Showing 10 results for Airway
Hassani V, Ardehali Sh,
Volume 59, Issue 4 (8-2001)
Abstract
Post-operative sore throat is one of the most common complications and complaints of patients after general anesthesia especially in operations that need endotracheal intubations. Its causes are: size of endotracheal tube and type of its cuff, inadequate airway humidification, trauma during intubation and suctioning, high flow of inspiratory gases, surgical manipulation of airway and adjacent organs, ect. Use of instruments with less invasion to upper respiratory tract, for example, face mask and airway, LMA or CPT are methods, used for decreasing the rate of post-operative sore throat. This study was performed to compare the rate of sore throat after general anesthesia between Laryngeal Mask Airway (LMA) and Cuffed Pharyngeal Tube (CPT). From the patients, 120 ASA: PS-I cases, were selected, who were candidates for elective surgery of Orthopedics, Urology, General surgery and Gynecology in Hazrat Rasool-Akram Hospital Complex in the year 2000. Their operation were performed in supine position and did not need muscle relaxation and the patients had spontaneous breathing. Duration of surgery was less than 2 hours. The patients were randomly allocated into two groups: LMA was used for one group and CPT for others. Immediately after operation, in the recovery room and at 6, 12, 18 and 24 hours after removing the tube, the patients were asked about sore throat and the results were recorded in the related sheets. The results was 31.7 percent of patients in group LMA and 0 percent of patients in group CPT, had sore throat. There were significant difference between groups (LMA and CPT) in presentation of sore throat (P<0.001).
Gharabaghian M, Sadeghy Sa, Mir Mohammad Sadeghi Sf, Rafieyani Sa,
Volume 60, Issue 4 (7-2002)
Abstract
Background: Cuffed pharyngeal tube is a device designed for ventilation of anesthetized patients. CPT has advantages over face mask including: maintaining of face mask can be difficult and boring after several minutes and mobility of the practitioner is reduced due to involvement of hands. Mask pressure can cause soft tissue and nerve damage around the nose. Anesthetic gas leakage from the mask adds to the operation room pollution. In difficult intubation CPT can be life-saving.
Materials and Methods: In our study CPT was compared with endotracheal tube (ET) in anesthetized patients. A scoring system for evaluating ventilation of patients was designed using symmetric chest wall motion during ventilation with anesthesia bag and sensing lung compliance through it, auscultation of breathing sounds, oscilation of bag with breathing and peripheral oxygen saturation by pulse oxymetry. Respiratory complications (pulmonary aspiration, Iaryngospasm and bronchospasm, nausea and vomiting) were looked for during anesthesia.
Results: The results showed that CPT was successful as ET in ventilation of spontaneously breathing patients and incidence of respiratory complications with CPT was no more than ET. Airway resistance was significantly greater with CPT than ET (P<0.05). Patients with ET had significantly greater incidence of sore throat than with CPT (P<0.05).
Conclusion: Thus we concluded that CPT can be used for ventilation of anesthetized patients not predisposed to pulmonary aspiration and whose peak airway pressure does not exceed 20-25 CmH2O.
Noyan Ashraf M.a, Zanjani A.p.e,
Volume 64, Issue 7 (8-2006)
Abstract
Background: During general anesthesia in patients with mediastinal mass compression effect on the heart, great intra thoracic vessels, or tracheal tree can lead to decrease venous return, cardiovascular collapse or tracheal obstruction. These complications may be worsened after induction of general anesthesia or prescribing muscle relaxants.
Case report: A twenty one years old female with huge anterior mediastinal mass was a candidate for right sided thoracotomy. Compression effect on the adjacent structures has been reported in chest CT scan and in echocardiography. Awake oro-tracheal intubation was performed in sitting position. Then patient positioned to left lateral decubitus for thoracotomy During surgery asystole occured. We changed the position to remove compression effect on the heart and great vessels. Fortunately these maneuvers changed asystole to sinus rhythm.
Conclusion: Decreased thoracic muscular tone and removed spontaneous ventilation after muscle relaxant may threaten patient’s life. Change of patient’s position can remove the compression effect.
Hosein Khan Z, Arbabi Sh, Ebrahim Soltani A,
Volume 65, Issue 1 (3-2008)
Abstract
Airway management is one of the most important subjects in medicine. This article reviews the history, assessment of airway prior to anesthesia, techniques and equip-ment of airway management and management of patients with anticipated and unan-ticipated difficult airways. This article covers recent literature on airway appliances and devices and their use in different circumstances. Airway assessment methods especially the recent Iranian method have been reviewed and discussed briefly in this article. On the whole the article covers the etiology of difficult airway and offers guidelines for safe practice of anesthesia in patients in whom airway is anticipated to be difficult.
