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Sample records for silicone tube intubation

  1. Comparison of Transcanalicular Multidiode Laser Dacryocystorhinostomy with and without Silicon Tube Intubation

    PubMed Central

    Yildirim, Yildiray; Kar, Taner; Topal, Tuncay; Cesmeci, Enver; Kaya, Abdullah; Colakoglu, Kadir; Aksoy, Yakup; Sonmez, Murat

    2016-01-01

    Aim. To compare the surgical outcomes of surgery with and without bicanalicular silicon tube intubation for the treatment of patients who have primary uncomplicated nasolacrimal duct obstruction. Methods. This retrospective study is comprised of 113 patients with uncomplicated primary nasolacrimal duct obstruction. There were 2 groups in the study: Group 1 (n = 58) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation and Group 2 (n = 55) patients underwent transcanalicular diode laser dacryocystorhinostomy surgery without bicanalicular silicon tube intubation. The follow-up period was 18.42 ± 2.8 months for Group 1 and 18.8 ± 2.1 months for Group 2. Results. Success was defined by irrigation of the lacrimal system without regurgitation and by the absence of epiphora. Success rates were 84.4% for Group 1 and 63.6% for Group 2 (P = 0.011). Statistically a significant difference was found between the two groups. Conclusion. The results of the study showed that transcanalicular diode laser dacryocystorhinostomy surgery with bicanalicular silicon tube intubation was more successful than the other method of surgery. Consequently, the application of silicone tube intubation in transcanalicular diode laser dacryocystorhinostomy surgery is recommended. PMID:27127644

  2. Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis

    PubMed Central

    Baek, Ji Sun; Lee, Saem; Lee, Jung Hye; Choi, Hye Sun; Jang, Jae Woo

    2016-01-01

    Purpose To evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis. Methods A retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups. Results A total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis. Conclusions Age was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis. PMID:27247514

  3. Re-DCR with Silicone Tube Intubation: An Effective Method of Management of Failed DCR.

    PubMed

    Hossain, M I; Nahar, L; Rashid, M A

    2015-10-01

    This prospective observational study was performed with twenty nine eyes of Twenty eight patients who were operated upon for chronic dacryocystitis eight months to two years six months before, presented with history of persistent watering and discharge. Number of male was 6(21%) and female was 22(79%). Re-DCR with silicone tube intubation was performed in all the patients. Post operative follow up for a period of 12-24 months revealed absence of symptoms in 28 eyes (97%) while 1(3%) eye persisted with watering and discharge despite uncomplicated surgical procedure. There are so many options for management of Failed DCR, among them Re-DCR with Silicone Tube Intubation is the most safe and less cost effective method. PMID:26620000

  4. Intubation Success through I-Gel® and Intubating Laryngeal Mask Airway® Using Flexible Silicone Tubes: A Randomised Noninferiority Trial

    PubMed Central

    Bhardwaj, Neerja; Sen, Indu Mohini; Sondekoppam, Rakesh V.

    2016-01-01

    Introduction. The study aims to test whether flexible silicone tubes (FST) improve performance and provide similar intubation success through I-Gel as compared to ILMA. Our trial is registered in CTRI and the registration number is “CTRI/2016/06/006997.” Methods. One hundred and twenty ASA status I-II patients scheduled for elective surgical procedures needing tracheal intubation were randomised to endotracheal intubation using FST through either I-Gel or ILMA. In the ILMA group (n = 60), intubation was attempted through ILMA using FST and, in the I-Gel group (n = 60), FST was inserted through I-Gel airway. Results. Successful intubation was achieved in 36.67% (95% CI 24.48%–48.86%) on first attempt through I-Gel (n = 22/60) compared to 68.33% (95% CI 56.56%–80.1%) in ILMA (n = 41/60) (p = 0.001). The overall intubation success rate was also lower with I-Gel group [58.3% (95% CI 45.82%–70.78%); n = 35] compared to ILMA [90% (95% CI 82.41%–97.59%); n = 54] (p < 0.001). The number of attempts, ease of intubation, and time to intubation were longer with I-Gel compared to ILMA. There were no differences in the other secondary outcomes. Conclusion. The first pass success rate and overall success of FST through an I-Gel airway were inferior to those of ILMA. PMID:27478436

  5. Submental intubation with reinforced tube for intubating laryngeal mask airway.

    PubMed

    Kim, Ki Jun; Lee, Jong Seok; Kim, Hyung-Jun; Ha, Ji-Young; Park, Hyun; Han, Dong Woo

    2005-08-31

    Submental endotracheal intubation is a simple and secure alternative to either nasoendotracheal intubation or a tracheostomy in the airway management of maxillofacial trauma. However, a submental endotracheal intubation is quite difficult to manage if adverse events such as a tube obstruction, accidental extubation, or a leaking cuff with the endotracheal tube in the submental route occur, which could endanger the patient. This paper describes the use of a LMA-FastrachTMETT in the submental endotracheal intubation of patients suffering from maxillofacial trauma. One of the patients was a 16-year-old male, and the other was a 19-year-old male. They were scheduled for an open reduction and internal fixation of the maxillofacial fracture including naso-orbital-ethmoidal (NOE) complex, and a zygomaticomaxillary complex fracture. A submental intubation with a LMA-FastrachTMETT was performed in both cases, and the operation proceeded without any difficulties. These cases show that the use of the LMA- FastrachTMETT can improve the safety and efficacy of submental endotracheal intubation. This is because the LMA- FastrachTMETT has a freely detachable connector, and is flexible enough to keep the patency despite the acute angle of airway. PMID:16127785

  6. In-Tube Laser Propulsion Configurations

    NASA Astrophysics Data System (ADS)

    Kim, Sukyum; Urabe, Naohide; Torikai, Hiroyuki; Sasoh, Akihiro; Jeung, In-Seuck

    2003-05-01

    Laser propulsion research activities at Shock Wave Research Center, Institute of Fluid Science, Tohoku University, focus themselves on `in-tube' configurations. The thrust is enhanced in a confined acceleration region. Other advantages are obtained from the viewpoint of practical application. We are now investigating various extensions of the Laser-driven In-Tube Accelerator (LITA) (1) ablative in-tube propulsion, (2) thrust enhancement using applied magnetic field, (3) plasma pre-generation using a pilot laser irradiation, (4) demonstration of supersonic laser propulsion. The progresses in these subjects are presented.

  7. Damage to the cuff of EMG tube at endotracheal intubation by using a lightwand -A case report-

    PubMed Central

    Kim, Hyun-Sook; Park, Keun-Suk; Kang, Mae-Hwa

    2010-01-01

    Electromyogpraphic endotracheal tube (EMG tube) is a new device used to monitor recurrent laryngeal nerve integrity during thyroid surgery. The EMG tube has 2 pairs of electrodes on the surface of silicon-based tube reached to inner space of tube cuff. We experienced an unusual endotracheal tube-related problem from the distinct structural feature of the EMG tube. In this case, we intubated a patient who had difficult airway with the EMG tube using a lightwand. After successful endotracheal intubation, we could not expand the pilot balloon and ventilate the patient effectively. We removed the EMG tube and found that one of electrodes of the EMG tube is bended and made a right angle with the long axis of the tube, and perforated the tube cuff. So we report this case to make anesthesia providers aware that much more attention is needed to use EMG tube during endotracheal intubation. PMID:21286432

  8. Evaluation of the Effect of Tracheal Tube Orientation on Success of Intubation through Intubating Laryngeal Mask Airway

    PubMed Central

    Chhatrapati, Swati; Auti, Subhhash Sadashiv; Aswar, Swapnil Ganesh

    2016-01-01

    Introduction Polyvinyl Chloride Endotracheal Tube (PVC ETT) can be used as an alternative to Fastrach Silicone Wire-Reinforced Tube (FTST) for intubation through Intubating Laryngeal Mask Airway (ILMA) as the latter is expensive and has low volume high pressure cuff. Aim To evaluate the effects of orientation of PVC ETT (normal curve and reverse curve) on the success of intubation through ILMA, haemodynamic response and postoperative sore throat. Materials and Methods Sixty healthy adult patients of ASA physical status I & II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were randomly divided into two groups. In Normal (N) group (n=30), the tracheal tube was inserted with its natural curve following the 90° curvature of ILMA. In Reverse (R) group (n=30), the tracheal tube was inserted with its natural curve directed opposite to the curvature of ILMA. The time taken to intubate, number of attempts, and maneuvers required for successful endotracheal intubation along with haemodynamics and oxygen saturation were noted. Postoperative sore throat was evaluated using a Verbal Analogue Scale (VAS) (0-10). Qualitative data was analysed by Chi-Square test and Fisher’s exact test. Quantitative data was analysed by unpaired t-test and Mann-Whitney test. Results Placement of ILMA was successful in all patients. Total Intubation Time (mean±SD) in Group N was 12.53±1.78 seconds and in Group R was 11.97±1.33 seconds (p>0.05). Tracheal intubation through ILMA was successful in all patients. First attempt success rate in R Group (26 patients, 86.7%) was higher than N Group (22 patients, 73.3%) (p>0.05). Four patients (13.3%) in R Group and 8 patients (26.7%) in N Group required 2nd step of Chandy’s maneuver during second attempt for successful intubation. Incidence of sore throat 6 hours postoperatively was statistically significant (median value 2.00 in N Group vs. 0.00 in R Group) between two groups. Conclusion PVC ETT with

  9. Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries

    PubMed Central

    Hosseinzadeh, Hamzeh; Taheri Talesh, Koroush; Golzari, Samad EJ; Gholizadeh, Hossein; Lotfi, Alireza; Hosseinzadeh, Parisa

    2013-01-01

    Introduction: Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications. Methods: 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited. Results: success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively. Conclusion:In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation. PMID:24404345

  10. Increased risks of endotracheal tube cuff colonization after prolonged intubation.

    PubMed

    Tsai, Wen-Hui; Hsu, Hui-Chi; Shih, Chung-Hung

    2014-06-30

    Mechanical ventilation using endotracheal tube (ETT) intubation is crucial in saving life but may also cause ventilator-associated pneumonia resulting in morbidity and mortality. The purpose of this study was to examine the effects of intubation duration on pathogen colonization rates of ETT cuff region, and its association with the subsequent re-intubation and tracheostomy. We enrolled 92 patients who were successfully weaned from ventilator and were extubated within 20 days of intubation duration. Patients were divided into Group I and II based on intubation for 1-9 days and 10-20 days, respectively. Pathogen colonization over ETT cuff region and extra-cuff region (including sputum and ETT aspirates) were assessed. As compared to Group I patients, Group II patients had a significant higher pathogen colonization rate (100% vs. 69.2%; P < 0.001) in the ETT cuff samples, but not in the extra-cuff samples (92.6% vs. 84.8%; P = 0.442). Further studies demonstrated that there was no difference between Group I and II patients in the percentages of patients with the same pathogen over both the cuff and extra-cuff samples (35.5% vs. 30.8%; P = 0.925), suggesting that the increased pathogen colonization rate over the ETT cuff region was least likely from the extra-cuff region. In addition, the results showed that longer intubation was also associated with increased tracheostomy rate from 9.3% to 28.9% for Group I and Group II respectively (P = 0.025). We conclude that longer intubation has a higher pathogen colonization rate over the ETT cuff region in patients receiving mechanical ventilation support; longer intubation also increases the trend of receiving re-intubation and tracheostomy. Our findings indicate that it is crucial to remove ETT as soon as possible and perform pathogen culture over the ETT cuff regions immediately after extubation. PMID:24826783

  11. Impulse enhancement by in-tube operation in laser propulsion

    NASA Astrophysics Data System (ADS)

    Sasoh, Akihiro; Urabe, Naohide; Kim, Sukyum

    2002-09-01

    The laser-driven in-tube accelerator (LITA) is a unique concept of laser propulsion. It is characterized by accelerating an object in a tube. Owing to a confinement effect, the thrust performance can be improved. This device has other advantages over the existing technology on the simplicity and suitability to environment. Experiments on the thrust performance of LITA were conducted. The thrust was determined from the object hovering condition. The measured dimensionless momentum coupling coefficient agrees between xenon and argon as the working gas. This implies that in order to obtain a high impulse chemical species with a low speed of sound is useful.

  12. Using a modified nasotracheal tube to prevent nasal ala pressure sore during prolonged nasotracheal intubation.

    PubMed

    Cherng, Chen-Hwan; Chen, Yuan-Wu

    2010-12-01

    Nasotracheal tube induced nasal ala pressure sores or necrosis during prolonged nasotracheal intubation have been reported, and it is a serious but preventable complication. Here we introduce a modified nasotracheal tube to prevent this complication. This modified nasotracheal tube is composed of two parts, an oral endotracheal tube and a proximal part of a preformed nasotracheal tube, which are linked by a connector. The use of this modified nasotracheal tube can prevent nasal ala pressure sores during prolonged nasotracheal intubation. PMID:20809246

  13. Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation

    PubMed Central

    Prior, Simon; Heaton, Jarom; Jatana, Kris R.; Rashid, Robert G.

    2010-01-01

    Abstract The placement of endotracheal tubes in the airway, particularly through the nose, can cause trauma. Their design might be an important etiologic factor, but they have changed little since their introduction. Recently Parker Medical (Bridgewater, Conn ) introduced the Parker Flex-Tip (PFT) tube, suggesting that it causes less trauma. This study aimed to compare the PFT endotracheal tube to a side-beveled, standard-tip endotracheal tube (ETT) for nasotracheal intubation (Figures 1 and 2). Forty consecutive oral surgery patients requiring nasotracheal intubation were randomized to receive either a standard ETT or the PFT tube. Intubations were recorded using a fiber-optic camera positioned proximal to the Murphy eye of the tube. This allowed visualization of the path and action of the tube tip as it traversed the nasal, pharyngeal, laryngeal, and tracheal airway regions. Video recordings made during intubation and extubation were evaluated for bleeding, trauma, and intubation time. Both bleeding and trauma were recorded using a visual analogue scale (VAS) and by 3 different evaluators. The PFT received significantly better VAS values than the standard tubes from all 3 raters (P < 0.05) in both the extent of trauma and bleeding. Since the intubations were purposefully conducted slowly for photographic reasons, neither tube displayed a time advantage. This study suggests that the PFT tube design may be safer by causing less trauma and bleeding than standard tube designs for nasotracheal intubation. PMID:20331335

  14. A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a cervical spine immobilisation

    PubMed Central

    2013-01-01

    Background The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex tracheal tube for intubation in patients with simulated cervical spine injury. Methods A group of 60 patients without any kind of the cervical spine injury, classified as the ASA physiological scale I or II and qualified for elective surgery procedures were intubated with the use of classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients have had the cervical collar placed on their neck for the simulation of intubation procedure in case of the spinal injury. Results The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60] respectively (p = 0.9705). No significant additional maneuvers were necessary during intubation with the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p = 0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists found intubations with the use of EndoFlex more demanding than intubation with conventional tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively. Conclusion In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it requires more maneuvers facilitating intubation and was found to be more difficult to use. PMID:24267640

  15. Palliation of malignant tracheal strictures using silicone T tubes.

    PubMed Central

    Insall, R L; Morritt, G N

    1991-01-01

    The use of silicone T tubes for intubation of malignant tracheobronchial strictures may provide some degree of palliation of this distressing condition. It was used in seven patients with malignant lesions and two with benign strictures (resulting from tracheal trauma and lung transplantation). Four patients (two with cancer) are still alive and well with the tube in position. All patients noted improvement in dyspnoea and stridor. The main problems were tube migration (one patient), tracheo-oesophageal fistula (one patient), and blockage of the tube by tumour (two patients) or encrusted secretions (three patients). Airway patency was restored when the tube was blocked by cleaning or by laser resection of the tumour. With careful supervision and education of the patient intubation can give useful palliation to patients with distressing upper airways obstruction. Images PMID:1709308

  16. Increased success of blind nasotracheal intubation through the use of nasogastric tubes as a guide.

    PubMed Central

    Sugiura, N.; Miyake, T.; Okui, K.; Hibi, G.; Oka, T.; Yamada, M.; Arai, T.

    1996-01-01

    We were able to improve the success rate of blind nasotracheal intubation by using nasogastric tubes as a guide during intubation, first, for passing the endotracheal tube through the nasal cavity, and second, passing it from the pharynx to the larynx. By adding both sedation by modified neuroleptanalgesia (NLA) and topical and transtracheal administration of lidocaine, our technique became safer and smoother. We have completed 36 cases without accident, with an average time for intubation of 8.25 min. The Rüsh spiral tube was thought to be the most suited to this form of intubation because of the 90 degrees cut of its tip, its high-volume cuff, and its flexibility in all directions. These features are useful for hearing breath sounds, raising the tip of the tube by inflation of the cuff, and advancing the tube in a turning motion. PMID:10323127

  17. Strengths and weaknesses of in-tube solid-phase microextraction: A scoping review.

    PubMed

    Fernández-Amado, M; Prieto-Blanco, M C; López-Mahía, P; Muniategui-Lorenzo, S; Prada-Rodríguez, D

    2016-02-01

    In-tube solid-phase microextraction (in-tube SPME or IT-SPME) is a sample preparation technique which has demonstrated over time its ability to couple with liquid chromatography (LC), as well as its advantages as a miniaturized technique. However, the in-tube SPME perspectives in the forthcoming years depend on solutions that can be brought to the environmental, industrial, food and biomedical analysis. The purpose of this scoping review is to examine the strengths and weaknesses of this technique during the period 2009 to 2015 in order to identify research gaps that should be addressed in the future, as well as the tendencies that are meant to strengthen the technique. In terms of methodological aspects, this scoping review shows the in-tube SPME strengths in the coupling with LC (LC-mass spectrometry, capillary LC, ultra-high-pressure LC), in the new performances (magnetic IT-SPME and electrochemically controlled in-tube SPME) and in the wide range of development of coatings and capillaries. Concerning the applicability, most in-tube SPME studies (around 80%) carry out environmental and biomedical analyses, a lower number food analyses and few industrial analyses. Some promising studies in proteomics have been performed. The review makes a critical description of parameters used in the optimization of in-tube SPME methods, highlighting the importance of some of them (i.e. type of capillary coatings). Commercial capillaries in environmental analysis and laboratory-prepared capillaries in biomedical analysis have been employed with good results. The most consolidated configuration is in-valve mode, however the cycle mode configuration is frequently chosen for biomedical analysis. This scoping review revealed that some aspects such as the combination of in-tube SPME with other sample treatment techniques for the analysis of solid samples should be developed in depth in the near future. PMID:26772124

  18. The Fast and Easy Way for Double-Lumen Tube Intubation: Individual Angle-Modification

    PubMed Central

    Min, Jeong Jin; Lee, Jong-Hwan; Kang, Se Hee; Kim, Eunhee; Lee, Sangmin M.; Cho, Jong Ho; Kim, Hong Kwan

    2016-01-01

    To find the faster and easier way than the existing intubating technique for double-lumen tube, we modified the angle of double-lumen tube according to an individual’s upper airway anatomy and compared the time needed and the number of attempts for successful intubation between individually angle-modified and non-modified double-lumen tubes. Adult patients undergoing elective thoracic surgery were randomly allocated in either non-angle-modified (Group N, n = 54) or angle-modified (Group M, n = 54) groups. During mask ventilation in the sniffing position, angle-modification was performed in Group M as follows: the distal tip of the tube was placed at the level of the cricoid cartilage and the shaft was bent at the intersection of the oral and pharyngeal axes estimated from the patient’s surface anatomy. The time needed and the number of attempts for successful intubation and Cormack and Lehane (C-L) grade were recorded. Overall median intubation time (sec) was significantly shorter in Group M than in Group N [10.2 vs. 15.1, P<0.001]. In addition, Group M showed the shorter median intubation time (sec) in C-L grades I-III [8.2 vs. 11.1 in C-L grade I, (P = 0.003), 10.3 vs. 15.3 in II, (P = 0.001), and 11.8 vs. 27.9 in III, (P<0.001), respectively]. Moreover, all intubation was successfully performed at the first attempt in patients with C-L grades I-III in Group M (P = 0.027). Our study showed an individual angle-modification would be useful for the fast and easy intubation of double-lumen tube in patients with C-L grades I-III. Trial Registration: ClinicalTrials.gov NCT02190032 PMID:27537372

  19. Impulse Characteristics of Laser-driven In-Tube Accelerator (LITA)

    SciTech Connect

    Ohtani, Toshiro; Mori, Koichi; Sasoh, Akihiro

    2006-05-02

    In this study, impulse generation processes induced by a single laser pulse in the laser-driven in-tube accelerator are studied through pressure history measured at the center of the projectile base, which acts also as a parabolic mirror. The effects of the fill pressure, laser energy and length of a shroud are analyzed.

  20. Impulse Characteristics of Laser-driven In-Tube Accelerator (LITA)

    NASA Astrophysics Data System (ADS)

    Ohtani, Toshiro; Mori, Koichi; Sasoh, Akihiro

    2006-05-01

    In this study, impulse generation processes induced by a single laser pulse in the laser-driven in-tube accelerator are studied through pressure history measured at the center of the projectile base, which acts also as a parabolic mirror. The effects of the fill pressure, laser energy and length of a shroud are analyzed.

  1. Endoscopic dacryocystorhinostomy with and without silicone intubation: 4 years retrospective study.

    PubMed

    Longari, F; Dehgani Mobaraki, P; Ricci, A L; Lapenna, R; Cagini, C; Ricci, G

    2016-08-01

    The objective of this study is to assess different outcomes between endoscopic dacryocystorhinostomy (En-DCR) with and without silicone intubation. We retrospectively analyzed 84 patients (89 procedures), suffering from chronic epiphora for primary acquired nasolacrimal duct obstruction, treated with En-DCR and divided into two groups depending on silicone stent intubation. The surgical outcomes were evaluated at 7 post-operative controls using Munk's score criteria. Functional success was defined as absence of epiphora, no further episodes of dacryocystitis, and a patent ostium after fluorescein irrigation. 45 En-DCR with stent and 44 En-DCR without stent were performed. Success rate after 18 months follow-up were, respectively, 82.2 % in the stent group and 88.6 % in the non-stent group (OR 0.59) with no statistical differences. The ostial size reduction has been reported in higher percentage in the stent group, mainly due to peristomal granuloma (OR 3.64), scar tissue formation (OR 2.25), and turbinoseptal synaechia (OR 1.76). The benefits of non-intubation are less patient discomfort, reduced surgical time and costs, simpler follow-up regimen and less intubation-associated complications. En-DCR without silicone stent intubation should be the first choice of procedure, stent intubation should be reserved in selected cases with poor local conditions pre and intra-operatively assessed. PMID:26732693

  2. Dependence of Initial Plasma Size on Laser-driven In-Tube Accelerator (LITA) Performance

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Ohtani, Toshiro; Sasoh, Akihiro; Choi, Jeong-Yeol

    2004-03-30

    At Tohoku University, experiments of Laser-driven In-Tube Accelerator (LITA) have been carried out. In order to observe the initial state of plasma and blast wave, the visualization experiment was carried out using the shadowgraph method. In this paper, dependency of initial plasma size on LITA performance is investigated numerically. The plasma size is estimated using shadowgraph images and the numerical results are compared with the experimental data of pressure measurement and results of previous modeling.

  3. Dependence of Initial Plasma Size on Laser-driven In-Tube Accelerator (LITA) Performance

    NASA Astrophysics Data System (ADS)

    Kim, Sukyum; Ohtani, Toshiro; Sasoh, Akihiro; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-01

    At Tohoku University, experiments of Laser-driven In-Tube Accelerator (LITA) have been carried out. In order to observe the initial state of plasma and blast wave, the visualization experiment was carried out using the shadowgraph method. In this paper, dependency of initial plasma size on LITA performance is investigated numerically. The plasma size is estimated using shadowgraph images and the numerical results are compared with the experimental data of pressure measurement and results of previous modeling.

  4. To Tube or Not to Tube? The Role of Intubation during Stroke Thrombectomy

    PubMed Central

    Takahashi, Courtney; Liang, Conrad W.; Liebeskind, David S.; Hinman, Jason D.

    2014-01-01

    In the 10 years since the FDA first cleared the use of endovascular devices for the treatment of acute stroke, definitive evidence that such therapy improves outcomes remains lacking. The decision to intubate patients undergoing stroke thrombectomy impacts multiple variables that may influence outcomes after stroke. Three main areas where intubation may deleteriously affect acute stroke management include the introduction of delays in revascularization, fluctuations in peri-procedural blood pressure, and hypocapnia, resulting in cerebral vasoconstriction. In this mini-review, we discuss the evidence supporting these limitations of intubation during stroke thrombectomy and encourage neurohospitalists, neurocritical care specialists, and neurointerventionalists to carefully consider the decision to intubate during thrombectomy and provide strategies to avoid potential complications associated with its use in acute stroke. PMID:25295027

  5. Online in-tube microextractor coupled with UV-Vis spectrophotometer for bisphenol A detection.

    PubMed

    Poorahong, Sujittra; Thammakhet, Chongdee; Thavarungkul, Panote; Kanatharana, Proespichaya

    2013-01-01

    A simple and high extraction efficiency online in-tube microextractor (ITME) was developed for bisphenol A (BPA) detection in water samples. The ITME was fabricated by a stepwise electrodeposition of polyaniline, polyethylene glycol and polydimethylsiloxane composite (CPANI) inside a silico-steel tube. The obtained ITME coupled with UV-Vis detection at 278 nm was investigated. By this method, the extraction and pre-concentration of BPA in water were carried out in a single step. Under optimum conditions, the system provided a linear dynamic range of 0.1 to 100 μM with a limit of detection of 20 nM (S/N ≥3). A single in-tube microextractor had a good stability of more than 60 consecutive injections for 10.0 μM BPA with a relative standard deviation of less than 4%. Moreover, a good tube-to-tube reproducibility and precision were obtained. The system was applied to detect BPA in water samples from six brands of baby bottles and the results showed good agreement with those obtained from the conventional GC-MS method. Acceptable percentage recoveries from the spiked water samples were obtained, ranging from 83-102% for this new method compared with 73-107% for the GC-MS standard method. This new in-tube CPANI microextractor provided an excellent extraction efficiency and a good reproducibility. In addition, it can also be easily applied for the analysis of other polar organic compounds contaminated in water sample. PMID:23245299

  6. Impulse-scaling in a laser-driven in-tube accelerator

    NASA Astrophysics Data System (ADS)

    Sasoh, A.; Urabe, N.; Kim, S. S. M.; Jeung, I.-S.

    The laser-driven in-tube accelerator (LITA) is a unique device for laser propulsion. It is characterized by the acceleration of a projectile in a tube. The thrust performance can be improved by exploiting a confinement effect. In the experiment, a 3.0-g projectile is vertically launched, and the momentum coupling coefficient is measured for various monoatomic gases. The measured coupling coefficient is almost proportional to the reciprocal of the speed of sound. The same impulse generation characteristics are obtained in simplified situations that are analyzed based on conservation relations.

  7. Vertical Launch Performance of Laser-driven In-Tube Accelerator

    NASA Astrophysics Data System (ADS)

    Urabe, Naohide; Kim, Sukyum; Sasoh, Akihiro; Jeung, In-Seuck

    2003-05-01

    We studied the vertical launch performance of the Laser-driven In-Tube Accelerator (LITA). This device is primarily characterized by accelerating a projectile in a tube. Owing to the confinement effect, the thrust performance is enhanced. The driver gas can be specified and its pressure be turned so that the impulse performance is optimized. In the experiments, a 3.0-gram projectile was vertically launched. The effects of the projectile exit condition, the laser beam incident direction and the driver gas species were experimentally studied.

  8. Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes

    PubMed Central

    Malhotra, SK; Bharath, KV; Saini, Vikas

    2016-01-01

    Background and Aims: Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I). Methods: One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case–control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts. Results: The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43). Conclusion: The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA. PMID:27141106

  9. Sampling Artifacts from Conductive Silicone Tubing

    SciTech Connect

    Timko, Michael T.; Yu, Zhenhong; Kroll, Jesse; Jayne, John T.; Worsnop, Douglas R.; Miake-Lye, Richard C.; Onasch, Timothy B.; Liscinsky, David; Kirchstetter, Thomas W.; Destaillats, Hugo; Holder, Amara L.; Smith, Jared D.; Wilson, Kevin R.

    2009-05-15

    We report evidence that carbon impregnated conductive silicone tubing used in aerosol sampling systems can introduce two types of experimental artifacts: 1) silicon tubing dynamically absorbs carbon dioxide gas, requiring greater than 5 minutes to reach equilibrium and 2) silicone tubing emits organic contaminants containing siloxane that adsorb onto particles traveling through it and onto downstream quartz fiber filters. The consequence can be substantial for engine exhaust measurements as both artifacts directly impact calculations of particulate mass-based emission indices. The emission of contaminants from the silicone tubing can result in overestimation of organic particle mass concentrations based on real-time aerosol mass spectrometry and the off-line thermal analysis of quartz filters. The adsorption of siloxane contaminants can affect the surface properties of aerosol particles; we observed a marked reduction in the water-affinity of soot particles passed through conductive silicone tubing. These combined observations suggest that the silicone tubing artifacts may have wide consequence for the aerosol community and should, therefore, be used with caution. Gentle heating, physical and chemical properties of the particle carriers, exposure to solvents, and tubing age may influence siloxane uptake. The amount of contamination is expected to increase as the tubing surface area increases and as the particle surface area increases. The effect is observed at ambient temperature and enhanced by mild heating (<100 oC). Further evaluation is warranted.

  10. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    SciTech Connect

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-30

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  11. Numerical Simulation of Laser-driven In-Tube Accelerator on Supersonic Condition

    NASA Astrophysics Data System (ADS)

    Kim, Sukyum; Jeung, In-Seuck; Choi, Jeong-Yeol

    2004-03-01

    Recently, several laser propulsion vehicles have been launched successfully. But these vehicles remained in a very low subsonic flight. Laser-driven In-Tube Accelerator (LITA) is developed as unique laser propulsion system at Tohoku University. In this paper, flow characteristics and momentum coupling coefficients are studied numerically in the supersonic condition with the same configuration of LITA. Because of the aerodynamic drag, the coupling coefficient could not get correctly especially at the low energy input. In this study, the coupling coefficient was calculated using the concept of the effective impulse.

  12. Double-lumen tube intubation using video laryngoscopy causes a milder cardiovascular response compared to classic direct laryngoscopy

    PubMed Central

    Wei, Wei; Tian, Ming

    2016-01-01

    Objective: To determine whether there is a clinically relevant difference between the circulatory responses to double-lumen tube intubation (DLTI) with the GlideScope video laryngoscope versus the Macintosh direct laryngoscope. Methods: Eighty adult patients requiring double-lumen tubes for thoracic surgery were randomly and equally allocated to either a Macintosh direct laryngoscope group (DL group, n = 40) or a Glide Scope video laryngoscope group (GS group, n = 40). DLTI was performed after airway evaluations and induction of anesthesia. Systolic blood pressure (SBP) and heart rate (HR) were recorded before induction (baseline values), immediately before intubation (post-induction values), at intubation and after intubation. Rate-pressure-product (RPP), and the areas under SBP- and HR-time curves were calculated. All data obtained by the two devices were compared. Results: After laryngoscope insertion, SBP of DL and GS groups changed significantly differently (13.1% vs. 4.6%, P< 0.001), while HR changed similarly (17.2% vs. 14.6%, P = 0.074). One minute after intubation, both SBP and HR significantly increased in both groups (SBP: 11.6% vs. 11.9%; HR: 18.4% vs. 10.8%), but there were no significant differences between the two groups. RPP significantly increased in both groups after laryngoscope insertion (32.6%, P=0.001; 18.2%, P=0.002), and there was a significant difference between the two groups (P =0.001). Throughout intubation, the areas under SBP-time curves had a significant difference between the two groups (P = 0.042), while those under HR-time curves did not differ significantly (P=0.06). Conclusion: The intubation response was most significant upon laryngoscope insertion during the whole intubation process. The GlideScope video laryngoscope induced milder circulatory fluctuations than the Macintosh direct laryngoscope did, suggesting that DLTI using video laryngoscopy can help reduce the cardiovascular response to intubation. PMID:27022341

  13. Corrosion casting of the subglottis following endotracheal tube intubation injury: a pilot study in Yorkshire piglets

    PubMed Central

    2013-01-01

    Purpose Subglottic stenosis can result from endotracheal tube injury. The mechanism by which this occurs, however, is not well understood. The purpose of this study was to examine the role of angiogenesis, hypoxia and ischemia in subglottic mucosal injury following endotracheal intubation. Methods Six Yorkshire piglets were randomized to either a control group (N=3, ventilated through laryngeal mask airway for corrosion casting) or accelerated subglottic injury group through intubation and induced hypoxia as per a previously described model (N=3). The vasculature of all animals was injected with liquid methyl methacrylate. After polymerization, the surrounding tissue was corroded with potassium hydroxide. The subglottic region was evaluated using scanning electron microscopy looking for angiogenic and hypoxic or degenerative features and groups were compared using Mann–Whitney tests and Friedman’s 2-way ANOVA. Results Animals in the accelerated subglottic injury group had less overall angiogenic features (P=.002) and more overall hypoxic/degenerative features (P=.000) compared with controls. Amongst angiogenic features, there was decreased budding (P=.000) and a trend toward decreased sprouting (P=.037) in the accelerated subglottic injury group with an increase in intussusception (P=.004), possibly representing early attempts at rapid revascularization. Amongst hypoxic/degenerative features, extravasation was the only feature that was significantly higher in the accelerated subglottic injury group (P=.000). Conclusions Subglottic injury due to intubation and hypoxia may lead to decreased angiogenesis and increased blood vessel damage resulting in extravasation of fluid and a decreased propensity toward wound healing in this animal model. PMID:24401165

  14. In-tube magnetic solid phase microextraction of some fluoroquinolones based on the use of sodium dodecyl sulfate coated Fe3O4 nanoparticles packed tube.

