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Sample records for achieve successful intubation

  1. [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

  2. 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

  3. 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

  4. A randomized comparison of the use of an optical compared with a rigid laryngoscope on the success rate of novices performing tracheal intubation.

    PubMed

    de Oliveira, Gildasio S; Fitzgerald, Paul C; Beckerly, Rena; McCarthy, Robert J

    2011-03-01

    Proficiency in tracheal intubation is a difficult skill to acquire, especially when using a rigid laryngoscope. We compared success in tracheal intubation by novices using an optical laryngoscope with that achieved with a rigid laryngoscope. After structured training in laryngoscopy and 5 consecutive successful intubation attempts using both the optical and rigid laryngoscope on a high-fidelity mannequin, trainees were randomly assigned to perform their first 2 tracheal intubations using either an optical or rigid laryngoscope using the standard Macintosh blade. The success rate for intubation was higher using the optical laryngoscope (23 of 30 attempts) compared with the rigid laryngoscope (8 of 30 attempts, P < 0.001). Intubation time was shorter using the optical laryngoscope (35 seconds; 95% confidence interval, 27-44 seconds) compared with the rigid laryngoscope (75 seconds; 95% confidence interval, 59-90 seconds) in successfully intubated patients (P < 0.001). Our study demonstrated greater successful tracheal intubation and reduced intubation time during the first two attempted intubations by novices using an optical compared with a rigid laryngoscope. PMID:21233492

  5. 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

  6. 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

  7. 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

  8. 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

  9. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department

    PubMed Central

    Sakles, John C.; Chiu, Stephen; Mosier, Jarrod; Walker, Corrine; Stolz, Uwe

    2015-01-01

    Objectives The goal of this study was to determine the association of first pass success with the incidence of adverse events (AEs) during emergency department (ED) intubations. Methods This was a retrospective analysis of prospectively collected continuous quality improvement data based on orotracheal intubations performed in an academic ED over a 4-year period. Following each intubation, the operator completed a data form regarding multiple aspects of the intubation, including patient and operator characteristics, method of intubation, device used, the number of attempts required, and AEs. Numerous AEs were tracked and included events such as witnessed aspiration, oxygen desaturation, esophageal intubation, hypotension, dysrhythmia, and cardiac arrest. Multivariable logistic regression was used to assess the relationship between the primary predictor variable of interest, first pass success, and the outcome variable, the presence of one or more AEs, after controlling for various other potential risk factors and confounders. Results Over the 4-year study period, there were 1,828 orotracheal intubations. If the intubation was successful on the first attempt, the incidence of one or more AEs was 14.2% (95% confidence interval [CI] = 12.4% to 16.2%). In cases requiring two attempts, the incidence of one or more AEs was 47.2% (95% CI = 41.8% to 52.7%); in cases requiring three attempts, the incidence of one or more AEs was 63.6% (95% CI = 53.7% to 72.6%); and in cases requiring four or more attempts, the incidence of one or more AEs was 70.6% (95% CI = 56.2.3% to 82.5%). Multivariable logistic regression showed that more than one attempt at tracheal intubation was a significant predictor of one or more AEs (adjusted odds ratio [aOR] = 7.52, 95% CI = 5.86 to 9.63). Conclusions When performing orotracheal intubation in the ED, first pass success is associated with a relatively small incidence of AEs. As the number of attempts increases, the incidence of AEs increases

  10. Factors Associated with First-Pass Success in Pediatric Intubation in the Emergency Department

    PubMed Central

    Goto, Tadahiro; Gibo, Koichiro; Hagiwara, Yusuke; Okubo, Masashi; Brown, David F.M.; Brown, Calvin A.; Hasegawa, Kohei

    2016-01-01

    Introduction The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED). Methods We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient’s age, sex, principal indication for intubation, methods (e.g., rapid sequence intubation [RSI]), devices, and intubator’s level of training and specialty. To evaluate independent predictors of first-pass success, we fit logistic regression model with generalized estimating equations. In the sensitivity analysis, we repeated the analysis in children <10 years. Results A total of 293 children aged ≤18 years who underwent ED intubation were eligible for the analysis. The overall first-pass success rate was 60% (95%CI [54%–66%]). In the multivariable model, age ≥10 years (adjusted odds ratio [aOR], 2.45; 95% CI [1.23–4.87]), use of RSI (aOR, 2.17; 95% CI [1.31–3.57]), and intubation attempt by an emergency physician (aOR, 3.21; 95% CI [1.78–5.83]) were significantly associated with a higher chance of first-pass success. Likewise, in the sensitivity analysis, the use of RSI (aOR, 3.05; 95% CI [1.63–5.70]), and intubation attempt by an emergency physician (aOR, 4.08; 95% CI [1.92–8.63]) were significantly associated with a higher chance of first-pass success. Conclusion Based on two large multicenter prospective studies of ED airway management, we found that older age, use of RSI, and intubation by emergency physicians were the independent predictors of a higher chance of first-pass success in children. Our findings should facilitate investigations to develop optimal airway management strategies in critically-ill children in the ED. PMID:26973736

  11. Successful use of nasal BiPAP in three patients previously requiring intubation and mechanical ventilation.

    PubMed

    Poponick, J M; Renston, J P; Emerman, C L

    1997-01-01

    Noninvasive mask ventilation may be used to treat patients with impending respiratory failure. In this case series, three patients with severe chronic obstructive pulmonary disease, who required mechanical ventilation in the past, were successfully treated with nasal bi-level positive airway pressure (BiPAP). All patients tolerated BiPAP well without complications. Therefore, nasal BiPAP may be considered a treatment option for patients with severe COPD who have previously required intubation and mechanical ventilation. PMID:9404794

  12. 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

  13. Patient- and operator-related factors associated with successful Glidescope intubations: a prospective observational study in 742 patients.

