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Video versus direct laryngoscopy on successful firstpass endotracheal intubation in ICU patients

World Journal of Emergency Medicine 2018年第2期9卷 99-104页

作者： Yong-xia Gao Yan-bo Song Ze-juan Gu Jin-song Zhang Xu-feng Chen Hao Sun Zhen Lu Department of Emergency Medicine the First Affiliated Hospital of Nanjing Medical University

BACKGROUND: Airway management in intensive care unit(ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy(DL) and that by using the video laryngoscopy(VL).METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. RESULTS: A total of 163 ICU patients underwent intubation during the study period(81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group(67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications(all P>0.05). CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

关键词： Intubation Video laryngoscopy Direct laryngoscopy Intensive care unit

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Median effective dose of remifentanil for awake laryngoscopy and intubation

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Chinese Medical Journal 2009年第13期122卷 1507-1512页

作者： XU Ya-chao XUE Fu-shan LUO Mao-ping YANG Quan-yong LIAO Xu LIU Yi ZHANG Yan-ming Department of Anesthesiology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100144 China

Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose （ED50） of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon＇s up-and-down method. Patient＇s reaction score at laryngoscopy and an Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED50 of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon＇s up-and-down method. In the patients who were scored as ＂accept＂, patient＇s OAA/S and reactJon scores at dJfferent observed points, JntubatJng conditJon score and patient＇s tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon＇s up-and-down method was （0.62±0.02） μg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg （95% CI, 0.54-0.70） and 0.83 μg/kg （95% CI, 0.73-2.59）, respectively. Nineteen patients who were scored as ＂accept＂ had an OAA/S of 〉15 and tolerated well laryngoscopy without significant di

关键词： laryngoscopy awake intubation remifentanil median effective dose sedation and analgesia

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Ultrasound for diagnosing new difficult laryngoscopy indicator: a prospective, self-controlled, assessor blinded, observational study

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Chinese Medical Journal 2019年第17期132卷 2066-2072页

作者： Lei Wang Yan-Kun Feng Liu Hong Wan-Li Xie Shi-Qiang Chen Ping Yin Qing-Ping Wu Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430022 China Department of Anesthesiology Wuhan No.1 Hospital Wuhan Hubei 430022 China Department of Ultrasound Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430022 China Department of Epidemiology and Health Statistics School of Public Health Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430030 China

Background: Unpredictable difficult laryngoscopy (DL) remains a challenge for anesthesiologists, especially when difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common airway assessment methods only perform superficial screening. Thus, the deep laryngopharyngeal anatomy may not be evaluated. Ultrasound-based airway assessment has been recently proposed as a useful, simple, and non-invasive bedside tool as an adjunct to clinical methods, which may facilitate identification of DL. The present study aimed to determine the correlation between ultrasound-measured indicators and DL. Methods: Patients undergoing elective surgery under general anesthesia with tracheal intubation were enrolled. Ultrasonic airway assessments were performed before anesthesia induction. Ultrasound diagnostic indicators included the thickness and width of the base of the tongue, the angle between the epiglottis and glottis, the length of the thyrohyoid membrane, and the thickness of the lateral pharyngeal wall. A score of ≥3 in the Modified Cormack-Lehane Scoring System was used as a standard of DL and was also applied to divide patients into DL and non-DL groups. The area under the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of various diagnostic indicators. Results: A total of 499 patients were enrolled into non-DL and DL groups comprising 452 (452/499, 90.6%) and 47 (47/499, 9.4%) patients, respectively. One ultrasonic diagnoses indicator correlated with DL, namely, the angle between the epiglottis and glottis. When the angle between the epiglottis and glottis was 50°, the area under the ROC curve was maximum (0.902), and the best sensitivity (81%) and specificity (89%) were achieved. Conclusions: Airway ultrasounds should be considered to identify DL. The ultrasonic angle measured between the epiglottis and glottis is highly associated with DL, which may occur when the angl