    PubMed

    Manbohi, Ahmad; Ahmadi, Seyyed Hamid

    2015-07-23

    In-tube magnetic solid phase microextraction (in-tube MSPME) of fluoroquinolones from water and urine samples based on the use of sodium dodecyl sulfate (SDS) coated Fe3O4 nanoparticles packed tube has been reported. After the preparation of Fe3O4 nanoparticles (NPs) by a batch synthesis, these NPs were introduced into a stainless steel tube by a syringe and then a strong magnet was placed around the tube, so that the Fe3O4 NPs were remained in the tube and the tube was used in the in-tube SPME-HPLC/UV for the analysis of fluoroquinolones in water and urine samples. Plackett-Burman design was employed for screening the variables significantly affecting the extraction efficiency. Then, the significant factors were more investigated by Box-Behnken design. Calibration curves were linear (R(2)>0.990) in the range of 0.1-1000μgL(-1) for ciprofloxacin (CIP) and 0.5-500μgL(-1) for enrofloxacin (ENR) and ofloxacin (OFL), respectively. LODs for all studied fluoroquinolones ranged from 0.01 to 0.05μgL(-1). The main advantages of this method were rapid and easy automation and analysis, short extraction time, high sensitivity, possibility of fully sorbent collection after analysis, wide linear range and no need to organic solvents in extraction. PMID:26231896

  15. A modified technique to improve the outcome of intubation with a left-sided double-lumen endobronchial tube

    PubMed Central

    2014-01-01

    Background The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. Methods We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. Results Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p <0.0001). T2 was also significantly shorter in the TOC group than the TOE group (27.2 ± 2.5 seconds versus 34.9 ± 3.0 seconds, p <0.0001). The severity of hoarseness on the first postoperative day and sore throat on the fourth postoperative day were significantly lower in the TOC group than the TOE group (p = 0.02 and <0.0001, respectively). The hemodynamic responses to intubation were broadly similar between the groups. Conclusion When placing a left-sided DLT using a VL, angling the bronchial lumen to a hockey stick

  16. Impulse Generation Mechanisms in a Laser-Driven In-Tube Accelerator

    NASA Astrophysics Data System (ADS)

    Choi, Jeong-Yeol; Kang, Ki-Ha; Sasoh, Akihiro; Jeung, In-Seuck; Urabe, Naohide; Kleine, Harald

    To enhance laser-propulsion thrust performance, a unique Laser-driven In-Tube Accelerator (LITA) has been developed. This paper numerically analyzes the impulse generation mechanisms in LITA. For this purpose, a LITA performance experiment was conducted in atmospheric air with a projectile installed on a ballistic pendulum to calibrate the numerical approximations. We conducted experimental flow visualization by framing shadowgraph and computational fluid dynamics solving the axi-symmetric Euler equation applied to an ideal gas. The results show that a laser-driven blast wave is generated by a spherical hot gas core where the supplied laser energy is absorbed first. The effect of confinement by the tube or shroud wall is confirmed. The impulse production is established not only from the interaction between the incident blast wave and projectile, but also from the following repetitive pressure waves. Assuming that about 30% of the input laser energy is absorbed by the working air, both the impulse and peak pressure agrees quantitatively between the experiment and numerical simulation.

  17. Blast Wave Formation by Laser-Sustained Nonequilibrium Plasma in the Laser-Driven In-Tube Accelerator Operation

    SciTech Connect

    Ogino, Yousuke; Ohnishi, Naofumi; Sawada, Keisuke; Sasoh, Akihiro

    2006-05-02

    Understanding the dynamics of laser-produced plasma is essentially important for increasing available thrust force in a gas-driven laser propulsion system such as laser-driven in-tube accelerator. A computer code is developed to explore the formation of expanding nonequilibrium plasma produced by laser irradiation. Various properties of the blast wave driven by the nonequilibrium plasma are examined. It is found that the blast wave propagation is substantially affected by radiative cooling effect for lower density case.

  18. Experimental Research on In-Tube Condensation Under Steady-State and Transient Conditions

    SciTech Connect

    Tanrikut, Ali; Yesin, Orhan

    2005-01-15

    In this research study, in-tube condensation in the presence of air was investigated experimentally at a heat exchanger of countercurrent type for different operating conditions. The test matrix for the steady-state condition covers the range of pressures P = 1.8 to 5.5 bars, vapor Reynolds numbers Re{sub v} = 45 000 to 94 000, and inlet air mass fraction values X{sub i} = 0 to 52%. The effect of air manifests itself by a reduction in the local heat flux and the local heat transfer coefficient. The local heat transfer coefficient is inversely proportional to the local air mass fraction. Both the local heat flux and the heat transfer coefficient vary with the system pressure and vapor mass flow rate. There is no effect of inlet superheating on the local heat flux. The film Reynolds number lies in the range of the turbulent region. Two experiments simulating loss of coolant to the secondary side of the condenser were performed, for pure steam and for an air/steam mixture. These transients show that the vapor suction rate, effective condensation length, and overall heat transfer rate are a function of the coolant boiloff rate and the air mass fraction.

  19. Headspace in-tube microextraction coupled with micellar electrokinetic chromatography of neutral aromatic compounds.

    PubMed

    Cho, Sung Min; Park, Bum Su; Jung, Woo Sung; Lee, Sang Won; Jung, Yunhwan; Chung, Doo Soo

    2016-02-01

    Headspace (HS) extraction can be carried out easily and aptly via single drop microextraction coupled with capillary electrophoresis (CE). However, one drawback is the difficulty of keeping the single drop stably at the capillary tip. To solve this problem, we have recently demonstrated HS in-tube microextraction (ITME) of acidic compounds such as chlrophenols in an acidic sample using a basic run buffer plug in the separation capillary for CE as an acceptor phase. In this report, an organic acceptor plug in a capillary was used to extract neutral organic volatile pollutants such as BTEX (benzene, toluene, ethylbenzene, and m-xylene). After extraction, the analytes enriched in the organic acceptor plug were analyzed with micellar electrokinetic chromatography (MEKC). The enrichment factors for BTEX in a standard solution were up to 350 under an optimal condition of 25°C for 20 min. As an application, BTEX spiked into bottled water were analyzed with HS-ITME-MEKC, and the enrichment factors for BTEX were up to 320. The limits of detections were 1-4 ppb, which are at least 200 times lower than the US Environmental Protection Agency guidelines for drinking water, except benzene. The entire procedure of HS-ITME-MEKC was carried out automatically using a commercial CE instrument. PMID:26653509

  20. Magnetism-Enhanced Monolith-Based In-Tube Solid Phase Microextraction.

    PubMed

    Mei, Meng; Huang, Xiaojia; Luo, Qing; Yuan, Dongxin

    2016-02-01

    Monolith-based in-tube solid phase microextraction (MB/IT-SPME) has received wide attention because of miniaturization, automation, expected loading capacity, and environmental friendliness. However, the unsatisfactory extraction efficiency becomes the main disadvantage of MB/IT-SPME. To overcome this circumstance, magnetism-enhanced MB/IT-SPME (ME-MB/IT-SPME) was developed in the present work, taking advantage of magnetic microfluidic principles. First, modified Fe3O4 nanoparticles were mixed with polymerization solution and in situ polymerized in the capillary to obtain a magnetic monolith extraction phase. After that, the monolithic capillary column was placed inside a magnetic coil that allowed the exertion of a variable magnetic field. The effects of intensity of magnetic field, adsorption and desorption flow rate, volume of sample, and desorption solvent on the performance of ME-MB/IT-SPME were investigated in detail. The analysis of six steroid hormones in water samples by the combination of ME-MB/IT-SPME with high-performance liquid chromatography with diode array detection was selected as a paradigm for the practical evaluation of ME-MB/IT-SPME. The application of a controlled magnetic field resulted in an obvious increase of extraction efficiencies of the target analytes between 70% and 100%. The present work demonstrated that application of different magnetic forces in adsorption and desorption steps can effectively enhance extraction efficiency of MB/IT-SPME systems. PMID:26742590

  1. The Feeding Tube- a Simple Yet Handy Aid to Intubate an Unanticipated Difficult Pediatric Airway.

    PubMed

    Thampi, S M; Salins, S R; Jacob, D P; Shrestha, A S

    2015-01-01

    Pediatric intubation requires certain unique set of additional skills compared to intubating adults. The challenges of successfully intubation of a child increases as the age and size of the child decrease and are compounded when airway difficulties arise for various reasons. Often in the rural setting, such procedures may have to be carried out by health care personnel who get trained on-the-job, and in the absence of adequate technological back-up. This leads to an increased incidence of failed intubations which can have devastating complications, especially in the pediatric age group. We describe a simple technique which helped us while intubate a 40-day old infant, without any major catastrophes. PMID:26994038

  2. An observational study of the feasibility of Airtraq guided intubations with Ring Adair Elvin tubes in pediatric population with cleft lip and palate

    PubMed Central

    Sharma, Ashima; Durga, Padmaja; Gurajala, Indira; Ramchandran, Gopinath

    2015-01-01

    Context: The airway management requires refined skills and technical help when associated with cleft lip and palate. Airtraq has improved our airway management skills and has been successfully used for rescue intubation in difficult pediatric airways. Aims: This study was to evaluate the efficacy of Airtraq as the primary intubation device in patients with cleft lip and palate. The study adheres to the STrengthening the Reporting of OBservational Studies Epidemiology Statement. Subjects and Methods: A total of 85 children posted consecutively for lip and palate repair were enrolled. Children were intubated with Ring Adair Elvin (RAE) tube using size 1 and 2 of Airtraq device. The design of Airtraq has an anatomical limitation to hold RAE tubes. The preformed bend of the tube was straightened with a malleable stylet. The intubations were assessed for device manipulations and time taken for glottis visualization and intubation, airway complications such as bleeding, laryngospasm and failed intubations. Statistical Analysis Used: The outcome data were reported as numbers and percentages or range with identified median value, where applicable. Results: The success rate of Airtraq guided intubations was 98.21%. The cumulative insertion times and intubation times were 31.50 ± 12.57 s and 48.04 ± 35.73 s respectively. Airtraq manipulations were applied in 25.45% subjects. Conclusions: The presence of cleft lip or palate did not hamper the insertion of Airtraq. The use of malleable stylet to facilitate the loading of the preformed tube into the guide channel is a simple and efficacious improvisation. Airtraq can be utilized as a primary intubation device in children with orofacial clefts. PMID:26712974

  3. [Airway equipment and its maintenance for a non difficult adult airway management (endotracheal intubation and its alternative: face mask, laryngeal mask airway, laryngeal tube)].

    PubMed

    Francon, D; Estèbe, J P; Ecoffey, C

    2003-08-01

    The airway equipment for a non difficult adult airway management are described: endotracheal tubes with a specific discussion on how to inflate the balloon, laryngoscopes and blades, stylets and intubation guides, oral airways, face masks, laryngeal mask airways and laryngeal tubes. Cleaning and disinfections with the maintenance are also discussed for each type of airway management. PMID:12943860

  4. Contamination from electrically conductive silicone tubing during aerosol chemical analysis

    SciTech Connect

    Yu, Yong; Alexander, M. L.; Perraud, Veronique; Bruns, Emily; Johnson, Stan; Ezell, Michael J.; Finlayson-Pitts, Barbara J.

    2009-06-01

    Electrically conductive silicone tubing is used to minimize losses in sampling lines during the analysis of airborne particle size distributions and number concentrations. We report contamination from this tubing using gas chromatography-mass spectrometry (GC-MS) of filter-collected samples as well as by particle mass spectrometry. Comparison of electrically conductive silicone and stainless steel tubing showed elevated siloxanes only for the silicone tubing. The extent of contamination increased with length of tubing to which the sample was exposed, and decreased with increasing relative humidity.

  5. Successful nasal intubation with a laryngeal nerve monitoring tube using bronchoscopy in a patient with plunging goiter: a case report

    PubMed Central

    2013-01-01

    Background The appropriate positioning of nerve integrity monitoring during thyroid surgery is of relevance. In this case report we describe our experience with accurate placement of a nerve integrity monitoring endotracheal tube, obtained by fiberoptic control, in a patient with expected difficult airway management. Case presentation We report the case of a 70-year-old obese woman scheduled for elective total thyroidectomy due to plunging intrathoracic goiter. The preoperative indirect laryngoscopy pointed out a massive bombè of the hypopharyngeal wall to the right and right vocal cord paralysis. The epiglottis was oedematous and the glottis could not be identified. On physical examination, the tongue was large and a Mallampati’s score of 3 was determined. Hence, due to an expected difficult airway management, a nasal intubation with an electromyographic nerve integrity monitoring endotracheal tube trough fiberoptic bronchoscopy was successfully performed. Conclusion Our experience suggests that nasal intubation can be safely performed by using a nerve integrity monitoring tube with the help of fiberoptic bronchoscopy. PMID:24229430

  6. Attapulgite Nanoparticles-Modified Monolithic Column for Hydrophilic In-Tube Solid-Phase Microextraction of Cyromazine and Melamine.

    PubMed

    Wang, Tingting; Chen, Yihui; Ma, Junfeng; Qian, Qian; Jin, Zhenfeng; Zhang, Lihua; Zhang, Yukui

    2016-02-01

    In current study, a novel monolithic capillary column with embedded attapulgite nanoparticles has been developed and exploited as a stationary phase in hydrophilic in-tube solid phase microextraction (SPME) of cyromazine and melamine. The fibrillar attapulgite nanoparticles were embedded in the poly(1-vinyl-3-(butyl-4-sulfonate) imidazolium-co-acrylamide-co-N,N'-methylenebis(acrylamide)) (poly(VBSIm-AM-MBA)) monolith via in situ polymerization. The attapulgite/polymerization ratio of the monolith was finely optimized. Primary factors of in-tube SPME including sample solvent, elution solvent, sample loading volume, elution volume, sample loading flow rate, and elution flow rate were thoroughly evaluated. Under optimal conditions, the limits of detection (LODs) were found to be 21.1 and 0.3 ng mL(-1) for cyromazine and melamine in the milk formula sample, respectively. Also, the recoveries of cyromazine and melamine spiked in the sample ranged from 94.5% to 109.9% with RSDs less than 7.6%. PMID:26743944

  7. Development of a cheap and accessible carbon fibers-in-poly(ether ether ketone) tube with high stability for online in-tube solid-phase microextraction.

    PubMed

    Feng, Juanjuan; Sun, Min; Bu, Yanan; Luo, Chuannan

    2016-02-01

    Carbon fibers (CFs) are one kind of important industrial materials that can be obtained commercially at low price. Based on the high extraction efficiency of carbon sorbents, a cheap and accessible carbon fibers-in-poly(ether ether ketone) (PEEK) tube was developed for online in-tube solid-phase microextraction (SPME) method. Coupled to high performance liquid chromatography (HPLC), the CFs-in-tube SPME was applied to analyze eight polycyclic aromatic hydrocarbons (PAHs) in environmental aqueous samples. Extraction conditions (sampling rate, extraction time, methanol content) and desorption time were investigated for optimization of conditions. Under the optimum conditions, the CFs-in-tube SPME-HPLC method provided high extraction efficiency with enrichment factors up to 1748. Good linearity (0.05-50 μg L(-1), 0.5-50 μg L(-1)) and low detection limits (0.01-0.1 μg L(-1)) were also obtained. The online analysis method was finally applied to determine several model PAHs analytes in real environmental aqueous samples. Some target analytes were detected and relative recoveries were in the range of 92.3-111%. Due to natural chemical stability of carbon fibers and PEEK tube, the CFs-in-tube device exhibited high resistance to organic solvent, acid and alkaline conditions. PMID:26653455

  8. Endotracheal tube intubation with the aid of a laryngeal mask airway, a fiberoptic bronchoscope, and a tube exchanger in a difficult airway patient: a case report.

    PubMed

    Sung, Joon Kyung; Kim, Hyung Gon; Kim, Jung Eun; Jang, Myung-Soo; Kang, Jong-Man

    2014-03-01

    A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations. PMID:24729847

  9. [Intubating laryngeal mask].

    PubMed

    Langenstein, H; Möller, F

    1998-01-01

    To improve the success of blind intubation through a laryngeal mask, Dr. A.I.J. Brain constructed the intubating laryngeal mask airway (ILMA), marketed under the name Fastrach. The new construction allows blind intubation with highly flexible endotracheal tubes up to 8 mm ID with cuff (straight Woodbridge type), securing the airway around the intubation process and maintaining most of the characteristics of a standard laryngeal mask airway (SLMA), including contraindications. An additional contraindication is the existence of a Zenker diverticle. Up to now, eight working groups reported a success rate of blind intubation through the ILMA of more than 90% in about 1,200 patients, with a success rate of blind intubation of more than 50% for the first intubation attempt. Ten percent of the patients were difficult to intubate with the same success rate for blind intubation as in normal patients. Reduced mouth opening does not seem to hinder the use of the ILMA in spite of its increased outer diameter of 2 cm, as long as it is possible to enlarge the mouth opening to > 2 cm during anaesthesia. The new ILMA more than doubles the success of blind intubation compared to an SLMA, irrespective of a large variety of intubation difficulties. Correct judgement of endotracheal tube position is mandatory. The ILMA has the potential to be used in patients who are difficult to intubate and to substitute the SLMA in "cannot ventilate--cannot intubate" situations. The future will show if the ILMA also will improve emergency airway management by inexperienced personnel, including intubation, as has been shown for the standard laryngeal mask airway in cardiopulmonary resuscitation for ventilation only. PMID:9611362

  10. Self-propelled in-tube shuttle and control system for automated measurements of magnetic field alignment

    NASA Astrophysics Data System (ADS)

    Boroski, W. N.; Nicol, T. H.; Pidcoe, S. V.; Zink, R. A.

    1990-03-01

    A magnetic field alignment gauge is used to measure the field angle as a function of axial position in each of the magnets for the Superconducting Super Collider (SSC). Present measurements are made by manually pushing the gauge through the magnet bore tube and stopping at intervals to record field measurements. Gauge location is controlled through graduation marks and alignment pins on the push rods. Field measurements are recorded on a logging multimeter with tape output. Described is a computerized control system being developed to replace the manual procedure for field alignment measurements. The automated system employs a pneumatic walking device to move the measurement gauge through the bore tube. Movement of the device, called the Self-Propelled In-Tube Shuttle (SPITS), is accomplished through an integral, gas driven, double-acting cylinder. The motion of the SPITS is transferred to the bore tube by means of a pair of controlled, retractable support feet. Control of the SPITS is accomplished through an RS-422 interface from an IBM-compatible computer to a series of solenoid-actuated air valves. Direction of SPITS travel is determined by the air-valve sequence, and is managed through the control software. Precise axial position of the gauge within the magnet is returned to the control system through an optically-encoded digital position transducer attached to the shuttle. Discussed is the performance of the transport device and control system during preliminary testing of the first prototype shuttle.

  11. Self-propelled in-tube shuttle and control system for automated measurements of magnetic field alignment

    SciTech Connect

    Boroski, W.N.; Nicol, T.H. ); Pidcoe, S.V. . Space Systems Div.); Zink, R.A. )

    1990-03-01

    A magnetic field alignment gauge is used to measure the field angle as a function of axial position in each of the magnets for the Superconducting Super Collider (SSC). Present measurements are made by manually pushing the through the magnet bore tube and stopping at intervals to record field measurements. Gauge location is controlled through graduation marks and alignment pins on the push rods. Field measurements are recorded on a logging multimeter with tape output. Described is a computerized control system being developed to replace the manual procedure for field alignment measurements. The automated system employs a pneumatic walking device to move the measurement gauge through the bore tube. Movement of the device, called the Self-Propelled In-Tube Shuttle (SPITS), is accomplished through an integral, gas driven, double-acting cylinder. The motion of the SPITS is transferred to the bore tube by means of a pair of controlled, retractable support feet. Control of the SPITS is accomplished through an RS-422 interface from an IBM-compatible computer to a series of solenoid-actuated air valves. Direction of SPITS travel is determined by the air-valve sequence, and is managed through the control software. Precise axial position of the gauge within the magnet is returned to the control system through an optically-encoded digital position transducer attached to the shuttle. Discussed is the performance of the transport device and control system during preliminary testing of the first prototype shuttle. 1 ref., 7 figs.

  12. Comparison of the GlideScope and the McGrath method using vascular forceps and a tube exchanger in cases of simulated difficult airway intubation

    PubMed Central

    Shim, Jae-Hang; Jeon, Woo Jae; Choe, Gyu Ho

    2016-01-01

    Background A "difficult airway" can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. Methods Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. Results There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). Conclusions Our results suggest that there are no significant differences in the intubations with GlideScope and McGrath using vascular forceps and tube exchangers in difficult intubation scenarios. PMID:27066203

  13. Selective molecularly imprinted polymer combined with restricted access material for in-tube SPME/UHPLC-MS/MS of parabens in breast milk samples.

    PubMed

    Souza, Israel D; Melo, Lidervan P; Jardim, Isabel C S F; Monteiro, Juliana C S; Nakano, Ana Marcia S; Queiroz, Maria Eugênia C

    2016-08-17

    A new molecularly imprinted polymer modified with restricted access material (a hydrophilic external layer), (MIP-RAM) was synthesized via polymerization in situ in an open fused silica capillary. This stationary phase was used as sorbent for in-tube solid phase microextraction (in-tube SPME) to determine parabens in breast milk samples by ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Scanning electron micrographs (SEM) illustrate MIP surface modification after glycerol dimethacrylate (hydrophilic monomer) incorporation. The interaction between parabens and MIP-RAM was investigated by Fourier-transform infrared (FTIR) spectroscopy. The Scatchard plot for MIP-RAM presented two linear parts with different slopes, illustrating binding sites with high- and low-affinity. Endogenous compounds exclusion from the MIP-RAM capillary was demonstrated by in-tube SPME/LC-UV assays carried out with blank milk samples. The in-tube SPME/UHPLC-MS/MS method presented linear range from 10 ng mL(-1) (LLOQ) to 400 ng mL(-1) with coefficients of determination higher than 0.99, inter-assay precision with coefficient of variation (CV) values ranging from 2 to 15%, and inter-assay accuracy with relative standard deviation (RSD) values ranging from -1% to 19%. Analytical validation parameters attested that in-tube SPME/UHPLC-MS/MS is an appropriate method to determine parabens in human milk samples to assess human exposure to these compounds. Analysis of breast milk samples from lactating women demonstrated that the proposed method is effective. PMID:27286769

  14. Nasal vs oral intubation.

    PubMed

    Holzapfel, L

    2003-05-01

    Both nasal and oral route for intubation have advantages and disadvantages. Oral intubation is easier to perform, faster and less painful than nasal intubation under direct laryngoscopy, while blind nasal intubation represents a good alternative in conscious patient, without sedation. In trauma patient, oral route should be preferred, with cervical immobilisation. By the contrary, nasal intubation can cause bleeding, retro-pharyngeal and turbinate bones injury, but it seems preferable in preventing laryngeal complications. Moreover nasal intubation seem to increase risk for sinusitis while, there is no clear advantage for any of the two routes, concerning nosocomial pneumonia, bacteriemia and otitis. Nevertheless nasal route increases comfort for the patient and decreases injury and necrosis of tongue and lips; tube fastening is simpler thus reducing accidental extubation. PMID:12768165

  15. Electroplating of nanostructured polyaniline-polypyrrole composite coating in a stainless-steel tube for on-line in-tube solid phase microextraction.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Esrafili, Ali; Rezaei, Fatemeh

    2015-06-01

    In this work, a novel and efficient on-line in-tube solid phase microextraction method followed by high performance liquid chromatography was developed for preconcentration and determination of trace amounts of parabens. A nanostructured polyaniline-polypyrrole composite was electrochemically deposited on the inner surface of a stainless steel tube and used as the extraction phase. Several important factors that influence the extraction efficiency, including type of solid-phase coating, extraction and desorption times, flow rates of the sample solution and eluent, pH, and ionic strength of the sample solution were investigated and optimized. Under the optimal conditions, the limits of detection were in the range of 0.02-0.04 μg L(-1). This method showed good linearity for parabens in the range of 0.07-50 μg L(-1), with coefficients of determination better than 0.998. The intra- and inter-assay precisions (RSD%, n=3) were in the range of 5.9-7.0% and 4.4-5.7% at three concentration levels of 2, 10, and 20 μg L(-1), respectively. The extraction recovery values for the spiked samples were in the acceptable range of 80.3-90.2%. The validated method was successfully applied for analysis of methyl-, ethyl-, and propyl parabens in some water, milk, and juice samples. PMID:25913328

  16. In-tube extraction of volatile organic compounds from aqueous samples: an economical alternative to purge and trap enrichment.

    PubMed

    Laaks, Jens; Jochmann, Maik A; Schilling, Beat; Schmidt, Torsten C

    2010-09-15

    A novel in-tube extraction device (ITEX 2) for headspace sampling was evaluated for GC/MS analysis of aqueous samples. Twenty compounds of regulatory and drinking water quality importance were analyzed, including halogenated hydrocarbons, BTEX compounds (benzene, toluene, ethylbenzene, xylenes), fuel oxygenates, geosmin, and 2-methylisoborneol. Five commercially available sorbent traps were compared for their compound specific extraction yield. On the basis of the results, a mixed bed trap was prepared and evaluated. The extraction parameters were optimized to yield maximum sensitivity within the time of a GC run, to avoid unnecessary downtime of the system. Method detection limits of 1-10 ng L(-1) were achieved for volatile organic compounds (VOCs), which is much lower than demands by regulatory limit values. The performance of the ITEX system is similar to that of purge and trap systems, but it requires lower sample volumes and is less prone to contamination, much simpler, more flexible, and affordable. Average relative standard deviations below 10% were achieved for all analytes, and recoveries from spiked tap water samples were between 90% and 103%, mostly. The extraction is nonexhaustive, removing a fraction of 7% to 55% of the target compounds, depending on the air-water partitioning coefficients. The method was also tested with nonsynthetic samples, including tap, pond, and reservoir water and different soft drinks. PMID:20722393

  17. Adsorbent phases with nanomaterials for in-tube solid-phase microextraction coupled on-line to liquid nanochromatography.

    PubMed

    González-Fuenzalida, R A; López-García, E; Moliner-Martínez, Y; Campíns-Falcó, P

    2016-02-01

    Following the present trends in miniaturization, a methodology that combines on-line In-Tube Solid-Phase Microextraction (IT-SPME) with Liquid Nanochromatography (nano-LC) and UV-vis diode array detection (DAD) was developed. This coupling was achieved by using two interconnected valves (i.e. conventional and micro-automatic valves) in the system of injection. As for IT-SPME, different materials, containing in some cases nanostructures or nanoparticles and in other cases polymeric adsorbent phases immobilized on capillary columns, were tested in order to improve extraction efficiencies of organic compounds; diclofenac was selected as the target analyte. Additionally, the transfer time of the sample between the two injection valves, as well as the lengths and the internal diameters of the capillary columns, was optimized. Under the selected conditions, the resulting IT-SPME-nano-LC-DAD method showed great potential to become a powerful analytical tool as it was successfully applied to the determination of diclofenac in pharmaceutical and water samples. For comparison purposes, IT-SPME coupled to Capillary Liquid Chromatography (Cap-LC) was used. The extraction yield of diclofenac reached near 80%, a high value for techniques that involve IT-SPME. Good accuracy (recoveries near 100%) and precision (4% RSD) were obtained. PMID:26795277

  18. [Isolated rupture of the left main-stem bronchus during intubation with a Carlens tube].

    PubMed

    Ortolo, B; Sainte-Rose, G; Brémant, S; Lecoeur, J; Rouge, M

    1988-01-01

    A case is reported of bronchial rupture due to a Carlens double-lumen tube. A 73 year old male patient was to undergo a double right lower and middle lobectomy for carcinoma. All went well and as expected until 20 min after the start of left-sided unilateral ventilation by way of the double-lumen tube. A sudden increase in the inspiratory pressures led to the discovery, first, of a leak around the cuff, and then, air bubbles in the mediastinum. Surgical exploration showed up the 4 cm long rupture in the pars membrana of the left main bronchus through which the cuff was herniating. The patient was reintubated and the rupture surgically repaired. The right upper lobe had not been ventilated for 45 min and there were signs of micro-atelectasia. The immediate postoperative course was rather stormy, with severe cardiac failure, recurring right upper lobe atelectasia and bilateral pulmonary infection. The patient was only definitely weaned from the respirator 40 days after the surgical incident. Although such complications with double-lumen tubes are rare, they must be recognized and surgically repaired very rapidly. A few simple rules to prevent these complications are discussed. PMID:3207231

  19. [Type I hypersensitivity to a silicone tube after laryngectomy].

    PubMed

    Stuck, B A; Hecksteden, K; Klimek, L; Hörmann, K

    2004-03-01

    While irritation of the tracheal mucosa is a common finding after laryngectomy, specific hypersensitivity to tracheal tubes or their components is extremely rare and has only been documented as a contact allergy. In this case report, we present type I hypersensitivity to tracheal tube components for the first time. The patient regularly used a special silicone tube for swimming after laryngectomy and complained about increasing tracheal irritation during and after the use of this tube. A standard skin prick test with common aeroallergens and a skin patch test with standard, rubber and adhesive allergens as well as with parts of the silicone tube was performed. Different parts of the tracheal tube were also tested with a scratch test. Total IgE as well as specific IgE for latex allergens was measured. Both skin prick and patch tests were negative. No specific IgE for latex allergens was detected. The scratch test generated strongly positive reactions against native tube material. The positive findings in the skin tests demonstrate specific hypersensitivity to the tracheal tube or its components in terms of a type I hypersensitivity. The causative component remains unclear. PMID:15007521

  20. Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively

    PubMed Central

    Cui, Fei; Liu, Jun; Li, Shuben; Yin, Weiqiang; Xin, Xu; Shao, Wenlong

    2016-01-01

    Background To assess the feasibility and safety of tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of a chest tube postoperatively compared with VATS under intubated anesthesia with single-lung mechanical ventilation. Methods A total of 91 patients undergoing tubeless VATS (60 sympathectomies, 22 bullae resections, and 9 mediastinal tumor resections) between December 2012 and December 2015 were included. Additionally, 82 patients were treated by VATS by the same team while under intubated general anesthesia (52 sympathectomies, 19 bullae resections, and 11 mediastinal tumor resections). Comprehensive early outcome data, including intraoperative and postoperative variables, were compared between the subgroups. Results In total, 89 patients in the tubeless group underwent an effective operation and exhibited good postoperative recovery, while 2 (one sympathectomy and one bullae resection) had their operation aborted for some reason. The tubeless group showed advantages in the postoperative fasting time, the mean duration of the postoperative hospital stay, and postoperative pain scores, while no significant difference was found in intraoperative blood loss, the operation time or postoperative complications between the tubeless group and the intubated group. Furthermore, 83% (49/59) of sympathectomies, 81% (17/21) of bullae resections, and 56% (5/9) of mediastinal tumor resections were achieved via day surgery. Conclusions In this study, our experience has shown that tubeless VATS is a safe and feasible surgery with certain advantages in selected patients with thoracic disease and that we can achieve day surgery in these cases.

  1. Application of silicon image tubes (SIVIT and SIT) to ground-based astronomy

    NASA Technical Reports Server (NTRS)

    Westphal, J. A.

    1973-01-01

    Studies conducted with ordinary silicon target tubes (SIVIT) and with silicon intensified tubes (SIT) are described. The operational characteristics of each type are given along with the advantages and disadvantages in various applications.

  2. [The evaluation of the utility of QuantiFERON TB-Gold In-Tube; QFT-GIT].

    PubMed

    Matsumoto, Tomoshige; Yamazaki, Toshio

    2014-09-01

    Four years has passed since QuantiFERON TB-Gold In-Tube (QFT-GIT), the third generation test, has replaced QuantiFERON-Gold in Japan. The QFT-GIT test detects interferon-gamma (IFN-γ), which is released from lymphocytes present in blood after exposure to the M. tuberculosis complex antigens ESAT-6, CFP-10 and TB7.7. These proteins are absent from all Bacille-Calmette-Guérin (BCG) strains and from most non-tuberculosis mycobacteria, resulting in fewer false positive reactions as seen with the tuberculin skin test (TST). We had various experiences with QFT-GIT during these four years. So, we discussed the usefulness and its limitation of QFT-GIT as follows: 1. Development of the principle of QuantiFERON-GIT: Nobuyuki HARADA (Research Institute of Immune Diagnosis (RIID)). QuantiFERON (QFT) was originated from diagnostic system for bovine in Australia. Although the first generation of QFT, in which PPD had been used as stimulating antigens, was approved in USA, its diagnostic value was not recognized in Japan where most of Japanese are vaccinated with BCG. By combining M. tuberculosis-specific antigens with QFT system, the second generation of QFT, QFT-Gold, was developed, and approved in Japan in 2005. QFT-Gold was soon incorporated in several guidelines such as contact investigations and nosocomial infection measures. Now, QFT-Gold was superseded by the improved QFT-Gold, the current QFT-GIT. However, since QFT-GIT may contain unstable factors including blood volume and shaking methods of blood collection tubes, development of the more improved version is strongly expected. 2. Evaluating the result of QFT-GIT in patients treated with dialysis and immunosuppressive agents: Hidetoshi IGARI (National Hospital Organization Chiba-East National Hospital) The effectiveness of QuantiFERON TB-Gold In-Tube was analyzed in the patients with chronic kidney disease (CKD) and rheumatoid arthritis (RA). QFT positive was 7% and 11% respectively, and indeterminate was 5% and 2

  3. Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model

    PubMed Central

    Moses, Mark W.; Zwerling, Alice; Cattamanchi, Adithya; Denkinger, Claudia M.; Banaei, Niaz; Kik, Sandra V.; Metcalfe, John; Pai, Madhukar; Dowdy, David

    2016-01-01

    Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a microsimulation Markov model that accounts for major sources of variability to project diagnostic outcomes in a simulated North American HCW cohort. Serial testing using a single QFT with the recommended conversion cutoff (IFN-g > 0.35 IU/mL) resulted in 24.6% (95% uncertainty range, UR: 23.8–25.5) of the entire population testing false-positive over ten years. Raising the cutoff to >1.0 IU/mL or confirming initial positive results with a (presumed independent) second test reduced this false-positive percentage to 2.3% (95%UR: 2.0–2.6%) or 4.1% (95%UR: 3.7–4.5%), but also reduced the proportion of true incident infections detected within the first year of infection from 76.5% (95%UR: 66.3–84.6%) to 54.8% (95%UR: 44.6–64.5%) or 61.5% (95%UR: 51.6–70.9%), respectively. Serial QFT testing of HCWs in North America may result in tremendous over-diagnosis and over-treatment of LTBI, with nearly thirty false-positives for every true infection diagnosed. Using higher cutoffs for conversion or confirmatory tests (for initial positives) can mitigate these effects, but will also diagnose fewer true infections. PMID:27469388

  4. Serial testing for latent tuberculosis using QuantiFERON-TB Gold In-Tube: A Markov model.

    PubMed

    Moses, Mark W; Zwerling, Alice; Cattamanchi, Adithya; Denkinger, Claudia M; Banaei, Niaz; Kik, Sandra V; Metcalfe, John; Pai, Madhukar; Dowdy, David

    2016-01-01

    Healthcare workers (HCWs) in low-incidence settings are often serially tested for latent TB infection (LTBI) with the QuantiFERON-TB Gold In-Tube (QFT) assay, which exhibits frequent conversions and reversions. The clinical impact of such variability on serial testing remains unknown. We used a microsimulation Markov model that accounts for major sources of variability to project diagnostic outcomes in a simulated North American HCW cohort. Serial testing using a single QFT with the recommended conversion cutoff (IFN-g > 0.35 IU/mL) resulted in 24.6% (95% uncertainty range, UR: 23.8-25.5) of the entire population testing false-positive over ten years. Raising the cutoff to >1.0 IU/mL or confirming initial positive results with a (presumed independent) second test reduced this false-positive percentage to 2.3% (95%UR: 2.0-2.6%) or 4.1% (95%UR: 3.7-4.5%), but also reduced the proportion of true incident infections detected within the first year of infection from 76.5% (95%UR: 66.3-84.6%) to 54.8% (95%UR: 44.6-64.5%) or 61.5% (95%UR: 51.6-70.9%), respectively. Serial QFT testing of HCWs in North America may result in tremendous over-diagnosis and over-treatment of LTBI, with nearly thirty false-positives for every true infection diagnosed. Using higher cutoffs for conversion or confirmatory tests (for initial positives) can mitigate these effects, but will also diagnose fewer true infections. PMID:27469388

  5. Automated and quantitative headspace in-tube extraction for the accurate determination of highly volatile compounds from wines and beers.

