Making Endotracheal Intubation Easy and Successful, Particularly in Unexpected Difficult Airway

Overview

Journal Int J Crit Illn Inj Sci

Specialty Critical Care

Date 2014 Apr 18

PMID 24741494

Citations 2

Authors

Susanne Abdulla

Sina Abdulla

Karl-Peter Schwemm

Regina Eckhardt

Walied Abdulla

Affiliations

Soon will be listed here.

Abstract

Background: Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians.

Purpose: We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study.

Settings And Design: Operating room, emergency department, intensive care unit (ICU), retrospective observational study.

Materials And Methods: A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise.

Statistical Analysis: Descriptive.

Results: Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists.

Conclusions: The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed.

Citing Articles

[Correlation between Predictive Index of Difficult Intubation and Cormack].

Dominguez-Perez M, Gonzalez-Dzib R Rev Med Inst Mex Seguro Soc. 2022; 61(1):15-20.

PMID: 36542358 PMC: 10395993.

Hemodynamic responses to tracheal intubation with Bonfils compared to C-MAC videolaryngoscope: a randomized trial.

Ezhar Y, DAragon F, Echave P BMC Anesthesiol. 2018; 18(1):124.

PMID: 30193574 PMC: 6129002. DOI: 10.1186/s12871-018-0592-7.

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