关键词： Ultrasonography laryngoscopy Airway management

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The role of direct laryngoscopy in the diagnosis of laryngeal cleft

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Open Journal of Pediatrics 2013年第2期3卷 92-95页

作者： Paul D. Neubauer Laura H. Swibel Rosenthal William I. Wooten III Carlton J. Zdanski Amelia F. Drake Department of Otolaryngology/Head and Neck Surgery University of North Carolina Children’s Hospital Chapel Hill USA Department of Otolaryngology—Head and Neck Surgery Loyola University Chicago Stritch School of Medicine Maywood USA Department of Surgery Section of Otolaryngology Yale-New Haven Hospital New Haven USA Division of Pediatric Pulmonology University of North Carolina Children’s Hospital Chapel Hill USA

Objective: To identify the presenting features of a laryngeal cleft in children. To compare rigid and flexible endoscopic methods available for identifying laryngeal cleft and determine their utility. Methods: The charts of all patients diagnosed with laryngeal cleft in a tertiary care institution between 2009 and 2010 were evaluated retrospectively for age, gender, comorbidity, presenting features, and results of bedside swallow evaluation. Findings on flexible and direct laryngoscopy, both performed under general anesthesia, were compared. Results: Eleven patients had a diagnosis of laryngeal cleft, confirmed by direct laryngoscopy. Nine of eleven had signs of aspiration on modified barium swallow study (MBSS). Of the eight subjects who underwent flexible laryngoscopy by a pulmonologist, a deep interarytenoid groove was only reported in four cases. In all eleven cases, the arytenoids could be physically separated during direct laryngoscopy, allowing for definitive diagnosis of the cleft and identification of its type and severity. Conclusion: Video swallow studies and flexible laryngoscopy may raise suspicion or even diagnose a laryngeal cleft, however, a laryngeal cleft must be confirmed by direct laryngscopy in which the interarytenoid space is palpated. Furthermore, a patient in whom symptoms persist but no laryngeal cleft is identified on flexible examination should have a direct laryngoscopy to rule out a cleft.

关键词： Laryngeal Cleft laryngoscopy Aspiration Children

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Novel flangeless video laryngoscope for limited mouth opening

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World Journal of Critical Care Medicine 2025年第1期14卷 118-121页

作者： Mohd Mustahsin Harshita Singh Division of Critical Care Medicine Department of Anaesthesiology and Critical CareEra UniversityLucknow 226003Uttar PradeshIndia Department of Anaesthesiology Era UniversityLucknow 226003Uttar PradeshIndia

Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and *** patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal *** overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful *** types of VL blades are *** devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.

关键词： Video laryngoscope Difficult intubation Intubation Airway management laryngoscopy

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Diagnostic utility of flexible fiberoptic nasopharyngolaryngoscopy recorded onto a smartphone: A pilot study

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2018年第2期4卷 135-139页

作者： Jason A. Brant Kevin Leahy Natasha Mirza Hospitals of the University of Pennsylvania Philadelphia PA USA

Objectives: To evaluate the diagnostic accuracy of flexible fiberoptic examinations of the larynx recorded onto smartphones. Methods: Prospective, blinded study of inpatients requiring laryngoscopy. A live exam was per-formed, then a smartphone was attached to the endoscope using a novel coupling device and the same examination was recorded. The live and recorded exams were evaluated by two lar-yngologists, each blinded to the findings of the other. Results: Eighteen subjects were evaluated. Evaluation of airway patency was identical (Kappa = 1.0 [1, 1]). Evaluation of vocal cord motion was identical for 14 subjects: 9 normal, 3 paretic, 2 paralytic (Kappa = 0.69 [0.38, 1]). Conclusion: There is high correlation between laryngeal diagnoses using live flexible fiberoptic laryngoscopy and recordings using a coupling device to transfer the recordings on to smart-phones. Critical findings such as airway patency and vocal fold motion showed the highest cor-relation.

