scholarly journals TO STUDY THE CORRELATION BETWEEN SONOGRAPHIC MODIFICATION OF CORMACK LEHANE SCORING WITH ACTUAL CL GRADING DURING DIRECT LARYNGOSCOPY

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Vishal Koundal
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Clinical Assessment ◽  
Direct Laryngoscopy ◽  
Himachal Pradesh ◽  
Keywords Ultrasound ◽  
Airway Assessment ◽  
Lehane Grade ◽  
Significant Difference ◽  
Grade 3

Background: Airway assessment is an essential aspect of preanaesthetic assessment. Presently, prediction of difficult airway is based on clinical assessment of airway. Methods:  Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results:  It was observed that 44% patients (n=88) were in grade 2 followed by 27 % (n=54) in grade 1, grade 3 was observed in 24.5% patients (n=49) whereas Cormack Lehane grade 4 was seen in 4.5% patients (n=9) Conclusion: The thyromental distance was more than 6.5 cm in the majority of patients (87.5%) while 12.5% had a thyromental distance less than 6.5 cm. There was a significant difference in Thyromental distance between different Cormack Lehane grades (P=0.001) Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy

scholarly journals TO MEASURE THE CORRELATION BETWEEN ULTRASONOGRAPHY MEASURED HYOMENTAL DISTANCE RATIO AND EASE OF LARYNGOSCOPY

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Vishal Koundal ◽  
Dr. Mahesh Kumar
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Himachal Pradesh ◽  
Morbidity And Mortality ◽  
Distance Ratio ◽  
Keywords Ultrasound ◽  
The Mean ◽  
Grade 3

Background: Difficult and failed tracheal intubation after direct laryngoscopy is a dreaded complication of general anesthesia as it is associated with serious morbidity and mortality. Methods: Prospective Observational conducted at Department of Anesthesiology, Dr. RPGMC Kangra at Tanda, Himachal Pradesh. Results: In the present study, the mean hyomental distance ratio was (mean±SD:1.1.±.127 and 1.04±.018) in predicting CL grade 3 and 4 respectively (P=0.010) and 1.12±.033, 1.11±.035 in grade 1 and 2 respectively. Conclusion: Ultrasound is better and fast in confirming endotracheal intubation. Keywords: Ultrasound, endotracheal intubation, direct laryngoscopy.

scholarly journals Difficult Airway Prediction Score for Intubation in Emergency Departments: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Sorravit Savatmongkorngul ◽  
Panrikan Pitakwong ◽  
Pungkava Srichar ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Prediction Score ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Assessment Score ◽  
Airway Assessment ◽  
Lehane Grade

Abstract Objective: Difficult intubation is associated with an increasing number of endotracheal intubation attempts. Repeated endotracheal intubation attempts are in turn associated with an increased risk of adverse events. Clinical prediction tools to predict difficult airway have limited application in emergency airway situations. This study was performed to develop a new model for predicting difficult intubation in the emergency department.Methods: This retrospective study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand. The study was conducted from June 2018 to July 2020. The inclusion criteria were an age of ≥15 years and treatment by emergency intubation in the emergency department. Difficult intubation was defined as a Cormack–Lehane grade III or IV laryngoscopic view. The predictive model and prediction score for detecting difficult intubation were developed by multivariable regression analysis.Results: During the study period, 617 patients met the inclusion criteria; of these, 83 (13.45%) had difficult intubation. Five independent factors were predictive of difficult intubation. The difficult airway assessment score that we developed to predict difficult airway intubation had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult intubation by 7.62 times.Conclusion: A difficult airway assessment score of >4 was associated with difficult intubation.