    PubMed

    Siu, L W L; Mathieson, E; Naik, V N; Chandra, D; Joo, H S

    2010-01-01

    The Glidescope Video Laryngoscope (Glidescope, Verathon Medical, Bothell, WA, U.S.A.) is a relatively new intubating device. It has been proposed to be useful for securing both routine airways and those where direct laryngoscopy may be difficult. In this prospective observational study, data for 742 intubations using the Glidescope were collected to investigate whether four factors are associated with successful tracheal intubation at first attempt using the Glidescope: previous Glidescope experience, previous direct laryngoscopy experience, level of anaesthesia training and clinical airway assessment. The likelihood of successful tracheal intubation at first attempt using the Glidescope increased with increasing previous Glidescope experience. Similarly, success was more likely in airways that were assessed as normal compared with those where direct laryngoscopies were either predicted or known to be difficult. Subgroup analysis indicated 83% first attempt success by 'experienced' Glidescope users in patients with documented difficult direct laryngoscopies. This supports its use as an adjunct device for management of airways where direct laryngoscopies prove difficult. With regard to the level of anaesthesia training, only medical students were more likely to fail with the Glidescope. Success was not associated with previous experience in direct laryngoscopy. The lack of association with direct laryngoscopy experience and level of anaesthesia training (beyond student level) suggests that expertise with traditional airway tools is not necessary to become proficient with the Glidescope. PMID:20191780

  14. [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

  15. Teaching for Successful Intelligence Raises School Achievement.

    ERIC Educational Resources Information Center

    Sternberg, Robert J.; Torff, Bruce; Grigorenko, Elena

    1998-01-01

    A "successful intelligence" intervention improved school achievement for a group of 225 ethnically diverse third-graders, both on performance assessments measuring analytical, creative, and practical achievements and on conventional multiple-choice memory assessments. Teaching for triarchic thinking facilitates factual recall, because learning…

  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. [Successful nasotracheal intubation with the Pentax-AWS Airwayscope and gum-elastic bougie in a patient with recurrent tongue cancer].

    PubMed

    Kitano, Manabu; Komasawa, Nobuyasu; Nakahira, Junko; Fujiwara, Shunsuke; Tatsumi, Shinichi; Minami, Toshiaki

    2014-04-01

    We report our experience of successful nasotracheal intubation with a spiral tube, by using the Pentax-AWS Airwayscope (AWS) with a gum-elastic bougie (GEB) in a patient with invasive recurrent tongue cancer. The patient was a 55-year-old man who had undergone partial resection of the tongue and cervical lymphadenectomy, and was scheduled for extended resection of the tongue and larynx under general anesthesia. Sufficient mask ventilation with the head-tilt and chin-lift maneuver was achieved. We first inserted AWS gently and visualized the glottis. Next, we inserted the 15 Fr GEB through his nasal aperture and placed it in the trachea under the guidance of the AWS monitor. This allowed us to place the spiral tube uneventfully through the GEB. No evidence of bleeding or damage of the tumor was found. Nasotracheal intubation with the GEB under the guidance of the AWS monitor may be useful in cases such as those involving tongue cancer in which oral space is either narrowed or restricted. PMID:24783605

  18. 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

  19. 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

  20. Achieving Successful School-University Collaboration.

    ERIC Educational Resources Information Center

    Borthwick, Arlene C.; Stirling, Terry; Nauman, April D.; Cook, Dale L.

    2003-01-01

    Investigated essential elements required to establish and maintain successful school-university partnerships as reported by principals, teachers, and university coordinators involved in both voluntary and mandated partnerships. Results identified five factors representing different perspectives on key elements for successful partnerships, with…

  1. Neurotic Fear of Success, Fear of Failure and Need Achievement.

    ERIC Educational Resources Information Center

    Boardman, Susan K.; And Others

    Neurotic fear of success is conceptually connected to achievement motivation and achievement related conflicts. To investigate the relationship between individuals identified as success-fearers, or failure-fearers, and those high in achievement motivation, 426 college students completed Cohen's Fear of Success Scale, Mandler-Sarason's Test Anxiety…

  2. Leadership Strategies: Achieving Personal and Professional Success.

    PubMed

    Menaker, Ronald

    2016-01-01

    Physicians and allied health staff in healthcare are finding themselves in situations characterized by uncertainty, chaos, and ambiguity, with high levels of burnout. A major influence is an aging U.S. population, resulting in increasing cost and reimbursement pressures. Medical group practices need leaders who have the capability to thrive in this environment. This article presents an integrated leadership model offering strategies and insights gained from keeping a journal for 40 years. Strategies to be shared include leading self through learning, leading others by developing relationships, leading organizations by achieving excellence, and achieving work-life integration and synergy. PMID:27443052

  3. Achieving Successful School-University Collaboration.

    ERIC Educational Resources Information Center

    Borthwick, Arlene C.; Stirling, Terry; Cook, Dale

    This study investigated participant perceptions of essential elements for establishing and maintaining successful school-university partnerships for school improvement, noting differences in perceptions of participants involved in voluntary partnerships versus those involved in partnerships required by the school district (schools placed on…

  4. [Successful fiberoptic tracheal intubation guided by Airwayscope with a thin Intlock blade in a patient with severe rheumatoid arthritis].