关键词： Telemedicine laryngoscopy Smartphone

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Laryngeal myxoma: A case report

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World Journal of Clinical Cases 2021年第12期9卷 2823-2829页

作者： Ting-Ting Yu Hong Yu Yu Cui Wei Liu Xiang-Yan Cui Xin Wang Department of Otolaryngology Head and Neck SurgeryJilin UniversityChangchun 130000Jilin ProvinceChina First Operation Room Jilin UniversityChangchun 130000Jilin ProvinceChina

BACKGROUND Myxomas are benign tumors of mesenchymal origin that rarely occur in the *** SUMMARY We report a case of a laryngeal myxoma that presented as a right vocal cord mass in a 54-year-old *** Laryngeal myxoma is a rare benign tumor in the *** is difficult to distinguish glottis myxoma from vocal cord polyps on *** recommend that otolaryngologists acquire a better understanding of this *** a laryngeal myxoma is suspected,dynamic laryngoscopy,acoustic voice analysis,and pathological biopsy should be performed.

关键词： Laryngeal myxoma Mesenchymal Glottis Hoarseness Dyspnea laryngoscopy Case report

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Comparison of five video-assisted intubation devices by novice and expert laryngoscopists for use in the aeromedical evacuation environment

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Military Medical Research 2017年第2期4卷 61-69页

作者： Matthew C.Wallace SSgt Tyler Britton Robbie Meek Sharon Walsh-Hart Col Todd E.Carter Steven J.Lisco University of Cincinnati Medical Center Department of Anesthesiology

Background: The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries *** novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices(VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on(NAL), Difficult Airway Lights on(DAL) and Difficult Airway Blackout(DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light ***: A convenience sample size of 40 participants(24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. Results: Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the Glide Scope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued hea

关键词： simulation difficult airway novice expert military video laryngoscopy light emission

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Comparison of Cardiac Output and Hemodynamic Responses of Intubation among Different Videolaryngoscopies in Normotensive and Hypertensive Patients

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第3期35卷 432-438页

作者： Amro Faez Abdelgawad 石琴芳 Mohamed AboHalawa 吴志林武宙阳陈向东姚尚龙 Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Department of Anesthesiology Faculty of Medicine Benha UniversityEgypt Department of Anesthesiology Faculty of Medicine Suez Canal University

Tracheal intubation with Macintosh laryngoscope（MAC） might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output（COP） and hemodynamic responses in normal blood pressure（n=60） and hypertensive patients（n=60） among 3 intubation devices： the MAC, the UE videolaryngoscopy ？（UE）, and the UE video intubation stylet ？（VS）. Cardiac index（CI）, stroke volume index（SVI）, heart rate（HR）, systolic blood pressure（SBP） and diastolic blood pressure（DBP） were recorded using Lidco Rapid V2？ preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups（P〈0.001） only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher（P〈0.05 or 〈0.01） than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.

关键词： arterial pressure response laryngoscopy tracheal intubation cardiac output

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Advanced Suction Device with Continuous Oxygen Supply for Performing Meconium Suction and Identical Procedures

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Journal of Biomedical Science and Engineering 2014年第12期7卷 988-993页

作者： Kumar Ritesh Bhavsar Raunak C. Subramanian Department of Biomedical Engineering VIT University Vellore India Department of Mechanical Engineering VIT University Vellore India

laryngoscopy is a medical procedure that provides a secure airway by passing a breathing tube through the mouth and into the lungs of a patient, and to perform meconium suction in newborns to avoid asphyxia. The ability to successfully perform meconium suction is highly dependent on operator skill and the availability of trained assistants to assist during the procedure. The immediate objective of this research paper is to present an improved device, so that the procedure can be performed at a faster pace and the need for assistants is eliminated. Experienced physicians have used the device presented in the paper on mannequin, and the operating time and ease were observed to have improved.

关键词： laryngoscopy Meconium Aspiration Syndrome

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