Comparative Study between two Ultrasound Aided Methods in PreoperativeAssessment of Difficult Airway in Obese Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Galal Aboul-so’od Saleh ◽  
Sherif Anis George ◽  
Gamal Eldin Adel Abdelhamid ◽  
Hazem Sameer Swedan
Keyword(s):  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Neutral Position ◽  
Obese Patients ◽  
Tissue Thickness ◽  
Exclusion Criteria ◽  
Airway Assessment ◽  
Thyrohyoid Membrane ◽  
Lehane Grade ◽  
Significant Difference

Abstract Background Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs. So, accurate airway assessment should always be performed so as to provide appropriate planning and management of expected difficult intubation and to limit any unexpected difficulties. Airway assessment using ultrasound has been proposed recently as a useful, simple and non-invasive bed side tool as an adjunct to clinical methods. Objective To establish whether correlations existed between two ultrasound measurements and the Cormack–Lehane grade during direct laryngoscopy, and whether these measurements are useful in predicting are stricted or difficult view especially in morbid obese individuals. The first is the measurement of the hyomental distance of the patient in neutral position of the neck and in fully extended neck calculating the ratio between both of them. While the second is the measurement of anterior cervical soft tissue thickness at three anatomical levels (hyoid bone, thyrohyoid membrane or ‘pre epiglottic space’ and anterior commissure). We chose these two new measurements from among the various ultrasound assessments made in previous studies because of their simplicity of execution in normal clinical and in emergency settings. Patients and Methods The current study is a prospective comparative clinical trial of assessment of difficult air way using two different ultrasound aided techniques in comparison to Cormack and lehane scoring system. Those patients were chosen upon some inclusion and exclusion criteria; inclusion criteria were (Age of the patient (25-60y), ASA I-II patients, Obese patients with body mass index > 30 kg /m2 and Pts undergoing bariatric surgery) and exclusion criteria were (Pathology of the airway (tumors), Deformity of the airway anatomy (burns, scars), History of facial, cervical, pharyngeal and epiglottis surgery or trauma, Patients with most teeth lost and Patient refusal). Results Regarding U/S measurements in method A patients; the average HMD-neutral of A patients was (53.58±5.33) mm, the average HMD-extension was (58±7.82) mm, and the average HMDR was (1.07±0.06). It showed highly significant decrease in HMD extension and HMDR in difficult group, compared to easy group, in A group of patients (p < 0.01respectively). Non-significant difference as regards HMD-neutral U/S measurements in method A (p > 0.05). Conclusion Ultrasonography can be a valuable adjunct in this aspect of airway assessment. Ultrasound assessment of pre-epiglottic tissue thickness at the level of the thyrohyoid membrane may be useful to predict restricted/difficult direct laryngoscopy and difficult intubation. The ratio of hyomental distance between neutral and extended positions may also be a good predictor of difficult direct laryngoscopy.

Survey on the Current State of Endotracheal Intubation Among the Critically Ill

2016 ◽  
Vol 33 (6) ◽  
pp. 354-360 ◽  
Author(s):  
Mohamed O. Seisa ◽  
Venkatesh Gondhi ◽  
Onur Demirci ◽  
Daniel A. Diedrich ◽  
Rahul Kashyap ◽  
...  
Keyword(s):  
Adverse Events ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Airway Device ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Drug Of Choice ◽  
Significant Difference

Objectives: In the last decade, the practice of intubation in the intensive care unit (ICU) has evolved. To further examine the current intubation practice in the ICU, we administered a survey to critical care physicians. Design: Cross-sectional survey study design. Setting: Thirty-two academic/nonacademic centers nationally and internationally. Measurements and Main Results: The survey was developed among a core group of physicians with the assistance of the Survey Research Center at Mayo Clinic, Rochester, Minnesota. The survey was pilot tested for functionality and reliability. The response rate was 82 (51%) of 160 among the 32 centers. Although propofol was the induction drug of choice, there was a significant difference with actual ketamine use and those who indicated a preference for it (ketamine: 52% vs 61%; P < .001). The most common airway device used for intubation was direct laryngoscopy (Miller laryngoscope blade) at 56 (68%) followed by video laryngoscopy at 26 (32%). Most (>90%) indicated that they have a difficult airway cart, but only 55 (67%) indicated they have a documented plan to handle a difficult airway with even lower results for documented review of adverse events (49%). Conclusion: Although propofol was the induction drug of choice, ketamine was a medication that many preferred to use, possibly relating to the fact that the most common complication postintubation is hypotension. Direct laryngoscopy remains the primary airway device for endotracheal intubation. Finally, although the majority stated they had a difficult airway cart available, most did not have a documented plan in place when encountering a difficult airway or a documented process to review adverse events surrounding intubation.