    PubMed

    Nakao, Kenta; Komasawa, Nobuyasu; Kusunoki, Tomohiro; Tatsumi, Shinichi; Soen, Masako; Uda, Rumiko; Akatsuka, Masafumi; Minami, Toshiaki

    2014-07-01

    We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. Ventilation via several supraglottic airway devices was unsatisfactory, while mask ventilation was easy after induction of anesthesia. She was referred to our hospital for application of veno-arterial extracorporeal life support in case of 'cannot ventilate and cannot intubate'. We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T. PMID:25098142

  5. 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

  6. [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

  7. 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

  8. Leadership Effects on Student Achievement and Sustained School Success

    ERIC Educational Resources Information Center

    Jacobson, Stephen

    2011-01-01

    Purpose: The purpose of this paper is to examine the effects of leadership on student achievement and sustained school success, especially in challenging, high-poverty schools. Design/methodology/approach: The paper combines a review of the leadership literature with findings drawn from longitudinal studies of the International Successful School…

  9. Helping Students Improve Academic Achievement and School Success Behavior

    ERIC Educational Resources Information Center

    Brigman, Greg; Campbell, Chari

    2003-01-01

    This article describes a study evaluating the impact of school-counselor-led interventions on student academic achievement and school success behavior. A group counseling and classroom guidance model called student success skills (SSS) was the primary intervention. The focus of the SSS model was on three sets of skills identified in several…

  10. Management Succession, School Socioeconomic Context, and Basic Skills Achievement.

    ERIC Educational Resources Information Center

    Rowan, Brian; Denk, Charles E.

    1984-01-01

    This study assessed the effects of a change in principals (management succession) on school level basic skills achievement using longitudinal data on 149 San Francisco Bay Area Schools. The findings indicate that changes can affect school achievement, but that leadership effects develop slowly and are conditioned by a schools' socioeconomic…

  11. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

    PubMed Central

    Gupta, Kumkum; Jain, Manish; Gupta, Prashant K.; Rastogi, Bhawna; Saxena, Sanjeev K.; Manngo, Aman

    2012-01-01

    Background: Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups – Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results: The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion: Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway. PMID:23162393

  12. 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

  13. Building Capability, Empowering Students, and Achieving Success: The Financial Empowerment for Student Success Initiative

    ERIC Educational Resources Information Center

    Broun, Dan

    2014-01-01

    The Financial Empowerment for Student Success (FESS) Initiative was a two-year initiative focused on increasing student success through the provision of financial services. Achieving the Dream, Inc. and MDC, Inc. joined together, with funding from the Bank of America Charitable Foundation, to support three Achieving the Dream Leader Colleges to…

  14. 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

  15. 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

  16. The Reading Success Intervention and the Relationship to Student Achievement

    ERIC Educational Resources Information Center

    Yudzentis, Jayne E.

    2012-01-01

    This quantitative, quasi-experimental study investigated the reading achievement of students at-risk of failure to learn to read. This study analyzed the effectiveness of the reading intervention program, Reading Success, which is used with at-risk first grade students in an elementary school district in DuPage County, Illinois. The Reading…

  17. 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

  18. 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

  19. 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

  20. Nursing for the complete VATS lobectomy performed with non-tracheal intubation

    PubMed Central

    Wang, Yidong; Lin, Suihong; Yin, Pengying; Xu, Yanwen

    2014-01-01

    Video-assisted thoracoscopic surgery (VATS) has without doubt been the most important advance in thoracic surgery. The general anesthesia before the tracheal intubation for VATS was often accompanied with tracheal mucosa and lung injuries, which were typically manifested as painful throat, nausea, vomiting, and other symptoms. However, the non-intubated anesthesia VATS can avoid these shortcomings due to its shorter anesthesia time, simpler steps, and quicker post-operative recovery. A total of 63 patients underwent VATS lobectomy under non-intubated anesthesia from July 2012 to July 2013. Good teamwork, proper pre-operative visit, and comfortable intra-operative position had ensured the success of these operations. In conclusion, adequate pre-operative preparation, careful nursing, and close cooperation can achieve a successful non-intubated anesthesia VATS. PMID:25093100

  1. 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

  2. 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

  3. 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

  4. 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

  5. Malaria in Turkey: successful control and strategies for achieving elimination.

    PubMed

    Özbilgina, Ahmet; Topluoglu, Seher; Es, Saffet; Islek, Elif; Mollahaliloglu, Salih; Erkoc, Yasin

    2011-01-01

    Turkey is located in the middle of Asia, Africa and Europe, close to Caucasia, Balkans and Middle East in subtropical climate zone. Malaria has been known since the early ages of human history and it was one of the leading diseases in Anatolian history, as well. Today, chloroquine-sensitive Plasmodium vivax is the only agent of autochthonous malaria cases in Turkey. The other Plasmodium species identified are isolated from imported cases of malaria. The most common vector of malaria in Turkey is Anopheles sacharovi followed by An. superpictus, An. maculipennis and An. subalpinus. In 2009, pre-elimination stage of Malaria Program was started due to dramatic decline in the number of malaria cases in Turkey (Total, 84; 38 autochthonous cases only in 26 foci in south-eastern Anatolia, and 46 imported cases; incidence: 0.1/100,000). As there were no detected cases of new autochthonous malaria in the first 8 months of 2010, elimination stage was started. The role of the persistent policies and successful applications of the Ministry of Health, such as the strict control of the patients using anti-malarial drugs especially chloroquine, avoidance of resistant insecticides, facilitation of access to patients via Health Transformation Program (HTP), establishment of close contact with the patients' families, and improvement of reporting and surveillance system, was essential. In addition, improvement maintained in the motivations and professional rights of malaria workers, as well in the coordination of field studies and maintenance of a decline or termination in vector-to-person transmission were all achieved with the insistent policies of the Ministry of Health. Other factors that probably contributed to elimination studies include lessening of military operations in south-eastern Anatolia and the lowering of malaria cases in neighbouring countries in recent years. Free access to health services concerning malaria is still successfully conducted throughout the country

  6. [Successful tracheal intubation using the GlideScope AVL in a pediatric patient with Pierre Robin syndrome].

