Fiberoptic intubation and laryngeal morbidity: a randomized controlled trial.

Background: Tracheal intubation with neuromuscular blocking agents is associated with a low incidence of minor vocal cord sequelae (8%). The aim of this noninferiority trial was to demonstrate that the frequency of vocal cord sequelae after fiberoptic intubation with a flexible silicone tube without neuromuscular blocking agents was less than 25% (maximum tolerable inferiority).

Methods: Two-hundred seventy patients were prospectively randomized to two groups.

Algorithms for management of the difficult airway.

Purpose Of Review: The purpose of this review is to examine recent evidence for the management of the difficult airway.

Recent Findings: Recent findings still recommend the importance of a predefined, simple strategy for both the anticipated and unanticipated difficult airway. For the former, awake fiberoptic intubation is still the 'gold standard'.

Comparison of direct and video-assisted views of the larynx during routine intubation.

Objective: To compare the direct and indirect (video monitor) views of the glottic opening using a new Macintosh blade that is modified to provide a video image of airway structures during laryngoscopy.

Design: Prospective multicenter trial.

Setting: 11 university-affiliated hospitals.

[Videolaryngoscopy versus direct laryngoscopy for elective endotracheal intubation].

Background: We compared the ease of viewing the glottis under direct vision during conventional laryngoscopy with the quality of indirectly viewing on a monitor during laryngoscopy with a Macintosh videolaryngoscope in a multicenter study.

Patients And Methods: After ethical approval and written informed consent of 300 patients with no anticipated difficult airway, conventional laryngoscopy with a Macintosh videolaryngoscopy blade was performed and the quality of the view of the glottis was assessed and documented according to the Cormack and Lehane scoring system as modified by Yentis and Lee. Subsequently, the indirect viewing conditions on the monitor were documented without changing the position of the blade.

Strategies and algorithms for management of the difficult airway.

Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios.

Comparision of etomidate and propofol for fibreoptic intubation as part of an airway management algorithm:a prospective, randomizes, double-blind study.

Background And Objective: In our algorithm for management of the anticipated difficult airway the induction agent (etomidate) is administered after the tip of the fibreoptic is placed in the trachea but before the tube is advanced over it. In a previous investigation we demonstrated the safety of this method. Due to its popularity as an induction agent, some would like to replace etomidate with propofol.

Structure and process quality illustrated by fibreoptic intubation: analysis of 1612 cases.

The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications.

[Comparison of algorithms for management of the difficult airway].

Management of the difficult airway and maintenance of the oxygenation are the most important tasks of the anaesthetist. Respiratory problems are still the most important single cause for anaesthesia-related accidents with poor outcome. Algorithms are step-wise procedures developed from a great number of recommendations and are well suited to automation and training procedures.

Fiberoptically-guided insertion of transtracheal catheters.

Regular use of the transtracheal catheter (TTC) both offers an opportunity for training for the difficult airway and facilitates elective endoscopic surgery. Fiberoptic guidance and exploratory puncture improve the insertion of the TTC.

Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies--an analysis of 13,248 intubations.

A fundamental skill of the anesthesiologist is airway management. We validated a simple endotracheal intubation algorithm with a large proportion of fiberoptic tracheal intubations used for years in daily practice. Over 2 yr, 13,248 intubations (>90% of all intubations, including obstetrics and ear, nose, and throat patients) in a heterogeneous patient population at our acute care hospital were evaluated prospectively.

[The difficult intubation. The value of BURP and 3 predictive tests of difficult intubation].

Unlabelled: The value of BURP (= backwards-upwards-rightwards-pressure of the larynx) was tested as a improvement of the visualisation of the larynx. Simultaneously we wanted to assess the value of different predictive tests of a difficult intubation, which are easy to perform as bedside tests.

Patients And Material: 1993 patients of all different surgical clinics in a tertiary care hospital in Switzerland were tested, the complete anaesthesiological staff was involved.

[Does post-puncture syndrome following lumbar puncture depend on needle diameter?].

The impact of needle size on the frequency of post-lumbar puncture syndrome (PPS) was investigated in 77 patients undergoing diagnostic lumbar puncture. 22-gauge needles were used in 44 patients (group A) and 19-gauge needles in 33 (group B). Because of severe postdural headache, an epidural blood patch was applied in 6 patients and resulted in immediate relief of symptoms.

[Postpuncture headache and blood patch].

Anesthetists performing spinal and epidural anaesthesia will inevitably be confronted with the problem of postspinal headache. Exact knowledge as to cause, diagnosis, and treatment of this troublesome complication are mandatory. The most important method of treatment, the epidural blood patch, belongs to the armamentarium of every anesthetist.

[Difficult intubation due to an unusual anomaly of the larynx].

A patient, scheduled for an ophthalmic operation could not be intubated in spite of various different attempts. The cause of the difficulties was a cartilagineous thickening of the right ary-epiglottic fold, which was lying like a second epiglottis over the entry of the glottis. The importance of ventilation-management by mask and close cooperation with a laryngologist is stressed.

[Success and failure rate in peridural anesthesia. A 1-year study].

The real significance of epidural anaesthesia is determined by its practicability in the daily routine. The present paper shows, that about 20% of all operations which will be anaesthetized by a large anaesthesia department can be done under epidural anaesthesia. In 84,6% of all patients under epidural anaesthesia, anaesthesia was satisfactory; 4.

[Epidural buprenorphine for postoperative analgesia after hip operations].

Two groups of 20 patients each were given immediately after hip-operation an epidural injection of 0,15 or 0,3 mg buprenorphine. Effects and side effects are compared with those observed in two groups of patients having the same type of operation, and given either 4 mg of morphine or saline (placebo) by epidural injection. Buprenorphine in both doses produced a shorter duration of analgesia than 4 mg of morphine.

[Postoperative analgesia with epidural morphine after hip operations (author's transl)].

80 patients undergoing hip surgery under lumbar epidural block have been studied (double blind) for postoperative analgesia. There were 4 groups, of 20 patients each, who received a single epidural injection of 0 mg, 2 mg or 4 mg morphine in 1 ml of saline added to 6 ml bupivacaine 0.5% or 4 mg morphine in 6 ml saline.

[Methods influencing intraoperative heat balance in the sterile enclosure (author's transl)].

More and more operations are performed in a sterile enclosure ("Sterilboxe") with a high fresh air turnover to achieve an optimum aseptic standard. This study investigated the question whether the climate of the "Sterilboxe" has a depressing effect on the body temperature of anaesthetized patients. Furthermore various devices were tested for their value in compensating for heat losses.