    PubMed

    Zapata, Julián; Mateo-Vivaracho, Laura; Lopez, Ricardo; Ferreira, Vicente

    2012-03-23

    An automatic headspace in-tube extraction (ITEX) method for the accurate determination of acetaldehyde, ethyl acetate, diacetyl and other volatile compounds from wine and beer has been developed and validated. Method accuracy is based on the nearly quantitative transference of volatile compounds from the sample to the ITEX trap. For achieving that goal most methodological aspects and parameters have been carefully examined. The vial and sample sizes and the trapping materials were found to be critical due to the pernicious saturation effects of ethanol. Small 2 mL vials containing very small amounts of sample (20 μL of 1:10 diluted sample) and a trap filled with 22 mg of Bond Elut ENV resins could guarantee a complete trapping of sample vapors. The complete extraction requires 100 × 0.5 mL pumping strokes at 60 °C and takes 24 min. Analytes are further desorbed at 240 °C into the GC injector under a 1:5 split ratio. The proportion of analytes finally transferred to the trap ranged from 85 to 99%. The validation of the method showed satisfactory figures of merit. Determination coefficients were better than 0.995 in all cases and good repeatability was also obtained (better than 7% in all cases). Reproducibility was better than 8.3% except for acetaldehyde (13.1%). Detection limits were below the odor detection thresholds of these target compounds in wine and beer and well below the normal ranges of occurrence. Recoveries were not significantly different to 100%, except in the case of acetaldehyde. In such a case it could be determined that the method is not able to break some of the adducts that this compound forms with sulfites. However, such problem was avoided after incubating the sample with glyoxal. The method can constitute a general and reliable alternative for the analysis of very volatile compounds in other difficult matrixes. PMID:22340891

  6. The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients

    PubMed Central

    Al Wakeel, Jamal Saleh; Makoshi, Ziyad; Al Ghonaim, Mohammed; Al Harbi, Ali; Al Suwaida, Abdulkareem; Algahtani, Farjah; Al Hedaithy, Mogbil; Almogairin, Sultan; Abdullah, Sami

    2015-01-01

    BACKGROUND AND AIM: Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients. METHODS: This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years. RESULTS: A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043). CONCLUSIONS: Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB. PMID:26664568

  7. Effect of Intravenous Acetaminophen (Paracetamol) on Hemodynamic Parameters Following Endotracheal Tube Intubation and Postoperative Pain in Caesarian Section Surgeries

    PubMed Central

    Soltani, Ghasem; Molkizadeh, Amirmasoud; Amini, Shahram

    2015-01-01

    Background: Use of analgesics, especially opioids, before delivery during cesarean section for preventing hemodynamic changes after endotracheal intubation and postoperative analgesia is limited due to their adverse effects on the neonate. Objectives: The aim of this study was to investigate the effect of intravenous acetaminophen (paracetamol) in blunting hemodynamic responses to endotracheal intubation and postoperative pain in parturient undergoing cesarean section by general anesthesia. Patients and Methods: Eighty parturients undergoing cesarean section by general anesthesia were randomly divided to receive either 15 mg/kg intravenous paracetamol (n = 40) or normal saline (n = 40) fifteen minutes before endotracheal intubation. Mean arterial blood pressure (MAP) and pulse rates were compared at baseline and after intubation at one minute interval for five minutes between the two groups. The patients were also compared for postoperative pain intensity and analgesic requirement. Results: Patients in the saline group experienced more pain in the recovery room (VAS 7.0 ± 1.24 vs. 6.15 ± 2.27; P value = 0.041) and required more fentanyl intraoperatively (150 µg vs. 87.7 ± 75; P value < 0.01) and meperidine postoperatively (12.88 ± 20.84 mg vs. 1.35 ± 5.73; P value = 0.002) than the paracetamol group. Mean arterial pressure (MAP) changes were similar after intubation in the both groups (P value = 0.71), however, pulse rates showed greater changes following intubation in the saline group (P value = 0.01). Conclusions: Intravenous acetaminophen administered before caesarean section reduced tachycardia after intubation, narcotic drugs administration during and after the operation and reduced pain in PACU. PMID:26705524

  8. Determination of aflatoxins in food samples by automated on-line in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Nonaka, Y; Saito, K; Hanioka, N; Narimatsu, S; Kataoka, H

    2009-05-15

    A simple and sensitive automated method for determination of aflatoxins (B1, B2, G1, and G2) in nuts, cereals, dried fruits, and spices was developed consisting of in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). Aflatoxins were separated within 8 min by high-performance liquid chromatography using a Zorbax Eclipse XDB-C8 column with methanol/acetonitrile (60/40, v/v): 5mM ammonium formate (45:55) as the mobile phase. Electrospray ionization conditions in the positive ion mode were optimized for MS detection of aflatoxins. The pseudo-molecular ions [M+H](+) were used to detect aflatoxins in selected ion monitoring (SIM) mode. The optimum in-tube SPME conditions were 25draw/eject cycles of 40 microL of sample using a Supel-Q PLOT capillary column as an extraction device. The extracted aflatoxins were readily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. Using the in-tube SPME LC-MS with SIM method, good linearity of the calibration curve (r>0.9994) was obtained in the concentration range of 0.05-2.0 ng/mL using aflatoxin M1 as an internal standard, and the detection limits (S/N=3) of aflatoxins were 2.1-2.8 pg/mL. The in-tube SPME method showed >23-fold higher sensitivity than the direct injection method (10 microL injection volume). The within-day and between-day precision (relative standard deviations) at the concentration of 1 ng/mL aflatoxin mixture were below 3.3% and 7.7% (n=5), respectively. This method was applied successfully to analysis of food samples without interference peaks. The recoveries of aflatoxins spiked into nuts and cereals were >80%, and the relative standard deviations were <11.2%. Aflatoxins were detected at <10 ng/g in several commercial food samples. PMID:19328492

  9. Fibreoptic intubation.

    PubMed

    Morris, I R

    1994-10-01

    Although not widely utilized, fibreoptic techniques represent a dramatic advance in the management of the difficult intubation. Particularly suited to the awake patient in the elective setting, fibreoptic intubation can also be useful in selected emergency situations, and can be done under general anaesthesia. In the awake patient fibreoptic intubation maintains a wide margin of safety while producing minimal patient discomfort, but requires adequate local anaesthesia of the airway. Intimate familiarity with the bronchoscope and the anatomy of the upper airway is essential as is careful attention to various aspects of technique. Intubation mannequins can be readily utilized to develop dexterity in bronchoscopic manipulation and intubation workshops are also effective in improving skills. This CME article provides the clinician with a detailed approach to the technique of fibreoptic intubation based on the author's personal experience supplemented by a limited literature review. Fibreoptic intubation is not a difficult skill to master and should be in the armamentarium of all practising anaesthetists. PMID:8001220

  10. Comparative studies of silicon photomultipliers and traditional vacuum photomultiplier tubes

    NASA Astrophysics Data System (ADS)

    Shi, Feng; Lü, Jun-Guang; Lu, Hong; Wang, Huan-Yu; Ma, Yu-Qian; Hu, Tao; Zhou, Li; Cai, Xiao; Sun, Li-Jun; Yu, Bo-Xiang; Fang, Jian; Xie, Yu-Guang; An, Zheng-Hua; Wang, Zhi-Gang; Gao, Min; Li, Xin-Qiao; Xu, Yan-Bing; Wang, Ping; Sun, Xi-Lei; Zhang, Ai-Wu; Xue, Zhen; Liu, Hong-Bang; Wang, Xiao-Dong; Zhao, Xiao-Yun; Zheng, Yang-Heng; Meng, Xiang-Cheng; Wang, Hui

    2011-01-01

    Silicon photomultipliers (SiPMs) are a new generation of semiconductor-based photon counting devices with the merits of low weight, low power consumption and low voltage operation, promising to meet the needs of space particle physics experiments. In this paper, comparative studies of SiPMs and traditional vacuum photomultiplier tubes (PMTs) have been performed regarding the basic properties of dark currents, dark counts and excess noise factors. The intrinsic optical crosstalk effect of SiPMs was evaluated.

  11. On-line electrochemically controlled in-tube solid phase microextraction of inorganic selenium followed by hydride generation atomic absorption spectrometry.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Shamsayei, Maryam; Safari, Meysam; Rezaei, Fatemeh

    2016-05-30

    In this work, for the first time, a rapid, simple and sensitive microextraction procedure is demonstrated for the matrix separation, preconcentration and determination of inorganic selenium species in water samples using an electrochemically controlled in-tube solid phase microextraction (EC-in-tube SPME) followed by hydride generation atomic absorption spectrometry (HG-AAS). In this approach, in which EC-in-tube SPME and HG-AAS system were combined, the total analysis time, was decreased and the accuracy, repeatability and sensitivity were increased. In addition, to increases extraction efficiency, a novel nanostructured composite coating consisting of polypyrrole (PPy) doped with ethyleneglycol dimethacrylate (EGDMA) was prepared on the inner surface of a stainless-steel tube by a facile electrodeposition method. To evaluate the offered setup and the new PPy-EGDMA coating, it was used to extract inorganic selenium species in water samples. Extraction of inorganic selenium species was carried out by applying a positive potential through the inner surface of coated in-tube under flow conditions. Under the optimized conditions, selenium was detected in amounts as small as 4.0 parts per trillion. The method showed good linearity in the range of 0.012-200 ng mL(-1), with coefficients of determination better than 0.9996. The intra- and inter-assay precisions (RSD%, n = 5) were in the range of 2.0-2.5% and 2.7-3.2%, respectively. The validated method was successfully applied for the analysis of inorganic selenium species in some water samples and satisfactory results were obtained. PMID:27154830

  12. Development of a new system for guidewire-assisted tracheal intubation: manikin and cadaver evaluation.

    PubMed

    Dhara, S S; McGlone, D J; Skinner, M W

    2016-01-01

    Guided intubation using a tracheal tube and semi-rigid introducer is associated with technical difficulties, failure and traumatic complications. We describe the development of a new system of guidewire-assisted tracheal intubation that may circumvent these problems. A reinforced silicone tracheal tube was modified with a guide channel built inside its wall, and a nitinol non-kinking guidewire was matched to this channel. Both anterograde and retrograde tracheal intubation were evaluated in a test rig, an airway manikin and then in preserved and fresh cadavers. There was minimal resistance to passage of the guidewire through the guide channel when the modified tube was in an anatomical configuration, in contrast to moderate resistance when an Airway Exchange Catheter was passed through a PVC tracheal tube. Intubation using the new equipment required increased force in the manikin and preserved cadavers, but minimal force in fresh cadavers. Resistance to tracheal tube advancement in preserved cadavers was overcome by withdrawal followed by 90° rotation, but this manoeuvre was not required in fresh cadavers. We suggest that the combination of the modified tracheal tube and matching guidewire may allow easy and reliable single-step guided tracheal intubation when used in patients. PMID:26559371

  13. Custom prefabrication of silicone tubes from urinary catheters for experimental peripheral nerve surgery.

    PubMed

    Saray, Aydin

    2004-01-01

    The entubulation principle represents a neurobiological approach to nerve surgery in which the role of the surgeon is limited and intrinsic healing capabilities of the nerve play the primary role. Herein, a technique for fabricating custom-made silicone tubes from a silicone urinary catheter is described. Silicone tubes with varying size and dimensions can be tailored depending on the diameter of the silicone urinary catheter (14 F to 18 F). Tubes crafted from silicone urinary catheters were used either as a nerve conduit to facilitate regeneration or as compressive nerve banding to simulate compressive neuropathy in the rat sciatic nerve. Custom-made silicone tubes have similar pros and cons to the commercially available silicone tubes regarding the capsule and foreign body reaction. It can be concluded that these cost effective tubes can be easily cut and used in experimental peripheral nerve surgery in developing countries where the cost of such materials becomes an important issue for the researchers. PMID:24115867

  14. EHD enhancement of pool and in-tube boiling of alternate refrigerants. Final report, 15 January 1993--15 June 1993

    SciTech Connect

    Ohadi, M.M.; Dessiatoun, S.; Singh, A.; Fanni, M.A.

    1993-08-01

    The Electrohydrodynamic (EHD) is an active heat transfer augmentation technique which utilizes the effect of secondary motions generated through the application of an electrostatic potential to a dielectric fluid. Net result is better momentum and heat transfer between the fluid and the heat transfer wall through destabilization of the thermal boundary layer and better mixing of the fluid adjacent to the heat transfer surface. EHD enhancement of refrigerant/refrigerant oil mixtures heat transfer using the Electrohydrodynamic (EHD) technique is the subject of a three-year experimental investigation in a project funded by the US Department of Energy, effective June 1, 1993. For the interim period between November 1992 and June 1993 when the DOE funds became available, the Air-Conditioning and Refrigeration Technology Institute (ARTI) provided partial funding for our EHD research program with the aim of accomplishing three major tasks: (1) conduct a comprehensive search of the literature on EHD-enhanced, in-tube and external boiling heat transfer enhancement of alternate refrigerants; (2) Design, fabricate, and instrument an in-tube, EHD-enhanced boiling/condensation test rig and perform preliminary testing of the setup; (3) conduct experiments and document new findings on EHD-enhanced external boiling of alternate refrigerants/refrigerant mixtures in an existing pool boiling test rig apparatus. Description of Tasks performed are described and results are discussed.

  15. The Multiple Silicone Tube Device, “Tubes within a Tube,” for Multiplication in Nerve Reconstruction

    PubMed Central

    Dahlin, Lars B.

    2014-01-01

    Multiple nerve branches were created during the regeneration procedure after a nerve injury and such multiple branches are suggested to be used to control, for example, prosthesis with many degrees of freedom. Transected rat sciatic nerve stumps were inserted into a nine mm long silicone tube, which contained four, five mm long, smaller tubes, thus leaving a five mm gap for regenerating nerve fibers. Six weeks later, several new nerve structures were formed not only in the four smaller tubes, but also in the spaces in-between. The 7–9 new continuous nerve structures, which were isolated as individual free nerves after removal of the tubes, were delineated by a perineurium and contained both myelinated and unmyelinated nerve fibers as well as blood vessels. Stimulation of the proximal nerve elicited contractions in distal muscles. Thin metal electrodes, inserted initially into the smaller tubes in some experiments, became embedded in the new nerve structures and when stimulated contractions of the distal muscles were observed. The “tubes within a tube” technique, creating multiple new nerves from a single “mother” nerve, can be used to record multiple signals for prosthetic device control or as sources for supply of multiple denervated targets. PMID:24864255

  16. Preparation and evaluation of a novel molecularly imprinted polymer coating for selective extraction of indomethacin from biological samples by electrochemically controlled in-tube solid phase microextraction.

    PubMed

    Asiabi, Hamid; Yamini, Yadollah; Seidi, Shahram; Ghahramanifard, Fazel

    2016-03-24

    In the present work, an automated on-line electrochemically controlled in-tube solid-phase microextraction (EC-in-tube SPME) coupled with HPLC-UV was developed for the selective extraction and preconcentration of indomethacin as a model analyte in biological samples. Applying an electrical potential can improve the extraction efficiency and provide more convenient manipulation of different properties of the extraction system including selectivity, clean-up, rate, and efficiency. For more enhancement of the selectivity and applicability of this method, a novel molecularly imprinted polymer coated tube was prepared and applied for extraction of indomethacin. For this purpose, nanostructured copolymer coating consisting of polypyrrole doped with ethylene glycol dimethacrylate was prepared on the inner surface of a stainless-steel tube by electrochemical synthesis. The characteristics and application of the tubes were investigated. Electron microscopy provided a cross linked porous surface and the average thickness of the MIP coating was 45 μm. Compared with the non-imprinted polymer coated tubes, the special selectivity for indomethacin was discovered with the molecularly imprinted coated tube. Moreover, stable and reproducible responses were obtained without being considerably influenced by interferences commonly existing in biological samples. Under the optimal conditions, the limits of detection were in the range of 0.07-2.0 μg L(-1) in different matrices. This method showed good linearity for indomethacin in the range of 0.1-200 μg L(-1), with coefficients of determination better than 0.996. The inter- and intra-assay precisions (RSD%, n = 3) were respectively in the range of 3.5-8.4% and 2.3-7.6% at three concentration levels of 7, 70 and 150 μg L(-1). The results showed that the proposed method can be successfully applied for selective analysis of indomethacin in biological samples. PMID:26944991

  17. Left-sided mouse intubation: description and evaluation.

    PubMed

    Singer, Thomas; Brand, Vanessa; Moehrlen, Ueli; Fehrenbach, Heinz; Purkabiri, Kurosch; Ott, Sebastian Robert; Stammberger, Uz; Ochs, Matthias; Hamacher, Jürg

    2010-02-01

    A method of left main bronchus intubation was developed based on a wire guide-based microscopic endotrachael mouse intubation technique. The authors used a 22 G x 1 inch catheter elongated by a 38-mm silicone tube, and a wire guide with a tag to assign the length of the wire completely covered by the silicon tube. The isoflurane-anesthetized mouse was hung perpendicularly with its incisors on a thread and transorally intubated under strict vision with the wire guide tip advanced 3 mm out of the catheter. Then the catheter was advanced about 6 to 8 mm into the trachea. Afterwards the wire guide was redrawn to the level of the catheter tip (blue tag on the wire guide appeared at the upper end of catheter) to prevent injury. Then the neck was pushed into a right lateral flexion with one finger against a foam block fixed on the vertical plate, causing a straight distance between mouth and left main bronchus. This positioning allows to gently advance the catheter into the left main bronchus by another about 20 mm, using the wire guide with its tip just within the tube, to achieve there a wedge position with gentle pressure.The technique had a success rate of more than 80% in 81 mice weighing 23 to 48 g. It may be of interest for unilateral lung intervention, e.g., with injurious substances or with drugs. PMID:20128679

  18. [Successful double-lumen tube intubation with the Pentax-AWS Airwayscope and a tracheal tube introducer in the lateral position for a patient with a giant mediastinal tumor].

    PubMed

    Nakao, Kenta; Komasawa, Nobuyasu; Kuzukawa, Yosuke; Fujitate, Yasutaka; Minami, Toshiaki

    2014-06-01

    Anesthetic management of a patient with giant mediastinal tumors is challenging from the perspective of both cardiovascular and respiratory management. We report the successful use of the Pentax-AWS Airwayscope (AWS; Hoya, Japan) and a tracheal tube introducer in the left lateral position for a patient with a giant mediastinal tumor. An 18-year-old man weighing 62 kg was scheduled for resection of a giant mediastinal tumor. He suffered from slight dyspnea in the supine position, and slept in the left lateral position. Preoperative chest X-P and computed tomography revealed compression of the left bronchus, heart and aorta. To avoid cardiac and respiratory collapse, anesthesia was induced in the left lateral position without a muscle relaxant. The patient was administered fentanyl 200 microg and propofol 150 mg; mask ventilation with the two-hand technique in the lateral position was successful. Subsequently, the AWS was inserted into his mouth and a 10 Fr tracheal tube introducer was placed in the trachea under the guidance of the AWS monitor. The patient was then intubated with a 35 Fr right-sided double-lumen tracheal tube under the guidance of the tracheal tube introducer. The head of the double-lumen tube was placed in the right bronchus under the guidance of a bronchofiberscope. Following tracheal tube placement, posture was shifted from the left lateral position to supine position without affecting vital signs. After median sternotomy, a muscle relaxant was administered for immobilization. PMID:24979858

  19. Development of a novel graphene/polyaniline electrodeposited coating for on-line in-tube solid phase microextraction of aldehydes in human exhaled breath condensate.

    PubMed

    Li, Yu; Xu, Hui

    2015-05-22

    In this work, we introduced a novel graphene/polyaniline (G/PANI) electrodeposited coating for on-line in-tube solid phase microextraction (IT-SPME) for the first time. The G/PANI coating was prepared on the internal surface of stainless steel tube by a facile in-situ electrodeposition method. The morphology and formation of the composite coating were confirmed by scanning electronic microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Some important experimental parameters that could affect the extraction and separation such as the coating thickness, internal diameter of tube, sampling flow rate as well as sample volume were optimized. The extraction performance of the IT-SPME coating was evaluated systematically. The coating exhibited enhanced mechanical stability, long lifespan, large specific surface area and good biocompatibility compared with polyaniline coating. The on-line IT-SPME method showed higher enrichment efficiency, faster analysis speed and higher automation level than off-line manual mode. Six aldehydes were determined simultaneously with low limits of detection of 0.02-0.04nmolL(-1) and good linearity (R(2)≥0.9920). The method has been applied successfully for the determination of aldehydes in human exhaled breath condensates with good recovery (70-120%) and satisfied reproducibility (relative standard deviation: 1.1-11.9%). This on-line IT-SPME method provides a promising approach for the determination of trace aldehydes with approving sensitivity in human exhaled breath condensates. PMID:25863926

  20. Intraoperative protection of cranial nerves and arteries by split silicone tube.

    PubMed

    Tanaka, Y; Kobayashi, S; Hongo, K; Oikawa, S

    1993-09-01

    The authors describe the usefulness of split silicone tubing to protect the cranial nerves and arteries during microneurosurgery. The inner diameter of the tube varied from 1.0 to 3.3 mm with a thickness of 0.125 mm. Application of the tube protects the nerves and arteries from mechanical trauma, electrical injury, and dryness. PMID:8413888

  1. Endobronchial hemorrhage after intubation with double-lumen endotracheal tube in a patient with idiopathic thrombocytopenic purpura for minimally invasive cardiac surgery: a case report

    PubMed Central

    Kim, Hee Young; Kim, Kyoung Hoon; Kim, Nam Won

    2014-01-01

    Minimally invasive cardiac surgery (MICS) requires lung isolation. Lung isolation is usually achieved with double-lumen endotracheal tube (DLT). Patients with idiopathic thrombocytopenic purpura (ITP) have an increased risk of bleeding events. We suspected endobronchial hemorrhage after exchange of DLT during induction of anesthesia for replacement of mitral valve in a 62-year-old man with a known ITP. The MICS was stopped and bronchial artery embolization was performed in the angiographic room. In the present case, in order to reduce the risk of bronchial arterial injury in ITP patient we intubated with single lumen endotracheal tube. Lung isolation led to achievement of intermittent total lung deflation. Based on the results, we recommend a high-dose intravenous immunoglobulin therapy and platelet transfusion prior to cardiac surgery in patients with ITP to increase platelet count. Moreover, it is proposed that in order to clear the vision during the operation, ventilation can be held or made intermittent both prior to cardiopulmonary bypass or at its conclusion to permit exposure. PMID:24567815

  2. Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis.

    PubMed

    Hong, Feng; Wei, Bin; Chen, Lin

    2015-01-01

    Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine. PMID:26090420

  3. Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis

    PubMed Central

    Wei, Bin; Chen, Lin

    2015-01-01

    Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine. PMID:26090420

  4. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5980 Gastrointestinal... intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube...

  5. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5980 Gastrointestinal... intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube...

  6. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5980 Gastrointestinal... intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube...

  7. 21 CFR 876.5980 - Gastrointestinal tube and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5980 Gastrointestinal... intubation, feeding tube, gastroenterostomy tube, Levine tube, nasogastric tube, single lumen tube...

  8. Determination of polycyclic aromatic hydrocarbons in food samples by automated on-line in-tube solid-phase microextraction coupled with high-performance liquid chromatography-fluorescence detection.

    PubMed

    Ishizaki, A; Saito, K; Hanioka, N; Narimatsu, S; Kataoka, H

    2010-08-27

    A simple and sensitive automated method, consisting of in-tube solid-phase microextraction (SPME) coupled with high-performance liquid chromatography-fluorescence detection (HPLC-FLD), was developed for the determination of 15 polycyclic aromatic hydrocarbons (PAHs) in food samples. PAHs were separated within 15 min by HPLC using a Zorbax Eclipse PAH column with a water/acetonitrile gradient elution program as the mobile phase. The optimum in-tube SPME conditions were 20 draw/eject cycles of 40 microL of sample using a CP-Sil 19CB capillary column as an extraction device. Low- and high-molecular weight PAHs were extracted effectively onto the capillary coating from 5% and 30% methanol solutions, respectively. The extracted PAHs were readily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. Using the in-tube SPME HPLC-FLD method, good linearity of the calibration curve (r>0.9972) was obtained in the concentration range of 0.05-2.0 ng/mL, and the detection limits (S/N=3) of PAHs were 0.32-4.63 pg/mL. The in-tube SPME method showed 18-47 fold higher sensitivity than the direct injection method. The intra-day and inter-day precision (relative standard deviations) for a 1 ng/mL PAH mixture were below 5.1% and 7.6% (n=5), respectively. This method was applied successfully to the analysis of tea products and dried food samples without interference peaks, and the recoveries of PAHs spiked into the tea samples were >70%. Low-molecular weight PAHs such as naphthalene and pyrene were detected in many foods, and carcinogenic benzo[a]pyrene, at relatively high concentrations, was also detected in some black tea samples. This method was also utilized to assess the release of PAHs from tea leaves into the liquor. PMID:20637468

  9. Sol-gel approach to in situ creation of high pH-resistant surface-bonded organic-inorganic hybrid zirconia coating for capillary microextraction (in-tube SPME).

    PubMed

    Alhooshani, Khalid; Kim, Tae-Young; Kabir, Abuzar; Malik, Abdul

    2005-01-01

    A novel zirconia-based hybrid organic-inorganic sol-gel coating was developed for capillary microextraction (CME) (in-tube SPME). High degree of chemical inertness inherent in zirconia makes it very difficult to covalently bind a suitable organic ligand to its surface. In the present work, this problem was addressed from a sol-gel chemistry point of view. Principles of sol-gel chemistry were employed to chemically bind a hydroxy-terminated silicone polymer (polydimethyldiphenylsiloxane, PDMDPS) to a sol-gel zirconia network in the course of its evolution from a highly reactive alkoxide precursor undergoing controlled hydrolytic polycondensation reactions. A fused silica capillary was filled with a properly designed sol solution to allow for the sol-gel reactions to take place within the capillary for a predetermined period of time (typically 15-30 min). In the course of this process, a layer of the evolving hybrid organic-inorganic sol-gel polymer got chemically anchored to the silanol groups on the capillary inner walls via condensation reaction. At the end of this in-capillary residence time, the unbonded part of the sol solution was expelled from the capillary under helium pressure, leaving behind a chemically bonded sol-gel zirconia-PDMDPS coating on the inner walls. Polycyclic aromatic hydrocarbons, ketones, and aldehydes were efficiently extracted and preconcentrated from dilute aqueous samples using sol-gel zirconia-PDMDPS coated capillaries followed by thermal desorption and GC analysis of the extracted solutes. The newly developed sol-gel hybrid zirconia coatings demonstrated excellent pH stability, and retained the extraction characteristics intact even after continuous rinsing with a 0.1 M NaOH solution for 24 h. To our knowledge, this is the first report on the use of a sol-gel zirconia-based hybrid organic-inorganic coating as an extraction medium in solid phase microextraction (SPME). PMID:15679137

  10. QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening of latent tuberculosis in recent immigrants to Italy.

    PubMed

    Saracino, Annalisa; Scotto, Gaetano; Fornabaio, Chiara; Martinelli, Domenico; Faleo, Giuseppina; Cibelli, Donatella; Tartaglia, Alessandra; Di Tullio, Rocco; Fazio, Vincenzina; Prato, Rosa; Monno, Laura; Angarano, Gioacchino

    2009-10-01

    To evaluate the agreement between QuantiFERON-TB Gold In-Tube test (QFT-GIT) and tuberculin skin test (TST) for the screening of latent tuberculosis infection (LTBI) in recent immigrants to Italy, 279 subjects were submitted to concomitant TST and QFT-GIT. The agreement was analyzed using k statistics. A total of 72/279 (25.8%) individuals were TST positive, while 107/279 (38.3%) were QFT-GIT positive. The overall agreement between QFT-GIT and TST was 70.9%, with k statistic of 0.35. Using different TST and QFT-GIT cut-offs, the best concordance value was obtained for QFT-GIT at > 2.64 IU/ml and TST at > 10mm (k = 0.409). Discordant results were found for 58 subjects (21%) with QFT-GIT positive/TST negative and 23 (8%) with QFT-GIT negative/TST positive. A high amount of discordance QFT-GIT+/TST- was described. QFT-GIT might increase the identification of LTBI cases among recent immigrants. PMID:20128443

  11. Risk factors for false-negative results of QuantiFERON-TB Gold In-Tube assay in non-HIV-infected patients with culture-confirmed tuberculosis.

    PubMed

    Kim, Eun Young; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; Kang, Young Ae

    2011-07-01

    Limited information is available on the risk factors for false-negative results with the new generation of QuantiFERON-TB Gold In-Tube (QFT-GIT) tests in non-HIV-infected patients with tuberculosis (TB). We sought to identify risk factors for false-negative QFT-GIT results in culture-confirmed TB patients. We reviewed the microbiological, laboratory, radiographic, and clinical data of 362 patients with positive M. tuberculosis cultures who received QFT-GIT tests at a Korean tertiary hospital between September 2006 and March 2010. Of these, 311 (85.9%) had true-positive and 51 (14.1%) had false-negative results. The false-negative group was more likely to have immunosuppressant diseases and lower platelet, protein, and albumin levels than the true-positive group. An immunosuppressive condition was an independent risk factor for false-negative QFT-GIT results in non-HIV-infected patients with active TB (odds ratio, 2.98; 95% confidence interval, 1.38-6.47; P = .006). Careful interpretation of negative QFT-GIT results is thus necessary in immunocompromised patients suspected of having active TB. PMID:21546200

  12. An awake double lumen endotracheal tube intubation using the Clarus Video System in a patient with an epiglottic cyst: a case report.

    PubMed

    Seo, Hyungseok; Lee, Gunn; Ha, Seung-Il; Song, Jun-Gol

    2014-02-01

    A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 µg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation. PMID:24624275

  13. Presumed latent ocular tuberculosis diagnosed with the positive quantiFERON-TB Gold In-Tube Test in a HLA-A29-positive patient.

    PubMed

    Rangel, Carlos Mario; Atencia, Cesar; Merayo-Lloves, Jesus; Fernandez-Vega Sanz, Alvaro

    2015-01-01

    A 59-year-old Hispanic woman presented with a 3-year history of floaters associated with bilateral reduced visual acuity. Her best-corrected visual acuity (BCVA) was 20/40. Both anterior segments were without inflammation, but fundoscopy showed mild vitreous inflammation and multiple inflammatory choroidal lesions. Tests for inflammatory and infectious diseases were negative except for human leucocyte antigen A29. The patient was diagnosed with birdshot choroidoretinopathy, and treatment was initiated with cyclosporine A 2.5 mg/kg/day. One year after treatment, the patient reported systemic symptoms with no improvement in visual acuity. Fundus findings remained with vitreal inflammation. QuantiFERON-TB Gold In-Tube Test was positive, and a diagnosis of presumed latent ocular tuberculosis (TB) was made. We initiated anti-TB treatment for 9 months. At 6 months of anti-TB therapy, there was no active inflammation. The patient was followed for 2 years with no medications and no active inflammation. Her final BCVA was 20/25. PMID:26045521

  14. In-tube electro-membrane extraction with a sub-microliter organic solvent consumption as an efficient technique for synthetic food dyes determination in foodstuff samples.

    PubMed

    Bazregar, Mohammad; Rajabi, Maryam; Yamini, Yadollah; Asghari, Alireza; Abdossalami asl, Yousef

    2015-09-01

    A simple and efficient extraction technique with a sub-microliter organic solvent consumption termed as in-tube electro-membrane extraction (IEME) is introduced. This method is based upon the electro-kinetic migration of ionized compounds by the application of an electrical potential difference. For this purpose, a thin polypropylene (PP) sheet placed inside a tube acts as a support for the membrane solvent, and 30μL of an aqueous acceptor solution is separated by this solvent from 1.2mL of an aqueous donor solution. This method yielded high extraction recoveries (63-81%), and the consumption of the organic solvent used was only 0.5μL. By performing this method, the purification is high, and the utilization of the organic solvent, used as a mediator, is very simple and repeatable. The proposed method was evaluated by extraction of four synthetic food dyes (Amaranth, Ponceau 4R, Allura Red, and Carmoisine) as the model analytes. Optimization of variables affecting the method was carried out in order to achieve the best extraction efficiency. These variables were the type of membrane solvent, applied extraction voltage, extraction time, pH range, and concentration of salt added. Under the optimized conditions, IEME-HPLC-UV provided a good linearity in the range of 1.00-800ngmL(-1), low limits of detection (0.3-1ngmL(-1)), and good extraction repeatabilities (RSDs below 5.2%, n=5). It seems that this design is a proper one for the automation of the method. Also the consumption of the organic solvent in a sub-microliter scale, and its simplicity, high efficiency, and high purification can help one getting closer to the objectives of the green chemistry. PMID:26256917

  15. Intentional esophageal intubation to improve visualization during emergent endotracheal intubation in the context of massive vomiting: a case report.

    PubMed

    Sorour, Khaled; Donovan, Lucas

    2015-03-01

    Impaired visualization during intubation due to vomitus of gastric contents is a potential cause of failed intubation. An 82-year-old woman was intubated emergently for respiratory distress secondary to aspiration of gastric contents. Her intubation was hindered by the presence of a massive amount of ongoing vomitus that impaired visualization and overwhelmed all suction capabilities. Intentional blind intubation of the esophagus with an endotracheal tube was performed with successful diversion of ongoing vomitus away from the airway. Thereafter, after brief suctioning, the larynx was quickly visualized and the patient was successfully intubated. PMID:25577031

  16. Spallation and migration of silicone from blood-pump tubing in patients on hemodialysis

    SciTech Connect

    Leong, A.S.; Disney, A.P.; Gove, D.W.

    1982-01-21

    Spalled particles of silicone were observed in the livers of patients with chronic renal failure treated by hemodialysis. The refractile particles of silicone were associated with various degrees of hepatic inflammation and fibrosis, and granulomatous hepatitis was evident in nine cases. Retrospective examination revealed the material in 18 of 38 liver-biopsy samples from patients on hemodialysis who had clinical hepatic dysfunction. Of 31 autopsies of patients who had undergone hemodialysis, 22 revealed silicone in the liver, and silicone was also present in the spleen in all cases and in the marrow, lungs, and nodes in some. Giant cells containing silicone were also observed in these organs. Silicone was present in patients who had undergone hemodialysis for six weeks to 84 months (mean, 24 months). The identity of the material was confirmed by atomic absorption and by electron microprobe analysis. The silicone was traced to a segment of silicone tubing located in the roller pump of the dialysis machine.

  17. The effect of ventilation tube insertion or trans-tympanic silicone plug insertion on a patulous Eustachian tube.

    PubMed

    Endo, Shiori; Mizuta, Kunihiro; Takahashi, Goro; Nakanishi, Hiroshi; Yamatodani, Takashi; Misawa, Kiyoshi; Hosokawa, Seiji; Mineta, Hiroyuki

    2016-06-01

    Conclusions This study suggests that long-term ventilation tube insertion is the first-choice surgical treatment for a 'sniff-type' patulous Eustachian tube (PET). When treating a refractory PET, it is important to determine whether the patient had a habitual sniff. Objectives PET patients were divided into two groups: patients with a habitual sniff (sniff-type PET) and those without a habitual sniff (non-sniff-type PET). This study examined the effects of ventilation tube insertion or silicone plug insertion in each group. Methods Surgical procedures such as ventilation tube insertion or trans-tympanic silicone plug insertion were performed for these patients. Tubotympanoaero-dynamic graphy (TTAG) was also performed to determine the mechanisms underlying these treatments. Results There were 11 cases (17 ears) of sniff-type PET and 20 cases (27 ears) of non-sniff-type PET. An improvement in symptoms was found in 72.7% of the patients who underwent silicone plug insertion (66.7% for sniff-type PET and 74.1% for non-sniff-type PET) and in 90.9% of the patients who underwent ventilation tube insertion for sniff-type PET. In TTAG assessments, many sniff-type PET patients showed significant synchronous changes at high levels of pressure (over 40 daPa) in the external auditory meatus and nasopharynx when performing a slight Valsalva manoeuvre (below 200 daPa). PMID:26903085

  18. Multiple automated headspace in-tube extraction for the accurate analysis of relevant wine aroma compounds and for the estimation of their relative liquid-gas transfer rates.

