Comparison of GlideScope™ visualization and neck flexion with lateral neck pressure nasogastric tube insertion techniques in anesthetized patients: a randomized clinical study

Abstract Objective Nasogastric tube (NGT) insertion in anesthetized and intubated patients can be challenging, even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between GlideScope™ visualization and neck flexion, with lateral neck pressure techniques. Material and methods This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery, under relaxant general anesthesia, who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope™ group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of the first and second attempts, duration of insertion, and complications were recorded. Results The total success rate was 79.1% in group G, compared with 76.7% in group F (P = 1). The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P < 0.001) and (70 vs 48.5 s P = 0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications for both techniques. Conclusion Using GlideScope™ visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique, in the degree of success rates of insertion. Although complications were not statistically significant between groups, neck flexion with lateral neck pressure technique was significantly less time-consuming for both first and second attempts. Trial registration Retrospectively registered: Thai Clinical Trial Registry (TCTR)20171229003. Registered on 19 December 2017

Download Full-text

Comparison of the GlideScopeTM Visualization and Neck Flexion with Lateral Neck Pressure Nasogastric Tube Insertion techniques in Anaesthetized Patients: A Prospective Randomized Clinical Study

10.21203/rs.2.22366/v1 ◽

2020 ◽

Author(s):

Pitchaporn Purngpipattrakul ◽

Suttasinee Petsakul ◽

Asst. Prof. Sunisa Chatmonkolchart ◽

Somrutai Boonchuduang ◽

Kanjana Nuanjun

Keyword(s):

Success Rate ◽

Nasogastric Tube ◽

Lateral Neck ◽

Neck Flexion ◽

Tube Insertion ◽

Randomized Clinical Study ◽

Insertion Techniques ◽

Time Required ◽

Neck Pressure ◽

Nasogastric Tube Insertion

Abstract Background Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope TM visualization and neck flexion with lateral neck pressure techniques. Methods This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope TM group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. Results The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Conclusions Using GlideScope TM visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion and complications were not statistically significant between groups, while neck flexion with lateral neck pressure technique was less time-consuming significantly both first and second attempts.

Download Full-text

The GlideScope with modified Magill forceps facilitates nasogastric tube insertion in anesthetized patients: A randomized clinical study

Journal of International Medical Research ◽

10.1177/0300060518772719 ◽

2018 ◽

Vol 46 (8) ◽

pp. 3124-3130 ◽

Cited By ~ 3

Author(s):

Han Joon Kim ◽

Su In Park ◽

Sang Yun Cho ◽

Min Jae Cho

Keyword(s):

General Anesthesia ◽

Success Rate ◽

Nasogastric Tube ◽

Insertion Time ◽

Control Group ◽

Magill Forceps ◽

Randomized Clinical Study ◽

Experimental Group ◽

Control Group Group

Objective Insertion of a nasogastric tube (NGT) in patients who have been intubated with an endotracheal tube while under general anesthesia can cause difficulties and lead to complications, including hemorrhage. A visualization-aided modality was recently used to facilitate NGT insertion. Some studies have focused on the role of modified Magill forceps, which have angles similar to those of the GlideScope blade (Verathon, Bothell, WA, USA). Methods Seventy patients were divided into a control group (Group C) and an experimental group (GlideScope and modified Magill forceps, Group M). Results The total NGT insertion time was significantly shorter in Group M than C (71.3 ± 22.6 vs. 96.7 ± 57.5 s; mean difference, –25.3 s; 95% confidence interval [CI], 20.8–71.5). There were also significantly fewer mean insertion attempts in Group M than C (1.0 ± 0.0 vs. 2.11 ± 0.93). The success rate for the first attempt in Group C was 37.1%, while that in Group M was 100% (relative risk, 2.7; 95% CI, 1.7–4.1). Conclusion The use of the GlideScope with modified Magill forceps for insertion of an NGT in patients who are already intubated and under general anesthesia will shorten the insertion time and improve the success rate.