Video vs. Direct Laryngoscopy

2018 ◽  
pp. 3-7
Keyword(s):  
Direct Laryngoscopy ◽  
Cervical Spine Injury ◽  
Rapid Sequence Induction ◽  
Spine Injury ◽  
Rapid Sequence ◽  
Lehane Grade ◽  
Airway Pathology ◽  
Sequence Induction ◽  
Grade 3 ◽  
Time Required

This chapter focuses on a randomized clinical trial asking the question: How does the GlideScope® Video Laryngoscope compare with direct laryngoscopy (DL) in terms of laryngoscopic view and time required for intubation? The study included adults electing surgery for which laryngoscopy was needed and excluded patients requiring rapid sequence induction or those with elevated intracranial pressure, known airway pathology, or cervical spine injury. In most patients, the GlideScope® yielded improved laryngoscopic views compared with DL, especially in the Cormack and Lehane grade 3 patients, demonstrating an advantage over DL for difficult intubations. This study was terminated early at 200 patients when the data demonstrated a difference in the GlideScope® view.

scholarly journals C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 225 ◽  
Author(s):  
Byeong Chul Min ◽  
Jong Eun Park ◽  
Gun Tak Lee ◽  
Tae Rim Kim ◽  
Hee Yoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Cardiopulmonary Resuscitation ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Multiple Logistic Regression Analysis ◽  
Video Laryngoscope ◽  
Multiple Logistic Regression ◽  
Total N ◽  
Significant Difference

Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17–2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.

scholarly journals Prediction of Difficult Airway Among Patients Requiring Endotracheal Intubation in a Tertiary Care Hospital in Eastern Nepal

2017 ◽  
Vol 56 (207) ◽  
pp. 314-318 ◽  
Author(s):  
Sindhu Khatiwada ◽  
Balkrishna Bhattarai ◽  
Krishna Pokharel ◽  
Roshan Acharya
Keyword(s):  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Tertiary Care ◽  
Difficult Laryngoscopy ◽  
Screening Tests ◽  
Care Hospital ◽  
Laryngoscopic View ◽  
Predictive Values ◽  
Lehane Grade

Introduction: Unanticipated difficult intubation is an undesirable situation. Various bedside screening tests are routinely performed for predicting difficult airway. Although considered a surrogate indicator, difficult laryngoscopy is not the exact measure of intubation difficulty. We aimed to determine the best screening test for predicting difficult laryngoscopy and the association between difficult laryngoscopic view and difficult intubation. Methods: This prospective, observational study involved 314, ASA I/II adult patients requiring endotracheal intubation for various routine surgical procedures. Sternomental distance < 12 cm, thyromental distance < 6.5cm, inter-incisor distance < 3.5 cm, mandibular protrusion grade 3 and modified Mallampati class III/IV were the predictors of difficult laryngoscopy. Laryngoscopic view was defined as ‘difficult’ when the Cormack and Lehane grade was III/ IV. The sensitivity, specificity, positive and negative predictive values and accuracy of these predictors were compared to find out the best predictor. Requirement of >3 attempts for insertion of the tracheal tube was defined as ‘difficult intubation’. The association between difficult laryngoscopic view and difficult intubation was determined. Results: The sensitivity of the modified Mallampati class for predicting difficult laryngoscopy was highest (83%). Twelve (3.8%) patients had grade III laryngoscopic view and none had a grade of IV. Intubation was difficult in seven (2.2%) patients. Majority of patients (4 of 7) with difficult intubation had difficult laryngoscopic view (p<0.001). Conclusions: Modified Mallampati test was better for predicting difficult laryngoscopy compared to other bedside screeing tests. Difficult laryngoscopy could significantly predict difficult intubation in our patients.   Keywords: Airway evaluation; difficult intubation; difficult laryngoscopy; modified Mallampati class; Nepalese patients; sensitivity.