    PubMed

    Zapata, Julián; Lopez, Ricardo; Herrero, Paula; Ferreira, Vicente

    2012-11-30

    An automated headspace in-tube extraction (ITEX) method combined with multiple headspace extraction (MHE) has been developed to provide simultaneously information about the accurate wine content in 20 relevant aroma compounds and about their relative transfer rates to the headspace and hence about the relative strength of their interactions with the matrix. In the method, 5 μL (for alcohols, acetates and carbonyl alcohols) or 200 μL (for ethyl esters) of wine sample were introduced in a 2 mL vial, heated at 35°C and extracted with 32 (for alcohols, acetates and carbonyl alcohols) or 16 (for ethyl esters) 0.5 mL pumping strokes in four consecutive extraction and analysis cycles. The application of the classical theory of Multiple Extractions makes it possible to obtain a highly reliable estimate of the total amount of volatile compound present in the sample and a second parameter, β, which is simply the proportion of volatile not transferred to the trap in one extraction cycle, but that seems to be a reliable indicator of the actual volatility of the compound in that particular wine. A study with 20 wines of different types and 1 synthetic sample has revealed the existence of significant differences in the relative volatility of 15 out of 20 odorants. Differences are particularly intense for acetaldehyde and other carbonyls, but are also notable for alcohols and long chain fatty acid ethyl esters. It is expected that these differences, linked likely to sulphur dioxide and some unknown specific compositional aspects of the wine matrix, can be responsible for relevant sensory changes, and may even be the cause explaining why the same aroma composition can produce different aroma perceptions in two different wines. PMID:23102525

  19. A novel ionic liquid-modified organic-polymer monolith as the sorbent for in-tube solid-phase microextraction of acidic food additives.

    PubMed

    Wang, Ting-Ting; Chen, Yi-Hui; Ma, Jun-Feng; Hu, Min-Jie; Li, Ying; Fang, Jiang-Hua; Gao, Hao-Qi

    2014-08-01

    A novel ionic liquid-modified organic-polymer monolithic capillary column was prepared and used for in-tube solid-phase microextraction (SPME) of acidic food additives. The primary amino group of 1-aminopropyl-3-methylimidazolium chloride was reacted with the epoxide group of glycidyl methacrylate. The as-prepared new monomer was then copolymerized in situ with acrylamide and N,N'-methylenebisacrylamide in the presence of polyethylene glycol (PEG)-8000 and PEG-10,000 as porogens. The extraction performance of the developed monolithic sorbent was evaluated for benzoic acid, 3-hydroxybenzoic acid, cinnamic acid, 2,4-dichlorophenoxyacetic acid, and 3-(trifluoromethyl)-cinnamic acid. Such a sorbent, bearing hydrophobic and anion-exchange groups, had high extraction efficiency towards the test compounds. The adsorption capacities for the analytes dissolved in water ranged from 0.18 to 1.74 μg cm(-1). Good linear calibration curves (R(2) > 0.99) were obtained, and the limits of detection (S/N = 3) for the analytes were found to be in the range 1.2-13.5 ng mL(-1). The recoveries of five acidic food additives spiked in Coca-Cola beverage samples ranged from 85.4 % to 98.3 %, with RSD less than 6.9 %. The excellent applicability of the ionic liquid (IL)-modified monolithic column was further tested by the determination of benzoic acid content in Sprite samples, further illustrating its good potential for analyzing food additives in complex samples. PMID:24939131

  20. Effective extraction of triazines from environmental water samples using magnetism-enhanced monolith-based in-tube solid phase microextraction.

    PubMed

    Mei, Meng; Huang, Xiaojia; Yang, Xiaodong; Luo, Qing

    2016-09-21

    This article reports on the effective extraction of triazines from environmental water samples using magnetism-enhanced monolith-based in-tube solid phase microextraction (ME-MB/IT-SPME). Firstly, monolithic poly (octyl methacrylate-co-ethyleneglycol dimethacrylate) capillary column doped with magnetic nanoparticles was synthesized inside a fused silica. After that, the monolithic capillary column was placed inside a magnetic coil that allowed the exertion of a variable magnetic field during adsorption and desorption steps. The effects of intensity of magnetic field, adsorption and desorption flow rate, volume of sample and desorption solvent, pH value and ionic strength in sample matrix on the performance of ME-MB/IT-SPME for triazines were investigated in details. Under the optimized conditions, the developed ME-MB/IT-SPME showed satisfactory quantitative extraction efficiencies of the target analytes between 64.8% and 99.7%. At the same time, the ME-MB/IT-SPME was combined with high-performance liquid chromatography with diode array detection to detect six triazines in water samples. The limits of detection (S/N = 3) and limits of quantification (S/N = 10) were in the ranges of 0.074-0.23 μg/L and 0.24-0.68 μg/L, respectively. The precision of the proposed method was evaluated in terms of intra- and inter-assay variability calculated as relative standard deviation, and it was found that the values were all below 10%. Finally, the developed method was successfully applied for environmental water samples such as farmland, lake and river water with spiked recoveries in the range of 70.7-119%. PMID:27590547

  1. The Dynamics of QuantiFERON-TB Gold In-Tube Conversion and Reversion in a Cohort of South African Adolescents

    PubMed Central

    Hatherill, Mark; Mahomed, Hassan; Hanekom, Willem A.; Campo, Monica; Hawn, Thomas R.; Wood, Robin; Scriba, Thomas J.

    2015-01-01

    Rationale: Interferon-γ release assays are used to diagnose tuberculosis infection. In developed countries, high rates of reversion following conversion have been described. Objectives: To assess QuantiFERON TB Gold In-Tube test (QFT) conversion and reversion dynamics in a tuberculosis-endemic setting. Methods: Adolescents aged 12–18 years residing near Cape Town were recruited. Tuberculin skin tests (TSTs) and QFTs were performed at baseline and after 2 years of follow up. Half of the participants had TST and QFT performed at additional time points. Participants were observed for incident tuberculosis disease for up to 5 years. Measurements and Main Results: Among 5,357 participants, 2,751 (51.4%) and 2,987 (55.8%) had positive QFT and TST results, respectively, at baseline. Annualized QFT and TST conversion risks were 14.0 and 13.0%, respectively, and reversion risks were 5.1 and 4.1%, respectively. Concordance was excellent for conversions (κ = 0.74), but poor for reversions (κ = 0.12). Among recent QFT converters, the magnitude of the QFT value was strongly inversely associated with risk of reversion (P < 0.0001). When longitudinal QFT data were analyzed in a cross-sectional manner, the annual risk of infection was 7.3%, whereas inclusion of reversions in the analysis showed that the actual risk of infection was 14.0%. Incident tuberculosis was 8-fold higher among QFT reverters than in participants with all negative QFT results (1.47 vs. 0.18 cases/100 person-years, P = 0.011). Conclusions: In this tuberculosis-endemic setting, annual risk of infection was extremely high, whereas QFT and TST conversion concordance was higher and QFT reversion rates were lower than reported in low-burden settings. PMID:25562578

  2. Outbreak of Transient Conversions of the QuantiFERON-TB Gold In-Tube Test in Laboratory Health Care Worker Screenings

    PubMed Central

    Peracchi, Marta; Zorzi, Diego; Fiorio, Silvia; Fallico, Loredana; Palù, Giorgio

    2012-01-01

    Gamma interferon release assays were recently introduced in health care worker (HCWs) screenings for tuberculosis surveillance. In longitudinal surveys, conversions and reversions are seen, and yet whether these changes are unspecific or are an expression of new infections and microbial clearance remains unclear. In order to further elucidate these changes, we analyzed an outbreak of 15 transient conversions in 53 HCWs who operate in the same laboratory and handle specimens potentially containing Mycobacterium tuberculosis who underwent screening by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test between 11 May and 30 June 2010: 15/46 (33%) negative HCWs showed a conversion and then reverted after 7 to 107 days. To validate these results, an evaluation of methodological procedures and test reliability, as well as an analysis of results obtained during the same period and processed by the same laboratory, was carried out. For the latter purpose, QFT-GIT results determined for 78 ward HCWs who underwent screening during the same period and were employed in departments with at least 3 infectious tuberculosis patients per year or had cared for an infectious patient without airborne precautions were analyzed with the following results: 6/63 (9%) HCWs with negative results in 3 different departments showed transient conversion (P = 0.002; odds ratio, 4.60; 95% confidence interval, 1.62 to 13.04). A retrospective survey of in-house biosafety practices led to determination of a single exposure factor within the laboratory. These data emphasize the validity of the hypothesis that a transient conversion demonstrates the presence of a real tubercular infection and could be an important indicator for occupational biosafety concerns. They also confirm that subjects with recent conversion should be retested before chest radiography and chemotherapy is offered. PMID:22518010

  3. Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients

    PubMed Central

    Seyhan, Ekrem Cengiz; Gunluoglu, Gulşah; Gunluoglu, Mehmet Zeki; Tural, Seda; Sökücü, Sinem

    2016-01-01

    BACKGROUND: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. METHODS: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. RESULTS: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). CONCLUSION: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients. PMID:27168859

  4. A combination of the QuantiFERON-TB Gold In-Tube assay and the detection of adenosine deaminase improves the diagnosis of tuberculous pleural effusion.

    PubMed

    Liu, Yuanyuan; Ou, Qinfang; Zheng, Jian; Shen, Lei; Zhang, Bingyan; Weng, Xinhua; Shao, Lingyun; Gao, Yan; Zhang, Wenhong

    2016-01-01

    The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remains difficult despite the availability of numerous diagnostic tools. The current study aimed to evaluate the performance of the whole blood QuantiFERON-TB Gold In-Tube (QFT-GIT) assay and conventional laboratory biomarkers in differential diagnosis of TPE and MPE in high tuberculosis prevalence areas. A total of 117 patients with pleural effusions were recruited, including 91 with TPE and 26 with MPE. All of the patients were tested with QFT-GIT, and the conventional biomarkers in both blood and pleural effusion were detected. The level of antigen-stimulated QFT-GIT in the whole blood of TPE patients was significantly higher than that of MPE (2.89 vs 0.33 IU/mL, P<0.0001). The sensitivity and specificity of QFT-GIT for the diagnosis of TPE were 93.0% and 60.0%, respectively. Among the biomarkers in blood and pleural effusion, pleural adenosine deaminase (ADA) was the most prominent biomarker, with a cutoff value of 15.35 IU/L. The sensitivity and specificity for the diagnosis of TPE were 93.4% and 96.2%, respectively. The diagnostic classification tree from the combination of these two biomarkers was 97.8% sensitive and 92.3% specific. Ultimately, the combination of whole blood QFT-GIT with pleural ADA improved both the specificity and positive predictive value to 100%. Thus, QFT-GIT is not superior to pleural ADA in the differential diagnosis of TPE and MPE. Combined whole blood QFT-GIT and pleural ADA detection can improve the diagnosis of TPE. PMID:27485497

  5. Factors that Predict Negative Results of QuantiFERON-TB Gold In-Tube Test in Patients with Culture-Confirmed Tuberculosis: A Multicenter Retrospective Cohort Study

    PubMed Central

    Kwon, Yong-Soo; Kim, Yee Hyung; Jeon, Kyeongman; Jeong, Byeong-Ho; Ryu, Yon Ju; Choi, Jae Chol; Kim, Ho Cheol; Koh, Won-Jung

    2015-01-01

    Background Interferon-γ release assays such as the QuantiFERON-TB Gold In-Tube Test (QFT-GIT) are designed to detect Mycobacterium tuberculosis infections, whether latent or manifesting as disease. However, a substantial number of persons with culture-confirmed tuberculosis (TB) have negative QFT-GITs. Information on host factors contributing to false-negative and indeterminate results are limited. Methods A multicenter retrospective cohort study was performed with 1,264 culture-confirmed TB patients older than 18 years who were subjected to the QFT-GIT at one of the six hospitals between May 2007 and February 2014. Patients with human immunodeficiency virus infection were excluded. Clinical and laboratory data were collected in South Korea. Results Of all patients, 87.6% (1,107/1,264) were diagnosed with pulmonary TB and 12.4% (157/1,264) with extrapulmonary TB. The rate of negative results was 14.4% (182/1,264). The following factors were highly correlated with false-negative results in the QFT-GIT: advanced age (age ≥ 65 years, odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03–2.39), bilateral disease as determined by chest radiography (OR 1.75, 95% CI 1.13–2.72), malignancy (OR 2.42, 95% CI 1.30–4.49), and lymphocytopenia (total lymphocyte count < 1.0 × 109/L, OR 1.86, 95% CI 1.21–2.87). Conclusions Consequently, QFT-GIT results need to be interpreted with caution in patients with these host risk factors such as the elderly, bilateral disease on chest radiography, or malignancy, or lymphocytopenia. PMID:26070207

  6. Comparison of the Sensitivity of QuantiFERON-TB Gold In-Tube and T-SPOT.TB According to Patient Age.

    PubMed

    Bae, Won; Park, Kyoung Un; Song, Eun Young; Kim, Se Joong; Lee, Yeon Joo; Park, Jong Sun; Cho, Young-Jae; Yoon, Ho Il; Yim, Jae-Joon; Lee, Choon-Taek; Lee, Jae Ho

    2016-01-01

    Currently, there are two types of interferon-gamma release assays (IGRAs) in use for the detection of tuberculosis (TB) infection, the QuantiFERON-TB Gold In-Tube test (GFT-GIT) and T-SPOT.TB. Owing to contradictory reports regarding whether the results of these IGRAs are affected by the age of the patient, we aimed to determine if these two tests have age-related differences in sensitivity. We retrospectively reviewed the medical records of diagnosed TB patients who were tested using either QFT-GIT or T-SPOT.TB from February 2008 to December 2013. The positivity of the two tests was analyzed and compared with true TB infection, which was defined as active TB based on either a positive Mycobacterium culture or a positive TB polymerase chain reaction. The QFT-GIT group included 192 TB patients, and the T-SPOT.TB group included 212 TB patients. Of the patients with pulmonary TB, 76 (39.6%) were in the QFT-GIT group and 143 (67.5%) in the T-SPOT.TB group. The overall sensitivity was 80.2% for QFT-GIT and 91.0% for T.SPOT.TB. The sensitivities of QFT-GIT and T-SPOT.TB according to age group were as follows: <29 years, 93.3% and 96.7%; 30-49 years, 86.5% and 94.7%; 50-69 years, 76.8% and 87.5%; and >70 years, 68.3% and 85.7%, respectively. The trend of age-related changes in sensitivity was significant for both QFT-GIT (p = 0.004) and T.SPOT.TB (p = 0.039). However, only QFT-GIT was significantly related to age in the multivariate analysis. QFT-GIT, but not T-SPOT.TB, was significantly affected by patient age. PMID:27258377

  7. Comparison of the Sensitivity of QuantiFERON-TB Gold In-Tube and T-SPOT.TB According to Patient Age

    PubMed Central

    Bae, Won; Park, Kyoung Un; Song, Eun Young; Kim, Se Joong; Lee, Yeon Joo; Park, Jong Sun; Cho, Young-Jae; Yoon, Ho Il; Yim, Jae-Joon; Lee, Choon-Taek; Lee, Jae Ho

    2016-01-01

    Currently, there are two types of interferon-gamma release assays (IGRAs) in use for the detection of tuberculosis (TB) infection, the QuantiFERON-TB Gold In-Tube test (GFT-GIT) and T-SPOT.TB. Owing to contradictory reports regarding whether the results of these IGRAs are affected by the age of the patient, we aimed to determine if these two tests have age-related differences in sensitivity. We retrospectively reviewed the medical records of diagnosed TB patients who were tested using either QFT-GIT or T-SPOT.TB from February 2008 to December 2013. The positivity of the two tests was analyzed and compared with true TB infection, which was defined as active TB based on either a positive Mycobacterium culture or a positive TB polymerase chain reaction. The QFT-GIT group included 192 TB patients, and the T-SPOT.TB group included 212 TB patients. Of the patients with pulmonary TB, 76 (39.6%) were in the QFT-GIT group and 143 (67.5%) in the T-SPOT.TB group. The overall sensitivity was 80.2% for QFT-GIT and 91.0% for T.SPOT.TB. The sensitivities of QFT-GIT and T-SPOT.TB according to age group were as follows: <29 years, 93.3% and 96.7%; 30–49 years, 86.5% and 94.7%; 50–69 years, 76.8% and 87.5%; and >70 years, 68.3% and 85.7%, respectively. The trend of age-related changes in sensitivity was significant for both QFT-GIT (p = 0.004) and T.SPOT.TB (p = 0.039). However, only QFT-GIT was significantly related to age in the multivariate analysis. QFT-GIT, but not T-SPOT.TB, was significantly affected by patient age. PMID:27258377

  8. A modified submental orotracheal intubation.

    PubMed

    Savitha, Keelara Shivalingaiah; Kujur, Abha Rani; Vikram, M S; Joseph, Shirley

    2016-01-01

    In patients with concomitant occurrence of maxillofacial and basilar skull fractures, open reduction and internal fixation is the treatment. It requires intermittent intra operative dental occlusion which precludes oral or nasal intubation. In such cases submental intubation (SMI) is a recognized technique in practice. We describe a modified technique for smooth exteriorization of the endotracheal tube (ETT) during SMI. As the SMI technique is unusual for the performer, emphasis is laid on the applied aspects to minimize probable complications during the procedure. With the modified technique we performed SMI uneventfully on five patients. PMID:26957708

  9. A modified submental orotracheal intubation

    PubMed Central

    Savitha, Keelara Shivalingaiah; Kujur, Abha Rani; Vikram, M. S.; Joseph, Shirley

    2016-01-01

    In patients with concomitant occurrence of maxillofacial and basilar skull fractures, open reduction and internal fixation is the treatment. It requires intermittent intra operative dental occlusion which precludes oral or nasal intubation. In such cases submental intubation (SMI) is a recognized technique in practice. We describe a modified technique for smooth exteriorization of the endotracheal tube (ETT) during SMI. As the SMI technique is unusual for the performer, emphasis is laid on the applied aspects to minimize probable complications during the procedure. With the modified technique we performed SMI uneventfully on five patients PMID:26957708

  10. Applications and techniques of gastrointestinal intubation.

    PubMed

    McLean, G K; Ring, E J; Freiman, D B

    1982-01-01

    Gastrointestinal intubation has found increasing applications over the past several years. Although usually an uncomplicated procedure, passage of an intestinal tube may be impeded by ineffective peristalsis, obstructing lesions or surgical alteration of the normal anatomy. A variety of techniques are described for passing tubes into the stomach, duodenum and small bowel. These techniques are an outgrowth of those initially developed for manipulating tubes through the vascular, biliary and genitourinary systems. The characteristics of the various decompression and alimentation tubes as well as the dangers of gastrointestinal intubation are also discussed. PMID:6809332

  11. Orotracheal intubation.

    PubMed

    Dauphinee, K

    1988-11-01

    The advantages of endotracheal intubations are many: patency of airway is reasonably assured, secretions may be removed easily from the tracheobronchial tree, the airway is better protected against aspiration, ventilation can be regulated, and drugs can be administered. The procedure is the "gold standard" of airway control, and the oral route is the most common used. The patient is assessed for potential difficulties that may arise from abnormalities of face and mouth: large face, large tongue, hypoplastic mandible, prominent or diseased maxillary teeth or facial fractures; or abnormalities of the neck: potential or real cervical spine instability, swelling, or laryngeal trauma. A plan is devised, together with one or more alternatives, should unforeseen difficulties arise, and in adherence to the principle of never removing the compensations of a coping patient. The skill is learned and practiced so that a gentle facility is always present at times of greatest need. PMID:3056706

  12. Low temperature solder process to join a copper tube to a silicon wafer

    NASA Astrophysics Data System (ADS)

    Versteeg, Christo; Scarpim de Souza, Marcio

    2014-06-01

    With the application for wafer level packages, which could be Complementary Metal-Oxide-Semiconductor (CMOS) based, and which requires a reduced atmosphere, a copper tube connection to a vacuum pump and the package is proposed. The method evaluated uses laser assisted brazing of a solder, to join the copper tube to a silicon wafer. The method was applied to a silicon wafer coated with a metallic interface to bond to the solder. The hermeticity of the joint was tested with a helium leak rate tester and the bonding energy thermal extent was verified with a thin layer of indium that melted wherever the substrate temperature rose above its melting temperature.

  13. Negative effect of immunosuppressive therapy in the performance of the QuantiFERON gold in-tube test in patients with immune-mediated inflammatory diseases.

    PubMed

    Ramos, José M; Masiá, Mar; Rodríguez, Juan C; López, Cristina; Padilla, Sergio; Robledano, Catalina; Navarro-Blasco, Francisco J; Matarredona, Jaime; García-Sepulcre, Mariana F; Gutiérrez, Félix

    2013-08-01

    To compare the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFG) for the detection of latent tuberculosis infection among patients with immune-mediated inflammatory diseases before antitumor necrosis factor-α therapy. A prospective study including 153 consecutive patients with rheumatoid arthritis (n = 53), psoriasis (n = 45), inflammatory bowel disease (n = 25), and spondyloarthropathy (n = 22) were included. QFG and TST were performed simultaneously. TST was positive in 43/153 (28.1 %) patients. QFG (cutoff ≥ 0.35 IU/ml) was positive in 15/153 (9.8 %) patients, and indeterminate in one (0.7 %). QFG (cutoff ≥ 0.10 IU/ml) was positive in 25/153 (16.3 %). 59.5 % of the patients were on immunosuppressive therapy at the time of testing. There was a significant difference in the rate of positive QFG between patients with and without immunosuppressive therapy after adjustment for age and gender (cutoff ≥ 0.35 IU/ml, 4.6 vs. 17.4 %; adjusted odds ratio [AOR], 0.2; 95 % confidence interval [CI], 0.06-0.8; p = 0.03 and cutoff ≥ 0.10 IU/ml, 11.2 vs. 24.2 %; AOR, 0.3; 95 % CI, 0.1-0.93; p = 0.04). Agreement between TST and QFG was 'fair' (κ = 0.354 and κ = 0.365, for cutoffs ≥ 0.35 and ≥0.10 IU/ml, respectively). Among patients without immunosuppressive therapy, the concordance between TST and QFG was 'moderate-substantial' (κ = 0.593 and κ = 0.690, for cutoffs ≥ 0.35 IU/ml and ≥0.10 IU/ml, respectively). By contrast, among patients on immunosuppressive therapy the concordance was 'poor' (κ = 0.085; κ = 0.041, respectively). Immunosuppressive therapy affects negatively QFG performance. In patients with immune-mediated inflammatory diseases, QFG may have a limited role for screening of latent tuberculosis infection. PMID:22736247

  14. Fluctuating Behavior and Influential Factors in the Performance of the QuantiFERON-TB Gold In-Tube Assay in the Diagnosis of Tuberculosis

    PubMed Central

    Shen, Yaojie; Shao, Lingyun; Zhang, Ying; Lu, Shuihua; Zhang, Wenhong

    2015-01-01

    Background The QuantiFERON-TB Gold In-Tube (QFT-GIT) is a newly developed but widely used interferon-γ release assay for diagnosing tuberculosis (TB). However, research has not determined whether age or the use of an immune suppressive or anti-TB treatment influences this assay’s ability to detect TB. We assessed the QFT-GIT diagnostic performance for active tuberculosis (ATB) in children and adults in an endemic country and explored the effects of glucocorticoids and anti-TB therapy on the diagnostic value of the QFT-GIT. Methods A total of 60 children and 212 adults with suspected ATB were evaluated with the QFT-GIT. The association between the QFT-GIT diagnostic value and pretreatment factors was qualitatively and quantitatively assessed. Results The sensitivity of the QFT-GIT was 83.9% (95% CI 66.3%-94.6%) in children, and 73.7% (95% CI 57.8%-85.2%) in adults. Glucocorticoids affected the mitogen-stimulated response in both children and adults. In subjects undergoing glucocorticoid pretreatment, 25.0% of the children presented with false-negative QFT-GIT results, 28.6% of adults presented with indeterminate results. For subjects pre-treated with anti-TB drugs, 44.4% presented with false-negative QFT-GIT results. Conclusions The QFT-GIT has higher sensitivity and specificity in children than adults. Glucocorticoid treatment negatively impacts the diagnostic value of the QFT-GIT in all age groups. Anti-TB treatment decreases the sensitivity of the QFT-GIT. Therefore, we recommend that the QFT-GIT assay be performed before TB-specific treatment is initiated and the test should not be used on people undergoing immunosuppression treatment, regardless of their age. A quantitative analysis of the QFT-GIT could be useful for assessing and monitoring TB-specific and non-specific immunity during conversion of the disease. PMID:26287382

  15. Intubation without muscle relaxant: an alternative technique for rapid tracheal intubation.

    PubMed

    Wong, A K; Teoh, G S

    1996-04-01

    The quality of laryngoscopy and tracheal intubation with propofol augmented by alfentanil was investigated as an alternative technique for rapid tracheal intubation. 119 patients aged between 18 and 60 years (ASA 1 and 2) undergoing elective surgery were prospectively studied in a randomized double-blind controlled fashion. Tracheal intubation facilitated by suxamethonium 1.0 mg/kg alfentanil 15 mu g/kg alfentanil 30 mu g/kg or saline control was compared after propofol induction. The quality of laryngoscopy and intubation were graded according to jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. Failure to intubate occurred in 4% and 17% with alfentanil 15 mu g/kg and saline control respectively Tracheal intubation was successful in all patients with alfentanil 30 mu g/kg and suxamethonium 1.0 mg/kg. Alfentanil 15 mu g/kg was not statistically significantly different from saline (P = 0.112). Alfentanil 30 mu g/kg provided similar overall intubating conditions (P = 0.5) to suxamethonium 1.0 mg/kg. Alfentanil in both dosages effectively attenuated the haemodynamic responses to laryngoscopy and tracheal intubation. PMID:9133197

  16. The Vacuum Silicon Photomultiplier Tube (VSiPMT): A new version of a hybrid photon detector

    NASA Astrophysics Data System (ADS)

    Russo, Stefano; Barbarino, Giancarlo; de Asmundis, Riccardo; De Rosa, Gianfranca

    2010-11-01

    The future astroparticle experiments will study both energetic phenomena and extremely rare events from astrophysical sources. Since most of these families of experiments are carried out by using scintillation phenomena, Cherenkov or fluorescence radiation, the development of photosensitive detectors seems to be the right way to increase the experimental sensitivity. Therefore we propose an innovative design for a modern, high gain, silicon-based Vacuum Silicon Photomultiplier Tube (VSiPMT), which combines three fully established and well-understood technologies: the manufacture of hemispherical vacuum tubes with the possibility of very large active areas, the photocathode glass deposition and the novel Geiger-mode avalanche silicon photodiode (G-APD) for which a mass production is today available. This new design, based on G-APD as the electron multiplier, allows overcoming the limits of a classical PMT dynode chain.

  17. 2-Hydroxypropyl-beta-cyclodextrin extracts 2-phenylphenol from silicone tubing.

    PubMed

    den Brok, Monique W J; van der Schoot, Sabien C; Nuijen, Bastiaan; Hillebrand, Michel J X; Beijnen, Jos H

    2004-07-01

    Cyclodextrins are capable to solubilise lipophilic drugs via (partial) inclusion in their lipophilic cavity. This, however, also provides the potential for the extraction of small molecules from production materials. In the present study, the potency of the commercially available and used cyclodextrin, 2-hydroxypropyl-beta-cyclodextrin (HPbetaCD) to extract the preservative 2-phenylphenol (2-PP) from platinum cured silicone tubing was tested. The presence of 2-PP was structurally confirmed with HPLC-UV and LC/MS/MS in HPbetaCD solutions after incubation with platinum cured silicone tubing. HPbetaCD concentration and prior tubing sterilisation were found not to influence the levels of 2-PP extracted. Interestingly, extraction to ethanol was 15-fold higher than observed for HPbetaCD solutions. 2-PP was extracted from silicone tubing during routine manufacture of a blank dosage form formulated with only HPbetaCD, resulting in detectable levels of 2-PP in the final product. In a freeze-dried dosage form containing HPbetaCD and an active pharmaceutical ingredient (exhibiting a stability constant for HPbetaCD/drug of 1045 L/mol), on the other hand, 2-PP was undetectable. PMID:15196635

  18. Determination of the oxidative stress biomarker urinary 8-hydroxy-2'-deoxyguanosine by automated on-line in-tube solid-phase microextraction coupled with liquid chromatography-tandem mass spectrometry.

    PubMed

    Kataoka, Hiroyuki; Mizuno, Keisuke; Oda, Eri; Saito, Akihiro

    2016-04-15

    A simple and sensitive method for the determination of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage in human urine, was developed using automated on-line in-tube solid-phase microextraction (SPME) coupled with stable isotope-dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS). Creatinine was also analyzed simultaneously to normalize urine volume by the in-tube SPME LC-MS/MS method, and 8-OHdG and creatinine were separated within 3min using a Zorbax Eclipse XDB-C8 column. Electrospray MS/MS for these compounds was performed on an API 4000 triple quadruple mass spectrometer in the positive ion mode by multiple reaction monitoring. The optimum in-tube SPME conditions were 20 draw/eject cycles of 40μL of sample at a flow rate of 200μL/min using a Carboxen 1006 PLOT capillary column as an extraction device. The extracted compounds were easily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. The calibration curve for 8-OHdG using its stable isotope-labeled internal standard was linear in the range of 0.05-10ng/mL, and the detection limit was 8.3pg/mL. The intra-day and inter-day precision (relative standard deviations) were below 3.1% and 9.6% (n=5), respectively. This method was applied successfully to the analysis of urine samples without any other pretreatment and interference peaks, with good recovery rates above 91% in spiked urine samples. The limits of quantification of 8-OHdG and creatinine in 0.1mL urine samples were about 0.32 and 0.69ng/mL (S/N=10), respectively. This method was utilized to assess the effects of smoking, green tea drinking and alcohol drinking on the urinary excretion of 8-OHdG. PMID:26349944

  19. Novel solvent-free microwave-assisted extraction coupled with low-density solvent-based in-tube ultrasound-assisted emulsification microextraction for the fast analysis of organophosphorus pesticides in soils.

    PubMed

    Su, Yi-Song; Yan, Cheing-Tong; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2013-07-01

    A novel and rapid solventless microwave-assisted extraction coupled with low-density solvent-based in-tube ultrasound-assisted emulsification microextraction has been developed for the efficient determination of nine organophosphorus pesticides in soils by GC analysis with microelectron capture detection. A specially designed, homemade glass tube inbuilt with a scaled capillary tube was used as an extraction device to collect and measure the separated extractant phase easily. Parameters affecting the efficiencies of the developed method were thoroughly investigated. From experimental results, the following conditions were selected for the extraction of organophosphorus pesticides from 1.0 g of soil sample to 5 mL of aqueous solution under 226 W of microwave irradiation for 2.5 min followed by ultrasound-assisted emulsification microextraction with 20 μL toluene for 30 s and then centrifugation at 3200 rpm for 3 min. Detections were linear in the range of 0.25-10 ng/g with detection limits between 0.04 and 0.13 ng/g for all target analytes. The applicability of the method to real samples was assessed on agricultural contaminated soils and the recoveries ranged between 91.4 and 101.3%. Compared to other methods, the present method was shown to be highly competitive in terms of sensitivity, cost, eco-friendly nature, and analysis speed. PMID:23681938

  20. Selective lung intubation during paediatric thoracic surgeries.

    PubMed

    Mixa, V; Nedomova, B; Rygl, M

    2016-01-01

    Selective lung intubation is a necessary prerequisite for the completion of most interventions comprising thoracotomy and thoracoscopy. In paediatric care, our site uses Univent tubes for children up to the age of three years and double-lumen tubes (DLT) for children from 6-8 years of age. In younger children, we usually use regular endotracheal intubation, with the lung being held in the hemithorax position being operated on using a surgical retractor. The article presents the analysis of 860 thoracic surgeries, of which 491 comprised selective intubation (Univent 57 cases, DLT 434 cases). The use of the aforementioned devices is connected with certain complications. Univent tube can be connected with intraoperative dislocation of the obturating balloon (29.8%) and balloon perforation (5.2%). DLT insertion may be connected with failure of tube fitting. In 84 cases we had to repeat DLT insertion (20.6%). In 8 cases we were not able to insert DLT at all (1.8%). Standard use of selective intubation methods in paediatric patients from two years of age improved the conditions for surgical interventions (Tab. 2, Fig. 2, Ref. 19). PMID:27546541

  1. Difficult Ventilation After Successful Intubation in the Emergency Setting due to a Ball Valve Clot.

    PubMed

    Liberman, Justin S; Weigel, Wade; Neal, Joseph M

    2016-05-15

    The inability to ventilate a patient after successful intubation is a rare but emergent situation and may be caused by obstruction of the endotracheal tube, bilateral tension pneumothorax, esophageal intubation, severe bronchospasm, or mainstem bronchus intubation. We describe an increase in mean airway pressure, inability to ventilate, and loss of cardiac output secondary to a blood clot acting as a ball valve at the end of an endotracheal tube. PMID:26934604

  2. In-Plane Ultrasound Propagation in an Elastic Silicone Tube as a Function of Tension

    NASA Astrophysics Data System (ADS)

    Rajakenttä, Tina; Salmi, Ari; Akujärvi, Altti; Haapalainen, Jonne; Hæggström, Edward

    2007-03-01

    The mechanical properties of a silicone tube blood vessel phantom (outer radius 4.04±0.04 mm and wall thickness 1.00±0.02 mm) carrying in-plane ultrasound wave propagation, was studied as function of applied axial tension. A 23 kHz, 1-cycle square signal was excited into the tube with a piezoceramic pickup and received with an inductive pickup. The wave phase velocities in the tube were determined by measuring the time-of-flight (TOF) at different inter-transducer distances. The longitudinal mode sound velocity ranged from 83 m/s to 88 m/s, and from 51 m/s to 58 m/s for the shear mode respectively with tensions ranging from 31 to 364 kPa. This compares with the FEM estimate. A laser-Doppler vibrometer (LDV) detected an out-of-plane mode propagating along the tube. An increase in the sound velocity caused by artificially induced lesions was detected.

  3. Biomonitoring method for the determination of polycyclic aromatic hydrocarbons in hair by online in-tube solid-phase microextraction coupled with high performance liquid chromatography and fluorescence detection.