    PubMed

    Iwai, Hidetaka; Mouri, Hideyuki; Hirabayashi, Yoshihiro; Takeuchi, Mamoru

    2014-06-01

    We report a successful use of GlideScope AVL in a pediatric patient with Pierre Robin syndrome. A 36-day-old boy weighing 2.8 kg with Pierre Robin syndrome presented for tracheostomy after several weeks of trial airway management in prone position, who had failed to relieve his obstructive apnea. The Pentax-AWS videolaryngoscope equipped with the neonate Introck could not visualize his glottic opening. The GlideScope AVL single-use video laryngoscope equipping the #1 stat captured the view of the vocal cords. A tracheal tube (2.5 mm ID) with 90 degrees angled stylet, however, did not advance into the glottic opening, colliding with the anterior wall of the larynx and/or the laryngeal ventricle. Bending the tip of the stylet in a direction opposite to the inherent memory of the tube facilitated the placement of the tube into the trachea PMID:24979857

  7. A Framework for Achieving e-Business Success

    ERIC Educational Resources Information Center

    Kumar, U.; Maheshwari, M.; Kumar, V.

    2004-01-01

    This paper presents the findings of an empirical study of critical factors associated with e-business success. An a priori model relating the success factors to e-business success is developed. The study uses the "balanced scorecard" methodology to measure the success of e-business organizations, as the authors believe that financial measures are…

  8. ALMA Achieves Major Milestone With Antenna-Link Success

    NASA Astrophysics Data System (ADS)

    2007-03-01

    The Atacama Large Millimeter/submillimeter Array (ALMA), an international telescope project, reached a major milestone on March 2, when two ALMA prototype antennas were first linked together as an integrated system to observe an astronomical object. The milestone achievement, technically termed "First Fringes," came at the ALMA Test Facility (ATF) on the grounds of the National Radio Astronomy Observatory's (NRAO) Very Large Array (VLA) radio telescope in New Mexico. NRAO is a facility of the National Science Foundation (NSF), managed by Associated Universities, Incorporated (AUI). AUI also is designated by NSF as the North American Executive for ALMA. ALMA Test Facility ALMA Test Facility, New Mexico: VertexRSI antenna, left; AEC antenna, right. CREDIT: Drew Medlin, NRAO/AUI/NSF Click on image for page of graphics and full information Faint radio waves emitted by the planet Saturn were collected by the two ALMA antennas, then processed by new, state-of-the-art electronics to turn the two antennas into a single, high-resolution telescope system, called an interferometer. Such pairs of antennas are the basic building blocks of multi-antenna imaging systems such as ALMA and the VLA. In such a system, each antenna is combined electronically with every other antenna to form a multitude of pairs. Each pair contributes unique information that is used to build a highly-detailed image of the astronomical object under observation. When completed in 2012, ALMA will have 66 antennas. The successful Saturn observation began at 7:13 p.m., U.S. Mountain Time Friday (0213 UTC Saturday). The planet's radio emissions at a frequency of 104 GigaHertz (GHz) were tracked by the ALMA system for more than an hour. "Our congratulations go to the dedicated team of scientists, engineers and technicians who produced this groundbreaking achievement for ALMA. Much hard work and many long hours went into this effort, and we appreciate it all. This team should be very proud today," said NRAO

  9. 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

  10. Success and Interactive Learning: Sailing toward Student Achievement

    ERIC Educational Resources Information Center

    Midcap, Richard; Seitzer, Joan; Holliday, Randy; Childs, Amy; Bowser, Dana

    2008-01-01

    Success and Interactive Learning's (SAIL) front-loaded retention activities and unique financial incentives have combined to improve retention, persistence, and success of first-time college students. Its effectiveness has been validated through a comparison of retention rates and aggregate quality-point averages of SAIL cohorts with those rates…

  11. [Successful Intubation in a Patient with Limited Oral Opening by Using a Combination of the Parker Flex-IT™ Stylet and McGRATH® MAC Laryngoscopy].

    PubMed

    Ueshima, Hironobu; Terao, Kazuhisa; Kitamura, Akira

    2015-10-01

    A 74-year-old female patient underwent a coil embolization for an unruptured cerebral aneurysm. A routine anesthetic protocol was devised as there was no risk of a difficult airway. We attempted to intubate by using direct laryngoscopy but were unable to because the mouth only opened approximately one finger-breadth. We then attempted to intubate using Mc-GRATH® MAC laryngoscopy; the McGRATH® MAC laryngoscope could be inserted orally by force, but a tracheal tube and stylet could not been guided into the glottis. We changed the stylet to a Parker Flex-IT™ Stylet (Parker Medical, CO, USA), which can be freely curved by pushing the sum button on the top of the stylet. As a result, easy intubation was possible, and the DLT was maneuvered at a proper angle while examining the vocal cords by using the Parker Flex-IT™ Stylet In conclusion, when a McGRATH® MAC laryngoscope cannot be operated freely in the oral cavity owing to a limited oral opening, we can instead intubate easily and effectively by using a combination of a Parker Flex-IT™ Stylet and the McGRATH® MAC video laryngoscope. PMID:26742408

  12. Multiple Intelligences and Student Achievement: Success Stories from Six Schools.

    ERIC Educational Resources Information Center

    Campbell, Linda; Campbell, Bruce

    This book examines educational programs that have used multiple intelligences (MI) theory for 5 or more years, and addresses such questions as: "How have MI programs affected student achievement?" and "Where and how were those results achieved?" Six schools (two elementary, two middle-level, and two high schools), which serve a variety of student…

  13. McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol

    PubMed Central

    Bailly, Arthur; Le Thuaut, Aurelie; Boisrame-Helms, Julie; Kamel, Toufik; Mercier, Emmanuelle; Ricard, Jean Damien; Lemiale, Virginie; Champigneulle, Benoit; Reignier, Jean