Efficacy of Oral Carvedilol Premedication in Attenuating the Hemodynamic Response to Direct Laryngoscopy and Endotracheal Intubation

2020 ◽  
Vol 5 (2) ◽  
pp. 1071-1075
Author(s):  
Siddhartha Koirala ◽  
Yogesh Dhakal ◽  
Sameep Raj Baral ◽  
Ashish Ghimire
Keyword(s):  
Heart Rate ◽  
Adverse Effects ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Low Dose ◽  
Elective Surgery ◽  
Demographic Data ◽  
Systemic Hypertension ◽  
Hemodynamic Responses ◽  
Significant Difference

Introduction: Laryngoscopy and endotracheal intubation is associated with significant hemodynamic changes. Though these changes are well tolerated in healthy patients, they are undesirable in patients with comorbidities like coronary artery disease, systemic hypertension, myocardial insufficiency and intracranial hypertension. Various drugs have been tried in an effort to attenuate adverse hemodynamic responses to intubation, but so far none is ideal.  Objectives: To find efficacy of low dose oral carvedilol in attenuating the hemodynamic responses to direct laryngoscopy and endotracheal intubation.  Methodology: In this randomized, prospective, double-blind placebocontrolled study 80 patients of either sex aged between 18 and 60 years of age, belonging to the American Society of Anesthesiologists (ASA) health status Classes I and II, undergoing elective surgery requiring general anesthesia with endotracheal intubation were included. Patients were randomly divided into two groups. Group A: given 3.125 mg of Carvedilol orally and Group B: given a placebo (Vitamin B capsule) orally one hour before intubation with sips of water. Hemodynamic parameters were noted before and then 1, 2, 5, 10, 15 min after intubation. Any adverse effects associated with drugs were noted.  Results: Both groups were well matched for their demographic data. There was a statistically significant difference (P< 0.05) between carvedilol and placebo in heart rate at all points of measurement after tracheal intubation. The systolic blood pressure was significantly lower in carvedilol group only at 5min after intubation. Diastolic and mean blood pressures were comparable in every points of measurement. None of the patients had any adverse effects.  Conclusion: Low dose carvedilol has statistically significant effect in attenuating the heart rate response to direct laryngoscopy and endotracheal intubation.

A Comparison of Paramedic First Pass Endotracheal Intubation Success Rate of the VividTrac VT-A 100, GlideScope Ranger, and Direct Laryngoscopy Under Simulated Prehospital Cervical Spinal Immobilization Conditions in a Cadaveric Model

2017 ◽  
Vol 32 (6) ◽  
pp. 621-624 ◽  
Author(s):  
Ryan Hodnick ◽  
Tony Zitek ◽  
Kellen Galster ◽  
Stephen Johnson ◽  
Bryan Bledsoe ◽  
...  
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Intubation Attempt ◽  
Spinal Immobilization ◽  
Significant Difference ◽  
Intubation Success ◽  
First Pass ◽  
Intubation Success Rate ◽  
Cadaveric Model