    PubMed

    Yamamoto, Yusuke; Ishizaki, Atsushi; Kataoka, Hiroyuki

    2015-09-01

    Polycyclic aromatic hydrocarbons (PAHs) are formed from the incomplete combustion or pyrolysis of organic matter during industrial processing and various human activities, but human exposure to PAHs has not yet been elucidated in detail. To assess long-term exposure to PAHs, we developed a simple and sensitive method for measuring PAHs in hair by online in-tube solid-phase microextraction using a CP-Sil 19CB capillary column as an extraction device, followed by high-performance liquid chromatography using a Zorbax Eclipse PAH column and fluorescence detection. Seventeen PAHs could be analyzed simultaneously, with good linearity from 20 to 1000pg/mL each as determined using stable isotope-labeled PAH internal standards. The detection limits of PAHs were 0.5-20.4pg/mL. PAHs in human hair samples were extracted by ultrasonication in 50mM NaOH in methanol, and successfully analyzed without any interference peaks, with good recovery rates above 70% in spiked hair samples. Using this method, we evaluated the suitability of using hair PAHs as biomarkers for long-term exposure. PMID:26245363

  4. Rapid determination of triclosan in personal care products using new in-tube based ultrasound-assisted salt-induced liquid-liquid microextraction coupled with high performance liquid chromatography-ultraviolet detection.

    PubMed

    Chen, Ming-Jen; Liu, Ya-Ting; Lin, Chiao-Wen; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2013-03-12

    This paper describes the development of a novel, simple and efficient in-tube based ultrasound-assisted salt-induced liquid-liquid microextraction (IT-USA-SI-LLME) technique for the rapid determination of triclosan (TCS) in personal care products by high performance liquid chromatography-ultraviolet (HPLC-UV) detection. IT-USA-SI-LLME method is based on the rapid phase separation of water-miscible organic solvent from the aqueous phase in the presence of high concentration of salt (salting-out phenomena) under ultrasonication. In the present work, an indigenously fabricated home-made glass extraction device (8-mL glass tube inbuilt with a self-scaled capillary tip) was utilized as the phase separation device for USA-SI-LLME. After the extraction, the upper extractant layer was narrowed into the self-scaled capillary tip by pushing the plunger plug; thus, the collection and measurement of the upper organic solvent layer was simple and convenient. The effects of various parameters on the extraction efficiency were thoroughly evaluated and optimized. Under optimal conditions, detection was linear in the concentration range of 0.4-100ngmL(-1) with correlation coefficient of 0.9968. The limit of detection was 0.09ngmL(-1) and the relative standard deviations ranged between 0.8 and 5.3% (n=5). The applicability of the developed method was demonstrated for the analysis of TCS in different commercial personal care products and the relative recoveries ranged from 90.4 to 98.5%. The present method was proven to be a simple, sensitive, less organic solvent consuming, inexpensive and rapid procedure for analysis of TCS in a variety of commercially available personal care products or cosmetic preparations. PMID:23452790

  5. Polydopamine/dialdehyde starch/chitosan composite coating for in-tube solid-phase microextraction and in-situ derivation to analysis of two liver cancer biomarkers in human blood.

    PubMed

    Wu, Shiju; Cai, Cuicui; Cheng, Jing; Cheng, Min; Zhou, Hongbin; Deng, Jiali

    2016-09-01

    In order to highly enrich two liver cancer biomarkers (hexanal and 2-butanone) in human blood, in this study, natural nontoxic polydopamine/dialdehyde starch/chitosan (PD/DAS/CHI) coating material was synthesized and immobilized on the inner wall of polytetrafluoro-ethlyene (PTFE) tube. It was used to develop the method based on in-tube solid-phase microextraction (IT-SPME) with in-situ derivatization (ISD) coupled to high performance liquid chromatography for the determination of the above mentioned two liver cancer biomarkers in human blood. The simple, rapid and sensitive IT-SPME-ISD method can be finished within 11 min. Under optimum conditions, the limits of detection (LODs) were 1.4 and 1.6 nmol L(-1) for hexanal and 2-butanone, respectively. The relative recoveries from real human blood samples were in the range from 70% to 91% with the intra- and inter-day precisions less than 7.2%. Furthermore, this method was successfully applied for the analysis of hexanal and 2-butanone in blood samples from healthy people with 0.42 ± 0.05 and 0.34 ± 0.04 μmol L(-1), while liver cancer patients with 1.90 ± 0.07  μmol L(-1) and 0.91 ± 0.07 μmol L(-1), respectively. The t-test's results showed there is a statistically significant difference between the data from healthy persons and liver cancer patients. Hence, the developed method might be applied in the screening of suspected liver cancer patients. PMID:27543020

  6. Cuff inflation to aid nasotracheal intubation using the C-MAC videolaryngoscope.

    PubMed

    Baddoo, H K; Phillips, B J

    2011-06-01

    A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation. PMID:21857727

  7. Proof of feasibility of the Vacuum Silicon PhotoMultiplier Tube (VSiPMT)

    NASA Astrophysics Data System (ADS)

    Barbarino, G.; Campajola, L.; de Asmundis, R.; De Rosa, G.; Fiorillo, G.; Migliozzi, P.; Barbato, F. C. T.; Mollo, C. M.; Russo, A.; Vivolo, D.

    2013-04-01

    The Vacuum Silicon PhotoMultiplier Tube (VSiPMT) is an innovative design we propose for a modern hybrid photodetector based on the combination of a Silicon PhotoMultiplier (SiPM) with a hemispherical vacuum glass PMT standard envelope. The basic idea is to replace the classical dynode chain of a PMT with a SiPM, which acts as an electron multiplying detector. Such a solution will match the goal of a large photocathode sensitive area with the performances of a SiPM. This will lead to many advantages such as lower power consumption, mild sensitivity to magnetic fields and high quantum efficiency. The feasibility of this idea has been throughly studied both from a theoretical and experimental point of view. As a first step we performed the full characterization of a special non-windowed Hamamatsu MPPC with a laser source. The response of the SiPM to an electron beam was studied as a function of the energy and of the incident angle by means of a Geant4-based simulation. In this paper we present the preliminary results of the characterization of the SiPM with an electron source and we discuss how the development of next generation SiPMs will overcome the main weaknesses of VSiPMT, such as relatively low PDE and high photocathode voltage.

  8. Corrosion resistant coatings for silicon carbide heat exchanger tubes -- Volume 3. Final report

    SciTech Connect

    Boss, D.E.

    1996-06-07

    The development of a silicon carbide (SiC) heat exchanger is a critical step in the development of the Externally-Fired Combined Cycle (EFCC) power system. SiC is the only material that provides the necessary combination of resistance to creep, thermal shock, and oxidation. While the SiC structure materials provide the thermomechanical and thermophysical properties needed for an efficient system, the mechanical properties of the SiC tubes are severely degraded through corrosion by the coal combustion products. To obtain the necessary service life of thousands of hours at temperature, a protective coating is needed that is stable with both the SiC tube and the coal combustion products, resists erosion from the particle laden gas stream, is thermal shock resistant, adheres to SiC during repeated thermal shocks (start-up, process upsets, shut-down), and allows the EFCC system to be cost competitive. This demanding set of technical performance and cost drivers was used in reviewing and selecting candidate protective materials. After a review of open literature, discussion with leading researchers in materials for coal combustion environments, and preliminary thermodynamic studies, a total of ten materials were identified for future study that were grouped into three categories: alumina-based materials, materials stable with SiO{sub 2}, and low expansion materials.

  9. Influence of Age and Nutritional Status on the Performance of the Tuberculin Skin Test and QuantiFERON-TB Gold In-Tube in Young Children Evaluated for Tuberculosis in Southern India

    PubMed Central

    Jenum, Synne; Selvam, Sumithra; Mahelai, Diana; Jesuraj, Nelson; Cárdenas, Vicky; Kenneth, John; Hesseling, Anneke C.; Doherty, Timothy Mark; Vaz, Mario

    2014-01-01

    Background: Reliable identification of Mycobacterium tuberculosis infection or tuberculosis (TB) disease in young children is vital to assure adequate preventive and curative treatment. The tuberculin skin test (TST) and IFNγ-release assays may supplement the diagnosis of pediatric TB as cases are typically bacteriologically unconfirmed. However, it is unclear to what extent the performance of TST and QuantiFERON-TB Gold In-Tube (QFT; Cellestis’ IFNγ-release assay test) depends on the demographic, clinical and nutritional characteristics of children in whom they are tested. Methods: During a 2-year prospective observational study of 4382 neonates in Southern India, children with suspected TB were investigated and classified by a standard TB diagnostic algorithm. Results: Clinical TB was diagnosed in 13 of 705 children referred for case verification with suspected TB. TST and QFT had a susceptibility for clinical TB of 31% and 23%, respectively, in this group. Children <2 years were more likely to test QFT indeterminate. A height-for-age Z score within the lowest quartile increased the odds ratio (OR) for a positive or indeterminate QFT result [OR 2.46 (1.19–5.06), OR 3.08 (1.10–8.58)], whereas the OR for a positive TST was reduced with a weight-for-height Z score within the lowest quartile [OR 0.17 (0.06–0.47)]. Conclusion: The sensitivities of the TST and QFT for clinical TB in children <3 years of age were equally poor in this population. Stunted children were more susceptible to Mycobacterium tuberculosis infection and more prone to indeterminate QFT results. TST was less reliable in children with wasting. PMID:24797993

  10. Do the tuberculin skin test and the QuantiFERON-TB Gold in-tube test agree in detecting latent tuberculosis among high-risk contacts? A systematic review and meta-analysis

    PubMed Central

    Ayubi, Erfan; Doosti-Irani, Amin; Mostafavi, Ehsan

    2015-01-01

    OBJECTIVES: The QuantiFERON-TB Gold in-tube test (QFT-GIT) and the tuberculin skin test (TST) are used to diagnose latent tuberculosis infection (LTBI). However, conclusive evidence regarding the agreement of these two tests among high risk contacts is lacking. This systematic review and meta-analysis aimed to estimate the agreement between the TST and the QFT-GIT using kappa statistics. METHODS: According to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, scientific databases including PubMed, Scopus, and Ovid were searched using a targeted search strategy to identify relevant studies published as of June 2015. Two researchers reviewed the eligibility of studies and extracted data from them. The pooled kappa estimate was determined using a random effect model. Subgroup analysis, Egger’s test and sensitivity analysis were also performed. RESULTS: A total of 6,744 articles were retrieved in the initial search, of which 24 studies had data suitable for meta-analysis. The pooled kappa coefficient and prevalence-adjusted bias-adjusted kappa were 0.40 (95% confidence interval [CI], 0.34 to 0.45) and 0.45 (95% CI, 0.38 to 0.49), respectively. The results of the subgroup analysis found that age group, quality of the study, location, and the TST cutoff point affected heterogeneity for the kappa estimate. No publication bias was found (Begg’s test, p=0.53; Egger’s test, p=0.32). CONCLUSIONS: The agreement between the QFT-GIT and the TST in diagnosing LTBI among high-risk contacts was found to range from fair to moderate. PMID:26493775

  11. Performance of QuantiFERON-TB Gold In-Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers

    PubMed Central

    Babayigit, Cenk; Ozer, Burcin; Inandi, Tacettin; Ozer, Cahit; Duran, Nizami; Gocmen, Orhan

    2014-01-01

    Background Tuberculin skin test (TST) has been used for years as an aid in diagnosing latent tuberculosis infection (LTBI) but it suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. In this study, it was aimed to compare the performance of a commercial IFN-γ release assay (QFT-GIT) with TST in the diagnosis of HCWs at risk for latent TB infection in BCG vaccinated population. Material/Methods Hundred healthy volunteer health care workers were enrolled. All were subjected to TST and QFT-GIT. Results were compared among Health Care Workers (HCWs) groups in terms of profession, workplace, working duration. Results TST is affected by previous BCG vaccinations and number of cases with QFT-GIT positivity is increased in accordance with the TST induration diameter range. QFT-GIT result was negative in 17 of 32 TST positive (≥15 mm) cases and positive in 4 of 61 cases whose TST diameters are between 6–14 mm, that is attritutable to previous BCG vaccination(s). It was negative in all cases with TST diameters between 0–5 mm. HCWs with positive QFT-GIT results were significantly older than the ones with negative results. Furthermore duration of work was significantly longer in QFT-GIT positive than in negative HCWs. Conclusions There was a moderate concordance between QFT-GIT and TST, when TST result was defined as positive with a ≥15 mm diameter of induration. We suggest that QFT-GIT can be used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and in population with routine BCG vaccination program. PMID:24681806

  12. X-ray spectroscopy in mammography with a silicon PIN photodiode with application to the measurement of tube voltage

    SciTech Connect

    Kuenzel, Roseli; Herdade, Silvio Bruni; Terini, Ricardo Andrade; Costa, Paulo Roberto

    2004-11-01

    In this work a silicon PIN photodiode was employed in mammographic x-ray spectroscopy under clinical and nonclinical conditions. Measurements have been performed at a constant potential tungsten anode tube, adapted in this work with molybdenum filters to produce a beam like that used in mammography, and at a clinical equipment with a molybdenum anode tube by using an additional aluminum filtration. The corrected x-ray spectra were in full agreement with those generated by theoretical models published in the literature and agree well with those measured with a CdZnTe detector for tube voltages less than 30 kV. The half value layer and the relative exposure values calculated from the corrected silicon PIN photodiode spectra were in agreement with those measured with an ionization chamber. These results indicate that a silicon PIN photodiode are very suitable for mammographic x-ray spectroscopy. As an application, the voltage (kV) applied to mammographic x-ray equipment has been measured through the evaluation of the spectra high energy cut off. Uncertainties evaluated for the voltage values calculated from the measured spectra are less than 0.13% for voltages in the range 20-35 kV. The low uncertainties associated with the obtained results in this work point out that the method employed can be accurately used for calibration of noninvasive mammographic kVp meters.

  13. Endotracheal intubation confirmation based on video image classification using a parallel GMMs framework: a preliminary evaluation.

    PubMed

    Lederman, Dror

    2011-01-01

    In this paper, the problem of endotracheal intubation confirmation is addressed. Endotracheal intubation is a complex procedure which requires high skills and the use of secondary confirmation devices to ensure correct positioning of the tube. A novel confirmation approach, based on video images classification, is introduced. The approach is based on identification of specific anatomical landmarks, including esophagus, upper trachea and main bifurcation of the trachea into the two primary bronchi ("carina"), as indicators of correct or incorrect tube insertion and positioning. Classification of the images is performed using a parallel Gaussian mixture models (GMMs) framework, which is composed of several GMMs, schematically connected in parallel, where each GMM represents a different imaging angle. The performance of the proposed approach was evaluated using a dataset of cow-intubation videos and a dataset of human-intubation videos. Each one of the video images was manually (visually) classified by a medical expert into one of three categories: upper-tracheal intubation, correct (carina) intubation, and esophageal intubation. The image classification algorithm was applied off-line using a leave-one-case-out method. The results show that the system correctly classified 1517 out of 1600 (94.8%) of the cow-intubation images, and 340 out of the 358 human images (95.0%). The classification results compared favorably with a "standard" GMM approach utilizing textural based features, as well as with a state-of-the-art classification method, tested on the cow-intubation dataset. PMID:20878236

  14. Lightwand intubation: I--a new lightwand device.

    PubMed

    Hung, O R; Stewart, R D

    1995-09-01

    Tracheal intubation under direct vision using a laryngoscope can be challenging and difficult even in experienced hands. Transillumination of the soft tissues of the neck using a lighted-stylet (lightwand) is one of many effective alternative intubating techniques developed during the past several decades. While many versions of lightwand have been available, each has its limitations. A newly developed lightwand (Trachlight) has incorporated many design modifications. It has a brighter bulb, permitting intubation under ambient light in most cases. A retractable stiff wire within the wand adds flexibility to facilitate both oral and nasal intubation. The flexible wand also allows visual (transillumination) guide to proper placement of the tip of the tracheal tube in the trachea. The Trachlight does have some limitations. It is a light-guided technique in which there is no direct visualization of the upper airway structures. It should be avoided in patients with known anatomical abnormalities of the upper airway and used with caution in patients in whom transillumination of the anterior neck may not be achieved adequately. As with any intubating technique, successful intubation using the Trachlight relies on the preparation of the patient and the operator's skill and experience. PMID:7497567

  15. Preparing to perform an awake fiberoptic intubation.

    PubMed Central

    Walsh, M. E.; Shorten, G. D.

    1998-01-01

    Fiberoptically guided tracheal intubation represents one of the most important advances in airway management to occur in the past thirty years. Perhaps its most important role is in management of the anticipated difficult airway. This is a situation in which the dangers of encountering the life-threatening "can't intubate, can't ventilate" situation can be avoided by placement of an endotracheal tube while the patient is awake. Although skill at the procedure of endoscopy is obviously necessary in this setting, these authors hold that success or failure of the technique frequently depends on the adequacy of preparation. These measures include 1) pre-operative assessment of the patient; 2) careful explanation of what lies in store; 3) "setting the stage"; 4) preparing the equipment to be used; and 5) preparing the patient (antisialogue, sedation, application of topical anesthesia to the upper airway). If these preparatory measures are carried out meticulously, the likelihood of performing a successful and comfortable awake fiberoptic tracheal intubation is greatly increased. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:10604785

  16. Silicone Tubes - Simple and Effective Tools for Gas Extraction and Monitoring in the Course of Hydrate Dissociation

    NASA Astrophysics Data System (ADS)

    Strauch, B.; Schicks, J. M.; Zimmer, M.

    2015-12-01

    The in situ dissociation of gas hydrate is prerequisite for the commercial recovery of natural gas from hydrate deposits. We examined different methods such as depressurization, thermal stimulation and distortion of the chemical equilibrium by carbon dioxide sequestration for methane gas production from hydrates within our Large Scale reservoir simulator LARS in a pilot plant scale. Within this setup, thin-walled (0.8 mm) silicon tubes are utilized for in situ gas capture. They function as membranes for the extraction of methane gas, leaving sediment and brine behind. The gas capture via silicone tube membranes is, due to their robust nature, reliably applicable in remote and rough areas. First tests show that, driven by the transmembrane pressure difference, the methane flux through these membranes is about 1 mL per minute per cm² membrane surface at a reservoir pressure of about 20 MPa. This is in good agreement with values reported in the literature [e.g. 2]. The operation of the membranes as a simple capture tool for the released methane from a hydrate deposit is therefore considered as feasible. Furthermore, silicone tube membranes are suitable for the quantification of free and dissolved gas volumes. For the monitoring of spatial and temporal gas distribution, LARS has been equipped with several silicone membranes at various locations. They have been utilized to monitor the progress of hydrate formation and decomposition and show that inhomogeneous gas distributions within the reservoir are detectable and terminable. The quantification of carbon dioxide/methane gas ratios during exchange experiments, however, is due to differences in water solubility and permeation rates of the gas species challenging. The study assesses the capability and limits of silicone tubes as membranes for gas extraction and as a tool to monitor gas distribution and composition in the course of hydrate dissociation experiments. [1] Merkel, T.C.; Bodnar, V.I.; Nagai, K.; Freeman, B

  17. Automatic endotracheal tube position confirmation system based on image classification--a preliminary assessment.

    PubMed

    Lederman, Dror; Lampotang, Samsun; Shamir, Micha Y

    2011-10-01

    Endotracheal intubation is a complex medical procedure in which a ventilating tube is inserted into the human trachea. Improper positioning carries potentially fatal consequences and therefore confirmation of correct positioning is mandatory. This paper introduces a novel system for endotracheal tube position confirmation. The proposed system comprises a miniature complementary metal oxide silicon sensor (CMOS) attached to the tip of a semi rigid stylet and connected to a digital signal processor (DSP) with an integrated video acquisition component. Video signals are acquired and processed by a confirmation algorithm implemented on the processor. The confirmation approach is based on video image classification, i.e., identifying desired expected anatomical structures (upper trachea and main bifurcation of the trachea) and undesired structures (esophagus). The desired and undesired images are indicators of correct or incorrect endotracheal tube positioning. The proposed methodology is comprised of a continuous and probabilistic image representation scheme using Gaussian mixture models (GMMs), estimated using a greedy algorithm. A multi-dimensional feature space, which consists of several textural-based features, is utilized to represent the images. The performance of the proposed algorithm was evaluated using two datasets: a dataset of 1600 images extracted from 10 videos recorded during intubations on dead cows, and a dataset of 358 images extracted from 8 videos recorded during intubations performed on human subjects. Each one of the video images was classified by a medical expert into one of three categories: upper tracheal intubation, correct (carina) intubation and esophageal intubation. The results, obtained using a leave-one-case-out method, show that the system correctly classified 1530 out of 1600 (95.6%) of the cow intubations images, and 351 out of the 358 human images (98.0%). Misclassification of an image of the esophagus as carina or upper

  18. Characterization of mechanical properties of hydroxyapatite-silicon-multi walled carbon nano tubes composite coatings synthesized by EPD on NiTi alloys for biomedical application.

    PubMed

    Khalili, Vida; Khalil-Allafi, Jafar; Sengstock, Christina; Motemani, Yahya; Paulsen, Alexander; Frenzel, Jan; Eggeler, Gunther; Köller, Manfred

    2016-06-01

    Release of Ni(1+) ions from NiTi alloy into tissue environment, biological response on the surface of NiTi and the allergic reaction of atopic people towards Ni are challengeable issues for biomedical application. In this study, composite coatings of hydroxyapatite-silicon multi walled carbon nano-tubes with 20wt% Silicon and 1wt% multi walled carbon nano-tubes of HA were deposited on a NiTi substrate using electrophoretic methods. The SEM images of coated samples exhibit a continuous and compact morphology for hydroxyapatite-silicon and hydroxyapatite-silicon-multi walled carbon nano-tubes coatings. Nano-indentation analysis on different locations of coatings represents the highest elastic modulus (45.8GPa) for HA-Si-MWCNTs which is between the elastic modulus of NiTi substrate (66.5GPa) and bone tissue (≈30GPa). This results in decrease of stress gradient on coating-substrate-bone interfaces during performance. The results of nano-scratch analysis show the highest critical distance of delamination (2.5mm) and normal load before failure (837mN) as well as highest critical contact pressure for hydroxyapatite-silicon-multi walled carbon nano-tubes coating. The cell culture results show that human mesenchymal stem cells are able to adhere and proliferate on the pure hydroxyapatite and composite coatings. The presence of both silicon and multi walled carbon nano-tubes (CS3) in the hydroxyapatite coating induce more adherence of viable human mesenchymal stem cells in contrast to the HA coated samples with only silicon (CS2). These results make hydroxyapatite-silicon-multi walled carbon nano-tubes a promising composite coating for future bone implant application. PMID:26897095

  19. Intensive care management of children intubated for croup: a retrospective analysis.

    PubMed

    Gelbart, B; Parsons, S; Sarpal, A; Ninova, P; Butt, W

    2016-03-01

    Croup remains the commonest reason for acute upper airway obstruction in children, yet there are scarce contemporary data of airway management in those requiring intubation. We performed a retrospective analysis of the intensive care management of children intubated for croup in two quaternary Paediatric Intensive Care Units: Royal Children's Hospital Melbourne, Australia and Alberta Children's Hospital Calgary, Canada. Patients intubated for less than three days were compared with those intubated for greater than three days. Patients less than 10 kg body weight were compared to those greater than 10 kg. Demographic, clinical and microbiological data were recorded. Seventy-seven cases of croup requiring intubation were identified. The median duration of intubation was 60 hours. Parainfluenza was the most common viral aetiology, detected in 30% of cases. Antibiotics were prescribed in 51% of patients. Corticosteroids were prescribed pre intubation in two-thirds of patients and all post intubation, with the median dose being prednisolone 3 mg/kg/day. Primary extubation failure occurred in 6.5% of patients. Neither the duration of intubation nor patient size were associated with extubation failure. An air leak test was performed in 69% of patients and poorly predicted extubation success. One non-urgent tracheostomy was performed and there was one death from hypoxic ischaemic encephalopathy. Endotracheal tube leak is poorly recorded and may not predict successful extubation. PMID:27029657

  20. Pentax-AWS videolaryngoscope for awake nasal intubation in patients with unstable necks.

    PubMed

    Asai, T

    2010-01-01

    In patients with unstable necks and at risk of pulmonary aspiration, awake fibreoptic intubation is often appropriate. However, stabilization of the neck can make fibreoptic intubation more difficult. I report the use of awake nasal intubation using the Pentax-Aiway Scope (AWS) in three patients with restricted neck movement, in whom awake fibreoptic intubation had failed. Case 1: a 59-yr-old man, at risk of aspiration, required an emergency cervical laminectomy. Awake fibreoptic intubation was attempted while a Halo vest was being applied, but it was impossible to see the glottis, mainly due to pharyngeal and laryngeal oedema. The Pentax-AWS was easily inserted orally, and nasotracheal intubation was achieved within 20 s. Case 2: an 85-yr-old woman with neck injury required emergency surgical stabilization. A retropharyngeal haematoma prevented a fibreoptic bronchoscope from being advanced beyond the epiglottis. Nasotracheal intubation using the Pentax-AWS (with the aid of a gum elastic bougie) was achieved within 1 min. Case 3: a 22-yr-old man, with partial spinal cord damage, was undergoing cervical laminoplasty. He was at risk of aspiration and had an oedematous larynx. Although it was possible to insert a fibreoptic bronchoscope into the trachea while the neck was stabilized with a Halo vest, it was impossible to advance a tube over the fibrescope. Awake nasotracheal intubation using the Pentax-AWS was achieved within 15 s. The Pentax-AWS may be useful for nasotracheal intubation in awake patients with restricted necks. PMID:19923133

  1. Airway management using transmylohyoid oroendotracheal (submental) intubation in maxillofacial trauma

    PubMed Central

    Khan, Imran; Sybil, Deborah; Singh, Anurag; Aggarwal, Tarun; Khan, Rizwan

    2014-01-01

    Successful management of airway in complex maxillofacial injuries is quite challenging. The complications and the post-operative care associated with tracheotomy makes it an unpopular choice for airway management meant solely for surgery in these patients. A retrospective analysis of 12 patients from June 2008 to December 2011, seeking treatment for pan facial fractures who underwent transmylohyoid oroendotracheal (submental) intubation is discussed here. The stepwise procedure is explained along with problems of intubation in pan facial fractures. The advantages, disadvantages and complications of transmylohyoid intubation are discussed and compared with alternative methods of air way management in such cases. This reliable, safe and easy method of airway management gives sterile surgical field without a change of tube. PMID:25937722

  2. Dental trauma prevention during endotracheal intubation--review of literature.

    PubMed

    Mańka-Malara, Katarzyna; Gawlak, Dominika; Hovhannisyan, Anahit; Klikowska, Marta; Kostrzewa-Janicka, Jolanta

    2015-01-01

    Endotracheal intubation is a procedure performed during general anaesthesia with the use of an endotracheal tube in order to maintain a patent airway. This routinely used procedure is connected with a risk of complications within the region of the masticatory system. Trauma of teeth, their surrounding structures and the soft tissue of the oral cavity is observed in app. 1.38 per 1000 procedures. The main causes of this damage are the surgical skills and experience of the surgeon, the anatomical conditions present and the mode of conducting the procedure. In order to reduce the risk of postoperative complications, patients with a high risk of sustaining an injury during endotracheal intubation should be equipped with elastic mouthguards, which reduces the possibility of damage. The scoring in a scale of endotracheal intubation difficulty should be used for qualification for the use of such mouthguards. PMID:26401748

  3. Development of a silicone membrane tube equilibrator for measuring partial pressures of volatile organic compounds in natural water.

    PubMed

    Ooki, Atsushi; Yokouchi, Yoko

    2008-08-01

    Methods for determining volatile organic compounds (VOCs) in water and air are required so that the VOCs' fluxes in water environments can be estimated. We developed a silicone membrane tube equilibrator for collecting gas-phase samples containing VOCs at equilibrium with natural water. The equilibrator consists of six silicone tubes housed in a polyvinyl chloride pipe. Equilibrated air samples collected from the equilibrator were analyzed with an automated preconcentration gas chromatography-mass spectrometry system for hourly measurements of VOC partial pressures. The partial pressures of all the target VOCs reached equilibrium within 1 h in the equilibrator. The system was used to determine VOC partial pressures in Lake Kasumigaura, a shallow eutrophic lake with a high concentration of suspended particulate matter (SPM). Compressed air was used daily to remove SPM deposited on the inner wall of the equilibrator and to maintain the equilibrium conditions for more than a week without the need to shut the system down. CH2Br2, CHCl3, CHBrCl2, CH2BrCl, C2H5I, C2Cl4, CH3I, and CH3Br in the lake were supersaturated with respect to the air, whereas CH3CI was undersaturated. CHCl3 had the highest flux (6.2 nmol m(-2) hr(-1)) during the observation period. PMID:18754497

  4. Video-assisted thoracoscopic surgery segmentectomy by non-intubated or intubated anesthesia: a comparative analysis of short-term outcome

    PubMed Central

    Guo, Zhihua; Yin, Weiqiang; Pan, Hui; Zhang, Xin; Xu, Xin; Shao, Wenlong; Chen, Hanzhang

    2016-01-01

    Background The aim of this study was to reveal the short-term outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy without tracheal intubation compared with intubated general anesthesia with one-lung ventilation (OLV). Methods We performed a retrospective review of our institutional database of consecutive 140 patients undergoing VATS anatomical segmentectomy from July 2011 to June 2015. Among them, 48 patients were treated without tracheal intubation using a combination of thoracic epidural anesthesia (TEA), intrathoracic vagal blockade, and sedation (non-intubated group). The other 92 patients were treated with intubated general anesthesia (intubated group). Safety and feasibility was evaluated by comparing the perioperative profiles and short-term outcomes of these two groups. Results Two groups had comparable surgical durations, intraoperative blood loss, postoperative chest tube drainage volume, and numbers of dissected lymph nodes (P>0.05). Patients who underwent non-intubated segmentectomy had higher peak end-tidal carbon dioxide (EtCO2) during operation (44.81 vs. 33.15 mmHg, P<0.001), less white blood cell changes before and after surgery (△WBC) (6.08×109 vs. 7.75×109, P=0.004), earlier resumption of oral intake (6.76 vs. 17.58 hours, P<0.001), shorter duration of postoperative chest tube drainage (2.25 vs. 3.16 days, P=0.047), less cost of anesthesia (¥5,757.19 vs. ¥7,401.85, P<0.001), and a trend toward shorter postoperative hospital stay (6.04 vs. 7.83 days, P=0.057). One patient (2.1%) in the non-intubated group required conversion to intubated OLV since a significant mediastinal movement. In the intubated group, there was one patient (1.1%) required conversion to thoracotomy due to uncontrolled bleeding. The incidence difference of postoperative complications between groups was not significant (P=0.248). There was no in-hospital death in either group. Conclusions Compared with intubated general anesthesia, non-intubated

  5. Influence of Alumina Reaction Tube Impurities on the Oxidation of Chemically-Vapor-Deposited Silicon Carbide

    NASA Technical Reports Server (NTRS)

    Opila, Elizabeth

    1995-01-01

    Pure coupons of chemically vapor deposited (CVD) SiC were oxidized for 100 h in dry flowing oxygen at 1300 C. The oxidation kinetics were monitored using thermogravimetry (TGA). The experiments were first performed using high-purity alumina reaction tubes. The experiments were then repeated using fused quartz reaction tubes. Differences in oxidation kinetics, scale composition, and scale morphology were observed. These differences were attributed to impurities in the alumina tubes. Investigators interested in high-temperature oxidation of silica formers should be aware that high-purity alumina can have significant effects on experiment results.

  6. Intubation methods by novice intubators in a manikin model.

    PubMed

    O'Carroll, Darragh C; Barnes, Robert L; Aratani, Ashley K; Lee, Dane C; Lau, Christopher A; Morton, Paul N; Yamamoto, Loren G; Berg, Benjamin W

    2013-10-01

    Tracheal Intubation is an important yet difficult skill to learn with many possible methods and techniques. Direct laryngoscopy is the standard method of tracheal intubation, but several instruments have been shown to be less difficult and have better performance characteristics than the traditional direct method. We compared 4 different intubation methods performed by novice intubators on manikins: conventional direct laryngoscopy, video laryngoscopy, Airtraq® laryngoscopy, and fiberoptic laryngoscopy. In addition, we attempted to find a correlation between playing videogames and intubation times in novice intubators. Video laryngoscopy had the best results for both our normal and difficult airway (cervical spine immobilization) manikin scenarios. When video was compared to direct in the normal airway scenario, it had a significantly higher success rate (100% vs 83% P=.02) and shorter intubation times (29.1 ± 27.4 sec vs 45.9 ± 39.5 sec, P=.03). In the difficult airway scenario video laryngoscopy maintained a significantly higher success rate (91% vs 71% P=0.04) and likelihood of success (3.2 ± 1.0 95%CI [2.9-3.5] vs 2.4 ± 0.9 95%CI [2.1-2.7]) when compared to direct laryngoscopy. Participants also reported significantly higher rates of self-confidence (3.5 ± 0.6 95%CI [3.3-3.7]) and ease of use (1.5 ± 0.7 95%CI [1.3-1.8]) with video laryngoscopy compared to all other methods. We found no correlation between videogame playing and intubation methods. PMID:24167768

  7. A rare complication of tracheal intubation.

    PubMed

    Shukeri, Wan Fadzlina Wan Muhd; Hassan, Wan Mohd Nazaruddin Wan; Nadarajan, Chandran

    2016-05-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI. PMID:27275080

  8. A rare complication of tracheal intubation

    PubMed Central

    Shukeri, Wan Fadzlina Wan Muhd; Hassan, Wan Mohd Nazaruddin Wan; Nadarajan, Chandran

    2016-01-01

    Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI. PMID:27275080

  9. Determinants of Success and Failure in Prehospital Endotracheal Intubation

    PubMed Central

    Myers, Lucas A.; Gallet, Charles G.; Kolb, Logan J.; Lohse, Christine M.; Russi, Christopher S.

    2016-01-01

    Introduction This study aimed to identify factors associated with successful endotracheal intubation (ETI) by a multisite emergency medical services (EMS) agency. Methods We collected data from the electronic prehospital record for all ETI attempts made from January through May 2010 by paramedics and other EMS crew members at a single multistate agency. If documentation was incomplete, the study team contacted the paramedic. Paramedics use the current National Association of EMS Physicians definition of an ETI attempt (laryngoscope blade entering the mouth). We analyzed patient and EMS factors affecting ETI. Results During 12,527 emergent ambulance responses, 200 intubation attempts were made in 150 patients. Intubation was successful in 113 (75%). A crew with paramedics was more than three times as likely to achieve successful intubation as a paramedic/emergency medical technician-Basic crew (odds ratio [OR], 3.30; p=0.03). A small tube (≤7.0 inches) was associated with a more than 4-fold increased likelihood of successful ETI compared with a large tube (≥7.5 inches) (OR, 4.25; p=0.01). After adjustment for these features, compared with little or no view of the glottis, a partial or entire view of the glottis was associated with a nearly 13-fold (OR, 12.98; p=0.001) and a nearly 40-fold (OR, 39.78; p<0.001) increased likelihood of successful intubation, respectively. Conclusion Successful ETI was more likely to be accomplished when a paramedic was partnered with another paramedic, when some or all of the glottis was visible and when a smaller endotracheal tube was used. PMID:27625734

  10. Determination of the voltage applied to x-ray tubes from the bremsstrahlung spectrum obtained with a silicon PIN photodiode.