Download Full-text

Clinical Trial Risk in Type-2 Diabetes: Importance of Patient History

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3hg73 ◽

2014 ◽

Vol 17 (3) ◽

pp. 393 ◽

Cited By ~ 2

Author(s):

Emmanuel O. Aiyere ◽

Jay Silverberg ◽

Safina Ali ◽

Jayson L. Parker

Keyword(s):

Type 2 Diabetes ◽

Clinical Trial ◽

Phase I ◽

Success Rate ◽

Phase Iii ◽

Success Rates ◽

Glucose Levels ◽

Treatment Naïve ◽

Diabetes Drug

Purpose. To determine the risk of clinical trial failure for drugs developed for type-2 diabetes. Methods. Drugs were investigated by reviewing phase I to phase III studies that were conducted between 1998 and February 2013. The clinical trial success rates were calculated and compared to the industry standard. The drugs were classified into GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors and “Other”. The exclusion criteria for drugs in this study: Drugs that were started in phase I studies prior to January 1998 for this indication and drugs whose primary indications were not for the control of blood glucose levels. Results. Data was extracted from clinicaltrials.gov; there were a total of 131 drug candidates that fit our specified criteria, of which 8 received FDA approval. The cumulative success rate for molecules developed for type-2 diabetes is 10%. Small molecules were more successful than biologics. A strong disparity was observed in phase III, with studies that utilised treatment naïve patients having a 40% success rate, compared to an 83% success rate in patients who have had previous anti-hyperglycemic exposure. Conclusions. 1 in 10 drugs that enter clinical testing in this disease will be approved. The DPP-4 inhibitor class of drugs had the highest success rate of all drug classes with a 63% cumulative success rate; while treatment naïve patients carried the greatest clinical trial risk. Keywords: Clinical trials, Type-2 diabetes, Drug development, Clinical trial risk. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Download Full-text

Accuracy of Endoscopic Transpapillary Gallbladder Drainage with Liquid-Based Cytology for Gallbladder Disease

Digestion ◽

10.1159/000519250 ◽

2021 ◽

pp. 1-10

Author(s):

Soichiro Kawahara ◽

Takeshi Tomoda ◽

Hironari Kato ◽

Toru Ueki ◽

Yutaka Akimoto ◽

...

Keyword(s):

Clinical Trial ◽

Adverse Events ◽

Diagnostic Accuracy ◽

Success Rate ◽

Cystic Duct ◽

Gallbladder Disease ◽

Drainage Tube ◽

Clinical Trial Registry ◽

Gallbladder Drainage ◽

Gallbladder Diseases

Introduction: Gallbladder carcinoma is often difficult to distinguish from benign gallbladder diseases. While the diagnostic accuracy of endoscopic transpapillary gallbladder drainage (ETGD) has been reported, these results were obtained retrospectively. This prospective study aimed to evaluate the cytological diagnostic accuracy of ETGD in patients with gallbladder disease. Methods: This single-arm prospective clinical trial included a total of 35 patients scheduled to undergo ETGD between March 2017 and September 2019. A 5F pigtail nasobiliary drainage tube was inserted into the gallbladder, and bile was collected over 5 times; if ETGD failed, a drainage tube was placed into the bile duct. The endpoints were, first, the cytological diagnostic accuracy of ETGD and, second, technical success rates and adverse events. Results: Of the 35 patients, 19 were finally diagnosed with gallbladder cancer. The success rate of ETGD tube insertion was 85.7%, and the morphological pattern of the cystic duct with the angle down and located on the right side had a significantly lower success rate for ETGD than that of other cystic duct patterns (odds ratio, 13.5; 95% confidence interval, 1.7–143.7; p = 0.02). Cytological samples were collected 5 times on median. The sensitivity, specificity, and accuracy in all patients were 78.9%, 100%, and 88.6%, respectively, while those in 30 patients with successful ETGD were 87.5%, 100%, and 93.3%, respectively. Adverse events occurred in 3 patients: mild pancreatitis in 1 patient and obstructive jaundice in 2 patients; all complications were resolved with conservative therapy. Discussion/Conclusions: Cytology using an ETGD tube is useful in differentiating benign and malignant gallbladder diseases (Clinical Trial Registry No. UMIN000026929).

