PDF herunterladen
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2015; 02(01): 033-037
DOI: 10.4103/2348-0548.148385
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Comparison of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar: A clinical study

Nitesh Gill
1   Department of Anaesthesiology, Sawai ManSingh Medical College, Jaipur, Rajasthan, India
,
Shobha Purohit
1   Department of Anaesthesiology, Sawai ManSingh Medical College, Jaipur, Rajasthan, India
,
Mukesh Godara
1   Department of Anaesthesiology, Sawai ManSingh Medical College, Jaipur, Rajasthan, India
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. Mai 2018 (online)

   Lizenzen und Reprints

Abstract

Background: Device like fibreoptic bronchoscope is gold standard for difficult intubation situations. It can be performed by both orotracheal and nasotracheal route. But, through nasal route there are more chances of nasal bleeding and pressure necrosis while through oral route there is only one problem, which is clearing of upper airway for bronchoscope. Manoeuvres like jaw thrust and chin lift are very useful in clearing upper airway for bronchoscope. The aim of this study was to compare ease of oral intubation using flexible fibreoptic bronchoscope with or without rigid cervical collar, in terms of need of manoeuvres: Jaw thrust and Chin lift. Materials and Methods: 25 patients in age range 20-50 years, of ASA ? - II, and of either sex undergoing elective surgery under general anaesthesia were randomly allocated into each group. There were two groups: Group A (Rigid Cervical Collar) and group B (Without Collar). Intubating condition was assessed in between these groups with need of manoeuvres like jaw thrust and chin lift. Quantitative data i.e. age, weight, thyromental distance and sternomental distance were presented as mean value and standard deviation. Intergroup comparison of quantitative data was done by t-test and probability was considered to be significant if less than <0.05. Categorical data i.e. sex, ASA grade, Mallampati grade and need of manoeuvres were presented as number and were compared among groups using Chi-square test. P < 0.05 was considered statistically significant. Results: There was significant (P < 0.05) difference between group A and group B in terms of use of manoeuvres for ease of intubation and clearing upper airway. In group B, need of jaw thrust and chin lift for clearing airway is significantly (P < 0.05) higher than collar group. Conclusion: We concluded that as far as the oral intubation with flexible fibreoptic bronchoscope is concerned, rigid cervical collar is very useful tool for making intubation easier.

Keywords

Airway - fibreoptic bronchoscope - intubation - jaw thrust - rigid cervical collar
 

