Endotracheal intubation with Airtraq versus Storz videolaryngoscope in children younger than two years - a randomized pilot-study

ABSTRACT: BACKGROUND: New laryngoscopes have become available for use in small children. The aim of the study was to compare the Storz videolaryngoscope (SVL) to the Airtraq Optical laryngoscope (AOL) for tracheal intubation in children younger than two years of age who had a normal airway assessment. Our hypothesis was that the SVL would have a better success rate than the AOL. METHODS: Ten children aged 2 years or younger scheduled for elective cleft lip/palate surgery were included. The anesthesia was standardized and a Cormack-Lehane (CL)-score was obtained using a Macintosh laryngoscope. After randomization CL-score and endotracheal tube positioning in front of the glottis was performed with one device, followed by the same procedure and intubation with the other device. The video-feed was recorded along with real-time audio. The primary endpoint was the success rate, defined as intubation in first attempt. Secondary endpoints were the time from start of laryngoscopy to CL-score, tube positioning in front of the glottis, and intubation. RESULTS: Two intubation attempts were needed in two of five patients randomized to the SVL. The difference in time (SVL vs. AOL) to CL-score was 4.5 sec (p = 0.0449). The difference in time (SVL vs. AOL) to tube positioning was 11.6 sec (p = 0.0015). Time to intubation was 29.0 sec for SVL and 15.8 sec for AOL. CONCLUSION: No difference in the success rate of endotracheal intubation could be established in this ten patient sample of children younger than two years with a normal airway assessment scheduled for elective cleft lip/palate surgery. However, the Airtraq Optical videolaryngoscope showed a number of time related advantages over the Storz videolaryngoscope. Because of the small sample size a larger trial is needed to confirm these findings. Both devices were considered safe in all intubations.     

Endotracheal Tube Perforation of the Hypopharynx

Perforation of the hypopharynx or esophagus is a serious though not often reported complication of endotracheal intubation. Only 12 cases had been reported before the eight which are presented here to emphasize this hazard of intubation. The early symptoms of perforation, which occurred during insertion of the tube, were: subcutaneous emphysema (seven patients), mediastinal emphysema (six), pneumothorax (two), cardiac arrest (one). One patient had no recognized early signs of perforation, but presented with an abscess of the mediastinum six weeks later. The site of perforation, determined by endoscopy in six patients, was the lateral hypopharynx in four, and the vallecula in two. The outcome of the eight perforations was as follows: two patients recovered on conservative management; in two, abscesses of the neck and in one an abscess of the mediastinum developed. All three recovered after drainage of the abscesses. Three patients died. Two outstanding characteristics of these eight cases were that in all of them intubation was attempted by physicians relatively inexperienced in the technique, and in all but one it was done in emergency. Since the use of intubation in emergency situations is increasing, all physicians in training should receive formal instruction in technique.     

Endotracheal Anæsthesia

(1) With certain exceptions, endotracheal an?sthesia is the best method for operations on the head and neck and for any other operation in which there may be a difficulty in controlling the patient's air-way. (2) Expiration should be provided for, in endotracheal an?sthesia, either by means of a second tube or by a tube of calibre sufficient to permit to-and-fro respiration. (3) Cocainization of the upper air-passages has decided advantages in endotracheal an?sthesia. (4) "Blind" intubation through the nose renders the method possible in cases where it is impossible to use a speculum. (5) The insufflation method is not specially indicated in abdominal surgery. (6) The routine use of endotracheal an?sthesia in teaching-hospitals for every class of case is detrimental to the production of sound an?sthetic knowledge in students who are likely to become general practitioners.     

大鼠气管插管方法学概述

由于大鼠呼吸频率较快、口腔狭小、声门较高,医学实验中气管内插管操作具有较多困难,多年来很多学者对大鼠气管内插管方法进行了大量研究。本文主要对大鼠气管内插管时动物和气管导管的选择、麻醉方式、插管的体位以及各种插管工具和方法等作一简要的综述。