Hussain Khan Z, Mirazimi F,
Volume 65, Issue 5 (8-2007)
Abstract
Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. If the anesthetist can anticipate which patients may be more difficult to intubate, can reduce the risks of anesthesia greatly and be more prepared for any difficulties that may occur. The aim of this study was to investigate the inability of patients to protrude the lower jaw in predicting difficult intubation.
Methods: In this prospective study, we enrolled 300 patients, above 16 years of age or older, who were scheduled for elective surgery. For all of the patients, before each operation, a single anesthesiologist measured the temporomandibular mobility, which was defined as the difference between the distances, from the lower incisors to the upper incisors in a neutral position and at maximum mandibular protrusion. At the time of intubation, another anesthesiologist, blinded to the preoperative airway assessment test, performed a laryngoscopy in which the laryngoscopic view of the larynx was determined according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.
Results: Twenty-one patients were identified as having difficult intubation. Only one patient could not be intubated. The forward movement of the mandible was significantly greater in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, P<0.001). The use of a cut-off point of less than 5 mm for prediction of difficult intubation showed a sensitivity of 92.86% and a specificity of 70.43%.
Conclusion: The forward movement of the mandible is significantly greater in patients with easy intubation compared those with difficult intubation Although infrequent difficulties may arise, most patients that do not have indicators of difficult intubation will be easy to intubate under anesthesia.
Hoseinkhan Z, Shamloo Sani N, Naghibi Mahmoodabadi T, Taghizadeh Imani A,
Volume 67, Issue 2 (5-2009)
Abstract
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Background: The ability
of a specific test to predict a difficult intubation is decreased by the
variability of definitions of difficult intubation/laryngoscopy. The Mallampati
classification system is a widely utilized approach for evaluating patients in
the preoperative setting. Zero class of Mallampati is a new class of airway
view that to add to the four modified Mallampati classes. This study estimates
the incidence of class zero airway and determines the ability of Mallampati
score, age and sex on the prediction of the larangoscopy grade.
Methods: This is a
cross sectional study in which 376 patients aged 7-18 years and A.S.A physical
status I or II were enrolled. They were scheduled for surgery under general
anesthesia All the airway assessments were done in the sitting position, with
the patient's head in neutral position, mouth fully open, tongue fully extended
and without phonation. After induction of general anesthesia, laryngoscopy
grade was assessed in sniffing position using the Cormak & Lehame grading
scale.
Results: Class zero
airways occurred in 0.3% of patients, and the patients with class zero airway
had a grade I laryngoscopy. 49.5% of patient had class I, 37.2% class II, 13%
of patient had class III and there found no patient with class IV airway. Grade
II and III laryngoscopy were more frequent in females than in males but this
correlation was not statistically significant.
Conclusions: Assessment
of airway by Mallampati scoring system and attention to the age can be an
important factor in the prediction of high laryngoscopy grade.
Noyan Ashraf Ma, Shahrokhi Damavand Sh, Maghsoodloo M, Peiravy Sereshke H,
Volume 67, Issue 2 (5-2009)
Abstract
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Background: The prediction of the probability of
difficult intubation and the associated problems before Induction of anesthesia
could be lifesaving. The aim of this study was the investigation of association
between the stage of thyroid cartilage prominency and laryngoscopic view for
predicting the difficult intubation.
Methods: Five hundred and thirty five patients
aged 18-60 years old,
with prominent thyroid cartilage, "Adam's apple", enrolled in a cross
-sectional study based on the stage of "Adam's apple" and the relationship with
laryngoscopic view. After induction of anesthesia, laryngoscopy performed and
laryngoscopic view of larynx was recorded, and analyzed according to Modified
Cormackand Lehane's Scoring.
Results: No significant association between
laryngoscopic view and thyroid cartilage prominency staging was observed. There
was no significant relationship in females and aged under 50 y.o. The relationship in males with poor
correlation coefficient was significant. The results are as follows: [male :(p=0.028, r=-0.096),
Female: (p=0.821, r=0.082), <50
yrs: (p=0.87, r=0.007)
no significant association for age decades and thyroid cartilage prominency
stages, were observed. In ages above 50 y.o, difference was significant. Thirty patients had a
laryngoscopic view in which the tracheal rings were visible just bellow the
vocal cords.
Conclusions: As
the increased age was related to laryngoscopic view and thyroid cartilage
prominency stage it seems that there is relationship between ages over 50 y.o and difficulty of laryngoscopic
view or intubation. With the observation of a view different from the grade I Cormack and Lehane's scoring, we named
it the "stage Ia"
that the tracheal rings are visible bellow the vocal cords during laryngoscopy.
