Endoscopic Study of Mechanisms of Failure of Endotracheal Tube Advancement into the Trachea during Awake Fiberoptic Orotracheal Intubation

2005 ◽  
Vol 102 (5) ◽  
pp. 910-914 ◽  
Author(s):  
Dana M. Johnson ◽  
Aaron M. From ◽  
Russell B. Smith ◽  
Robert P. From ◽  
Mazen A. Maktabi
Keyword(s):  
Endotracheal Tube ◽  
Nerve Block ◽  
Soft Tissues ◽  
Orotracheal Intubation ◽  
Topical Anesthesia ◽  
Successful Intubation ◽  
Flexible Bronchoscope ◽  
Endoscopic Study ◽  
The Right ◽  
Relevant Factors

Background Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiberoptic orotracheal intubation is often impeded. The goal of this study was to identify the sites and mechanisms that inhibit the passing of the ETT into the trachea. Methods Forty-five consenting patients underwent a clinically indicated awake fiberoptic orotracheal intubation. After topical anesthesia, nerve block, or both, an awake fiberoptic orotracheal intubation was performed. The placement of the FB and advancement of the ETT over the FB were videotaped using a second nasally inserted FB. An otolaryngologist later reviewed the videotaped data. Results The right arytenoid or the interarytenoid soft tissues inhibited advancement of the ETT in 42 and 11% of all patients, respectively. In all cases in which the FB was located on the right side of the larynx, failure of ETT advancement almost always occurred at the right arytenoid. Withdrawing the ETT and rotating it 90 degrees counterclockwise resulted in successful intubation on the second, third, and fourth attempts in 26.6, 20, and 0.7% of patients, respectively. Conclusion The right arytenoid frequently inhibits advancement of the ETT over the FB into the trachea during awake fiberoptic orotracheal intubation. The FB position in the larynx before tube advancement and the orientation of the ETT are relevant factors in failure of advancement of the ETT into the trachea. The authors recommend positioning the FB in the center of the larynx and orienting the bevel of the ETT to face posteriorly during the first attempt at intubation.

DETERMINANTS OF ORAL ENDOTRACHEAL TUBE PLACEMENT: A CROSS SECTIONAL STUDY

2021 ◽  
pp. 66-68
Author(s):  
Pankaj Kumar ◽  
Sudha Singh ◽  
Aditya Prakash
Keyword(s):  
Endotracheal Tube ◽  
Pearson Correlation ◽  
Orotracheal Intubation ◽  
Cross Sectional Study ◽  
Tube Placement ◽  
Vocal Cords ◽  
Cross Sectional ◽  
Endotracheal Tube Placement ◽  
The Mean ◽  
The Right

Introduction: Finding the best depth of endotracheal tube (ET) placement has been a challenge because of the complications caused due to its malposition. Aims: To nd the best depth of placement of oral ET in Indian adult patients. Methods And Design: This study was conducted in 125 ASA I and II patients requiring general anaesthesia and orotracheal intubation. Methods: After placing the ET with the designated black mark at vocal cords, various airway distances were measured from the right angle of mouth using a bre optic bronchoscope. Statistical Analysis: Mean (SD) and median (range) of various parameters and Pearson correlation coefcient was calculated. Results: The mean lip-carina distance, i.e., total airway length was 23.52±1.72 cm and 22.11±1.26 cm in males and females, respectively. With black mark of ET between vocal cords, the mean ET tip-carina distance of 4.19±1.60 cm in males and 2.78±1.52 cm females was found to be less than the recommended safe distance. Conclusions: Height has the best correlation to lip to carina distance. Fixing the tube at recommended distances in both male and female will lead to carinal stimulation or endobronchial placement in many Indian patients. The formula “(Height in cm/7) -2.5.” gives us an idea about the approximate depth of ET placement.