    2015-01-01

    Introduction Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope. The primary goal of this trial was to determine whether videolaryngoscopy increased the frequency of successful first-pass intubation in critically ill patients, compared to direct view Macintosh laryngoscopy. Methods and analysis MACMAN is a multicentre, open-label, randomised controlled superiority trial. Consecutive patients requiring intubation are randomly allocated to either the McGRATH MAC videolaryngoscope or the Macintosh laryngoscope, with stratification by centre and operator experience. The expected frequency of successful first-pass intubation is 65% in the Macintosh group and 80% in the videolaryngoscope group. With α set at 5%, to achieve 90% power for detecting this difference, 185 patients are needed in each group (370 in all). The primary outcome is the proportion of patients with successful first-pass orotracheal intubation, compared between the two groups using a generalised mixed model to take the stratification factors into account. Ethics and dissemination The study project has been approved by the appropriate ethics committee (CPP Ouest 2, # 2014-A00674-43). Informed consent is not required, as both laryngoscopy methods are considered standard care in France; information is provided before study inclusion. If videolaryngoscopy proves superior to Macintosh laryngoscopy, its use will become standard practice, thereby decreasing first-pass intubation failure rates and, potentially, the frequency of intubation

  14. Achieving succession planning and implementation: one healthcare network's story.

    PubMed

    Capuano, Terry Ann; MacKenzie, Richard

    2013-01-01

    Frequent transitions in leadership can cause inefficiency, inconsistency, and lack of alignment with priorities and strategy. Retaining management talent and collaboratively planning their succession can help ensure organizational survival. Succession planning, in healthcare and other industries, addresses some of these concerns; however, there is a dearth of descriptive articles emphasizing "how to." This article demonstrates one healthcare network's comprehensive system for succession planning and implementation. Leaders looking to plan their human resource processes for organizational sustainability would be able to emulate and adapt practices for their networks. PMID:24409581

  15. 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

  16. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

    PubMed Central

    Kajekar, Payal; Mendonca, Cyprian; Danha, Rati; Hillermann, Carl

    2014-01-01

    Background and Aims: Pentax airway scope (AWS) has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade), total dose of local anaesthetic used, anaesthetists rating and patient's tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%). The mean (standard deviation) intubation time and total time to complete the tracheal intubation was 5.4 (2.4) and 13.9 (3.7) min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS). Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route. PMID:25197114

  17. Achieving Success: Perceptions of Students from Migrant Farmwork Families

    ERIC Educational Resources Information Center

    McHatton, Patricia Alvarez; Zalaquett, Carlos P.; Cranson-Gingras, Ann

    2006-01-01

    In their pursuit of an education, students from migrant farmworker families experience multiple challenges such as high mobility rates and a lack of curriculum alignment and credit transfer across local, state, and national boundaries. Despite these challenges, many of these students graduate from high school and successfully transition into…

  18. Achieving Success in Obtaining Grant Funding as a Research Scholar

    ERIC Educational Resources Information Center

    Cherubini, Lorenzo

    2014-01-01

    The process of writing successful grant proposals has received not so dubious attention in the last several decades. This article provides contextual significance resulting from a review of literature spanning 1975 to 2013. I identify essential vocabulary stemming from the literature review to familiarize the reader with the terminology associated…

  19. An Analysis of How Multicultural Adult Orphans Achieve Economic Success

    ERIC Educational Resources Information Center

    Simonee, Saundra W.

    2014-01-01

    Successful multicultural adult orphans who were not adopted pose an interesting challenge in their history, their physical, psychological, social emotional and personal identity development. One must understand their journey from orphanhood to adulthood and their current prominent status in life to build a contextualized personal story (Banks,…

  20. An Examination of the Impact of Successive and Non-Successive Geometry Classes on High School Student Achievement

    ERIC Educational Resources Information Center

    Sugg, Steven L.

    2012-01-01

    This study examines the impact of successive versus non-successive scheduling of mathematics courses on the achievement of ninth-grade students in a suburban Oregon high school. The Oregon Assessment of Knowledge and Skills and student performance on the geometry course final exam were employed to compare the achievement of intact groups of…

  1. Project Achievement: An After-School Success Story.

    ERIC Educational Resources Information Center

    Mercure, Christine M.

    1993-01-01

    To improve its school failure rate, a Virginia intermediate school instituted Project Achievement, a privately funded program helping at-risk students complete homework assignments. Structured into three one-hour sessions featuring tutoring, interdisciplinary study groups, and special activities, the project is immensely popular. During the summer…

  2. Reading First: Student Achievement, Teacher Empowerment, National Success

    ERIC Educational Resources Information Center

    US Department of Education, 2008

    2008-01-01

    This publication highlights the Reading First program as the academic cornerstone of the No Child Left Behind Act, and cites state achievement data indicating that Reading First students from nearly every grade and subgroup have made gains in reading proficiency. Restoration of full funding for the program has been requested for Fiscal Year 2009.

