scholarly journals Kinking of Disposable Fiberoptic Bronchoscope During Difficult Nasal Awake Intubation

2019 ◽  
pp. 1-2
Author(s):  
Cyrus Motamed ◽  
Lauriane Bordenave ◽  
Cyrus Motamed ◽  
Mohamed Abdellaoui
Keyword(s):  
Endotracheal Tube ◽  
Operating Room ◽  
Local Anesthesia ◽  
Awake Intubation ◽  
Total Intravenous Anesthesia ◽  
Fiberoptic Intubation ◽  
Fiberoptic Bronchoscope ◽  
Cricothyroid Membrane ◽  
Jet Ventilation ◽  
Intravenous Anesthesia

Background: disposable fiberoptic for intubation are more and more available in operating room We hereby report a complication of a difficult fiberoptic intubation performed with a disposable fiberscope. Case: Under remifentanil sedation Visualizing the glottis was easy while advancing the endotracheal tube through the fiberscope was mildly difficult. Removing the fiberscope was impossible as was the removal of the endotracheal tube. The patient was becoming uncomfortable. Under local anesthesia we performed a jet ventilation after puncture of the cricothyroid membrane followed by total intravenous anesthesia. A cervicofacial surgeon visualized the kinking of the fiberscope at the tip of the endotracheal tube. The fiberscope was removed under direct vision with a rigid bronchoscope. Conclusion: Because of more flexibility disposable fiberscopes may kink during the introduction of the endotracheal tube.

scholarly journals Risks of Propofol-based Total Intravenous Anesthesia Compared with Local Anesthesia in Patients Undergoing Percutaneous Transluminal Angioplasty in The Lower Extremity

2020 ◽  
Author(s):  
Wejpisit Wongwiwattananon ◽  
Jatuporn Pakpirom ◽  
Raviwan Akarapatima
Keyword(s):  
Logistic Regression ◽  
Lower Extremity ◽  
Local Anesthesia ◽  
Percutaneous Transluminal Angioplasty ◽  
Perioperative Complications ◽  
Transluminal Angioplasty ◽  
Total Intravenous Anesthesia ◽  
P Value ◽  
Intravenous Anesthesia ◽  
Percutaneous Transluminal

Objective: This study aimed to determine the risks of propofol-based total intravenous anesthesia (TIVA) compared to local anesthesia (LA) in patients undergoing percutaneous transluminal angioplasty (PTA) in a lower extremity. Material and Methods: A retrospective cohort study was conducted in 231 patients who underwent PTA in the lower extremity using either propofol-based TIVA or LA between January 2016 and September 2018. The outcomes of interest included perioperative major adverse cardiac events (MACE) and minor perioperative complications. Risk factors analysis was performed using a univariate logistic regression and backward stepwise multivariate logistic regression. Results: Although the rate of perioperative MACE was two times higher in the propofol-based TIVA group (7.8%) than the LA group (3.9%), no significant difference was found (p-value=0.221). The propofol-based TIVA group had a significantly higher incidence of all minor perioperative complications than the LA group (77.6% vs 13.6%, p value<0.001). Multivariate analysis found that low body mass index (BMI) and American Society of Anesthesiologists classification III were independent factors associated with perioperative MACE, while propofol-based TIVA, body weight (or BMI), hypertension, diabetes mellitus, previous coronary artery disease, and previous congestive hear failure were associated with perioperative minor complications. Conclusion: Based on this study, no significant differences in perioperative MACE were found using either TIVA or LA. However, TIVA produced a significantly higher incidence of perioperative minor complication than LA. Close intraoperative monitoring should be implemented when using propofol-based TIVA in patients undergoing PTA in the lower extremity.

Intrapulmonary Drug Administration during High Frequency Jet Ventilation

1985 ◽  
Vol 1 (S1) ◽  
pp. 220-222 ◽  
Author(s):  
M. Klain ◽  
H. Keszler ◽  
U. Nordin ◽  
R. Kalla
Keyword(s):  
Endotracheal Tube ◽  
High Frequency ◽  
Jet Stream ◽  
Cricothyroid Membrane ◽  
Inspiratory Time ◽  
Jet Ventilation ◽  
Upper Airways ◽  
Cuffed Endotracheal Tube ◽  
Peripheral Airways ◽  
High Frequency Jet Ventilation

It has previously been demonstrated that high frequency jet ventilation, via transtracheal cricothyroid membrane puncture, can maintain good gas exchange even during cardiopulmonary resuscitation. When the upper airways were filled with fluid, aspiration could be prevented without a cuffed endotracheal tube when respiratory rates of 100/min or higher and an inspiratory time of at least 50% were used. We have also shown that cricothyroid membrane puncture is relatively easy to perform and produces less tracheal damage than a cuffed endotracheal tube.In one of our studies, cardio-green dye was mixed into the jet using a Y-connector on the proximal end of the angiocath cannula (Figure 1). In two dogs, the distribution of the dye in the lungs was investigated. It was found that nebulized dye was transported by the jet stream to the most distant bronchi which could be observed. On subsequent autopsy, the dye was found in the most peripheral airways.

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