The massive nodular cutaneous and soft tissues lesions of the right shoulder and the arm as the extramedullary manifestation of the advanced stage of multiple myeloma

Oncoreview ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 180-183
Author(s):  
Arkadiusz Drobiecki ◽  
Marcin Pasiarski ◽  
Agnieszka Stelmach-Gołdyś ◽  
Bartosz Garus
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissues ◽  
Advanced Stage ◽  
The Right

scholarly journals Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110196
Author(s):  
Xiaotong Peng ◽  
Zhi Duan ◽  
Hongling Yin ◽  
Furong Dai ◽  
Huining Liu
Keyword(s):  
Adverse Events ◽  
Soft Tissues ◽  
Malignant Tumors ◽  
Cystic Teratoma ◽  
Abdominal Distension ◽  
Epithelioid Angiosarcoma ◽  
History Of ◽  
New Ideas ◽  
The Right ◽  
Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

scholarly journals Primitive Neuroectodermal Tumor of the Liver: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eduardo Cambruzzi ◽  
Enilde Eloena Guerra ◽  
Hamilton Cardoso Hilgert ◽  
Herbert Jorge Schmitz ◽  
Vinícius Lopes Silva ◽  
...  
Keyword(s):  
Primitive Neuroectodermal Tumor ◽  
Soft Tissues ◽  
Young Patients ◽  
Neuroectodermal Tumor ◽  
Solid Mass ◽  
Resected Liver ◽  
The Central Nervous System ◽  
Right Lobe ◽  
Upper Abdominal ◽  
The Right

Primary liver sarcomas represent a rare group of neoplasias, with angiosarcoma being the most common histological type. Primitive neuroectodermal tumor (PNET) represents a high malignant neoplasia that usually affects the central nervous system and soft tissues. An 18-year-old male patient was admitted with clinical complains of pain in the right upper abdominal quadrant. The clinical evaluation revealed a solid mass in the right hepatic lobe. On the gross examination of the resected liver specimen, the right lobe of the liver was replaced by a yellow-red solid mass measuring 21 cm in its largest dimension. On the histopathology, a tumor composed of small round blue cells with little cytoplasm and round nuclei was identified. The lesion revealed positive immunoexpression for vimentin and CD99 and negative immunostaining for desmin, CD45, cytokeratin, and neuroblastoma protein, suggesting, then, the diagnosis of PNET. Although it is an unusual tumor, it should be considered in the differential diagnosis of liver masses, especially in young patients.

NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 243-246 ◽  
Author(s):  
Yuichi Yoshii ◽  
Tomoo Ishii ◽  
Shinsuke Sakai
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Soft Tissue Infection ◽  
Soft Tissues ◽  
Biceps Brachii ◽  
Subcutaneous Tissue ◽  
Oral Bacteria ◽  
Tissue Infection ◽  
Left Elbow ◽  
The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

COMPARISON OF ‘AIRWAY NERVE BLOCK’ VS ‘SPRAY-AS-YOU-GO’ METHOD USED FOR AWAKE FLEXIBLE BRONCHOSCOPIC INTUBATION IN COMBINATION WITH CONSCIOUS SEDATION – A PROSPECTIVE, RANDOMISED, SINGLE BLIND STUDY

2021 ◽  
pp. 3-6
Author(s):  
Devesh Kumar Gupta ◽  
Shinu Kaur ◽  
Deepti Gupta
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Nerve Block ◽  
Conscious Sedation ◽  
Nasotracheal Intubation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Mean ◽  
Lidocaine Spray ◽  
Single Blind

Introduction: Fibreoptic Intubation (FOI) is the gold standard for managing difcult airways. There are various approaches such as: Nebulization with lidocaine; 'Spray as you go'(SAYGO); Airway nerve block - blocking superior laryngeal nerve & recurrent laryngeal nerve & sedation. The present study aims to compare 'airway nerve block' (NB) and 'spray as you go'(SA) method for awake exible bronchoscopic intubation used in combination with conscious sedation. Methods: 60 patients of age group 18 – 65 years with difcult airway undergoing general anaesthesia with nasotracheal intubation, were randomly allocated into two groups. After premedication & nasal preparation, all patients received injection dexmedetomidine at a dose of 1µg/kg in 100ml of 0.9% NS over 10 minutes. In Group SA, 2ml lignocaine 4% was sprayed above and below the cords after visibility of glottic opening via working channel of the bronchoscope and 2 ml lignocaine 4% within trachea before insertion of endotracheal tube. In Group NB, bilateral superior laryngeal nerves & recurrent laryngeal nerve was blocked. Then a exible breoptic bronchoscope preloaded with a exometallic endotracheal tube of appropriate size was then inserted via nasal route. Results: The mean intubation time for Group NB [87.27 ± 7.58 sec] was shorter than that for Group SA [190.33 ± 9.14] (p<0.0001). Conclusion: Awake exible bronchoscopic intubation under sedation with airway nerve block provides better intubating conditions compared to SAYGO

Sign in / Sign up

Export Citation Format

Share Document