Download Full-text

A randomized clinical trial of nasogastric tube insertion in intubated patient: comparison between finger method and reverse Sellick maneuver

Medical Journal of Indonesia ◽

10.13181/mji.v28i4.2704 ◽

2019 ◽

Vol 28 (4) ◽

pp. 311-5

Author(s):

Rahendra ◽

Aida Rosita Tantri ◽

Liliana Mangkuwerdojo

Keyword(s):

Clinical Trial ◽

Success Rate ◽

Randomized Clinical Trial ◽

Nasogastric Tube ◽

Complication Rate ◽

Third Party ◽

Chi Square ◽

Group 13 ◽

Blood Spots ◽

Chi Square Test

BACKGROUND Finger method is a new simple technique of nasogastric tube (NGT) insertion for intubated patients which only requires the practitioner’s own fingers. This study was aimed to compare the feasibility of finger method and the standard reverse Sellick maneuver in NGT insertion for intubated patients. METHODS This was a single-blinded, randomized clinical trial that included 210 patients aged 18–65 years old who were intubated under general anesthesia and needed NGT insertion. Initially, subjects were randomly allocated by the third party into two groups: subjects who had NGT insertion with finger method and those with reverse Sellick maneuver. Success rate of NGT insertion at the first attempt, duration of the procedure, and complication rate of blood spots were all recorded. Chi-square test and Mann–Whitney analysis were used to analyze the data. RESULTS Success rate of NGT insertion at the first attempt in finger method group was higher in comparison with reverse Sellick maneuver group (81.6% versus 60%, respectively, p = 0.002). Likewise, the median of NGT insertion duration was longer in finger group compared to reverse Sellick maneuver group (13 sec versus 12 sec, respectively, p < 0.001) but it was not clinically significant. Moreover, the complication rate of blood spots found during the procedure was lower in subjects with finger method than with reverse Sellick maneuver (10.7% versus 28%, respectively, p = 0.003). CONCLUSIONS Using finger method was more feasible than reverse Sellick maneuvers in NGT insertion.

Download Full-text

Prospective clinical evaluation of chairside-fabricated zirconia-reinforced lithium silicate ceramic partial crowns—5-year results

Clinical Oral Investigations ◽

10.1007/s00784-021-04132-y ◽

2021 ◽

Author(s):

Sven Rinke ◽

Tanja Zuck ◽

Tim Hausdörfer ◽

Andreas Leha ◽

Torsten Wassmann ◽

...

Keyword(s):

Success Rate ◽

Cox Regression ◽

Lithium Silicate ◽

Event Analysis ◽

Success Rates ◽

Clinical Trial Registration ◽

Randomized Clinical Study ◽

Increased Risk ◽

Group 2 ◽

Group 1

Abstract Objectives A university-based randomized clinical study evaluated the 5-year performance of chairside-fabricated zirconia-reinforced lithium silicate (ZLS)-ceramic partial crowns. Material and methods Forty-five patients were restored with 61 chairside-fabricated ZLS-restorations (Cerec SW 4.2, Dentsply Sirona, Germany; Vita Suprinity, Vita Zahnfabrik, Germany). Deviating from the manufacturers’ recommendations, restorations with reduced minimum material thicknesses (MMT) were fabricated: group 1, MMT = 0.5–0.74 mm (n = 31); group 2, MMT = 0.75–1.0 mm (n = 30). For luting, a self-adhesive cement (SAC) or a total-etch technique with a composite cement (TEC) was applied. Statistical evaluation was performed by time-to-event analysis (Kaplan–Meier). Possible covariates of the survival (SVR) and success rates (SCR), evaluated in a Cox regression model, were MMT, restoration position (premolar/molar), and cementation technique (SAC vs. TEC). Results Forty patients (54 restorations, premolars, n = 23; molars, n = 31) participated in the 5-year follow-up. Five losses due to ceramic fractures occurred in group 1 (n = 28) (SVR: 83.0% [95% confidence interval (CI): 0.71–0.96]). Group 2 (n = 26) showed no losses (SVR: 100%). The success rate for partial crowns placed on premolars was 100% and 69% (95% CI: 0.54–0.84) for molar restorations. Recementation was required in 4 restorations with SAC (SCR: 86% [95% CI: 0.73–0.99]; SCR-DC: 100%). Restorations in group 2 showed a significantly reduced risk of material fracture hazard ratio (HR) = 0.09, p = 0.0292) compared with the restorations in group 1. Molar partial crowns showed an increased risk for a clinical intervention (HR = 5.26, p = 0.0222) compared to premolar restorations. Conclusions Material thickness and position of the restoration are risk factors influencing the survival and success rate of ZLS-ceramic partial crowns. Clinical relevance Observation of an MMT of at least 0.75–1.0 mm for ZLS-ceramics is essential to avoid material-related fractures. Clinical trial registration: German Clinical Trails Register (trial number: DRKS00005611)