    PubMed

    Silva, M C; Herdade, S B; Lammoglia, P; Costa, P R; Terini, R A

    2000-11-01

    This work describes a methodology for the obtainment of the electron accelerating potential (kVp) applied to an x-ray tube, through the determination of the end point of the energy spectrum of the radiation emitted by the tube. The measurements have been performed utilizing alternatively two silicon PIN photodiodes, directly irradiated by the x-ray beam. Both were operated at room temperature, with low bias, so avoiding the drawbacks presented by photomultiplier tubes and germanium detectors. The energy calibration of the system was performed with X- and gamma-emitter radioactive sources, which makes the method absolute. Each kVp value was determined by means of a linear regression in the end of the spectrum, to give, simultaneously, a good fit of the straight line to the experimental data and a low standard deviation for the kVp value. Results of the measurements carried out with an x-ray tube connected to a three-phase generator, using additional filtration between 1.5 and 4.0 mm of Cu, are presented. This filtration was used in order to minimize the contribution of low energy photons and to reduce pulse pile-up. Errors determined for the values of kVp are between 0.06 and 0.16 kV, in the potential range from 50 to 100 kV. As an example, the methodology has been applied in the verification of the secondary calibration of a voltage divider, utilized, by its turn, in the tertiary calibration of noninvasive kVp meters. All intrinsic sources of errors involved in the process are discussed and evaluated. PMID:11128315

  11. First results of performance tests of the newly designed Vacuum Silicon Photo Multiplier Tube (VSiPMT).

    NASA Astrophysics Data System (ADS)

    de Asmundis, R.; Barbarino, G.; Barbato, F. C. T.; Campajola, L.; De Rosa, G.; Fiorillo, G.; Migliozzi, P.; Mollo, C. M.; Rossi, B.; Vivolo, D.

    2014-04-01

    We invented (2007) the VSiPMT, a novel, high-gain, photo detector device and we publically proposed this idea in an International Conference for the first time at the 11th Topical Seminar on Innovative Particle and Radiation Detectors (IPRD08) in Siena, triggering deep discussions on the feasibility of the device itself and on the convenience of such a solution. After several years spent in designing, evaluation, tests and eventually negotiations with some suppliers, we finally got a couple of prototypes of the Vacuum Silicon Photo Multiplier Tube (VSiPMT) made under our specifications by Hamamatsu. We present in this paper the most important results of characterization tests of the first prototypes of the VSiPMT.

  12. Front-end circuit for position sensitive silicon and vacuum tube photomultipliers with gain control and depth of interaction measurement

    NASA Astrophysics Data System (ADS)

    Herrero, Vicente; Colom, Ricardo; Gadea, Rafael; Lerche, Christoph W.; Cerdá, Joaquín; Sebastiá, Ángel; Benlloch, José M.

    2007-06-01

    Silicon Photomultipliers, though still under development for mass production, may be an alternative to traditional Vacuum Photomultipliers Tubes (VPMT). As a consequence, electronic front-ends initially designed for VPMT will need to be modified. In this simulation, an improved architecture is presented which is able to obtain impact position and depth of interaction of a gamma ray within a continuous scintillation crystal, using either kind of PM. A current sensitive preamplifier stage with individual gain adjustment interfaces the multi-anode PM outputs with a current division resistor network. The preamplifier stage allows to improve front-end processing delay and temporal resolution behavior as well as to increase impact position calculation resolution. Depth of interaction (DOI) is calculated from the width of the scintillation light distribution, which is related to the sum of voltages in resistor network input nodes. This operation is done by means of a high-speed current mode scheme.

  13. Pulmonary Delivery of Vancomycin Dry Powder Aerosol to Intubated Rabbits.

    PubMed

    Sullivan, Bradley P; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2015-08-01

    Antibiotic multiresistant pneumonia is a risk associated with long-term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant Staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study, we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of iv and pulmonary administered vancomycin in intubated rabbits through an endotracheal tube system. Cascade impaction studies indicated that using an endotracheal tube, which bypasses deposition in the mouth and throat, increased the amount of drug entering the lung. Bypassing the endotracheal tube with a catheter further enhanced drug deposition in the lung. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus iv infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, indicating that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during iv administration. PMID:25915095

  14. A Non-invasive Real-time Localization System for Enhanced Efficacy in Nasogastric Intubation.

    PubMed

    Sun, Zhenglong; Foong, Shaohui; Maréchal, Luc; Tan, U-Xuan; Teo, Tee Hui; Shabbir, Asim

    2015-12-01

    Nasogastric (NG) intubation is one of the most commonly performed clinical procedures. Real-time localization and tracking of the NG tube passage at the larynx region into the esophagus is crucial for safety, but is lacking in current practice. In this paper, we present the design, analysis and evaluation of a non-invasive real-time localization system using passive magnetic tracking techniques to improve efficacy of the clinical NG intubation process. By embedding a small permanent magnet at the insertion tip of the NG tube, a wearable system containing embedded sensors around the neck can determine the absolute position of the NG tube inside the body in real-time to assist in insertion. In order to validate the feasibility of the proposed system in detecting erroneous tube placement, typical reference intubation trajectories are first analyzed using anatomically correct models and localization accuracy of the system are evaluated using a precise robotic platform. It is found that the root-mean-squared tracking accuracy is within 5.3 mm for both the esophagus and trachea intubation pathways. Experiments were also designed and performed to demonstrate that the system is capable of tracking the NG tube accurately in biological environments even in presence of stationary ferromagnetic objects (such as clinical instruments). With minimal physical modification to the NG tube and clinical process, this system allows accurate and efficient localization and confirmation of correct NG tube placement without supplemental radiographic methods which is considered the current clinical standard. PMID:26108204

  15. Fully Digital Arrays of Silicon Photomultipliers (dSiPM) - a Scalable Alternative to Vacuum Photomultiplier Tubes (PMT)

    NASA Astrophysics Data System (ADS)

    Haemisch, York; Frach, Thomas; Degenhardt, Carsten; Thon, Andreas

    Silicon Photomultipliers (SiPMs) have emerged as promising alternative to fast vacuum photomultiplier tubes (PMT). A fully digital implementation of the Silicon Photomultiplier (dSiPM) has been developed in order to overcome the deficiencies and limitations of the so far only analog SiPMs (aSiPMs). Our sensor is based on arrays of single photon avalanche photodiodes (SPADs) integrated in a standard CMOS process. Photons are detected directly by sensing the voltage at the SPAD anode using a dedicated cell electronics block next to each diode. This block also contains active quenching and recharge circuits as well as a one bit memory for the selective inhibit of detector cells. A balanced trigger network is used to propagate the trigger signal from all cells to the integrated time-to-digital converter. In consequence, photons are detected and counted as digital signals, thus making the sensor less susceptible to temperature variations and electronic noise. The integration with CMOS logic provides the added benefit of low power consumption and possible integration of data post-processing directly in the sensor. In this overview paper, we discuss the sensor architecture together with its characteristics with a focus on scalability and practicability aspects for applications in medical imaging, high energy- and astrophysics.

  16. Making endotracheal intubation easy and successful, particularly in unexpected difficult airway

    PubMed Central

    Abdulla, Susanne; Abdulla, Sina; Schwemm, Karl-Peter; Eckhardt, Regina; Abdulla, Walied

    2014-01-01

    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. PMID:24741494

  17. Air-Q intubating laryngeal airway: A study of the second generation supraglottic airway device

    PubMed Central

    Attarde, Viren Bhaskar; Kotekar, Nalini; Shetty, Sarika M

    2016-01-01

    Background and Aims: Air-Q intubating laryngeal mask airway (ILA) is used as a supraglottic airway device and as a conduit for endotracheal intubation. This study aims to assess the efficacy of the Air-Q ILA regarding ease of insertion, adequacy of ventilation, rate of successful intubation, haemodynamic response and airway morbidity. Methods: Sixty patients presenting for elective surgery at our Medical College Hospital were selected. Following adequate premedication, baseline vital parameters, pulse rate and blood pressure were recorded. Air-Q size 3.5 for patients 50-70 kg and size 4.5 for 70-100 kg was selected. After achieving adequate intubating conditions, Air-Q ILA was introduced. Confirming adequate ventilation, appropriate sized endotracheal tube was advanced through the Air-Q blindly to intubate the trachea. Placement of the endotracheal tube in trachea was confirmed. Results: Air-Q ILA was successfully inserted in 88.3% of patients in first attempt and 11.7% patients in second attempt. Ventilation was adequate in 100% of patients. Intubation was successful in 76.7% of patients with Air-Q ILA. 23.3% of patients were intubated by direct laryngoscopy following failure with two attempts using Air-Q ILA. Post-intubation the change in heart rate was statistically significant (P < 0.0001). 10% of patients were noted to have a sore throat and 5% of patients had mild airway trauma. Conclusion: Air-Q ILA is a reliable device as a supraglottic airway ensuring adequate ventilation as well as a conduit for endotracheal intubation. It benefits the patient by avoiding the stress of direct laryngoscopy and is also superior alternative device for use in a difficult airway. PMID:27212722

  18. Isolation, structural determination, synthesis and quantitative determination of impurities in Intron-A, leached from a silicone tubing.

    PubMed

    Chan, Tze-Ming; Pramanik, Birendra; Aslanian, Robert; Gullo, Vincent; Patel, Mahesh; Cronin, Bart; Boyce, Chris; McCormick, Kevin; Berlin, Mike; Zhu, Xiaohong; Buevich, Alexei; Heimark, Larry; Bartner, Peter; Chen, Guodong; Pu, Haiyan; Hegde, Vinod

    2009-02-20

    Investigation of unexpected levels of impurities in Intron product has revealed the presence of low levels of impurities leached from the silicone tubing (Rehau RAU-SIK) on the Bosch filling line. In order to investigate the effect of these compounds (1a, 1b and 2) on humans, they were isolated identified and synthesized. They were extracted from the tubing by stirring in Intron placebo at room temperature for 72 h and were enriched on a reverse phase CHP-20P column, eluting with gradient aqueous ACN and were separated by HPLC. Structural elucidation of 1a, 1b and 2 by MS and NMR studies demonstrated them to be halogenated biphenyl carboxylic acids. The structures were confirmed by independent synthesis. Levels of extractable impurities in first filled vials of actual production are estimated to be in the range of 0.01-0.55 microg/vial for each leached impurity. Potential toxicity of these extractables does not represent a risk for patients under the conditions of clinical use. PMID:19150187

  19. Wave propagation in the silicon tube: comparison of the two-point and three-point pressure methods.

    PubMed

    Ursino, M; Artioli, E

    1992-01-01

    The values of the propagation coefficient measured on a silicon rubber tube in the frequency range 1-15 Hz were compared, using four different equations. The first formula is based on three simultaneous pressure measurements performed at equidistant points; the remaining three equations are original, and make use of only two of the three pressure measurements together with a no-flow condition at the terminal tube section. The results of our trials demonstrate that the experimental phase velocity, obtained with all equations, settles at a value about 25% in excess of the theoretical one computed with a classic linear mathematical model. This result may be explained by an increase in the dynamical Young modulus with respect to that measured in static conditions. However, the three-point method introduces great errors in the results in the frequency range 11-14 Hz where the spectrum of the second signal becomes minimum. In all cases, the experimental value of attenuation per wavelength at mid-high frequencies is greater than the theoretical one valid for a purely elastic tube. The attenuation values obtained with the two-point method can be explained by introducing a small contribution of wall viscoelasticity (2-3 degrees) into the linear model. Attenuation per wavelength computed with the three-point methods turns out about threefold that computed with each of the two-point formulas. This result supports the idea that the accuracy of the three-point method may be insufficient to achieve correct estimation of wave attenuation, especially when the distance between transducers is small compared to wavelength. PMID:1458210

  20. Tracheal intubation: tricks of the trade.

    PubMed

    Murphy, Michael F; Hung, Orlando R; Law, J Adam

    2008-11-01

    This article describes the use of laryngoscopy for tracheal intubation. Maneuvers basic to successful orotracheal laryngoscopic intubation are described, which should be incorporated into the skill sets of individuals called on to manage the airway in an emergency. PMID:19059097

  1. Silicon carbide at nanoscale: Finite single-walled to "infinite" multi-walled tubes

    NASA Astrophysics Data System (ADS)

    Adhikari, Kapil

    A systematic ab initio study of silicon carbide (SiC) nanostructures, especially finite single-walled, infinite double- and multi-walled nanotubes and nanocones is presented. Electronic and structural properties of all these nanostructures have been calculated using hybrid density functionals (B3LYP and PBE0) as implemented in the GAUSSIAN 03/09 suite of software. The unusual dependence of band gap of silicon carbide nanotubes (SiCNT) has been explained as a direct consequence of curvature effect on the ionicity of the bonds. The study of fullerene hemisphere capped, finite SiC nanotubes indicates that the carbon-capped SiC nanotubes are energetically more preferred than silicon-capped finite or hydrogen terminated infinite nanotubes. Capping a nanotube by fullerene hemisphere reduces its band gap. SiC nanocones have also been investigated as possible cap structures of nanotubes. Electronic properties of the nanocones are found to be strongly dependent upon their tip and edge structures, with possible interesting applications in surface science. Three types of double-walled SiCNTs (n, n)@(m, m) (3 ≤ n ≤ 6 ; 7 ≤ m ≤ 12) have been studied using the finite cluster approximation. The stabilities of these nanotubes are of the same order as those of the single-walled SiC nanotubes and it should be experimentally possible to synthesize both single-walled and double-walled SiC nanotubes. The binding energy per atom or the cohesive energy of the double-walled nanotubes depends not only on the number of atoms but also on the coupling of the constituent single-walled nanotubes and their types. A study of binding energies, Mulliken charges, density of states and HOMO-LUMO gaps has been performed for all nanotubes from (n, n)@(n+3,n+3) to (n, n)@(n+6, n+6) (n=3-6). Evolution of band gaps of the SiCNTs with increase in the number of walls has also been investigated. The nature of interaction between transition metal atoms and silicon carbide nanotubes with different

  2. Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection

    PubMed Central

    Li, Xin; Hu, Bin; Miao, Jinbai

    2016-01-01

    Background The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. Methods The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. Results In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. Conclusions The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications. PMID:26941976

  3. Nasotracheal intubation with MacGrath videolaryngoscope using Schroeder directional stylet: Case series

    PubMed Central

    Das, Bikramjit; Ahmed, Syed Moied; Raza, Nadeem

    2015-01-01

    Background and Aims: MacGrath videolaryngoscope is one of the recent videolaryngoscopes, which can be used to facilitate nasotracheal intubations using Scroeder directional stylet. Material and Methods: 15 patients, American Society of Anesthesiologists Grades I-II, undergoing tonsillectomy, requiring nasotracheal intubation were included. All patients were intubated with MacGrath videolaryngoscope and Schroeder stylet. Primary outcome measures were duration and ease of intubation. Overall success rate, number of attempts, modified Cormack-Lehane (C-L) grading, and complications were also recorded. Results: All 15 intubations were successful during first laryngoscopy attempt. C-L Grade I views were obtained in 14 patients (93%) and Grade II view in one patient (7%). The time required to obtain the best C-L view was 9.4 ± 1.5 s. The time taken to complete tracheal intubation was 34.27 ± 3.38 s. Average numerical rating scale for tracheal intubation was 8.7 ± 0.9. Minor complications occurred in four patients (26.7%). Conclusions: MacGrath videolaryngoscope produces excellent laryngoscopic views in patients with normal airways. Impaction of tracheal tube on posterior nasopharyngeal wall can be overcome by Schroeder stylet. PMID:25948909

  4. Fiberoptic bronchoscopy-assisted endotracheal intubation in a patient with a large tracheal tumor.

    PubMed

    Pang, Lei; Feng, Yan-Hua; Ma, Hai-Chun; Dong, Su

    2015-04-01

    In the event of a high degree of airway obstruction, endotracheal intubation can be impossible and even dangerous, because it can cause complete airway obstruction, especially in patients with high tracheal lesions. However, a smaller endotracheal tube under the guidance of a bronchoscope can be insinuated past obstructive tumor in most noncircumferential cases. Here we report a case of successful fiberoptic bronchoscopy-assisted endotracheal intubation in a patient undergoing surgical resection of a large, high tracheal tumor causing severe tracheal stenosis. A 42-year-old Chinese man presented with dyspnea, intermittent irritable cough, and sleep deprivation for one and a half years. X-rays and computed tomography scan of the chest revealed an irregular pedunculated soft tissue mass within the tracheal lumen. The mass occupied over 90% of the lumen and caused severe tracheal stenosis. Endotracheal intubation was done to perform tracheal tumor resection under general anesthesia. After several failed conventional endotracheal intubation attempts, fiberoptic bronchoscopy-assisted intubation was successful. The patient received mechanical ventilation and then underwent tumor resection and a permanent tracheostomy. This case provides evidence of the usefulness of the fiberoptic bronchoscopy-assisted intubation technique in management of an anticipated difficult airway and suggests that tracheal intubation can be performed directly in patients with a tracheal tumor who can sleep in the supine position, even if they have occasional sleep deprivation and severe tracheal obstruction as revealed by imaging techniques. PMID:25875537

  5. Sonographic detection of tracheal or esophageal intubation: A cadaver study

    PubMed Central

    Tejesh, CA; Manjunath, AC; Shivakumar, S; Vinayak, PS; Yatish, B; Geetha, CR

    2016-01-01

    Background: The correct position of the endotracheal tube is confirmed by various modalities, most of which are not entirely reliable. Ultrasound is now increasingly available to anesthesiologists in the operating theater and is an attractive alternative. To investigate the usefulness of sonography in identifying the correct tracheal tube position in human cadavers. Materials and Methods: Endotracheal tubes placed randomly into trachea or esophagus was identified with a linear ultrasound probe placed transversely just above the suprasternal notch by a single anesthesiologist. Results: Of the 100 intubations performed at random, 99 were correctly identified to give a sensitivity of 100% and a specificity of 97.9%. Conclusion: Sonography is a useful technique to identify correct position of the tracheal tube. PMID:27375387

  6. Safe intubation in Morquio-Brailsford syndrome: A challenge for the anesthesiologist.

    PubMed

    Chaudhuri, Souvik; Duggappa, Arun Kumar Handigodu; Mathew, Shaji; Venkatesh, Sandeep

    2013-04-01

    Morquio-Brailsford syndrome is a type of mucopolysaccharidoses. It is a rare disease with features of short stature, atlantoaxial instability with risk of cord damage, odontoid hypoplasia, pectus carinatum, spine deformities, hepatomegaly, and restrictive lung disease. Neck movements during intubation are associated with the risk of quadriparesis due to cervical instability. This, along with the distortion of the airway anatomy due to deposition of mucopolysaccharides makes airway management arduous. We present our experience in management of difficult airway in a 3-year-old girl with Morquio-Brailsford syndrome posted for magnetic resonance imaging and computerized tomography scan of a suspected unstable cervical spine. As utmost sagacity during intubation is required, the child was intubated inside operation theatre in the presence of experienced anesthesiologists and then shifted to the peripheral location. Intubation was done with an endotracheal tube railroaded over a pediatric fibreoptic bronchoscope passed through the lumen of a classic laryngeal mask airway, keeping head in neutral position. PMID:23878456

  7. Comparative Performance of the Photomultiplier Tube and the Silicon Avalanche Photodiode When Used as Detectors in Angular Scattering Measurements

    NASA Astrophysics Data System (ADS)

    Kroner, D. O.; Nelson, R. M.; Boryta, M. D.; Hapke, B. W.; Manatt, K.; Smythe, W. D.

    2014-12-01

    We report the results of a comparative study of two types of photometric detectors that are commonly used for, spacecraft, ground-based telescope, and laboratory observations in support of precise angular scattering investigations of the type described in a companion paper (Nelson et al., this meeting). The performance of the state of the art Hamamatsu C12703-01 Silicon Avalanche photodiode (SAD) was compared to that of the Hamamatsu R928 Photomultiplier tube (PMT). The Hamamatsu R928 evolved from a sequence of photometric detectors with a long history of use in support of laboratory and remote sensing studies, tracing backwards to include the RCA 1P21 and the RCA 931A. Two newly acquired SADs were bench tested along with a new R928 photomultiplier tube that was thermoelectrically cooled to -10 deg C. The SAD's employed electronic thermal compensation supplied by the manufacturer. The SADs and PMT measured electromagnetic radiation from solid-state lasers of wavelength 635 nm after the radiation was reflected from diffusely-scattering surfaces of varying albedos. The SADs were housed on tripods that were co-aligned with the PMT and laser. The photometric detectors were placed 4.3 meters from a reflecting disk. The disk was rotated to reduce the effect of laser speckle. All detectors in the experiment were equipped with notch filters that transmit light only of the wavelength emitted by the laser. Three SR830 DSP Lock-in Amplifiers were connected to the detectors and various setting configurations were compared in order to optimize signal to noise. Neutral Density filters (ND 0,3 and ND 0,9) were placed in the light path to determine the linearity in the response function of the detectors. We conclude that in this application SADs and PMTs produce comparable photometric precision and fidelity. SADs offer greater convenience because thermal compensation circuitry is integrated with the detector. This work was partially supported by NASA's Cassini Science

  8. High temperature life prediction of monolithic silicon carbide heat exchanger tubes

    SciTech Connect

    Sandifer, J.B.; Edwards, M.J.; Brown, T.S. III; Duffy, S.F.

    1994-01-01

    The need for improved performance in high temperature environments is prompting industry to consider the use of structural ceramic materials in heat exchanger tubes and other high temperature components. ln recognition of this need the U. S. Department of Energy has supported work for the development of nondestructive methods for evaluating flaws in monolithic ceramic components and the associated establishment of criteria for the acceptance of flawed components. Under this development of flaw assessment criteria DOE supported the work being presented in this paper. The approach to developing the life prediction model combines finite element predictions considering creep behavior with continuum damage mechanics and Weibull reliability statistics. ABAQUS is used to predict time dependent creep response of the component based on experimental creep data. A continuity parameter is then calculated at each time step following continuum damage mechanics methods. Finally Weibull statistics are used with the resulting continuity parameter to predict the reliability at each time step through the use of the NASA-Lewis computer program CARES interfaced to ABAQUS with ABACARES. There is very limited data available to characterize the creep continuum damage and reliability behavior of the material. For the life prediction model reported it is assumed that the material damages isotropically. Directional effects of the damage can be added as material databases improve.

  9. Method and apparatus for stable silicon dioxide layers on silicon grown in silicon nitride ambient

    NASA Technical Reports Server (NTRS)

    Cohen, R. A.; Wheeler, R. K. (Inventor)

    1974-01-01

    A method and apparatus for thermally growing stable silicon dioxide layers on silicon is disclosed. A previously etched and baked silicon nitride tube placed in a furnace is used to grow the silicon dioxide. First, pure oxygen is allowed to flow through the tube to initially coat the inside surface of the tube with a thin layer of silicon dioxide. After the tube is coated with the thin layer of silicon dioxide, the silicon is oxidized thermally in a normal fashion. If the tube becomes contaminated, the silicon dioxide is etched off thereby exposing clean silicon nitride and then the inside of the tube is recoated with silicon dioxide. As is disclosed, the silicon nitride tube can also be used as the ambient for the pyrolytic decomposition of silane and ammonia to form thin layers of clean silicon nitride.

  10. A comparison of blind and lightwand-guided tracheal intubation through the intubating laryngeal mask.

    PubMed

    Kihara, S; Watanabe, S; Taguchi, N; Suga, A; Brimacombe, J R

    2000-05-01

    We have tested the hypothesis that intubation success rates, haemodynamic changes, airway complications and postoperative pharyngolaryngeal morbidity differ between blind and lightwand-guided intubation through the intubating laryngeal mask airway. One hundred and twenty paralysed anasthetised adult patients (ASA I-II, no known or predicted difficult airways) were assigned in a random manner to one of two equal-sized groups. In the blind group, patients were intubated blindly through the intubating laryngeal mask airway. In the lightwand group, patients were intubated through the intubating laryngeal mask airway assisted by transillumination of the neck with a lightwand. A standard sequence of adjusting manoeuvres was followed if resistance occurred during intubation or if transillumination was incorrect. The number of adjusting manoeuvres, time to intubation, intubation success rates, haemodynamic changes (pre-induction, pre-intubation, postintubation), oesophageal intubation, mucosal trauma (blood detected), hypoxia (oxygen saturation < 95%) and postoperative pharyngolaryngeal morbidity (double-blinded) were documented. Overall intubation success was similar (blind, 93%; lightwand, 100%), but time to successful intubation was significantly shorter (67 vs. 46 s, p = 0. 027) and the number of adjusting manoeuvres was significantly fewer (p = 0.024) in the lightwand group. There were no significant differences in blood pressure or heart rate between the groups at any time. Oesophageal intubation occurred more frequently in the blind group (18 vs. 0%, p = 0.002). The incidence and severity of mucosal injury, sore throat and hoarseness were similar between the groups. We conclude that lightwand-guided intubation through the intubating laryngeal mask is superior to the blind technique. PMID:10792132

  11. Awake intubating laryngeal mask airway placement in a morbidly obese patient with ankylosing spondylitis and unstable thoracic spine.

    PubMed

    Herman, Abbey G; Mahla, Michael E

    2016-08-01

    Intubating laryngeal mask airways can be used to provide continuous ventilation throughout intubation. This is a case of a morbidly obese (body mass index = 58) 65-year-old woman with T10 and T11 compression fractures. Optimal positioning for airway management was hindered by her unstable spine, minimal neck range of motion, and extreme pain with any movement. An intubating laryngeal mask airway was placed in the awake, topically anesthetized patient, and the laryngeal mask airway and endotracheal tube combination was left in place throughout surgery. PMID:27290947

  12. Long-term effect of neonatal endotracheal intubation on palatal form and symmetry in 8-11-year-old children.

    PubMed

    Macey-Dare, L V; Moles, D R; Evans, R D; Nixon, F

    1999-12-01

    Premature and low birth weight infants often require neonatal oral intubation for resuscitation and to relieve respiratory distress. The endotracheal tube exerts pressure on the developing palate, which can result in palatal groove formation, a high-arched palate, and palatal asymmetry. The purpose of this investigation was to determine whether such intubation can have a long-term effect on palatal form and symmetry. Arch widths, palatal widths, and palatal depths were measured from the study casts of 43, 8-11-year-old previously intubated premature and low birth weight children using a reflex microscope, with a fixed rectangular Cartesian co-ordinate system, and compared with a group of non-intubated gender- and age-matched controls. Significant differences were found between the intubated and non-intubated children. The intubated children had significantly narrower palatal widths posteriorly (P < or = 0.001), steeper palatal vaults anteriorly (P < or = 0.01), and exhibited a directional palatal width asymmetry with the left side of the palate measuring consistently wider than the right. These differences did not, however, appear to be affected by the length of intubation. Therefore, it is concluded that an oral endotracheal tube might exert excess force on the developing alveolus anteriorly with the tube being displaced to the right of the palate posteriorly leading to a steep anterior palatal vault and a left-sided palatal asymmetry, which can persist until the age of 11 years of age. PMID:10665200

  13. Fiberoptic intubation with patients in sitting position.

    PubMed

    Lai, Yu-Yung; Chien, Jui-Teng; Huang, Shen-Jer

    2007-09-01

    Flexible fiberoptic endoscope is the most valuable tool for anesthesiologists to manage difficult airways. Correctly positioning of the patient during fiberoptic intubation aids the clinician to rapidly secure the airway, because it not only saves time, but also minimizes the risk of repeated attempts of intubation with possible serious consequences in the wake. In general, fiberoptic intubation is carried out with the patient in the supine position, but there are situations in which the intubation requires the subjects to be in the sitting position. The sitting position also changes the position of performing anesthesiologist relative to the patient, presenting an inverse view contrary to that of traditional laryngoscopy. We can often obtain a superior view from fiberoptic intubation. Fiberoptic intubation in the sitting position can be applied to all patients, as long as there is no contraindication of having a patient be sat. PMID:17972620

  14. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    PubMed Central

    Tang, Chaoliang; Chai, Xiaoqing; Kang, Fang; Huang, Xiang; Hou, Tao; Tang, Fei; Li, Juan

    2015-01-01

    Background. The adverse events induced by intubation and extubation may cause intracranial hemorrhage and increase of intracranial pressure, especially in posterior fossa surgery patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT) or I-gel facilitated endotracheal tube intubation (Group TI). Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P < 0.05 versus Group TT). Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery. PMID:26273146

  15. Pulmonary delivery of vancomycin dry powder aerosol to intubated rabbits

    PubMed Central

    Sullivan, Bradley P.; El-Gendy, Nashwa; Kuehl, Christopher; Berkland, Cory

    2016-01-01

    Antibiotic multi-resistant pneumonia is a risk associated with long term mechanical ventilation. Vancomycin is commonly prescribed for methicillin-resistant staphylococcus aureus infections; however, current formulations of vancomycin are only given intravenously. High doses of vancomycin have been associated with severe renal toxicity. In this study we characterized dry powder vancomyin as a potential inhaled therapeutic aerosol and compared pharmacokinetic profiles of i.v. and pulmonary administered vancomycin in intubated rabbits using a novel endotracheal tube catheter system. Cascade Impaction studies indicated that using an endotracheal tube, which bypasses deposition the mouth and throat, increased the amount of drug entering the lung. Drug deposition in the lung was further enhanced by using an endotracheal tube catheter, which did not alter the aerosol fine particle fraction. Interestingly, intubated rabbits administered 1 mg/kg vancomycin via inhalation had similar AUC to rabbits that were administered 1 mg/kg vancomycin via a single bolus i.v. infusion; however, inhalation of vancomycin reduced Cmax and increased Tmax, suggesting that inhaled vancomycin resulted in more sustained pulmonary levels of vancomycin. Collectively, these results suggested that dry powder vancomycin can successfully be delivered by pulmonary inhalation in intubated patients. Furthermore, as inhaled vancomycin is delivered locally to the site of pulmonary infection, this delivery route could reduce the total dose required for therapeutic efficacy and simultaneously reduce the risk of renal toxicity by eliminating the high levels of systemic drug exposure required to push the pulmonary dose to therapeutic thresholds during i.v. administration. PMID:25915095

  16. Traumatic perforation of the trachea in two horses caused by orotracheal intubation.

    PubMed

    Saulez, M N; Dzikiti, B; Voigt, A

    2009-06-01

    Two of 348 horses that underwent gastrointestinal surgery under general anaesthesia developed perforations in their tracheas caused by the endotracheal tube. In one case the damage was probably caused when the horse was being moved from the induction room for surgery and excessive traction was exerted on the tube when the anaesthetic machine was moved too far ahead of the horse. The trachea of the other horse may have been damaged when it was intubated. PMID:19502628

  17. RETROGRADE INTUBATION VIA LARYNGEAL MASK AIRWAY IN A PAEDIATRIC PATIENT WITH FALLOT-TYPE VENTRICULAR SEPTAL DEFECT AND CLEFT PALATE DEFORMITY.

    PubMed

    Ciftci, Taner; Erbatur, Serkan

    2016-02-01

    We report the case ofa pediatric patient with tetralogy of Fallot (TOF) and cleft palate deformity with difficult intubation in which a laryngeal mask airway (LMA) was used and converted into an endotracheal tube through retrograde intubation. The patient with TOF was scheduled for repair of the congenital bilateral cleft lip and palate. Inhalational induction with 4% sevoflurane was started. Conventional tracheal intubation was impossible because the patient had a difficult airway, and the procedure could cause severe cyanosis and respiratory distress. An LMA was inserted to maintain ventilation and anesthesia and to facilitate intubation. Retrograde intubation and a catheter mount were used to convert the LMA into a conventional endotracheal tube without difficulty. Airway management for patients with TOF and cleft palate deformity is not clear. Retrograde intubation permits replacing an LMA with an endotracheal tube. This method enables maintaining the airway until the LMA is exchanged with an endotracheal tube. This technique seems useful to facilitate difficult airway intubation in pediatric patients with TOF and cleft palate deformity. PMID:27382820

  18. Effects of fentanyl-lidocaine-propofol and dexmedetomidine-lidocaine-propofol on tracheal intubation without use of muscle relaxants.

    PubMed

    Hanci, Volkan; Erdoğan, Gülay; Okyay, Rahşan Dilek; Yurtlu, Bülent Serhan; Ayoğlu, Hilal; Baydilek, Yunus; Turan, Işil Ozkoçak

    2010-05-01

    The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 mg/kg dexmedetomidine (Group D, n = 30) or 2 mg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine. PMID:20466334

  19. The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

    PubMed Central

    Komatsu, Ryu; Nagata, Osamu; Sessler, Daniel I.; Ozaki, Makoto

    2005-01-01

    Although the difficulty of tracheal intubation in the lateral position has not been systematically evaluated, airway loss during surgery in a laterally positioned patient may have hazardous consequences. We explored whether the intubating laryngeal mask airway (ILMA) facilitates tracheal intubation in patients with normal airway anatomy, i.e., Mallampati grade ≤ 3 and thyromental distance ≥ 5 cm, positioned in the lateral position. And we evaluated whether this technique can be used as a rescue when the airway is lost mid-case in laterally positioned patients with respect to success rate and intubation time. Anesthesia was induced with propofol, fentanyl, and vecuronium in 50 patients undergoing spine surgery for lumbar disk herniation (Lateral) and 50 undergoing other surgical procedures (Supine). Patients having disk surgery (Lateral) were positioned on their right or left sides before induction of general anesthesia, and intubation was performed in that position. Patients in control group (Supine) were anesthetized in supine position, and intubation was performed in that position. Intubation was performed blindly via an ILMA in both groups. The time required for intubation and number and types of adjusting maneuvers employed were recorded. Data were compared by Mann-Whitney U, Fisher’s exact, chi-square, or unpaired t-tests, as appropriate. Data presented as mean (SD). Demographic and airway measures were similar in the two groups, except for mouth opening which was slightly wider in patients in the lateral position: 5.1 (0.9) vs. 4.6 (0.7) cm. The time required for intubation was similar in each group (≈25 s), as was intubation success (96%). We conclude that blind intubation via an ILMA offers a frequent success rate and a clinically acceptable intubation time (< one min) even in the lateral position. Summary Blind intubation via the intubating laryngeal mask airway (ILMA) offers a high success rate and a clinically acceptable intubation time even in

  20. Swallowing dysfunction following endotracheal intubation: Age matters.

    PubMed

    Tsai, Min-Hsuan; Ku, Shih-Chi; Wang, Tyng-Guey; Hsiao, Tzu-Yu; Lee, Jang-Jaer; Chan, Ding-Cheng; Huang, Guan-Hua; Chen, Cheryl Chia-Hui

    2016-06-01

    To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20-64 years) and older participants (≥65 years).PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients. PMID:27310972

  1. Submental intubation: An alternative to tracheostomy when nasoendotracheal intubation is unsuccessful - A case report.