Noyan Ashraf Ma, Samadi Sh, Ghanaati H, Farahani Dawood-Abadi A,
Volume 67, Issue 5 (8-2009)
Abstract
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Background: The
insertion depth of tracheal tube differs based on sex, age, position of head
and neck, type of surgery, and anatomical consideration. The aim of this study
was to determine the airway related distances in Iranian patients with a
non-invasive, and accurate method, the computerized reconstruction of High
Resolution CT
(HRCT)
Virtual Bronchoscopy.
Methods: A total of 140 Iranian
patients who became candidate for sinus and chest tomography, were enrolled in
a cross- sectional study in Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2008. After
reconstruction of airway related distances, Incisor- Vocal cord (IVD), Vocal
cord- Carina (VCD) and
Incisor- Carinal (ICD) Distances were determined.
Results: A total of 140 patients
were evaluated, while 70(50%) were male. There was no statistically significant
difference between age groups, sex and BMI in study patients. The
measured IVD were 145.5±9.7 (males), 127.29±6.3 (females)
and 136.43±12.29mm (total).
For VCD, the
distances were 131±13.99 (males), 122.59±11.7 (females), and 127.09±13.65mm (total).
The measures for ICD in males, females, and total of patients were 277.17±16.63, 249.88±11.54, and 263.52±19.66mm
respectively.
Conclusion: The insertion depth for fixation of endotracheal tube
in Iranian adult patients is the same as that of anesthesia textbooks. There
were no statistically significant difference between our study data and
previously measured distances using invasive and less accurate methods. Virtual
bronchoscopy is a noninvasive and accurate method based on reconstruction of
computed tomographic images and the reconstructed images of tomography could be
useful in measuring and assessment of airway anatomy.
Khosro Barkhordari , Samaneh Yaghooti , Sepideh Nikkhah , Afsaneh Aein , Arash Jalali , Akbar Shafiee ,
Volume 74, Issue 9 (12-2016)
Abstract
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Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable.
Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95) and the control group (n= 161). The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr)> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG) characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups.
Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively). There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005) and also the euroSCORE was higher (P< 0.002). There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both) as well as lower HCO3 and pH (P< 0.001 for both) were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both). The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups.
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Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.
Alireza Mahoori, Nazli Karami , Seyedeh Zahra Karimi Sarabi ,
Volume 77, Issue 9 (12-2019)
Abstract
Background: Emergence from general anesthesia and removing of tracheal tube can be associated with coughing, agitation, and hemodynamic disturbances. Dexmedetomidine is an alpha two adrenoceptor agonist that has effective sedation with less cardiovascular unstability and respiratory depression and may be useful for extubation and prevention of hemodynamic response during tracheal tube removing. The aim of this study was to evaluate the effect of dexmedetomidine on hemodynamic responses during endotracheal extubation and sedation level in recovery room.
Methods: In an analytical study, fifty women aged 20-50 years old candidate to cholecystectomy under general anesthesia and tracheal intubation were entered randomly to this study in two groups (no. 25) at Imam Khomeini Hospital, Urmia, Iran, and under support of Urmia University of Medical Sciences Urmia, Iran, from May 2017 to May 2018. Ten minutes before end of surgery, 0.8 µg/kg dexmedetomidine in the study group and for the other patients in control group normal saline as placebo were infused over ten minutes. During the emergence phase, blood pressure, heart rate and oxygen saturation were recorded at 0,1,2,3 and 5 minutes after extubation. Also, sedation index was evaluated via the Ramsay sedation score and recorded at recovery room.
Results: Heart rate, systolic blood pressure and diastolic blood pressure in patient with infusion of dexmedetomidine were lower significantly at 1,2,3 and 5 minutes after extubation than control group. Data for heart rate, systolic and diastolic pressure, at min 1 after extubation were 81±6 vs. 88±9, 120.64±13.21 vs. 137.52±11.06, 72.84±8.32 vs. 81.36±9.26 in dexmedetomidine and control groups respectively. Data for heart rate, systolic and diastolic pressure, at min 5 after extubation were 73±6 vs. 80±8, 110.64±10.68 vs. 119.88±10.01, 69.84±8.32 vs. 73.48±5.13 in study and control groups, respectively. As well as 80% of the patients in dexmedetomidine group had satisfactory sedation and cooperation in compare to the 28% in control group (P=0.001).
Conclusion: Intravenous infusion of 0.8 µg/kg dexmedetomidine 10 minutes before extubation of endotracheal tube and during emergence, facilitate extubation and lead to hemodynamic stability and satisfactory sedation.