  3. Orchestrating ACO success: how top performers achieve shared savings.

    PubMed

    Harris, John M; Elizondo, Idette; Brown, Amanda M

    2016-03-01

    Leaders of the top-performing accountable care organizations in the Medicare Shared Savings Program attribute the success of their organizations in large part to seven strategies: Seek action-oriented leadership. Transform primary care physician practices. Keep patients out of the emergency department. Ensure all transitions are smooth. Make effective use of available data. Share information on physician performance. Keep patients engaged. PMID:27183758

  4. Achieving success with the silicone expander for overacting superior obliques.

    PubMed Central

    Pollard, Z F; Greenberg, M

    1999-01-01

    PURPOSE: To report the results of and complications with silicone expander surgery for the overacting superior oblique. METHODS: A total of 26 patients with bilateral overaction of the superior oblique and A-pattern strabismus and 5 patients with unilateral overacting superior oblique secondary to inferior oblique palsy were treated with a 7 mm silicone expander. Care was taken not to enter the sub-Tenon's space. RESULTS: The group that underwent bilateral superior oblique surgery had an average preoperative pattern of 37.42 diopters (D) and an average correction of 35.37 D. Three patients had a severe unilateral postoperative inflammatory incident that was successfully treated with oral and topical corticosteroids. One of these patient developed Brown's syndrome. Another patient, who had no postoperative inflammatory incident, also developed Brown's syndrome. In these 4 patients, the sub-Tenon's space was inadvertently entered during surgery. CONCLUSION: The silicone expander surgery has a very high success rate in treating the A-pattern associated with the bilateral overacting superior oblique. This procedure also works well for the unilateral superior oblique that overacts owing to an inferior oblique palsy. No cyclotorsion symptoms occurred after this surgery. However, 4 patients had complications because the sub-Tenon's space was exposed during surgery. With this procedure, there is a learning curve to obtain the skill not to enter the sub-Tenon's space. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 PMID:10703132

  5. Nutrigerontology: a key for achieving successful ageing and longevity.

    PubMed

    Aiello, Anna; Accardi, Giulia; Candore, Giuseppina; Carruba, Giuseppe; Davinelli, Sergio; Passarino, Giuseppe; Scapagnini, Giovanni; Vasto, Sonya; Caruso, Calogero

    2016-01-01

    During the last two centuries the average lifespan has increased at a rate of approximately 3 months/year in both sexes, hence oldest old people are becoming the population with the fastest growth in Western World. Although the average life expectancy is increasing dramatically, the healthy lifespan is not going at the same pace. This underscores the importance of studies on the prevention of age-related diseases, in order to satisfactorily decrease the medical, economic and social problems associated to advancing age, related to an increased number of individuals not autonomous and affected by invalidating pathologies. In particular, data from experimental studies in model organisms have consistently shown that nutrient signalling pathways are involved in longevity, affecting the prevalence of age-related loss of function, including age-related diseases. Accordingly, nutrigerontology is defined as the scientific discipline that studies the impact of nutrients, foods, macronutrient ratios, and diets on lifespan, ageing process, and age-related diseases. To discuss the potential relevance of this new science in the attainment of successful ageing and longevity, three original studies performed in Sicily with local foods and two reviews have been assembled in this series. Data clearly demonstrate the positive effects of nutraceuticals, functional foods and Mediterranean Diet on several biological parameters. In fact, they could represent a prevention for many age-related diseases, and, although not a solution for this social plague, at least a remedy to alleviate it. Thus, the possibility to create a dietary pattern, based on the combined strategy of the use of both nutraceuticals and functional foods should permit to create a new therapeutic strategy, based not only on a specific bioactive molecule or on a specific food but on a integrated approach that, starting from the local dietary habits, can be led to a "nutrafunctional diet" applicable worldwide. PMID

  6. 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

  7. Patients' Perceptions of the Causes of Their Success and Lack of Success in Achieving Their Potential in Spinal Cord Rehabilitation

    ERIC Educational Resources Information Center

    Belciug, Marian P.

    2012-01-01

    The objective of this study was to examine the patients' perception of the causes of their success and lack of success in achieving their potential in rehabilitation and their emotional reactions to the outcome of their rehabilitation. Thirty-five patients with spinal cord injury who were participating in the Rehabilitation Program at Hamilton…

  8. The Achievement Gap: Factors That Influenced the Achievement of Successful Black Students

    ERIC Educational Resources Information Center

    Morton, Kwame R., Sr.

    2011-01-01

    The academic underperformance of Black students when compared to their White peers has confounded educators nationwide. This discrepancy in academic performance commonly referred to as the achievement gap has become a national crisis which has led to one of the most significant educational reforms undertaken in the United States of America in the…

  9. 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

  10. IT Project Success w\\7120 and 7123 NPRs to Achieve Project Success

    NASA Technical Reports Server (NTRS)

    Walley, Tina L.

    2009-01-01

    This slide presentation reviews management techniques to assure information technology development project success. Details include the work products, the work breakdown structure (WBS), system integration, verification and validation (IV&V), and deployment and operations. An example, the NASA Consolidated Active Directory (NCAD), is reviewed.

  11. Using Achieving the Dream to Meet Accreditation Requirements. Principles and Practices of Student Success

    ERIC Educational Resources Information Center

    Manning, Terri Mulkins

    2009-01-01

    The fundamental concepts of Achieving the Dream--using evidence to develop and evaluate strategies for improving student learning and success--are also important to successful efforts to meet accreditation requirements. Following the Achieving the Dream approach can help community colleges organize and document improvement efforts in ways that are…

  12. Fibreoptic vs videolaryngoscopic (C-MAC(®) D-BLADE) nasal awake intubation under local anaesthesia.

    PubMed

    Kramer, A; Müller, D; Pförtner, R; Mohr, C; Groeben, H

    2015-04-01

    Numerous indirect laryngoscopes have been introduced into clinical practice and their use for tracheal intubation under local anaesthesia has been described. However, a study comparing indirect laryngoscopic vs fibreoptic intubation under local anaesthesia and sedation appears lacking. Therefore, we evaluated both techniques in 100 patients with an anticipated difficult nasal intubation time for intubation the primary outcome. We also assessed success rate, glottic view, Ramsey score, and patients' and anaesthetists' satisfaction. The median (IQR [range]) time for intubation was significantly shorter with the videolaryngoscope with 38 (24-65 [11-420]) s vs 94 (48-323 [19-1020]) s (p < 0.0001). There was no difference in the success rate of intubation (96% for both techniques; p > 0.9999) and satisfaction of the anaesthetists and patients. We conclude that in anticipated difficult nasal intubation a videolaryngoscope represents an acceptable alternative to fibreoptic intubation. PMID:25764403

  13. Successful intubation of a difficult airway due to a large obstructive vocal cord polyp augmented by the delivery of a transtracheal injection of local anaesthetic.