    PubMed

    Franco, Johnny; Coppage, Jeffrey; Fallucco, Michael; Ferguson, John Scott

    2009-01-01

    Submental intubation (SI) has been proposed as an alternative to nasoendotracheal intubation when oral endotracheal intubation is contraindicated. In patients who require intubation for maxillofacial reconstruction, this is an alternative to a traditional tracheostomy. The present case report presents an 18-year-old woman who suffered a comminuted mandibular fracture. Two days after her accident, she was taken to the operating room for open reduction with internal fixation of her mandible; however, the anesthesia staff was unable to nasally intubate the patient. A SI was performed. The procedure was completed without complications and the surgery accomplished with the SI. The patient was able to avoid a tracheostomy for an isolated operation. SI avoids the dangers of nasoendotracheal intubation in patients with midfacial fractures and avoids complications related to tracheostomy. Thus, SI may serve as an alternative to tracheostomy in patients without other medical conditions and indications for long-term intubation. PMID:21119832

  2. Obesity and Cecal Intubation Time

    PubMed Central

    Jain, Deepanshu; Goyal, Abhinav; Uribe, Jorge

    2016-01-01

    Background/Aims: Obesity is a much-debated factor with conflicting evidence regarding its association with cecum intubation rates during colonoscopy. We aimed to identify the association between cecal intubation (CI) time and obesity by eliminating confounding factors. Methods: A retrospective chart review of subjects undergoing outpatient colonoscopy was conducted. The population was categorized by sex and obesity (body mass index [BMI, kg/m2]: I, <24.9; II, 25 to 29.9; III, ≥30). CI time was used as a marker for a difficult colonoscopy. Mean CI times (MCT) were compared for statistical significance using analysis of variance tests. Results: A total of 926 subjects were included. Overall MCT was 15.7±7.9 minutes, and it was 15.9±7.9 and 15.5±7.9 minutes for men and women, respectively. MCT among women for BMI category I, II, and III was 14.4±6.5, 15.5±8.3, and 16.2±8.1 minutes (p=0.55), whereas for men, it was 16.3±8.9, 15.9±8.0, and 15.6±7.2 minutes (p=0.95), respectively. Conclusions: BMI had a positive association with CI time for women, but had a negative association with CI for men. PMID:26867549

  3. Comparison of the Success of Two Techniques for the Endotracheal Intubation with C-MAC Video Laryngoscope Miller Blade in Children: A Prospective Randomized Study

    PubMed Central

    Sinha, Renu; Sharma, Ankur; Ray, Bikash Ranjan; Kumar Pandey, Ravinder; Darlong, Vanlalnghka; Punj, Jyotsna; Chandralekha, Chandralekha; Upadhyay, Ashish Datt

    2016-01-01

    Background. Ease of endotracheal intubation with C-MAC video laryngoscope (VLS) with Miller blades 0 and 1 has not been evaluated in children. Methods. Sixty children weighing 3–15 kg with normal airway were randomly divided into two groups. Intubation was done with C-MAC VLS Miller blade using either nonstyletted endotracheal tube (ETT) (group WS) or styletted ETT (group S). The time for intubation and total procedure, intubation attempts, failed intubation, blade repositioning or external laryngeal maneuver, and complications were recorded. Results. The median (minimum/maximum) time for intubation in group WS and group S was 19.5 (9/48) seconds and 13.0 (18/55) seconds, respectively (p = 0.03). The median (minimum/maximum) time for procedure in group WS was 30.5 (18/72) seconds and in group S was 24.5 (14/67) seconds, respectively (p = 0.02). Intubation in first attempt was done in 28 children in group WS and in 30 children in group S. Repositioning was required in 14 children in group WS and in 7 children in group S (p = 0.06). There were no failure to intubate, desaturation, and bradycardia in both groups. Conclusion. Styletted ETT significantly reduces time for intubation and time for procedure in comparison to nonstyletted ETT. PMID:27293429

  4. Comparison of the Success of Two Techniques for the Endotracheal Intubation with C-MAC Video Laryngoscope Miller Blade in Children: A Prospective Randomized Study.

    PubMed

    Sinha, Renu; Sharma, Ankur; Ray, Bikash Ranjan; Kumar Pandey, Ravinder; Darlong, Vanlalnghka; Punj, Jyotsna; Chandralekha, Chandralekha; Upadhyay, Ashish Datt

    2016-01-01

    Background. Ease of endotracheal intubation with C-MAC video laryngoscope (VLS) with Miller blades 0 and 1 has not been evaluated in children. Methods. Sixty children weighing 3-15 kg with normal airway were randomly divided into two groups. Intubation was done with C-MAC VLS Miller blade using either nonstyletted endotracheal tube (ETT) (group WS) or styletted ETT (group S). The time for intubation and total procedure, intubation attempts, failed intubation, blade repositioning or external laryngeal maneuver, and complications were recorded. Results. The median (minimum/maximum) time for intubation in group WS and group S was 19.5 (9/48) seconds and 13.0 (18/55) seconds, respectively (p = 0.03). The median (minimum/maximum) time for procedure in group WS was 30.5 (18/72) seconds and in group S was 24.5 (14/67) seconds, respectively (p = 0.02). Intubation in first attempt was done in 28 children in group WS and in 30 children in group S. Repositioning was required in 14 children in group WS and in 7 children in group S (p = 0.06). There were no failure to intubate, desaturation, and bradycardia in both groups. Conclusion. Styletted ETT significantly reduces time for intubation and time for procedure in comparison to nonstyletted ETT. PMID:27293429

  5. Can the ETView VivaSight SL Rival Conventional Intubation Using the Macintosh Laryngoscope During Adult Resuscitation by Novice Physicians?

    PubMed Central

    Szarpak, Lukasz; Truszewski, Zenon; Czyzewski, Lukasz; Kurowski, Andrzej

    2015-01-01

    Abstract The aim of this study was to assess the performance of the ETView VivaSight SL (ETView) single-lumen airway tube with an integrated high-resolution imaging camera in a manikin-simulated cardiopulmonary resuscitation scenario with and without chest compression. This was a randomized crossover manikin trial. Following a brief training session, 107 volunteer novice physicians who were inexperienced with airway management attempted to intubate a manikin using a Macintosh laryngoscope (MAC) and an ETView, with and without chest compressions. The participants were instructed to make 3 attempts in each scenario. In this trial, we compared intubation time, intubation success rates, and glottic visibility using a Cormack & Lehane Grade. Dental compression and ease of use of each device were also assessed. Median intubation times for the ETView and MAC without chest compressions were 17 (IQR, 15–19) s and 27 (IQR, 25–33) s, respectively (P < 0.001). The ETView proved more successful on the first intubation attempt than the MAC, regardless of compressions. Continuation of compressions caused an increase in intubation times for both the ETView (P = 0.27) and the MAC (P < 0.005). The ETView VivaSight SL is an effective tool for endotracheal intubation when used by novice physicians in a manikin-simulated cardiac arrest, both with and without chest compressions. Trial Registration: clinicaltrials.gov Identifier: NCT02295618. PMID:26020389

  6. Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

    PubMed

    Afreen, Mahrukh; Ansari, Murtaza Ahsan

    2015-12-01

    Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube. PMID:26627529

  7. Tracheal laceration as a complication of out-of-hospital emergency tracheal intubation in a patient with COPD.

    PubMed

    Üzümcügil, Filiz; Babaoğlu, Gülçin; Denizci, Ezgi; Sarıcaoğlu, Fatma; Kanbak, Meral

    2015-01-01

    Tracheobronchial injuries related to emergency endotracheal intubations are reported to be associated with an increased risk of mortality. Many mechanical risk factors may become more frequent in an emergency setting leading to such injuries. Aside from these factors that may complicate endotracheal intubation, this procedure is not recommended a priori for ventilation due to the resulting interruptions in external chest compressions, by 2010 cardiopulmonary resuscitation (CPR) and external chest compression guidelines. We present a 78-year-old woman with known chronic obstructive pulmonary disease who had a tracheal laceration after emergency endotracheal intubation during CPR. Thorax computed tomography revealed an overinflated tube cuff. The trachea was repaired surgically; however, our patient died on the fourth postoperative day due to multiple-organ failure. Prehospital providers must remain especially vigilant to priorities in airway management during CPR and aware of the dangers associated with field tracheal intubation under less than ideal conditions. PMID:25066906

  8. Effective Bolus Dose of Sufentanil to Attenuate Cardiovascular Responses in Laryngoscopic Double-Lumen Endobronchial Intubation

    PubMed Central

    Choi, Byung-Hee; Lee, Yong-Cheol

    2016-01-01

    Background Sufentanil is a potent opioid analgesic frequently used in clinical anesthesia. Double-lumen endobronchial intubation induces profound cardiovascular responses in comparison with ordinary endotracheal intubation because of the larger tube diameter and direct irritation of the carina. Objectives The purpose of this study was to determine the effective bolus dose of sufentanil to attenuate hemodynamic changes in response to laryngoscopic double-lumen endobronchial intubation. Patients and Methods We randomly assigned 72 patients aged 18 - 65 years and with an American Society of Anesthesiologists physical status of 1 or 2 to one of four sufentanil dose groups: NS, S0.1, S0.2, or S0.3. The respective doses for the groups were as follows: normal saline, 0.1 mcg/kg of sufentanil, 0.2 mcg/kg of sufentanil, and 0.3 mcg/kg of sufentanil. Blood pressure and heart rate were recorded during the pre-anesthesia period at baseline, pre-intubation, immediate post-intubation, and every minute during 5 minutes after intubation. Results Baseline mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 89.8 ± 12.1, 89.2 ± 10.9, 88.8 ± 13.6, and 90.7 ± 11.1, respectively. At immediate post-intubation, the mean arterial pressures in the NS, S0.1, S0.2, and S0.3 groups were 129.7 ± 14.7, 120.7 ± 14.2, 120.8 ± 17.2, and 96.7 ± 10.4, respectively. At immediate post-intubation, the mean arterial pressure in the NS, S0.1, and S0.2 groups significantly increased from baseline (P < 0.001), but the S0.3 group showed no difference. In the time point comparison at immediate post- intubation, the S0.3 group had a significantly lower mean arterial pressure than did the NS, S0.1, and S0.2 groups (P < 0.001). Conclusions We found that 0.3 mcg/kg of sufentanil attenuates cardiovascular responses to double-lumen endobronchial intubation without adverse effects. PMID:27252903

  9. [Awake intubation using Pentax Airway Scope as an alternative to awake fiberoptic intubation in management of anticipated difficult tracheal intubation in major burn patients].

    PubMed

    Fayolle-Pivot, L; Magnin, C; Tissot, S; Bertin-Maghit, M; Allaouchiche, B

    2013-05-01

    Intubating patients with facial burn is difficult to most anesthesiologists. Awake flexible fiberoptic intubation is the gold standard for management of anticipated difficult tracheal intubation. However, serious facial burn and dysmorphic syndrome can make fiberoptic intubation more difficult or impossible. We report the use of awake oral intubation using the Pentax-Airway Scope (AWS) in two major burn patients with facial injury, in whom awake fiberoptic intubation was impossible. As shown in morbidly obese patient and in patients with unstable necks, AWS could be useful to facilitate tracheal intubation in awake, facial burn patients presenting with a potentially difficult airway. Awake AWS intubation seems as a potential alternative to awake fiberoptic intubation. PMID:23453928

  10. Visible, safe and certain endotracheal intubation using endoscope system and inhalation anesthesia for rats.

    PubMed

    Konno, Kenjiro; Shiotani, Yumi; Itano, Naoki; Ogawa, Teppei; Hatakeyama, Mika; Shioya, Kyoko; Kasai, Noriyuki

    2014-10-01

    Anesthesia strongly influences laboratory animals, and it can also greatly affect the experimental data. Rats rank only second to mice in the number used in research fields, such as organ transplantation, regenerative medicine and imaging. Therefore, appropriate and effective anesthesia, including the protocol of the endotracheal intubation and inhalation anesthesia, is crucial. Hence, we evaluated these methods in this study. Twelve Wistar rats were intraperitoneally injected with M/M/B: 0.3/4/5, comprising of medetomidine, midazolam and butorphanol at a dose of 0.3 mg/kg + 4.0 mg/kg + 5.0 mg/kg body weight/rat, respectively. An endotracheal tube was then intubated into the trachea. After intubation, the rats were connected to the inhalation anesthesia circuit using isoflurane, and vital signs were measured until 30 min after connection. All intubations were successfully finished within 1 min, and the values of the vital signs were normal and stable. In addition, histopathological observation of the trachea and lungs showed no trauma. These results suggest that this visible endotracheal intubation method is simple, reliable, safe and favorable with regard to the rats' welfare. PMID:25030602

  11. Measurement of insulation integrity of IUE camera tube facsimiles by partial discharges method and diffusion of gases through various silicone rubbers

    NASA Technical Reports Server (NTRS)

    Bever, R. S.

    1977-01-01

    Several dummy tubes imitating the IUE Camera System design were encapsulated with Solithane 2, Conathane EN-11, Green and Black Hysols and SMRD 432. Various flaws were purposefully placed in some of these. Partial discharge testing in vacuum under direct voltage conditions was carried once a week for 12 weeks, 15 kv dc being applied during normal working hours for 40 hours duration per week. None of the units showed much damage during this time judging by the P.D. energy histograms. A more complete mathematical presentation is given on diffusion and permeation than previously. Measurements of diffusion constants for various silicone rubbers are carried out by the Time-Lag method and compared to other determinations in the literature. Calculations of the time required for diffusion through a thick wall are demonstrated in the long time approximation and for dimensions pertaining to void and wall sizes of a delamination problem in the LANDSAT-C vidicon tubes. An actual delaminated LANDSAT-C tube and some facsimiles are immersed in vacuum for long periods and tested for catastrophic breakdown due to diffusion of gas, by application of high voltage.

  12. Thoracoscopic tracheal reconstruction without surgical field intubation

    PubMed Central

    Zhao, Kejia; Mei, Jiandong; Hai, Yang; Liu, Chengwu; Ma, Lin

    2016-01-01

    Abstract A cross‐filed endotracheal intubation is usually applied to maintain single lung ventilation during both open and thoracoscopic tracheal resection and reconstruction. Herein, we report a case of thoracoscopic tracheal resection and reconstruction with interrupted ventilation via transoral endotracheal intubation in a patient with thoracic tracheal adenocarcinoma. Tracheal anastomosis was accomplished using a running suture with a 3‐0 Prolene stitch. PMID:27385994

  13. Assessment of Truflex™ articulating stylet versus conventional rigid Portex™ stylet as an intubation guide with the D-blade of C-Mac™ videolaryngoscope during elective tracheal intubation: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background A variety of videolaryngoscopes with angulated blade have been recently introduced into clinical practice. They provide an indirect view of the glottic structures in normal and challenging clinical settings. Despite the very good visualization of the laryngeal structures by these devices, the insertion and advancement of the endotracheal tube may be prolonged and occasionally fail as it does not conform to the enhanced angulation of the blade. To overcome this handicap, it is recommended to use a pre-shaped, styleted tracheal tube during intubation. Unfortunately, these malleable rigid stylets permit only a fixed shape to the advancing endotracheal tube. This may necessitate withdrawal of endotracheal tube-stylet assembly for reshaping, before undertaking a new attempt. This may cause soft tissue injury and hemodynamic disturbance. This single-blinded randomized clinical trial aims to overcome these handicaps using a novel method of dynamically changing the shape of the advancing endotracheal tube by Truflex™ articulating stylet as per need during D-blade C-Mac™ videolaryngoscopy. Methods One hundred and fifty four patients between 18 and 60 years of age belonging to either sex undergoing tracheal intubation under uniform general anesthetic technique will be randomly divided into Portex™ malleable stylet group and Truflex™ articulating stylet group. The primary efficacy variable of success/failure between the two groups will be analyzed using the chi square test. For comparison of intubation times and the Intubation Difficulty Score, ANOVA will be used. Primary efficacy endpoint results will be successful or failed tracheal intubation in the first attempt, total intubation time and the intubation difficulty score. Secondary efficacy endpoints will be overall user satisfaction graded from 1 to 10 (1 = very poor, 10 = excellent), Cormack and Lehane’s grading, glotticoscopy time and ETT negotiation time and total number of intubation

  14. Combined use of a McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report.

    PubMed

    Kim, Yongsuk; Kim, Jeong Eun; Jeong, Da Hye; Lee, Jaemin

    2014-04-01

    Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath® MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath® MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome. PMID:24851168

  15. Complications of tracheal intubation in critically ill pediatric cancer patients

    PubMed Central

    Siddiqui, Suhail Sarwar; Janarthanan, S.; Harish, M. M.; Chaudhari, Harish; Prabu, R. Natesh; Divatia, Jigeeshu V.; Kulkarni, Atul Prabhakar

    2016-01-01

    Background and Aims: The oncologists are treating cancer more aggressively, leading to increase in number of pediatric admissions to the ICU. Due to anatomical and physiological differences, pediatric patients are at high risk of complications during intubation. We evaluated the incidence of complications during intubations in pediatric patients in our ICU. Subjects and Methods: We performed retrospective analysis of complications occurring during intubation in 42 pediatric patients. All intubations were orotracheal. We recorded number of attempts at intubation, need for use of intubation adjuncts and complications during laryngoscopy and intubation. The incidence of difficult intubation, hypoxia, and severe cardiovascular collapse was also noted. Results: Complications occurred during 13 (31%) intubations. Hypoxia and severe cardiovascular collapse occurred in during 7 (16.7%) intubations each, while 4 patients (9.5%) (n=4) had cardiac arrest during intubation. Thirty three (78.6%) intubations were successful in first attempt and difficult intubation was recorded in 4 patients. Conclusion: Critically ill pediatric cancer patients have a high rate of complications during intubation. PMID:27555695

  16. A Randomized Comparison Simulating Face to Face Endotracheal Intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope

    PubMed Central

    Choi, Hyun Young; Oh, Young Min; Kang, Gu Hyun; Kang, Hyunggoo; Jang, Yong Soo; Kim, Wonhee; Kim, Euichung; Cho, Young Soon; Choi, Hyukjoong; Kim, Hyunjong; Kim, Gyoung Yong

    2015-01-01

    Objectives. Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS), Glidescope video laryngoscope (GVL), and C-MAC video laryngoscope (C-MAC)). Method. Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time), tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening) score. In addition, we compared success rate according to the number of attempts and complications. Result. VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. Conclusion. AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation. PMID:26161424

  17. Patient draping and endotracheal tube positioning during facelift surgery.

    PubMed

    Dobryansky, Michael; Morrison, Colin M; Zins, James E

    2009-07-01

    A comprehensive approach to facial rejuvenation often requires facelift surgery combined with ancillary facial procedures. This may require prolonged operating time under general anesthesia or conscious sedation. When general anesthesia is used, secure endotracheal tube fixation and ready access to the face is essential. We describe an anesthetic technique that assures secure tube placement, rapid intubation, and ready access to the entire face. A fiber-reinforced tube is placed orotracheally, wired to the mandibular dentition, and brought over the head in the fashion similar to a nasotracheal tube. The reinforced nature of the tube prevents kinking and allows rapid repositioning inferiorly to allow access to the upper face. In over 400 rhytidectomies, this technique has allowed rapid intubation and surgical preparation. There have been no airway-related problems or other related complications. This is a safe, effective, and rapid means of securing orotracheal intubation during facial esthetic surgery allowing ready access to the face. PMID:19546664

  18. Laryngeal complications by orotracheal intubation: Literature review

    PubMed Central

    Mota, Luiz Alberto Alves; de Cavalho, Glauber Barbosa; Brito, Valeska Almeida

    2012-01-01

    Sumamry Introduction: The injuries caused for the orotracheal intubation are common in our way and widely told by literature. Generally the pipe rank of or consequence of its permanence in the aerial ways of the patient is caused by accidents in. It has diverse types of larynx injuries, caused for multiple mechanisms. Objective: To verify, in literature, the main causes of laryngeal complications after- orotracheal intubation and its mechanisms of injury. Revision of Literature: The searched databases had been LILACS, BIREME and SCIELO. Were updated, books and theses had been used, delimiting itself the period enters 1953 the 2009. The keywords used for the search of articles had been: complications, injuries, larynx, intubation, endotracheal, orotracheal, granulomas, stenosis. 59 references had been selected. The used criteria of inclusion for the choice of articles had been the ones that had shown to the diverse types of injuries caused for the orotracheal intubation and its pathophysiology. Final Considerations: This revision of literature was motivated by the comment in the practical clinic of a great number of laryngeal sequels in patients submitted to the orotracheal intubation. Of that is ahead important the knowledge, for the professionals of the area of health, the types of complications and its causes, with intention to prevent them, adopting measured of prevention of these injuries. PMID:25991942

  19. Out-of-Hospital Endotracheal Intubation Experience and Patient Outcomes

    PubMed Central

    Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Lave, Judith R.; Yealy, Donald M.

    2011-01-01

    Study objective Previous studies suggest improved patient outcomes for providers who perform high volumes of complex medical procedures. Out-of-hospital tracheal intubation is a difficult procedure. We seek to determine the association between rescuer procedural experience and patient survival after out-of-hospital tracheal intubation. Methods We analyzed probabilistically linked Pennsylvania statewide emergency medicine services, hospital discharge, and death data of patients receiving out-of-hospital tracheal intubation. We defined tracheal intubation experience as cumulative tracheal intubation during 2000 to 2005; low=1 to 10 tracheal intubations, medium=11 to 25 tracheal intubations, high=26 to 50 tracheal intubations, and very high=greater than 50 tracheal intubations. We identified survival on hospital discharge of patients intubated during 2003 to 2005. Using generalized estimating equations, we evaluated the association between patient survival and out-of-hospital rescuer cumulative tracheal intubation experience, adjusted for clinical covariates. Results During 2003 to 2005, 4,846 rescuers performed tracheal intubation. These individuals performed tracheal intubation on 33,117 patients during 2003 to 2005 and 62,586 patients during 2000 to 2005. Among 21,753 cardiac arrests, adjusted odds of survival was higher for patients intubated by rescuers with very high tracheal intubation experience; adjusted odds ratio (OR) versus low tracheal intubation experience: very high 1.48 (95% confidence interval [CI] 1.15 to 1.89), high 1.13 (95% CI 0.98 to 1.31), and medium 1.02 (95% CI 0.91 to 1.15). Among 8,162 medical nonarrests, adjusted odds of survival were higher for patients intubated by rescuers with high and very high tracheal intubation experience; adjusted OR versus low tracheal intubation experience: very high 1.55 (95% CI 1.08 to 2.22), high 1.29 (95% CI 1.04 to 1.59), and medium 1.16 (95% CI 0.97 to 1.38). Among 3,202 trauma nonarrests, survival was not

  20. Non-intubated uniportal lung surgery†.

    PubMed

    Rocco, Gaetano

    2016-01-01

    Uniportal video-assisted thoracoscopic surgery (uniVATS) is currently being used to diagnose and treat several intrathoracic conditions with minimal morbidity and reduced hospital stay compared with standard multiport VATS surgery. The potential advantages of uniVATS can be also enhanced by the adoption of loco-regional anaesthesiological techniques in non-intubated or awake patients yielding the possibility of performing an ever larger proportion of thoracic surgical procedures in an outpatient setting. This review will look at organizational and technical aspects of implementing a non-intubated uniVATS program. PMID:26764415

  1. Myocardial ischaemia during tracheal intubation and extubation.

    PubMed

    Edwards, N D; Alford, A M; Dobson, P M; Peacock, J E; Reilly, C S

    1994-10-01

    The incidence of myocardial ischaemia during tracheal intubation and extubation was compared using ambulatory ECG monitoring in 60 patients undergoing a variety of different surgical operations. Seven patients had myocardial ischaemia after tracheal intubation and seven patients during tracheal extubation. The patients who developed myocardial ischaemia during tracheal extubation had significantly greater rate-pressure products immediately before tracheal extubation (P < 0.05) and 1 min after tracheal extubation (P < 0.01) compared with those patients who did not develop myocardial ischaemia during extubation. PMID:7999498

  2. Air-Q laryngeal airway for rescue and tracheal intubation.

    PubMed

    Ads, Ayman; Auerbach, Frederic; Ryan, Kelly; El-Ganzouri, Abdel R

    2016-08-01

    We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. All personal identifiers that could lead to his identification have been removed from this report. A 59-year-old man was scheduled for a flexible and rigid bronchoscopy with possible laser excision of tracheal stenosis. He had a history of hypertension, atrial fibrillation, and diabetes. Assessment of airway revealed a thyromental distance of 6.5 cm, Mallampati class II, and body weight of 110 kg. He had hoarseness and audible inspiratory/expiratory stridor with Spo2 90% breathing room air. After induction and muscle relaxation, tracheal intubation and flexible bronchoscopy were achieved without incident. The patient was then extubated and a rigid bronchoscopy was attempted but failed with Spo2 dropping to 92%; rocuronium 60 mg was given, and reintubation was accomplished with a 7.5-mm endotracheal tube. A second rigid bronchoscopy attempt failed, with Spo2 dropping to 63%. Subsequent direct laryngoscopy revealed a bloody hypopharynx. A size 4.5 Air-Q LA was placed successfully and confirmed with capnography, and Spo2 returned to 100%. The airway was suctioned through the Air-Q LA device, and the airway was secured using a fiberoptic bronchoscope to place an endotracheal tube of 7.5-mm internal diameter. The case was canceled because of edema of the upper airway from multiple attempts with rigid bronchoscopy. The patient was transported

  3. Evaluation of the Truview™ EVO2 laryngoscope for nasotracheal intubation

    PubMed Central

    Raveendra, U. S.; Mehandale, Sripada G.; Shetty, Sumalatha R.; Kamath, Manjunath R.

    2012-01-01

    Background: The Truview™ EVO2 laryngoscope, with its unique optical lens system and blade tip angulation, has proved its usefulness in providing adequate laryngeal exposure and intubation via the oral route. However, the same has not been evaluated for nasotracheal intubation. Aim: We evaluated the suitability of the Truview™ EVO2 laryngoscope for nasotracheal intubation. Methods: Fifty ASA grade I and II elective surgical patients were studied. Patients aged below 15 years or having difficult airway were excluded. Under standard anesthesia protocol, nasotracheal intubation was performed using a Truview™ EVO2 laryngoscope and, in cases of inability to complete intubation in three attempts, the Macintosh laryngoscope was used. Time taken for intubation, use of Magill's forceps and need for optimization maneuvers were noted. The primary outcome was percentage of successful intubation, while hemodynamic changes and duration of intubation were taken as secondary outcomes. Results: Majority (94%) could be intubated successfully with the Truview™ EVO2 laryngoscope. Average time taken for intubation was 50.1 s. The hemodynamic changes were not clinically significant. Regression analysis revealed lack of association between duration of intubation and hemodynamic changes. There were no serious complications. Conclusion: The Truview™ EVO2 laryngoscope is a useful tool in performing nasotracheal intubation, ensuring a high level of success rate among patients with normal airway anatomy. PMID:23492842

  4. Preparing hydroxyapatite-silicon composite suspensions with homogeneous distribution of multi-walled carbon nano-tubes for electrophoretic coating of NiTi bone implant and their effect on the surface morphology

    NASA Astrophysics Data System (ADS)

    Khalili, Vida; Khalil-Allafi, Jafar; Xia, Wei; Parsa, Alireza B.; Frenzel, Jan; Somsen, Christoph; Eggeler, Gunther

    2016-03-01

    Preparing a stable suspension is a main step towards the electrophoretically depositing of homogeneous and dense composite coatings on NiTi for its biomedical application. In the present study, different composite suspensions of hydroxyapatite, silicon and multi-walled carbon nano-tubes were prepared using n-butanol and triethanolamine as media and dispersing agent, respectively. Multi-walled carbon nanotubes were first functionalized in the nitric acid vapor for 15 h at 175 °C, and then mixed into suspensions. Thermal desorption spectroscopy profiles indicate the formation of functional groups on multi-walled carbon nano-tubes. An excellent suspension stability can be achieved for different amounts of triethanolamine. The amount of triethanolamine can be increased by adding a second component to a stable hydroxyapatite suspension due to an electrostatic interaction between components in suspension. The stability of composite suspension is less than that of the hydroxyapatite suspension, due to density differences, which under the gravitational force promote the demixing. The scanning electron microscopy images of the coatings surface show that more dense coatings are developed on NiTi substrate using electrophoretic deposition and sintering at 850 °C in the simultaneous presence of silicon and multi-walled carbon nanotubes in the hydroxyapatite coatings. The atomic force microscopy results of the coatings surface represent that composite coatings of hydroxyapatite-20 wt.% silicon and hydroxyapatite-20 wt.% silicon-1 wt.% multi-walled carbon nano-tubes with low zeta potential have rougher surfaces.

  5. Petrous Apex Cholesterol Granuloma: Importance of Pedicled Nasoseptal Flap in Addition to Silicone T-tube for Prevention of Occlusion of Drainage Route in Transsphenoidal Approach—A Technical Note

    PubMed Central

    SHIBAO, Shunsuke; TODA, Masahiro; TOMITA, Toshiki; SAITO, Katsuya; OGAWA, Kaoru; KAWASE, Takeshi; YOSHIDA, Kazunari

    2015-01-01

    Recently, petrous apex cholesterol granulomas (CGs) have been treated via the endoscopic endonasal transsphenoidal approach (EEA) using a silicone tube, to prevent drainage route occlusion. Occlusion of the drainage route has led to problems with recurrence. The aim of this report is to describe the use of a surgical technique to prevent drainage route occlusion. In surgical technique, the posterolateral wall of the sphenoid sinus was opened by EEA. After cyst debridement, a vascularized nasoseptal flap with a width of approximately 4 cm was inserted into the lumen with a silicone T-tube with a diameter of 7 mm. This technique was used in two patients: the first patient during the second operation after recurrence following occlusion of the drainage route, and the second patient during the first operation. Opening of the cyst wall was confirmed endoscopically in both patients 12–24 months after surgery, even after removal of the T-tube. In conclusion, the use of a pedicled nasoseptal flap with a silicone tube is useful to prevent CG recurrence, by paranasal cavitization of the cystic cavity. PMID:25797784

  6. Nasogastric tube syndrome induced by an indwelling long intestinal tube.

    PubMed

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-04-21

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube. PMID:27099450

  7. Nasogastric tube syndrome induced by an indwelling long intestinal tube

    PubMed Central

    Sano, Naoki; Yamamoto, Masayoshi; Nagai, Kentaro; Yamada, Keiichi; Ohkohchi, Nobuhiro

    2016-01-01

    The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube. PMID:27099450

  8. A Comparison of the C-MAC Video Laryngoscope to the Macintosh Direct Laryngoscope for Intubation in the Emergency Department

    PubMed Central

    Sakles, John C.; Mosier, Jarrod; Chiu, Stephen; Cosentino, Mari; Kalin, Leah

    2015-01-01

    Study objective We determine the proportion of successful intubations with the C-MAC video laryngoscope (C-MAC) compared with the direct laryngoscope in emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected data entered into a continuous quality improvement database during a 28-month period in an academic ED. After each intubation, the operator completed a standardized data form evaluating multiple aspects of the intubation, including patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. Intubation was considered ultimately successful if the endotracheal tube was correctly inserted into the trachea with the initial device. An attempt was defined as insertion of the device into the mouth regardless of whether there was an attempt to pass the tube. The primary outcome measure was ultimate success. Secondary outcome measures were first-attempt success, Cormack-Lehane view, and esophageal intubation. Multivariate logistic regression analyses, with the inclusion of a propensity score, were performed for the outcome variables ultimate success and first-attempt success. Results During the 28-month study period, 750 intubations were performed with either the C-MAC with a size 3 or 4 blade or a direct laryngoscope with a Macintosh size 3 or 4 blade. Of these, 255 were performed with the C-MAC as the initial device and 495 with a Macintosh direct laryngoscope as the initial device. The C-MAC resulted in successful intubation in 248 of 255 cases (97.3%; 95% confidence interval [CI] 94.4% to 98.9%). A direct laryngoscope resulted in successful intubation in 418 of 495 cases (84.4%; 95% CI 81.0% to 87.5%). In the multivariate regression model, with a propensity score included, the C-MAC was positively predictive of ultimate success (odds ratio 12.7; 95% CI 4.1 to 38.8) and first-attempt success (odds

  9. Steroids for intubated croup masking airway haemangioma.

    PubMed Central

    Kiff, K M; Mok, Q; Dunne, J; Tasker, R C

    1996-01-01

    Recently, the beneficial role of steroids for acute laryngotracheobronchitis has been more clearly defined for both intubated and unintubated patients. However, corticosteroids also improve the clinical signs of airway haemangiomata. Two patients are described who illustrate how this can be a source of diagnostic confusion. PMID:8660054

  10. Electron tube

    DOEpatents

    Suyama, Motohiro; Fukasawa, Atsuhito; Arisaka, Katsushi; Wang, Hanguo

    2011-12-20

    An electron tube of the present invention includes: a vacuum vessel including a face plate portion made of synthetic silica and having a surface on which a photoelectric surface is provided, a stem portion arranged facing the photoelectric surface and made of synthetic silica, and a side tube portion having one end connected to the face plate portion and the other end connected to the stem portion and made of synthetic silica; a projection portion arranged in the vacuum vessel, extending from the stem portion toward the photoelectric surface, and made of synthetic silica; and an electron detector arranged on the projection portion, for detecting electrons from the photoelectric surface, and made of silicon.

  11. The AirView Study: Comparison of Intubation Conditions and Ease between the Airtraq-AirView and the King Vision

    PubMed Central

    Schoettker, Patrick; Corniche, Jocelyn

    2015-01-01

    We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on a difficult airway manikin. Participants had a professional experience of 12 years: 60.0% possessed the Airtraq in their hospital, 46.7% the King Vision, and 20.0% both. Median time difference [IQR] to identify glottis (1.1 [−1.3; 3.9] P = 0.019), for tube insertion (2.1 [−2.6; 9.4] P = 0.002) and lung ventilation (2.8 [−2.4; 11.5] P = 0.001), was shorter with the Airtraq-AirView. Median time for glottis visualization was significantly shorter with the Airtraq-AirView (5.3 [4.0; 8.4] versus 6.4 [4.6; 9.1]). Cormack Lehane before intubation was better with the King Vision (P = 0.03); no difference was noted during intubation, for subjective device insertion or quality of epiglottis visualisation. Assessment of tracheal tube insertion was better with the Airtraq-AirView. The Airtraq-AirView allows faster identification of the landmarks and intubation in a difficult airway manikin, while clinical relevance remains to be studied. Anaesthetists assessed the intubation better with the Airtraq-AirView. PMID:26161393

  12. The AirView Study: Comparison of Intubation Conditions and Ease between the Airtraq-AirView and the King Vision.

    PubMed

    Schoettker, Patrick; Corniche, Jocelyn

    2015-01-01

    We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on a difficult airway manikin. Participants had a professional experience of 12 years: 60.0% possessed the Airtraq in their hospital, 46.7% the King Vision, and 20.0% both. Median time difference [IQR] to identify glottis (1.1 [-1.3; 3.9] P = 0.019), for tube insertion (2.1 [-2.6; 9.4] P = 0.002) and lung ventilation (2.8 [-2.4; 11.5] P = 0.001), was shorter with the Airtraq-AirView. Median time for glottis visualization was significantly shorter with the Airtraq-AirView (5.3 [4.0; 8.4] versus 6.4 [4.6; 9.1]). Cormack Lehane before intubation was better with the King Vision (P = 0.03); no difference was noted during intubation, for subjective device insertion or quality of epiglottis visualisation. Assessment of tracheal tube insertion was better with the Airtraq-AirView. The Airtraq-AirView allows faster identification of the landmarks and intubation in a difficult airway manikin, while clinical relevance remains to be studied. Anaesthetists assessed the intubation better with the Airtraq-AirView. PMID:26161393

  13. [Tracheal intubation using Airtraq optical laryngoscope in an adult patient with Goldenhar syndrome].

