glidescope® and Karl Storz DCI® videolaryngoscopes in a paediatric manikin,

ANAESTHESIA, Issue 8 2010
D. M. Hurford
Summary A new paediatric Glidescope® (Cobalt GVL® Stat) has recently become available. This varies in design from the Karl Storz DCI® videolaryngoscope, as it possesses a short curved disposable blade compared with the narrower straighter blade of the Storz®. We compared the time taken for tracheal intubation under normal and difficult intubation conditions in a paediatric manikin. A total of 32 anaesthetists completed four intubations in a random order, with each participant blinded to the airway condition. We hypothesised there would be no difference between the devices. The results showed no difference in tracheal intubation time between the Glidescope and the Storz videolaryngoscope. The mean (SD) times under normal conditions were 18.8 (5.2) s vs 19.9 (6.1) s, (p = 0.16), respectively. Under difficult conditions the times were 22.6 (10.5) vs 27.0 (14.2) s, (p = 0.13), respectively. There were no differences in the visual analogue scores for field of view, ease of use, willingness to use in an emergency, and overall satisfaction. [source]

Optimal remifentanil dosage for providing excellent intubating conditions when co-administered with a single standard dose of propofol

ANAESTHESIA, Issue 7 2009
L. Bouvet
Summary This dose,response study aimed to determine the dose of remifentanil combined with propofol 2.5 mg.kg,1 which provided excellent intubation conditions in 95% of patients. Ninety premedicated female ASA 1 and 2 patients were randomly allocated to five remifentanil dose groups (1, 2, 3, 4 or 5 ,g.kg,1). Induction of anaesthesia was performed with a blinded dose of remifentanil infused over 60 s simultaneously co-administered with propofol 2.5 mg.kg,1 infused over 45 s. Tracheal intubation was attempted 150 s after the beginning of induction. Intubating conditions were assessed with the Copenhagen score. A probit analysis was performed to calculate the intubating efficient doses (IED) of remifentanil in 95% of patients (IED95). Our data revealed that the IED95 of remifentanil was 4.0 (95% CI: 3.4,5.6) ,g.kg,1, which was associated with a maximum decrease in heart rate and mean arterial pressure of < 30%, a finding which also applied to the other groups. [source]