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Successful Insertion (successful + insertion)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

How to manage difficulties with colonoscope insertion

DIGESTIVE ENDOSCOPY, Issue 2 2001
Masaaki Miyaoka
Unsuccessful insertion of a colonoscope is usually as a result of bending or looping of the scope. Looping of the colonoscope increases when too much air is insufflated or the scope is inserted with undue force, resulting in increased pain and risk of perforation. Successful insertion therefore requires careful handling of the scope to keep it straight, careful regulation of air levels, shortening of the colon length by gathering of the colon folds and rapid correction of any looping that should occur. This can be complicated in cases with an unusually long colon or with adhesion. The use of a colonoscope with variable rigidity or a small-caliber colonoscope is recommended to increase the rate of successful insertion to relieve pain and to prevent accidents. [source]

A prospective, randomised, cross-over trial comparing the EndoFlex® and standard tracheal tubes in patients with predicted easy intubation

ANAESTHESIA, Issue 11 2009
W. H. L. Teoh
Summary We aimed to determine if using the EndoFlex® tracheal tube on the first intubation attempt provided improved placement times and intubation success compared with a standard-type tracheal tube in 50 patients undergoing gynaecological surgery in a prospective, randomised, cross-over trial. We found that using the EndoFlex resulted in shorter intubation times (mean (SD) 14.8 (9.7) vs 30.1 (30.5) s), easier intubation (VAS, median (range) 10 (0,70) vs 20 (0,100)), and an increased rate of successful insertion at the first attempt; all p < 0.001. Flexing the distal tip of the EndoFlex was used in 18 patients. There were reductions in the use of external laryngeal pressure, advancement of laryngoscope blade and increased lifting force when intubating with the EndoFlex. Furthermore, patients with a grade 2 (19/50) or 3 (6/50) laryngoscopic view had shorter intubation times, easier intubation and reduced insertion attempts with the EndoFlex. The EndoFlex is a satisfactory alternative to a standard-type tracheal tube, even with an anterior larynx. [source]

A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway,

ANAESTHESIA, Issue 6 2009
C. Janakiraman
Summary In a randomised cross-over study, we compared the performance of the single use i-gel supraglottic airway and reusable classic laryngeal mask airway (cLMATM) in 50 healthy anaesthetised patients who were breathing spontaneously. Primary outcome was successful insertion at first attempt. Secondary outcomes included overall insertion success rate, ease of insertion, leak pressure and fibreoptic position. Success rate for insertion at the first attempt was significantly different (54% with i-gel vs 86% with cLMA; p = 0.001). Overall success after two attempts (when the anaesthetist was allowed to change the size of the device) improved to 84% with i-gel vs 92% with cLMA; p = 0.22. In 14 patients, the i-gel when used first needed to be replaced with a larger size. Leak pressure was higher for the i-gel (median [IQR] 20 [14,24] cm H2O than the cLMA 17 [12,22] cm H2O; p = 0.023). The fibreoptic view through the device was significantly better with the i-gel than the cLMA, which was statistically significant (p = 0.03). We conclude that, with its current sizing recommendations, the i-gel is not an acceptable alternative to cLMA. However because of the significantly improved success rate after a larger sized i-gel was used, we recommend the manufacturer to review the sizing guidelines to improve the success rate. [source]

Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre-existing skills: a manikin study,

ANAESTHESIA, Issue 5 2009
B. M. Wahlen
Summary The classic Laryngeal Mask Airway (cLMAÔ), ProSeal Laryngeal Mask Airway (PLMAÔ), Intubating Laryngeal Mask AirwayÔ (ILMAÔ), Combitube (CTÔ), Laryngeal Tube (LTÔ) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non-anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible. [source]

Awake insertion of the laryngeal mask airway using topical lidocaine and intravenous remifentanil,

ANAESTHESIA, Issue 1 2006
M. C. Lee
Summary We assessed the use of intravenous remifentanil for the insertion of the laryngeal mask airway in 10 healthy awake volunteers, a technique primarily developed to facilitate functional magnetic resonance imaging studies of anaesthesia. Each volunteer received 200 ,g glycopyrronium intravenously. Topical airway anaesthesia was effected by 4 ml nebulised lidocaine 4%, followed by 12 sprays of lidocaine 10%. Remifentanil was subsequently infused to achieve an initial target effect-site concentration of 2 ng.ml,1; increments of 1 ng.ml,1 were allowed with the maximum effect-site concentration limited to 6 ng.ml,1. Insertion of the laryngeal mask airway was successful on the first attempt in all cases. The median (IQR [range]) target effect-site remifentanil concentration at insertion was 2.5 (2,3 [2,4]) ng.ml,1. All volunteers were co-operative during the procedure and only one reported discomfort. Sore throat was a complication in all volunteers. We conclude that the technique allows successful insertion of the laryngeal mask airway in healthy awake volunteers under conditions that were safe and reproducible. [source]

Developing a strategy to reduce the high morbidity of patients with long-term urinary catheters: the BioMed catheter research clinic

BJU INTERNATIONAL, Issue 6 2007
Azhar A. Khan
OBJECTIVE To assess the idea of managing patients having problems with long-term catheterization (LTC, normally used when all other methods of bladder management have failed or are unsuitable) in a dedicated clinic, to present a prospective analysis of consecutive new patients attending between February 2002 and October 2006, and to establish the incidence of bladder stones in patients who have recurrent catheter encrustation and blockage. PATIENTS AND METHODS Patients treated with LTC are a large heterogeneous group, mainly consisting of elderly people who have chronic disabilities, and catheter-associated complications occur in > 70% of them. In all, 260 consecutive new patients having problems with LTC were assessed; the evaluation consisted of basic demographics, a detailed history, clinical examination, urine analysis and flexible cystoscopy (FC) via the catheterization route. Patients with bladder stones were screened with FC for recurrence of stones at 3, 6 and 12 months after treatment. RESULTS In all, 117 men and 143 women (mean age 67.7 years, range 23,97) were assessed; 147 (55.5%) had catheter encrustation. FC showed that 66 of the 147 patients (45%) had bladder stones. Forty-eight patients (73%) were successfully treated at the same clinic appointment and their stones were removed with the help of a tip-less stone basket. Eighteen patients (27%) were referred for inpatient treatment of bladder stones under general anaesthesia. Twenty of 66 patients with bladder stones (30%) formed recurrent bladder stones at a mean (range) follow-up of 8.1 (3,18 months). In addition, 36 patients had successful insertion of suprapubic catheter (SPC) under local anaesthetic in the clinic, and 11 were referred for SPC insertion under general anaesthesia. Two patients were diagnosed with bladder transitional cell carcinoma. CONCLUSION The introduction of a dedicated catheter clinic, equipped with facilities such as FC and a hoist, enables patients to be treated in an environment that meets their needs and potentially reduces the risk of more complex stone removal and catheter problems at a later date. It can also act as a potential source of data for use in research and development. A significant proportion (45%) of patients with catheter encrustation and blockage had formed bladder stones. Our study provides a rationale for FC of all such patients to detect and remove stones. [source]