    PubMed

    Sasanuma, Hiromi; Niwa, Yasunori; Shimada, Nobuhiro; Machida, Masanari; Irei, Takeshi; Hayashi, Kenji; Takeuchi, Mamoru

    2013-07-01

    A 23-year-old woman with Goldenhar syndrome and conductive deafness was scheduled for tympanoplasty. Goldenhar syndrome is a developmental disorder characterized by ear malformation, mandibular hypoplasia, and vertebral anomalies. Furthermore, she had micrognathia, trismus, and mandibular hypoplasia. Awake taracheal intubation was attempted to prevent airway obstruction, because we had anticipated her difficult airway (micrognathia, trismus, and mandibular hypoplasia). The vocal cords were visualized with a Cormac and Lehane grade I, using the Airtraq optical laryngoscope Small (Size 2), under sedation. Then, an endotracheal tube was inserted after induction of general anesthesia. This is the first case report on the successful orotracheal intubation using Airtraq in an adult with Goldenhar syndrome. PMID:23905414

  14. Node of Ranvier formation along fibres regenerating through silicone tube implants: a freeze-fracture and thin-section electron microscopic study.

    PubMed

    Le Beau, J M; Powell, H C; Ellisman, M H

    1987-06-01

    Thin-section and freeze-fracture electron microscopy have been used to examine the morphogenesis of the node of Ranvier in peripheral nerves regenerating through silicone tubes. A major question posed by this study is whether node formation in fibres regenerating across a gap recapitulates that occurring in normal development. Node formation occurs concurrently with myelination and follows a similar spatial gradient of progression from a proximal to distal direction along the regenerated nerve. Presumptive nodal sites appear prior to myelin formation and are identified as a prominent subaxolemmal density in thin sections and axonal particle patches in freeze-fracture. Following the appearance of presumptive nodes in regenerating fibres, dimeric particles are inserted into the axolemma adjacent to the node. These particles are in close apposition to the overlying Schwann cell terminal processes and with maturity adopt the same circumferential orientation seen in adult nodes. The nodal axolemma of regenerating fibres shows a characteristic increase in the prominence of its subaxolemmal densification and number of heterogeneously sized particles. Mature regenerated nodes demonstrate a complete annulus of nodal particles indistinguishable from control nodes. The results of the present study show that the nodal architecture of regenerating fibres is a faithful reconstruction of normal mature nodes, thus indicating that the morphological correlates associated with saltatory conduction at the node are present in regenerated nodes. PMID:3612184

  15. Hybrid endotracheal tubes

    NASA Astrophysics Data System (ADS)

    Sakezles, Christopher Thomas

    Intubation involves the placement of a tube into the tracheal lumen and is prescribed in any setting in which the airway must be stabilized or the patient anesthetized. The purpose of the endotracheal tube in these procedures is to maintain a viable airway, facilitate mechanical ventilation, allow the administration of anesthetics, and prevent the reflux of vomitus into the lungs. In order to satisfy these requirements a nearly airtight seal must be maintained between the tube and the tracheal lining. Most conventional endotracheal tubes provide this seal by employing a cuff that is inflated once the tube is in place. However, the design of this cuff and properties of the material are a source of irritation and injury to the tracheal tissues. In fact, the complication rate for endotracheal intubation is reported to be between 10 and 60%, with manifestations ranging from severe sore throat to erosion through the tracheal wall. These complications are caused by a combination of the materials employed and the forces exerted by the cuff on the tracheal tissues. In particular, the abrasive action of the cuff shears cells from the lining, epithelium adhering to the cuff is removed during extubation, and normal forces exerted on the basement tissues disrupt the blood supply and cause pressure necrosis. The complications associated with tracheal intubation may be reduced or eliminated by employing airway devices constructed from hydrogel materials. Hydrogels are a class of crosslinked polymers which swell in the presence of moisture, and may contain more than 95% water by weight. For the current study, several prototype airway devices were constructed from hydrogel materials including poly(vinyl alcohol), poly(hydroxyethyl methacrylate), and poly(vinyl pyrrolidone). The raw hydrogel materials from this group were subjected to tensile, swelling, and biocompatibility testing, while the finished devices were subjected to extensive mechanical simulation and animal trials

  16. Encountering unexpected difficult airway: relationship with the intubation difficulty scale

    PubMed Central

    Koh, Wonuk; Kim, Hajung; Kim, Kyongsun; Ro, Young-Jin

    2016-01-01

    Background An unexpected difficult intubation can be very challenging and if it is not managed properly, it may expose the encountered patient to significant risks. The intubation difficulty scale (IDS) has been used as a validated method to evaluate a global degree of intubation difficulty. The aims of this study were to evaluate the prevalence and characteristics of unexpected difficult intubation using the IDS. Methods We retrospectively reviewed 951 patients undergoing elective surgery in a single medical center. Patients expected to have a difficult intubation or who had history of difficult intubation were excluded. Each patient was assessed by the IDS scoring system with seven variables. Total prevalence of difficult intubation and the contributing individual factors were further analyzed. Results For the 951 patients, the difficult intubation cases presenting IDS > 5 was 5.8% of total cases (n = 55). The prevalence of Cormack-Lehane Grade 3 or 4 was 16.2% (n = 154). Most of the difficult intubation cases were managed by simple additional maneuvers and techniques such as stylet application, additional lifting force and laryngeal pressure. Conclusions Unexpected difficult airway was present in 5.8% of patients and most was managed effectively. Among the components of IDS, the Cormack-Lehane grade was most sensitive for predicting difficult intubation. PMID:27274369

  17. Hands-Off Time for Endotracheal Intubation during CPR Is Not Altered by the Use of the C-MAC Video-Laryngoscope Compared to Conventional Direct Laryngoscopy. A Randomized Crossover Manikin Study

    PubMed Central

    Schuerner, Philipp; Grande, Bastian; Piegeler, Tobias; Schlaepfer, Martin; Saager, Leif; Hutcherson, Matthew T.; Spahn, Donat R.

    2016-01-01

    Introduction Sufficient ventilation and oxygenation through proper airway management is essential in patients undergoing cardio-pulmonary resuscitation (CPR). Although widely discussed, securing the airway using an endotracheal tube is considered the standard of care. Endotracheal intubation may be challenging and causes prolonged interruption of chest compressions. Videolaryngoscopes have been introduced to better visualize the vocal cords and accelerate intubation, which makes endotracheal intubation much safer and may contribute to intubation success. Therefore, we aimed to compare hands-off time and intubation success of direct laryngoscopy with videolaryngoscopy (C-MAC, Karl Storz, Tuttlingen, Germany) in a randomized, cross-over manikin study. Methods Twenty-six anesthesia residents and twelve anesthesia consultants of the University Hospital Zurich were recruited through a voluntary enrolment. All participants performed endotracheal intubation using direct laryngoscopy and C-MAC in a random order during ongoing chest compressions. Participants were strictly advised to stop chest compression only if necessary. Results The median hands-off time was 1.9 seconds in direct laryngoscopy, compared to 3 seconds in the C-MAC group. In direct laryngoscopy 39 intubation attempts were recorded, resulting in an overall first intubation attempt success rate of 97%, compared to 38 intubation attempts and 100% overall first intubation attempt success rate in the C-MAC group. Conclusion As a conclusion, the results of our manikin-study demonstrate that video laryngoscopes might not be beneficial compared to conventional, direct laryngoscopy in easily accessible airways under CPR conditions and in experienced hands. The benefits of video laryngoscopes are of course more distinct in overcoming difficult airways, as it converts a potential “blind intubation” into an intubation under visual control. PMID:27195693

  18. Post Intubation Tracheal Stenosis in Children

    PubMed Central

    Caruselli, Marco; Amici, Mirco; Galante, Dario; Paut, Olivier; De Francisci, Giovanni; Carboni, Laura

    2014-01-01

    Many authors have reported that tracheal stenosis is a complication that can follow tracheal intubation in both adults and children. The symptoms, when they do appear, can be confused with asthma, with subsequent treatment providing only mild and inconsistent relief. We report here the case of an 8 year old girl admitted to our hospital for whooping cough that was not responding to therapy. PMID:25635215

  19. An alternative method of endotracheal intubation of common marmosets (Callithrix jacchus).

    PubMed

    Thomas, A A; Leach, M C; Flecknell, P A

    2012-01-01

    Endotracheal intubation was carried out in 11 common marmosets (Callithrix jacchus). A commercially available tilting stand and a Miller laryngoscope blade were used to visualize the larynx. Anaesthesia was induced with alphaxalone (10.6 ± 1.6 mg/kg intramuscularly, followed by 3.2 ± 1.2 mg/kg intravenously). The diameter of the proximal trachea easily fitted an endotracheal tube made from readily available material (a 12 G 'over the needle' catheter). Once the tip of the endotracheal tube was at the level of the vocal folds, the tube had to be gently rotated through a 180° angle in order to pass through the larynx into the trachea. Assessment of the dimensions of the larynx and trachea, and comparison with external anatomical features of the animals (n = 10) showed that the length of the trachea could be predicted by multiplying the craniosacral length of the marmoset by a factor of 0.42. PMID:22048957

  20. [Morphological findings after tracheotomy and laryngeal intubation (author's transl)].

    PubMed

    Metter, D

    1979-03-01

    4 fatal cases after tracheotomy and 35 cases after endotracheal anaesthesia were examined taking pathomorphological aspects into consideration. In long-period intubation mucous membrane necroses occurred as of the 4th day. After 6 days' intubation skeletizations of the tracheal rings were established in each case. Infections of the decubial ulcers and errosion haemorrhages from the necrotically altered tracheal wall were frequent complications. Faulty intubation of the oesophagus and the right bronchus, aspirations and reflex-related circulatory failure during intubation as well as hypoxic damage as a result of the windpipe opening being impaired are discussed from the morphological point of view. PMID:433463

  1. [Endotracheal hemorrhage caused by fissuration of the innominate artery during prolonged intubation. Surgical treatment].

    PubMed

    Couraud, L; Hafez, A; Velly, J F

    1984-11-24

    We present our surgical procedure for the control of tracheal haemorrhages due to fissuration of the innominate artery in patients with prolonged tracheal intubation or tracheostomy. Temporary haemostasis and protection of the airways against flooding are ensured by downward advancement of the tube, overinflation of the cuffs and digital pressure if required. The fistula is then located and surgical haemostasis is obtained by resection of the innominate artery away from the infected area. The arterial stumps are covered up for protection against secondary infection. Re-establishment of blood flow is not systematic. Cervicosternotomy is regarded as the incision of choice. No complication was encountered in patients treated by this method. PMID:6239257

  2. Tube support

    DOEpatents

    Mullinax, Jerry L.

    1988-01-01

    A tube support for supporting horizontal tubes from an inclined vertical support tube passing between the horizontal tubes. A support button is welded to the vertical support tube. Two clamping bars or plates, the lower edges of one bearing on the support button, are removably bolted to the inclined vertical tube. The clamping bars provide upper and lower surface support for the horizontal tubes.

  3. Difficult endotracheal intubation secondary to tracheal deviation and stenosis in a patient with severe kyphoscoliosis: a case report

    PubMed Central

    Park, Sang Hyun; Jo, Jun-ho

    2016-01-01

    We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea. PMID:27482317

  4. Intubating ability of house-officers in University Hospital, Kuala Lumpur.

    PubMed

    Kuen, C Y

    1989-06-01

    A survey showed only 27% of our house-officers know how to intubate. Ninety-two percent however recognise the alternative to intubation. On the whole, knowledge centering around intubation is generally lacking. PMID:2626121

  5. [Successful tracheal intubation through the air-Q intubating laryngeal airway in a patient with severe pharyngeal edema].

    PubMed

    Ishio, Junichi; Komasawa, Nobuyasu; Nakano, Shoko; Omoto, Haruka; Tatsumi, Shinichi; Tanaka, Motoshige; Minami, Toshiaki

    2014-01-01

    A 68-year-old man was diagnosed with severe pharyngeal edema after neck lymph node dissection for cancer of the external ear canal. He was scheduled for an emergency tracheotomy, but preoperative fiberoptic laryngoscopy revealed airway and glottic obstruction due to severe pharyngeal edema. As difficult mask ventilation and tracheal intubation were anticipated, intubation under spontaneous ventilation was performed to avoid a "can't ventilate, can't intubate" situation. The first attempt to intubate the patient using the Pentax-AWS Airwayscope with a thin Intlock resulted in failure due to hindered visualization of the glottis. Therefore, a size 3.5 air-Q intubating laryngeal airway was inserted using a bronchofiberscope to perform tracheal intubation through a laryngeal mask. Successful tracheal intubation was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway can be useful in the setting of anticipated difficult mask ventilation and tracheal intubation, as in the case of severe pharyngeal edema. PMID:24558935

  6. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    PubMed Central

    Hansen, Matthew; Loker, William; Warden, Craig

    2016-01-01

    Introduction The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS) run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots) of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic regression. The

  7. A Comparison of the GlideScope Video Laryngoscope to the C-MAC Video Laryngoscope for Intubation in the Emergency Department

    PubMed Central

    Mosier, Jarrod; Chiu, Stephen; Patanwala, Asad E.; Sakles, John C.

    2015-01-01

    Study objective There is growing use of video laryngoscopy in US emergency departments (EDs). This study seeks to compare intubation success between the GlideScope video laryngoscope and the C-MAC video laryngoscope (C-MAC) in ED intubations. Methods This was an analysis of quality improvement data collected during a 3-year period in an academic ED. After each intubation, the operator completed a standardized data form reporting patient demographics, indication for intubation, device(s) used, reason for device selection, difficult airway characteristics, number of attempts, and outcome of each attempt. An attempt was defined as insertion of the device into the mouth regardless of attempt at tube placement. The primary outcomes were first pass and overall intubation success. The study compared success rates between the GlideScope video laryngoscope and the C-MAC groups, using multivariable logistic regression and adjusting for potential confounders. Results During the 3-year study period, there were 463 intubations, including 230 with the GlideScope video laryngoscope as the initial device and 233 with the C-MAC as the initial device. The GlideScope video laryngoscope resulted in first-pass success in 189 of 230 intubations (82.2%; 95% confidence interval [CI] 76.6% to 86.9%) and overall success in 221 of 230 intubations (96.1%; 95% CI 92.7% to 98.2%). The C-MAC resulted in first-pass success in 196 of 233 intubations (84.1%; 95% CI 78.8% to 88.6%) and overall success in 225 of 233 intubations (96.6%; 95% CI 93.4% to 98.5%). In a multivariate logistic regression analysis, the type of video laryngoscopic device was not associated with first-pass (odds ratio 1.1; 95% CI 0.6 to 2.1) or overall success (odds ratio 1.2; 95% CI 0.5 to 3.1). Conclusion In this study of video laryngoscopy in the ED, the GlideScope video laryngoscope and the C-MAC were associated with similar rates of intubation success. PMID:23374414

  8. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience

    PubMed Central

    Banerjee, Praveer K; Jain, Abhineet; Behera, Bikram

    2016-01-01

    Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist. PMID:27601740

  9. Feeding Tubes

    MedlinePlus

    ... administer the TPN. Tubes Used for Enteral Feeds NG (Nasogastric Tube) A flexible tube is placed via ... down through the esophagus into the stomach. The NG tube can be used to empty the stomach ...

  10. Ear Tubes

    MedlinePlus

    ... Meeting Calendar Find an ENT Doctor Near You Ear Tubes Ear Tubes Patient Health Information News media ... and throat specialist) may be considered. What are ear tubes? Ear tubes are tiny cylinders placed through ...

  11. Evaporative heat transfer and enhancement performance of serpentine tubes with strip-type inserts using refrigerant-134a

    SciTech Connect

    Hsieh, S.S.; Jang, K.J.; Huang, M.T.

    1999-08-01

    Recent technological implications have given rise to increased interest in enhancement of the in-tube evaporation used in many air conditioning and refrigeration systems. Although many past studies have examined in-tube evaporative heat transfer enhancement and the associated pressure drop with internally finned tubes, in-tube evaporations with strip-type inserts, using R-134a as a refrigerant, have not been conducted. In addition, the fundamental phenomenon of nucleate boiling from a heated wall subject to a strip-type insert is as yet not well understood, especially for the flow in serpentine tubes. In this study, flow boiling tests were conducted in serpentine coil with inserts. To accomplish these tasks, experiments were performed in a seven-pass serpentine test tube with longitudinal strip and cross-strip types inserts, 10.6-mm inside diameter with R-134a as the boiling fluid immersed in a hot water bath.

  12. [Application of Non-intubated Anesthesia in VATS].

    PubMed

    Dai, Xiaotan; Song, Pingping; Zhang, Baijiang

    2016-05-20

    Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper. PMID:27215461

  13. Sunscope: a video-guided intubation system through a detachable imaging probe.

    PubMed

    Yeh, Jia-Rong; Shieh, Jiann-Shing; Lin, Chih-Peng; Sun, Wei-Zen

    2008-06-01

    We have designed a novel apparatus, the Sunscope, which integrates a semiconductor image sensor into a compact video-guided intubation system. This device consists of three separate modules: viewer, console and visual tube. The 4-inch LCD viewer panel displays the real-time video image with optimal view angle. The console is designed with respect to ergonomics allowing comfortable manipulation and internally accommodating the power supply, image processing components and connector platform for both viewer and probe. The distal end of the detachable probe is packaged with a high resolution lens, CMOS sensor, and four LEDs. The proximal end is a 6-pin connector which can be readily removed and attached on demand. The probe is detachable and disposable with length and diameter adaptable to the size of the endotracheal tube. In our preliminary test, the video-guided apparatus helped inexperienced performers to identify the vocal cords correctly and improve the success rate of intubation on the simulation model. With further improvements on the miniature design, all captured images could be transmitted to remote devices through standard wireless transmission and could thus be stored in a specific database station. The wireless technique enables image sharing on multiple devices while a powerful database can provide valuable resources for training, data mining and serial case studies. We demonstrate that the CMOS image sensor combined with advanced reduced instruction set computer machine can serve as a visual aid for tracheal intubation. The disposable station will become a revolutionary technology both in clinical practice and medical education. PMID:18593652

  14. Safety and efficacy of nasogastric intubation for gastrointestinal bleeding after myocardial infarction: an analysis of 125 patients at two tertiary cardiac referral hospitals.

    PubMed

    Cappell, Mitchell S

    2005-11-01

    Our purpose was to analyze risks versus benefits of nasogastric (NG) intubation for gastrointestinal (GI) bleeding performed soon after myocardial infarction (MI). While NG intubation and aspiration is relatively safe, clinically beneficial, and routinely performed in the general population for recent GI bleeding, its safety after MI is unstudied and unknown. In addition to the usual complications of NG tubes, patients status post-MI may be particularly susceptible to myocardial ischemia or cardiac arrhythmias from anxiety or discomfort during intubation. We studied NG intubation within 30 days of MI in 125 patients at two hospitals from 1986 through 2001. Indications for NG intubation included melena in 55 patients; fecal occult blood with an acute hematocrit decline, severe anemia, or sudden hypotension in 37; hematemesis in 18; bright red blood per rectum in 8; and dark red blood per rectum in 7. The intubation was performed on average 5.3 +/- 7.2 (SD) days after MI. NG aspiration revealed bright red blood in 38 patients, "coffee grounds"-appearing blood in 45, and clear (or bilious) fluid in 42. Among 114 of the patients undergoing esophagogastroduodenoscopy (EGD), EGD revealed the cause of bleeding in 79 (95%) of 83 patients with a grossly bloody NG aspirate versus 12 (39%) of 31 patients with a clear aspirate (P < 0.0001, OR = 31.3, OR CI = 9.4-103.1). Among 85 patients undergoing EGD within 16 hr of NG intubation, stigmata of recent hemorrhage were present in 28 (42%) of 66 with a bloody NG aspirate versus 3 (16%) of 19 with a clear aspirate (P = 0.06, OR = 3.93). Among 35 patients undergoing lower GI endoscopy, lower endoscopy revealed the cause of bleeding in 14 (56%) of 25 patients with a clear NG aspirate versus 1 (10%) of 10 patients with a grossly bloody aspirate (P < 0.04, OR = 11.46, OR CI = 1.55-78.3). The two NG tube complications (epistaxis during intubation and gastric erosions from NG suctioning) were neither cardiac nor major (requiring blood

  15. Comparison of end-tidal carbon dioxide, oxygen saturation and clinical signs for the detection of oesophageal intubation.

    PubMed

    Vaghadia, H; Jenkins, L C; Ford, R W

    1989-09-01

    The reliability of various methods for detecting oesophageal intubation was assessed by means of a single blind study in rats. Both oesophagus and trachea were simultaneously intubated. The presence or absence of various clinical signs was noted during tracheal or oesophageal ventilation and arterial blood gases and end-tidal CO2 were measured. Oesophageal ventilation for one minute was associated with significant decreases (P less than 0.001) in pH, PaO2 and SaO2 and a significant (P less than 0.001) increase in PaCO2. Although mean PaO2 decreased by 70 per cent and mean SaO2 decreased by 31 per cent, 43 percent of rats failed to demonstrate a decrease in SaO2 below 85 per cent. Oxygen saturation was the least reliable method for detecting oesophageal intubation (sensitivity = 0.5, specificity = 0.9, positive predictive value (PPV) = 0.8). Chest movement was the most reliable clinical sign for detecting oesophageal intubation (sensitivity = 0.9, specificity = 1.0, PPV = 1.0). Oesophageal rattle was the second most reliable clinical sign (PPV = 0.9). Moisture condensation in the tracheal tube (PPV = 1.0) and abdominal distension (PPV = 0.9) were judged to be the least reliable because each had a high false negative rate of 0.3. The most reliable method for the early detection of oesophageal intubation in rats was end-tidal, CO2 (sensitivity 1.0, specificity = 1.0, PPV = 1.0). In addition, end-tidal CO2 when used in conjunction with the four clinical signs improved the reliability of these signs. PMID:2507183

  16. Iatrogenic post-intubation tracheal rupture treated conservatively without intubation: a case report

    PubMed Central

    Prunet, Bertrand; Lacroix, Guillaume; Asencio, Yves; Cathelinaud, Olivier; Avaro, Jean-Philippe; Goutorbe, Philippe

    2008-01-01

    Background Tracheal rupture is a rare but life-threatening complication that most commonly occurrs after blunt trauma to the chest, but which may also complicate tracheal intubation. We report a case of post-intubation tracheal rupture after cataract surgery under general anesthesia treated conservatively. Case presentation Four hours after extubation, a 67 year-old woman developed subcutaneous emphysema of the facial, bilateral laterocervical and upper anterior chest. Tracheobronchial fiberendoscopy showed a posterior tracheal transmural rupture 4 cm long located 2.5 cm above the carina that opened in inspiration. The location of the lesion and features of the patient favoured conservative treatment with antibiotic cover. The patient made a full and uncomplicated recovery and was discharged fourteen days after the original injury. Conclusion Two therapeutic strategies are currently employed for post-intubation tracheal rupture: a non-surgical strategy for small injuries and a surgical strategy for larger injuries. This case report presented the non-surgical therapeutic strategy of a large tracheal injury. PMID:18945364

  17. Comparative effectiveness of standard endotracheal tubes vs. endotracheal tubes with continuous subglottic suctioning on ventilator-associated pneumonia rates.

    PubMed

    Speroni, Karen Gabel; Lucas, Joy; Dugan, Lisa; O'Meara-Lett, Mildred; Putman, Marissa; Daniel, Marlon; Atherton, Martin

    2011-01-01

    Ventilator-associated pneumonia (VAP) accounts for the majority of nosocomial pneumonias, which may increase intensive care and prolonged hospital stays. Endotracheal tubes allowing continuous subglottic suctioning may reduce VAP; however, they are more expensive than standard endotracheal tubes not allowing continuous suctioning. he objective of this study was to measure the comparative costs associated with continuous subglottic suctioning endotracheal tubes (CSS-ETT) versus standard endotracheal tubes (S-ETT) among intubated patients and whether cost differential is offset by the occurrence of VAP in patients receiving either type of intubation. A retrospective chart review was conducted for 154 intubated adult patients (77 = S-ETT; 77 = CSS-ETT). The S-ETT group had one case of VAP; the CSS-ETT group had none. The mean total hospital charges were higher for the S-ETT group ($103,600; CSS-ETT= $88,500) (p = 0.3). Although the average number of intubation days and ICU days were greater for the CSS-ETT group, there were no cases of VAP compared to the S-ETT group. ased upon the one S-ETT VAP case and the VAP attributable costs, it is cost effective to use the CSS-ETT. PMID:21469484

  18. Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope

    PubMed Central

    2014-01-01

    Background Tracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one. Methods Twenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt. Results Intubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P < 0.05). Duration of glottis exposure was significantly shorter in Airtraq group compared to Macintosh group (50 ± 19 s vs. 81 ± 27 s, P < 0.001). A grade I Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation in Airtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group

  19. Pretracheal Abscess Following Two Weeks of Endotracheal Intubation

    PubMed Central

    Neupane, Narayan; Schmidt, M. Frances; Gulati, Neerja; Perwaiz, Muhammad; Hammoudeh, Fadi; Kennedy, Eneh; Zahir, Mehjabin; Enriquez, Danilo; Quist, Joseph

    2011-01-01

    Pretracheal abscess due to endotracheal intubation has not been reported in literature. We present a case of a female patient who was admitted with acute hypercapnic respiratory failure. Patient was initially managed with noninvasive ventilation but eventually was intubated after sustaining a cardiac arrest. She could not be extubated because of poor weaning parameters, so a tracheostomy was planned. During surgery, a pretracheal abscess was found with destruction of the second, third, and fourth tracheal rings and intact posterior tracheal wall. The possible risk factors, mechanism of injury, and preventive strategy of tracheal complication of intubation are discussed. PMID:21451779

  20. [Esophageal intubation for palliative treatment in advanced carcinoma of the esophagus and cardia].

    PubMed

    Domene, C E; Cecconello, I; Volpe, P; Zilberstein, B; Sakai, P; Ishioka, S; Pinotti, H W

    1998-01-01

    This is a report of 121 cases of advanced esophageal and cardia cancer managed by endoscopic and surgical esophageal intubation. They were submitted to surgical intubation 69 (53%) patients, and 52 (47%) to endoscopic intubation. There were 32.5% of technical complications in endoscopic intubation and 26.5% in surgical intubation. Perfuration was more frequent (11.5%) in endoscopic intubation than surgical group. Mortality rate was 17.3% for endoscopic and 5.8% for surgical intubation. Perfuration was the main cause of death in endoscopic intubation. Survival rate was 3.5 months for endoscopic and 4.7 months for surgical intubation. The majority of patients died of cancer evolution--caquexia (55.5%), carcinomatosis (4.5%) and brain methastasis (1.1%). The results of endoscopic and surgical intubation in this group of patients recommend its use in patients with advanced esophageal and cardic cancer. PMID:9699358

  1. TUBE TESTER

    DOEpatents

    Gittings, H.T. Jr.; Kalbach, J.F.

    1958-01-14

    This patent relates to tube testing, and in particular describes a tube tester for automatic testing of a number of vacuum tubes while in service and as frequently as may be desired. In it broadest aspects the tube tester compares a particular tube with a standard tube tarough a difference amplifier. An unbalanced condition in the circuit of the latter produced by excessive deviation of the tube in its characteristics from standard actuates a switch mechanism stopping the testing cycle and indicating the defective tube.

  2. Submental intubation in maxillofacial fracture: a case report

    PubMed Central

    2016-01-01

    It can be challenging to create a safe airway in maxilla facial fracture and some skull surgeries. In this case study, the patient experienced jaw fractures that disturbed the dental occlusion and associated fracture of the base of the skull. Neither nasal nor oral intubation was possible based on the side effects of tracheotomy; therefore, submental intubation was applied successfully. The procedure and results are presented in the text. PMID:27429940

  3. Circular Scan Streak Tube Development

    NASA Technical Reports Server (NTRS)

    Nevin, S.

    1980-01-01

    A streak tube having circular scan was designed, built and tested. Continuous circular scan, easily derived from out of phase sine waves applied to the conventional deflection plates, permits the timing of pulses traveling long baselines. At the tube's output a circular array of 720 elements is scanned to provide 30 to 40 picosecond resolution. Initial difficulties with electron bombarded silicon arrays were circumvented by using microchannel plates within the streak tube to provide the needed electronic amplification and digital sensitivity and coupling the 720 element arrays to the electron beam by means of a phosphor on a fiber optics. Two ceramic body tubes with S-20 photocathodes were tested and delivered.

  4. Submental intubation: A journey over the last 25 years

    PubMed Central

    Das, Sabyasachi; Das, Tara Pada; Ghosh, Pralay S.

    2012-01-01

    Airway management in patients with faciomaxillary injuries is challenging due to disruption of components of upper airway. The anesthesiologist has to share the airway with the surgeons. Oral and nasal routes for intubation are often not feasible. Most patients have associated nasal fractures, which precludes use of nasal route of intubation. Intermittent intraoperative dental occlusion is needed to check alignment of the fracture fragments, which contraindicates the use of orotracheal intubation. Tracheostomy in such situations is conventional and time-tested; however, it has life-threatening complications, it needs special postoperative care, lengthens hospital stay, and adds to expenses. Retromolar intubation may be an option, But the retromolar space may not be adequate in all adult patients. Submental intubation provides intraoperative airway control, avoids use of oral and nasal route, with minimal complications. Submental intubation allows intraoperative dental occlusion and is an acceptable option, especially when long-term postoperative ventilation is not planned. This technique has minimal complications and has better patients’ and surgeons’ acceptability. There have been several modifications of this technique with an expectation of an improved outcome. The limitations are longer time for preparation, inability to maintain long-term postoperative ventilation and unfamiliarity of the technique itself. The technique is an acceptable alternative to tracheostomy for the good per-operative airway access. PMID:22869933

  5. Factors Associated with Intubation Time and ICU Stay After CABG

    PubMed Central

    Flegler, Suzanny; Paro, Flavia Marini

    2015-01-01

    OBJECTIVE The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass. METHODS This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil. RESULTS The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay. CONCLUSION In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay. PMID:26934403

  6. Assessment of the subglottic region by ultrasonography for estimation of appropriate size endotracheal tube: A clinical prospective study

    PubMed Central

    Gupta, Kumkum; Gupta, Prashant K.; Rastogi, Bhawna; Krishan, Atul; Jain, Manish; Garg, Gouri

    2012-01-01

    Background: Endotracheal intubation is important to carry out various surgical procedures. The estimation of endotracheal tube size is governed by narrowest diameter of the upper airway. The objective of the study was to assess the narrowest tracheal diameter by ultrasound for selection of the appropriate size endotracheal tube. Materials and Methods: After the approval of institution ethical committee and written informed consent, 112 patients aged 3 to 18 years of both genders with normal airways, scheduled for surgery under general anesthesia and intubation, were enrolled for this prospective clinical observational study. Preanesthetic ultrasonography of the subglottic region was performed by experienced ultrasonologist with a high-resolution linear array transducer in sniffing position for every patient and the subglottic tracheal diameter was estimated to select the appropriate-size endotracheal tube. The endotracheal tube, calculated on the basis of physical indices and by ultrasound, was statistically correlated with the appropriate size endotracheal tube used clinically for intubation. Results: The ultrasound guided selection criterion has estimated the appropriate-sized endotracheal tube better than physical indices (age or height)-based formulas. The estimated endotracheal tube size by ultrasound was significantly correlated with the clinically used endotracheal tube. Conclusion: Ultrasonography may be used for the assessment of the subglottic diameter of trachea in children to estimate the appropriate size endotracheal tube for intubation. PMID:25885609

  7. [Successful awake tracheal intubation in the sitting position using the Pentax-AWS Airwayscope in a patient with hypopharyngeal cancer and gastroesophageal regurgitation].

    PubMed

    Miyazaki, Yu; Komasawa, Nobuyasu; Omoto, Haruka; Miyazaki, Shinichiro; Kido, Haruki; Minami, Toshiaki

    2014-06-01

    We report the successful awake tracheal intubation in a patient with hypopharyngeal cancer and gastroesophageal regurgitation with the TaperGuard Evac tracheal tube (TaperGuard) and Pentax-AWS Airwayscope (AWS). A 63-year-old man with hypopharyngeal cancer with invasion to the glottis was scheduled for total laryngectomy under general anesthesia. He had undergone thoracic esophagectomy and could not maintain supine position due to severe gastroesophageal regurgitation. To avoid vomiting after induction of anesthesia, we planned awake intubation in the sitting position with the AWS. After topical anesthesia with 8% lidocaine and infusion of fentanyl and continuous dexmedetomidine, the AWS was inserted into his mouth in the sitting position from the cranial side. The AWS allowed visualizing the glottis avoiding the cancer, leading to safe placement of the tracheal tube. PMID:24979861

  8. Sitting Nasal Intubation With Fiberoptic in an Elective Mandible Surgery Under General Anesthesia

    PubMed Central

    Etemadi, Seyyed Hassan; Bahrami, Amir; Farahmand, Ali Mohammad; Zamani, Mohammad Mahdi

    2015-01-01

    Introduction: Patients with mandible deformity may die, as a result of airway management failures. The awake nasal fiberoptic intubation is known as the optimum intubation method, in the mentioned patients, although, in several cases, fiberoptic intubation fails. Case Presentation: The present case discusses a patient with severe deformity of mandible that was admitted for correction with free-flap. The following intubation techniques were used for her airway management, respectively: blind awake nasal intubation, awake oral fiberoptic and awake nasal fiberoptic, which failed all. We therefore decided to perform awake nasal intubation, with fiberoptic, in sitting position. Conclusions: In this case, after failure of awake fiberoptic intubation, awake direct laryngoscopy and blind nasal intubation, finally awake nasal intubation in sitting position, using fiberoptic led to success. PMID:26705521

  9. [Tracheo-bronchial intubation for surgery of the esophagus via a thoracic approach].

    PubMed

    Bornet, J L; Desprats, R

    1977-01-01

    Tracheo-bronchial intubation using a double-lumen Carlens tube provides the surgeon with a mediastinal operating field free of any obstruction by the lung and provides greater surgical ease than that of an assistant retracting a constantly invasive lung with tracheal intubation. This anaesthetic technique involving the ventilation of only one lung during the endothoracic period of the surgical procedure has not been used routinely for extra-pulmonary surgery since the shunt which is created leads to a fear of dangerous hypoxia. The aim of this study involving 30 patients is to demonstrate that the blood oxygen saturation obtained by the careful ventilation of a single lung, that of the side on which the patient is lying, is perfectly acceptable and comparable with the preoperative oxygen saturation of the subject at rest. This is obtained at the price of an increase in insufflation pressures of the order of 100 percent. Re-expansion of the collapsed lung without visual confirmation after careful endobronchial aspiration makes it possible to prevent the development of areas of micro-atelectasia and to ensure the absence of any pulmonary postoperative complications. PMID:22287

  10. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures

    PubMed Central

    Lalwani, Jaya; Dubey, Kamta Prasad; Sahu, Bal Swaroop; Shah, Pratibha Jain

    2010-01-01

    The laryngeal mask airway (LMA) is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA), a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05) after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO2 (%) and EtCO2 levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures. PMID:21224972