Download Full-text

Modified Gastric Biopsy Forceps as a Flexible Stylet-Assisted Nasogastric Tube Insertion in Anesthetized and Intubated Patients: A Prospective Randomized Controlled Study

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.08.13050 ◽

2021 ◽

Vol 104 (8) ◽

pp. 1222-1228

Keyword(s):

Success Rate ◽

Nasogastric Tube ◽

Gastric Biopsy ◽

Controlled Study ◽

Control Group ◽

Minor Bleeding ◽

Biopsy Forceps ◽

Success Rates ◽

Tube Insertion ◽

Nasogastric Tube Insertion

Background: Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. The authors hypothesized that gastric biopsy forceps could be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Materials and Methods: Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results: The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (p=0.013). The overall success rate was higher in the stylet group (100% versus 85%, p=0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85±9.62 versus 62.4±59.38 seconds, p=0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% versus 32.5%, p=0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% versus 17.5%, p=0.057). No other complications were observed in either groups. Conclusion: The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications. Keywords: Nasogastric tube; Insertion; Stylet; Gastric biopsy forceps; Success rate

Download Full-text

Oro- and Nasogastric Tube Passage in Intubated Patients

Anesthesiology ◽

10.1097/00000542-199907000-00022 ◽

1999 ◽

Vol 91 (1) ◽

pp. 137-143 ◽

Cited By ~ 60

Author(s):

Steven Ozer ◽

Jonathan L. Benumof

Keyword(s):

General Anesthesia ◽

Nasogastric Tube ◽

Gastric Tube ◽

Average Distance ◽

Arytenoid Cartilage ◽

Lateral Neck ◽

Piriform Sinus ◽

Thyrohyoid Membrane ◽

First Pass ◽

Neck Pressure

Background Insertion of a gastric tube (GT) in anesthetized, paralyzed, and intubated patients can be difficult The purpose of this study was to determine fiberoptically why GTs succeed or fail to enter the esophagus and, based on these findings, to determine a mechanism for converting failures into successes. Methods Sixty patients under general anesthesia and orotracheally intubated were studied. The larynx and hypopharynx of each patient were viewed via a fiberscope placed through the left naris. GTs were passed orally (OGT) and nasally (NGT) in all patients, and the pathway of passage or site of resistance was visualized. In cases of resistance, medially directed ipsilateral neck pressure was applied over the lateral thyrohyoid membrane (termed lateral neck pressure) to try to allow passage of the GT. Results All 60 patients had both an OGT and NGT passed for a total of 120 attempts. The GT passed easily on the first attempt in 92 of 120 insertions (77%) (for OGT 51/60 = 85% and for NGT 41/60 = 68%, P < 0.05). In 92% of these first-pass successes, the GT entered the hypopharynx just lateral to the arytenoid cartilages. The GT met resistance and failed to pass in 28 of 120 insertions (23%) (for OGT 9/60 = 15% and for NGT 19/60 = 32%). The sites of impaction were the piriform sinuses (13/28 = 46%), arytenoid cartilages (7/28 = 25%), and trachea (6/28 = 21%), and two OGTs did not pass the oropharynx (2/28 = 70%). Lateral neck pressure was attempted 20 times (for the piriform sinus and arytenoid cartilage impactions) with 17 successes (85%) and three failures (15%). The average distance to passage of the OGT and NGT by the arytenoid cartilage was 13.2 and 16.2 cm, respectively. Conclusion GTs enter the hypopharynx just lateral to the arytenoid cartilages. Consequently, the most common sites of resistance at the laryngeal level are the arytenoid cartilages and piriform sinuses. Lateral neck pressure compresses the piriform sinuses and moves the arytenoid cartilages medially, relieving 85% of these GT impactions.

Download Full-text

Stainless steel or titanium mini-implants?