  • REFERENCES

  • 1 Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: A meta-analysis of bedside screening test performance. Anesthesiology 2005; 103: 429-37
    CrossrefPubMedGoogle Scholar
  • 2 Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P. et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45: 757-76
    CrossrefPubMedGoogle Scholar
  • 3 Benumof JL. Difficult laryngoscopy: Obtaining the best view. Can J Anaesth 1994; 41 (5 Pt 1) 361-5
    CrossrefPubMedGoogle Scholar
  • 4 Bainton CR. Models to facilitate the learning of fiberoptic technique. Int Anesthesiol Clin 1994; 32: 47-55
    CrossrefPubMedGoogle Scholar
  • 5 Bainton CR. Difficult intubation: What's the best test?. Can J Anaesth 1996; 43: 541-3
    CrossrefPubMedGoogle Scholar
  • 6 Stackhouse RA, Bainton CR. Difficult airway management. In: Hughes SC, Rosen M, Levinson G. editors. Anesthesia for Obstetrics. 4th ed.. Baltimore: Williams and Wilkins; 2001. p. 375-90
    Google Scholar
  • 7 Stackhouse RA, Marks JD, Bainton CR. Performing fiberoptic endotracheal intubation: Clinical aspects. Int Anesthesiol Clin 1994; 32: 57-73
    CrossrefPubMedGoogle Scholar
  • 8 Ovassapian A. Fiberoptic tracheal intubation in adults. In: Ovassapian A. editor. Fiberoptic Endoscopy and the Difficult Airway. 2nd ed.. Philadelphia: Lippincott-Raven; 1996
    Google Scholar
  • 9 Kim YC, Lee SH, Noh GJ, Cho SY, Yeom JH, Shin WJ. et al. Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg 2000; 91: 698-701
    CrossrefPubMedGoogle Scholar
  • 10 Tintinalli JE, Claffey J. Complications of nasotracheal intubation. Ann Emerg Med 1981; 10: 142-4
    CrossrefPubMedGoogle Scholar
  • 11 Moore DC. Middle turbinectomy: A complication of IMPROPER nasal intubation?. Anesthesiology 2000; 92: 1504-5
    PubMedGoogle Scholar
  • 12 Williams AR, Burt N, Warren T. Accidental middle turbinectomy: A complication of nasal intubation. Anesthesiology 1999; 90: 1782-4
    CrossrefPubMedGoogle Scholar
  • 13 Coe TR, Human M. The peri-operative complications of nasal intubation: A comparison of nostril side. Anaesthesia 2001; 56: 447-50
    CrossrefPubMedGoogle Scholar
  • 14 Smith JE, Reid AP. Identifying the more patent nostril before nasotracheal intubation. Anaesthesia 2001; 56: 258-62
    CrossrefPubMedGoogle Scholar
  • 15 Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Dore CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth 1991; 66: 157-62
    CrossrefPubMedGoogle Scholar
  • 16 Mason RA. Learning fibreoptic intubation: Fundamental problems. Anaesthesia 1992; 47: 729-31
    CrossrefPubMedGoogle Scholar
  • 17 Roberts JT. Preparing to use the flexible fiber-optic laryngoscope. J Clin Anesth 1991; 3: 64-75
    CrossrefPubMedGoogle Scholar
  • 18 Hartley M, Morris S, Vaughan RS. Teaching fibreoptic intubation. Effect of alfentanil on the haemodynamic response. Anaesthesia 1994; 49: 335-7
    CrossrefPubMedGoogle Scholar
  • 19 Lucas DN, Yentis SM. A comparison of the intubating laryngeal mask tracheal tube with a standard tracheal tube for fibreoptic intubation. Anaesthesia 2000; 55: 358-61
    CrossrefPubMedGoogle Scholar
  • 20 Cole AF, Mallon JS, Rolbin SH, Ananthanarayan C. Fiberoptic intubation using anesthetized, paralyzed, apneic patients: Results of a residency training program. Anesthesiology 1996; 84: 1101-6
    CrossrefPubMedGoogle Scholar
  • 21 Hakala P, Randell T, Valli H. Laryngoscopy and fibreoptic intubation in acromegalic patients. Br J Anaesth 1998; 80: 345-7
    CrossrefPubMedGoogle Scholar
  • 22 Berman RA. A method for blind intubation of the trachea or oesophagus. Anesth Analg 1977; 56: 866-7
    PubMedGoogle Scholar
  • 23 Ovassapian A. A new fiberoptic intubating airway. Anesth Analg 1987; Suppl 66: S132
    CrossrefPubMedGoogle Scholar
  • 24 Williams RT, Maltby JR. Airway intubator. Anesth Analg 1982; 61: 309
    PubMedGoogle Scholar
  • 25 Hakala P, Randell T. Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation. Anaesthesia 1995; 50: 735-7
    CrossrefPubMedGoogle Scholar
  • 26 Randell. Valli H, Hakal P. Comparison between the Ovassapian intubating airway and the Berman intubation airway in fibreoptic intubation. Eur J Anaesth 1997; 14: 380-4
    CrossrefPubMedGoogle Scholar
  • 27 Aoyama K, Seto A, Takenaka I. Simple modification of the Ovassapian fiberoptic intubating airway. Anesthesiology 1999; 91: 897
    CrossrefPubMedGoogle Scholar
  • 28 Stackhouse RA. Fiberoptic airway management. Anesthesiology Clin North Am 2002; 20: 930-51
    PubMedGoogle Scholar
  • 29 Boidin MP. Airway patency in the unconscious patient. Br J Anaesth 1985; 57: 306-10
    CrossrefPubMedGoogle Scholar
  • 30 Benumof JL. Nonintubation management of the airway: Mask ventilation. In: Benumof JL. editor. Airway Management: Principles and Practice. 1st ed.. St Louis: Mosby; 1996. p. 233
    Google Scholar
  • 31 Durga VK, Millns JP, Smith JE. Manoeuvres used to clear the airway during fibreoptic intubation. Br J Anaesth 2001; 87: 207-11
    CrossrefPubMedGoogle Scholar
  • 32 Aoyama K, Takenaka I, Nagaoka E, Kadoya T. Jaw thrust maneuver for endotracheal intubation using a fiberoptic stylet. Anesth Analg 2000; 90: 1457-8
    PubMedGoogle Scholar
  • 33 Murashima K, Fukutome T. Effect of jaw-thrust manoeuvre on the laryngeal inlet. Anaesthesia 1998; 53: 203-4
    PubMedGoogle Scholar
  • 34 Wong DM, Prabhu A, Chakraborty S, Tan G, Massicotte EM, Cooper R. Cervical spine motion during flexible bronchoscopy compared with the Lo Pro GlideScope. Br J Anaesth 2009; 102: 424-30
    CrossrefPubMedGoogle Scholar
  • 35 Hastings RH, Kelly SD. Neurologic deterioration associated with airway management in a cervical spine injured patient. Anaesthesiology 1993; 78: 580-3
    CrossrefPubMedGoogle Scholar
  • 36 Schwartz D, Johnson C, Roberts J. A maneuver to facilitate flexible fiberoptic intubation. Anesthesiology 1989; 71: 470-1
    CrossrefPubMedGoogle Scholar
  • 37 Koga K, Asai T, Latto IP, Vaughan RS. Effect of size of a tracheal tube and the efficacy of the use of the laryngeal mask for fibrescope-aided tracheal intubation. Anaesthesia 1997; 52: 131-5
    CrossrefPubMedGoogle Scholar