Efficacy of height-based formula to predict insertion depth of left-sided double lumen tube: A prospective observational study

The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height0.916) could predict the accurate insertion depth of a left-sided double-lumen tube. After obtaining ethical approval, 66 patients who underwent thoracic surgery were included. A left-sided double-lumen tube was advanced blindly to the predicted depth of insertion calculated using our formula. The optimal position of the left-sided double-lumen tube was confirmed using a fibreoptic bronchoscope. The primary outcome was the percentage of tubes placed in the optimal position without the need for further adjustments. The secondary outcomes included the need for bronchoscopic adjustments and the final correct insertion depth of the left-sided double-lumen tube. The formula resulted in an optimum position of the left-sided double-lumen tube without further adjustments in 45 patients (70%) (95% confidence interval 58%–80%). The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.

Implementation of an Anaesthesia Quality Improvement Programme to Reduce Fibreoptic Bronchoscope Repair Incidents

Background. This study was aimed at investigating the effectiveness of the implementation of a comprehensive quality improvement programme (QIP) for reducing the repair rate of the fibreoptic bronchoscope (FOB). Methods. A three-stage improvement strategy was implemented between January 2013 and December 2016. Stage one is the acquisition of information on violations of practice guidelines, repair rate, cost of repair, and incidence of unavailability of FOB during anaesthesia induction of the previous year through auditing. Stage two is the implementation of a quality improvement campaign (QIC) based on the results of stage one. Stage three is the programme perpetuation through monitoring compliance with policy on FOB use by regular internal audits. The effectiveness was retrospectively analyzed on a yearly basis. Results. The annual repair rate, repair cost, and incidence of FOB unavailability before the QIP implementation were 1%, 18,757 USD, and 1.4%, respectively. After QIC, the repair rate in 2013 dropped by 81% (from 1% in 2012 to 0.19% in 2013, p<0.05). The annual repair cost fell by 32% from 18,758 USD (2012) to 12,820 USD (2013). Besides, the incidence of FOB unavailability plummeted by 71% from 1.4% to 0.4% during the same period. The annual repair rates and incidence of FOB unavailability remained lower in subsequent three years than those before QIP implementation. Conclusion. Implementation of a quality improvement programme was effective for reducing the rate and cost of FOB repair as well as unavailability rate, highlighting its beneficial impact on cost-effectiveness and patient safety in a tertiary referral center setting.

A Study for dexmedetomidine for Fibreoptic intubation

Trauma is a major fitness hassle of modern-day society and maxillofacial injuries because of high-pace trauma from avenue visitors accidents, sports activities accidents or falls require airway renovation with cervical spine stabilisation and manage of bleeding along a unique set of problems.Compromised airway is lifestyles-threatening both within the early and later levels leading to hypoxia or obstruction. Awake fibreoptic bronchoscope (FOB)-guided endotracheal intubation (AFOI) is an powerful method for coping with patients with tough airway, and is presently taken into consideration the gold standard(eleven). Dexmedetomidine at a dose of 0.75 mcg/kg and 1.0 mcg/kg over 20 mins turned into drastically found to be powerful in maintaining sufferers comfy at some point of Awake fibre optic intubation. While 0.5 mcg/kg of loading dose had strong haemodynamics and did no longer have any adverse occasions, 1 mcg/kg of loading dose precipitated high blood pressure in 2 sufferers and 0.75 mcg/kg of loading dose triggered cardiac rhythm abnormality (ventricular ectopics) in one patient. Dexmedetomidine at a loading dose of 0.5 mcg/kg is secure, whereas loading doses of zero.75 mcg/kg and 1 mcg/kg gives better patient consolation. More quantity of research ought to be finished the use of a packing dose of 0.75 mcg/kg to set up its protection.

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

Background: Nasotracheal intubation (NTI) is frequently performed in oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy. Methods: Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was recorded using direct laryngoscopy five minutes after completing NTI and was scored as one of four grades according to the following modified criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis. Results: The time to complete NTI was significantly longer in the fibreoptic group than that in the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% confidence interval (CI), 10.4 to 18.1). In addition, mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9). No moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported at any time point after extubation in the two groups (P = 0.74). Conclusion: NTI can be completed successfully using either fibreoptic bronchoscopy or a Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, the Disposcope endoscope requires less execution time (the NTI time).

A comparison between the Disposcope endoscope and fiberoptic bronchoscope for nasotracheal intubation-A randomized controlled trial

Background: Nasotracheal intubation (NTI) is frequently performed in oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy. Methods: Sixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. Then, the NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was recorded using direct laryngoscopy five minutes after completing NTI and was scored as one of four grades according to the following modified criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis. Results: The time to complete NTI was significantly longer in the fibreoptic group than that in the Disposcope group (38.4 sec vs 24.1 sec; mean difference, 14.2 sec; 95% confidence interval (CI), 10.4 to 18.1). In addition, mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9). No moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported at any time point after extubation in the two groups (P = 0.74). Conclusion: NTI can be completed successfully using either fibreoptic bronchoscopy or a Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, the Disposcope endoscope requires less execution time (the NTI time).