    PubMed

    George, Jayan; Kader, Jishar Abdul; Arumugam, Sivasundari; Murphy, Anthony

    2015-01-01

    We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short. We delivered a transtracheal injection of local anaesthesia. This approach allowed for safe passage of the endotracheal tube. In patients such as this it may be worth considering the use of a transtracheal injection in the first instance. PMID:26628451

  14. Failed fibreoptic intubation: 70° rigid nasendoscope and Frova introducer to the rescue

    PubMed Central

    Vinayagam, Stalin; Prakash, MVS Satya; Kundra, Pankaj; Gopalakrishnan, Surianarayana

    2016-01-01

    Endotracheal intubation was successfully accomplished with 70° rigid nasendoscope under video guidance in two patients in whom repeated attempts to secure airway with flexible fibreoptic bronchoscope were unsuccessful. Both patients had compromised airway (laryngeal papillomatosis and a huge thyroid swelling) and were uncooperative. Frova intubating introducer was used along with 70° rigid nasendoscope to accomplish tracheal intubation under video guidance. PMID:27512168

  15. 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

  16. Engaging Faculty in the Achieving the Dream Initiative. Principles and Practices of Student Success

    ERIC Educational Resources Information Center

    Birnback, Lara; Friedman, Will

    2009-01-01

    Stakeholder engagement is critical to the success of Achieving the Dream. Broad-based support for the college's student success agenda and institutional change efforts requires engaging faculty, staff, students, community members, and others in the change process. These stakeholders can bring to light critical obstacles to student success and help…

  17. Explanations for Success and Failure by Low and Average School Achievers.

    ERIC Educational Resources Information Center

    Bond, Lynne A.; Johnson, Jeannette L.

    Low and average school achievers in grades 1 and 2 and grades 4 and 5 made attributions for successes and failures on school related and unrelated tasks. Students in the low achievement group were participants of the Title I program, and tested a year below their age-mates on reading and math achievement. Students were given two booklets of four…

  18. Why achievement motivation predicts success in business but failure in politics: the importance of personal control.

    PubMed

    Winter, David G

    2010-12-01

    Several decades of research have established that implicit achievement motivation (n Achievement) is associated with success in business, particularly in entrepreneurial or sales roles. However, several political psychology studies have shown that achievement motivation is not associated with success in politics; rather, implicit power motivation often predicts political success. Having versus lacking control may be a key difference between business and politics. Case studies suggest that achievement-motivated U.S. presidents and other world leaders often become frustrated and thereby fail because of lack of control, whereas power-motivated presidents develop ways to work with this inherent feature of politics. A reevaluation of previous research suggests that, in fact, relationships between achievement motivation and business success only occur when control is high. The theme of control is also prominent in the development of achievement motivation. Cross-national data are also consistent with this analysis: In democratic industrialized countries, national levels of achievement motivation are associated with strong executive control. In countries with low opportunity for education (thus fewer opportunities to develop a sense of personal control), achievement motivation is associated with internal violence. Many of these manifestations of frustrated achievement motivation in politics resemble authoritarianism. This conclusion is tested by data from a longitudinal study of 113 male college students, showing that high initial achievement motivation combined with frustrated desires for control is related to increases in authoritarianism (F-scale scores) during the college years. Implications for the psychology of leadership and practical politics are discussed. PMID:21039527

  19. [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

  20. Creating Effective Board-CEO Relationships and Fundraising to Achieve Successful Student Outcomes

    ERIC Educational Resources Information Center

    White, Frances L.

    2011-01-01

    More and more accountability and successful educational outcomes are being demanded of colleges. Achieving successful outcomes requires strong and courageous leadership at all levels of the institution, but getting the faculty to improve teaching and learning outcomes very often requires a president/chief executive officer (CEO) who not only…

  1. The Impact of Reading Success Academy on High School Reading Achievement

    ERIC Educational Resources Information Center

    Burlison, Kelly; Chave, Josh

    2014-01-01

    The study explores the effectiveness of the Reading Success Academy on the reading achievement of the selected group of ninth-grade students in a comprehensive high school. We examine in what ways the Reading Success Academy may improve the reading proficiency rates and amount of reading growth of ninth-grade students. The results indicate that…

  2. The Impact of Achievement Press on Student Success in Elementary Schools

    ERIC Educational Resources Information Center

    Smith, Page A.; Kearney, W. Sean

    2013-01-01

    Purpose: The purpose of this study is to examine the relative impact of achievement press on student success in elementary schools in the Southwestern USA. Design/methodology/approach: Data from individual teacher assessments and student achievement tests are collected and aggregated at the campus level. Hierarchical linear modeling is utilized to…

  3. Arts Achieve, Impacting Student Success in the Arts: Preliminary Findings after One Year of Implementation

    ERIC Educational Resources Information Center

    Mastrorilli, Tara M.; Harnett, Susanne; Zhu, Jing

    2014-01-01

    The "Arts Achieve: Impacting Student Success in the Arts" project involves a partnership between the New York City Department of Education (NYCDOE) and five of the city's premier arts organizations. "Arts Achieve" provides intensive and targeted professional development to arts teachers over a three-year period. The goal…