The Angle Orthodontist ◽

10.2319/081619-536.1 ◽

2020 ◽

Vol 90 (4) ◽

pp. 587-597 ◽

Cited By ~ 1

Author(s):

Paulo Mecenas ◽

Daybelis Gonzalez Espinosa ◽

Paula Coutinho Cardoso ◽

David Normando

Keyword(s):

Clinical Trial ◽

Stainless Steel ◽

Success Rate ◽

Randomized Clinical Trial ◽

Risk Of Bias ◽

Current Evidence ◽

Success Rates ◽

Level Of Evidence ◽

Manual Search ◽

Mini Implants

ABSTRACT Objectives To investigate whether there was a difference in success rates when stainless steel (SS) was compared to titanium mini-implants (MIs) in orthodontic patients. Materials and Methods PubMed, Cochrane, Scopus, Web of Science, Lilacs, Google Scholar, Clinical Trials, and OpenGray were searched without restrictions. A manual search was also performed in the references of the included articles. Studies comparing the success rate between SS and titanium MIs were included. Risk of bias (RoB) was assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies-of Interventions) Tool or RoB 2.0 according to the study design. The level of evidence was assessed through GRADE (Grading of Recommendation, Assessment, Development, and Evaluation). Results Six studies met the eligibility criteria. One study was a randomized clinical trial that evaluated extraalveolar MIs, and nonrandomized trials examined interradicular MIs. The RCT presented a low RoB, two nonrandomized trials presented a moderate risk, and three presented a high risk. The quality of the evidence was high for the randomized clinical trial and moderate for the nonrandomized trials. Most studies found no difference between materials, with good success rates for both (SS, 74.6%–100%; titanium: 80.9%–100%) and only one study, with a high RoB, showed a higher success rate with titanium MIs (90%) when compared with SS (50%). A quantitative analysis was not because of the great heterogeneity among the studies. Conclusions Although limited, the current evidence seems to show that the material used is not a major factor in the success rate of MIs. Because it has a lower cost than titanium and presents similar clinical efficiency, SS is a great material for orthodontic MIs.

Download Full-text

Orotracheal intubation incorporating aerosol-mitigating strategies by anaesthesiologists, intensivists and emergency physicians: a simulation study

BMJ Simulation and Technology Enhanced Learning ◽

10.1136/bmjstel-2020-000757 ◽

2021 ◽

pp. bmjstel-2020-000757

Author(s):

Saullo Queiroz Silveira ◽

Leopoldo Muniz da Silva ◽

Anthony M-H Ho ◽

Cláudio Muller Kakuda ◽

Daniel Wagner de Castro Lima Santos ◽

...

Keyword(s):

Intensive Care ◽

Success Rate ◽

Direct Laryngoscopy ◽

Healthcare Providers ◽

Orotracheal Intubation ◽

Emergency Physicians ◽

Success Rates ◽

Increased Risk ◽

Procedural Time ◽

Time Required

BackgroundOrotracheal intubation (OTI) can result in aerosolisation leading to an increased risk of infection for healthcare providers, a key concern during the COVID-19 pandemic.ObjectiveThis study aimed to evaluate the OTI time and success rate of two aerosol-mitigating strategies under direct laryngoscopy and videolaryngoscopy performed by anaesthesiologists, intensive care physicians and emergency physicians who were voluntarily recruited for OTI in an airway simulation model.MethodologyThe outcomes were successful OTI, degree of airway visualisation and time required for OTI. Not using a stylet during OTI reduced the success rate among non-anaesthesiologists and increased the time required for intubation, regardless of the laryngoscopy device used.ResultsSuccess rates were similar among physicians from different specialties during OTI using videolaryngoscopy with a stylet. The time required for successful OTI by intensive care and emergency physicians using videolaryngoscopy with a stylet was longer compared with anaesthesiologists using the same technique. Videolaryngoscopy increased the time required for OTI among intensive care physicians compared with direct laryngoscopy. The aerosol-mitigating strategy under direct laryngoscopy with stylet did not increase the time required for intubation, nor did it interfere with OTI success, regardless of the specialty of the performing physician.ConclusionsThe use of a stylet within the endotracheal tube, especially for non-anaesthesiologists, had an impact on OTI success rates and decreased procedural time.

Download Full-text