Comparative effectiveness of topical lignocaine nebulization and airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis

Background: Awake fiber-optic nasal intubation is a gold standard management of difficult airway in temporal mandibular (TM) joint ankylosis. Aims and Objectives: We compared topical lignocaine nebulization with airway nerve blocks for awake fiber-optic nasal intubation in TM joint ankylosis. Materials and Methods: Fifty patients of either gender were randomly allocated into two groups of 25 each. Group I received 10 ml of 2% lignocaine nebulization over a period for 20 min. Group II received bilateral superior laryngeal nerve block and transtracheal recurrent laryngeal nerve block (each with 2 ml of 2% lignocaine). Awake fiber-optic bronchoscopy-guided nasal intubation was done in all patients. All the patients received sedation during the procedure. The intubation time, intubating conditions, vocal cord position, cough severity, and degree of patient satisfaction were recorded. Student’s t-test was used to analyze parametric data, while the Mann–Whitney U-test was applied to non-parametric data and Fisher’s test to categorical data. P<0.05 was considered statistically significant. Results: The time taken for intubation was significantly shorter in Group II [110.2 (14.6) s compared with Group I (211.0 [22.3] s) (P=0.028 ss). The intubating conditions and degree of patient comfort were better in Group II compared with Group I. Although all patients were successfully intubated, patient satisfaction was higher in Group II. Conclusion: Airway nerve block is a better way of anesthetizing airway as compared to nebulization for awake fiber-optic nasal intubation. However, nebulization with lignocaine may be an alternative in situations where nerve blocks are not feasible or may be used as an adjuvant to nerve blocks.

GOLDENHAR SYNDROME-NO MORE A CHALLENGE TO ANAESTHESIOLOGIST

A patient K/C/O Goldenhar syndrome came for right external ear reconstruction. Patient had typical features of the syndrome with hypoplastic mandible and maxillae, malocclusion of teeth ,malaligned teeth ,retrognathia and hypoplastic hyoid bone . Anticipating a difcult intubation it was decided to go ahead with awake intubation in this patient . Blind nasal intubation was planned because of unavailability of breoptic in our institution and it was achieved with 7 mm ivory white north pole tube with dexmedetomidine infusion at rate of 0.5mcg/kg/hr and topical anaesthesia .

Modified Retrograde Nasal Intubation: A New Airway Technique and Devices

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a “cannot intubate, cannot ventilate” scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices.

Conversion of an oral to nasal intubation in difficult nasal anatomy patients: two case reports

Background Nasal intubation is indispensable for some cases that require intraoral surgical access, and the fiberoptic bronchoscope is the best tool for difficult airways. However, fiberoptic bronchoscopy is not always possible in cases with altered pharyngeal anatomy. Case presentation In this report, we introduce a novel technique for retrograde endotracheal oral-to-nasal conversion with an ordinary endotracheal tube exchange catheter. A 49-year-old male with a fractured mandible angle and symphysis was scheduled to undergo mandible reconstruction. Secondly, a 45-year-old male who had a bone defect in the mandible angle and ramus was scheduled for mandible and oral cavity reconstruction. We chose to intubate orally first and successfully converted the endotracheal tube from oral to nasal retrogressively using a tube exchange catheter. Conclusions Our simple and safe technique, which use a tube exchange catheter retrogressively, provides an alternative method for a difficult airway in which the fiberscope is not helpful.

Repositioning of the Severe Prolapsed Silicone Tubes after Bicanalicular Nasal Intubation: A Novel Technique

Background. Bicanalicular nasal intubation is widely used in lacrimal drainage system surgery. Its common complication is lateral displacement or spontaneous prolapse. When the distal part of the silicone tubes cannot be seen in the nose endoscopically, either repositioning or removal could be a challenge. We developed a simple technique to reposition the severe prolapsed silicone tubes. Method. This retrospective study included 6 patients with severe prolapsed silicone tubes who had undergone bicanalicular nasal intubation between January 2017 and December 2019. We used a memory wire probe to pull a nylon suture through the lacrimal passage retrograde. Then, the nylon suture was cut into two lines. One line was coiled to the prolapsed tube and tied to another line. This nylon turned into a “lasso” to capture the silicone tube and then lock its knot. By pulling the nylon suture, the severe prolapsed silicone tube was repositioned to the nasal cavity. Results. Using this technique, we successfully repositioned severe prolapsed silicone tubes without any complication in 6 cases. Conclusions. Silicone tube reposition guiding by using a memory wire probe is an optional technique in the treatment of prolapse of silicone tubes, particularly if the distal part of the silicon tube was embedded in the lacrimal sac and cannot be seen in the nose by endoscopy. It is a feasible, minimally invasive, safe, and effective method, avoiding premature tube removal.

Correlation of nosocomial infection with prolonged hospital stay in Kano Nigeria

Nosocomial infections or Health Care prolonged hospital stay and has been implicated in increase in socio-economic disturbance, long term disability, and increased mortality rate. There is paucity information on the burden of HCAIs because of poorly developed surveillance systems and inexistent control methods. We aimed to investigate the prevalence of nosocomial infection due to prolonged hospital stay in selected tertiary hospitals of Kano metropolis. Retrospective data were collected from three hospitals with a total number of admitted patients and the number of prolonged hospital stays during the month of study. A total of 401 clinical samples collected from patients admitted for ≥14 days and the age of ≥18 years from all study sites. Examples include wound swabs, urine samples, urine catheters, and nasal intubation. All the samples were processed by the standard bacteriological laboratory procedure of the Clinical laboratory standard institute. The results showed that the percentage of prolonged hospital stay in Kano 40.34%, Murtala Muhammad Specialist Hospital (MMSH) 50.54% with the least at Muhammad Abdullahi Wase Specialist (MAWSH) 28.91%. Age served as significant factors for acquired HCAIs; participants aged were 41- 70 years have a higher prevalence of nosocomial infections. From 138 positive isolates observed, Murtala Muhammad Specialist Hospital (MMSH) has height nosocomial infection of 41.4%, with the least Aminu Kano Teaching Hospital (AKTH) has 29%. Among the Site of infection, 34.8% isolates were wounds Swabs (SSIs), urine (UTI) 31.2%, an least was nasal intubation 11.6%. Among pathogens isolated E. coli is the most prominent organism with 26.1% and the least Streptococcus pyogenes (7.9%). This study showed that the prevalence of Prolong hospital stay in Kano was 40.34%, AKTH 39.53% and MAWSH 28.91%. The prevalence of nosocomial infection was 34.3%. Gram-negative bacteria were the predominant isolates.