AbstractObjectiveThe primary goal of this study was to compare paramedic first pass success rate between two different video laryngoscopes and direct laryngoscopy (DL) under simulated prehospital conditions in a cadaveric model.MethodsThis was a non-randomized, group-controlled trial in which five non-embalmed, non-frozen cadavers were intubated under prehospital spinal immobilization conditions using DL and with both the GlideScope Ranger (GL; Verathon Inc, Bothell, Washington USA) and the VividTrac VT-A100 (VT; Vivid Medical, Palo Alto, California USA). Participants had to intubate each cadaver with each of the three devices (DL, GL, or VT) in a randomly assigned order. Paramedics were given 31 seconds for an intubation attempt and a maximum of three attempts per device to successfully intubate each cadaver. Confirmation of successful endotracheal intubation (ETI) was confirmed by one of the six on-site physicians.ResultsSuccessful ETI within three attempts across all devices occurred 99.5% of the time overall and individually 98.5% of the time for VT, 100.0% of the time for GL, and 100.0% of the time for DL. First pass success overall was 64.4%. Individually, first pass success was 60.0% for VT, 68.8% for GL, and 64.5% for DL. A chi-square test revealed no statistically significant difference amongst the three devices for first pass success rates (P=.583). Average time to successful intubation was 42.2 seconds for VT, 38.0 seconds for GL, and 33.7 for seconds for DL. The average number of intubation attempts for each device were as follows: 1.48 for VT, 1.40 for GL, and 1.42 for DL.ConclusionThe was no statistically significant difference in first pass or overall successful ETI rates between DL and video laryngoscopy (VL) with either the GL or VT (adult).HodnickR, ZitekT, GalsterK, JohnsonS, BledsoeB, EbbsD. A comparison of paramedic first pass endotracheal intubation success rate of the VividTrac VT-A 100, GlideScope Ranger, and direct laryngoscopy under simulated prehospital cervical spinal immobilization conditions in a cadaveric model. Prehosp Disaster Med. 2017;32(6):621–624.

scholarly journals Comparison of fastrach LMA and ILMA methods for airway management

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Mustafa Ozgur Cırık ◽  
◽  
Ramazan Baldemir ◽  
Sema Avcı ◽  
Hayal Tezel ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Upper Airway ◽  
Demographic Parameters ◽  
Success Rates ◽  
Airway Complications ◽  
Group I ◽  
Significant Difference ◽  
Intubation Success

The aim of this study is to compare the hemodynamic responses, durations of intubation, intubation success rates and postoperative upper airway complications between the intubation performed with direct laryngoscopy and blind intubation performed with LMA-Fastrach application in normotensive patients. This present study was performed with the approval of ethical committee and in the surgery rooms between the date March 2010-August 2010. The study was performed on 80 patients aged between 18 and 60 and had American Anesthetists Assosiation (ASA) classification I-II. Endotracheal intubation was essential in their elective abdomen surgeries. The patients were divided into 2 groups as ILMA-Fastrach Group (Group I, n=40) and laryngoscopy group (Group L, n=40). 80 patients aged between 18 and 60. Of those, 54 (67.5%) were female and 26 (32.5%) were male. The age average of the patients was 46.3 ± 10.7. There was not a statistically significant difference between the demographic parameters of the patients. When compared to the onset value of SAP in Group I and Group L, a statistically significant difference was not detected in the groups in terms of SAP 1st minute and 5th minute values. When compared to the SAP onset value of the cases, the decrease in the 1st minute was statistically significant and when compared to the 1st minute value, the decrease in the 5th minute was not statistically significant. In the groups, a statistically significant difference was not observed in terms of DAP outset 1st and 5th minute values. When compared to the DAP onset value of the patients in Group L, the increase in the 1st minute was statistically significant. When compared to the 1st minute value, the decrease in the 5th minute was statistically significant. When compared to the onset value of MAP in Group L, the increase in the 1st minute was statistically significant. In terms of HR onset 1st and 5th minute values a statistically significant value was not detected. In conclusion, patients performed endotracheal intubation with LMA-Fastrach was more stabile than the ones intubated with direct laryngoscopy in terms of hemodynamics. Fewer complications were observed in LMA-Fastrach group and there was not any difference in terms of success rates.

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