  4. Relationship between Achievement Goals, Meta-Cognition and Academic Success in Pakistan

    ERIC Educational Resources Information Center

    Sarwar, Muhammad; Yousuf, Muhammad Imran; Hussain, Shafqat; Noreen, Shumaila

    2009-01-01

    The research was the replication of the study done by Coutinho (2006) and it aimed at finding the relationship between achievement goals, meta-cognition and academic success. Achievement goals were further divided into two types: mastery and performance. The participants were 119 students enrolled in M. A. Education, Department of Education at the…

  5. 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

  6. [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

  7. Learning and performance of endotracheal intubation by paramedical students: Comparison of GlideScope® and intubating laryngeal mask airway with direct laryngoscopy in manikins

    PubMed Central

    Bahathiq, Adil Omar; Abdelmontaleb, Tharwat Helmy; Newigy, Mohammed Khairt

    2016-01-01

    Background and Aims: GlideScope video laryngoscope (GVL) and intubating laryngeal mask airway (I-LMA) may be used to facilitate intubation and secure the airway in patients with normal and abnormal airways. The aim of this study was to evaluate whether (GVL) and (I-LMA) facilitate and improve the tracheal intubation success rate and could be learned and performed easily by paramedic students when compared with Macintosh direct laryngoscopy (DL). Methods: This study was a prospective, randomised crossover trial that included 100 paramedic students. Macintosh DL, I-LMA and GVL were tested in both normal and difficult airway scenarios. Each participant was allowed up to three intubation attempts with each device, in each scenario. The time required to perform tracheal intubation, the success rate, number of intubation attempts and of optimisation manoeuvres and the severity of dental trauma were recorded. Statistical analysis was performed using Chi-square, one-way ANOVA, or Kruskal-Wallis test as appropriate, followed by post hoc test. Results: GVL and I-LMA required less time to successfully perform tracheal intubation, showed a greater success rate of intubation, reduced the number of intubation attempts and optimization manoeuvres required and reduced the severity of dental trauma compared to Macintosh DL in both normal and difficult airway scenarios. Conclusion: GVL and I-LMA provide better airway management than Macintosh DL in both normal and difficult airway scenarios. PMID:27212721

  8. 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

  9. Closing the Math Achievement Gap: Institutions Find Success with MyMathLab

    ERIC Educational Resources Information Center

    Stewart, Pearl

    2012-01-01

    Institutions find success with Pearson Education's MyMathLab. The Department of Mathematical Sciences at the University of Memphis (UM) reported a narrowing of the achievement gap between Black and White students. According to the study conducted by UM professors and titled "The Effectiveness of Blended Instruction in Postsecondary General…

  10. Reading for Success: The Effectiveness of Literacy Interventions for Increasing Student Achievement in Core Academic Classes

    ERIC Educational Resources Information Center

    Harrell, Margaret A.

    2014-01-01

    The purpose of this action research study was to utilize quantitative and qualitative data to measure the effects of Tier 2 and Tier 3 literacy interventions as they affect student achievement in the secondary school setting. The research questions addressed performance of students who were enrolled in Reading for Success as compared to a cohort…

  11. The Influence of Achievement Motivation, Success, and Intended Effort on Behavioral Intensity.

    ERIC Educational Resources Information Center

    Latta, R. Michael

    Two experiments were designed to test Kukla's cognitive theory of task performance, based on intended effort. Experiment I was designed to determine if success feedback leads to an overall increase in performance level and differential asymptotic performance for those high and low in achievement motivation. Experiment 2 was aimed at determining if…

  12. Success in Higher Education: The Challenge to Achieve Academic Standing and Social Position

    ERIC Educational Resources Information Center

    Life, James

    2015-01-01

    When students look at their classmates in the classroom, consciously or unconsciously, they see competitors both for academic recognition and social success. How do they fit in relation to others and how do they succeed in achieving both? Traditional views on the drive to succeed and the fear of failure are well known as motivators for achieving…

  13. Collaborating with Parents for Early School Success: The Achieving-Behaving-Caring Program

    ERIC Educational Resources Information Center

    McConaughy, Stephanie H.; Kay, Pam; Welkowitz, Julie A.; Hewitt, Kim; Fitzgerald, Martha D.

    2007-01-01

    The Achieving-Behaving-Caring (ABC) Program is an evidence-based approach to addressing the needs of elementary students at risk for emotional and behavioral difficulties and promoting successful home-school collaboration. This practical guide demonstrates how classroom teachers and parents can work together to boost individual children's…

  14. Indicators of Success in Achieving the El Centro College Goals, 1997-2000.

    ERIC Educational Resources Information Center

    El Centro Coll., Dallas, TX.

    This is a report on indicators of success in achieving community college goals at El Centro College (Texas). The report provides statistics from 1997-2000 and focuses on the progress of nine goals: (1) institutionalizing service beyond expectation--according to student satisfaction surveys, campus changes that have occurred between 1996 and 1999…

  15. Developing a Latino Mentoring Program: Project MALES (Mentoring to Achieve Latino Educational Success)

    ERIC Educational Resources Information Center

    Sáenz, Victor B.; Ponjuan, Luis; Segovia, Jorge, Jr.; Del Real Viramontes, José

    2015-01-01

    This chapter highlights the development of Project MALES (Mentoring to Achieve Latino Educational Success). At the center of Project MALES is a mentoring program that aims to cultivate an engaged support network for males of color at the University of Texas at Austin and across surrounding communities. Specifically, there is a discussion of the…

  16. High School Success: An Effective Intervention for Achievement and Dropout Prevention

    ERIC Educational Resources Information Center

    Lowder, Christopher Michael

    2012-01-01

    The purpose of this mixed-design study was to use quantitative and qualitative research to explore the effects of High School Success (a course for at-risk ninth graders) and its effectiveness on student achievement, attendance, and dropout prevention. The research questions address whether there is a significant difference between at-risk ninth…

  17. Student Success Skills: An Evidence-Based Cognitive and Social Change Theory for Student Achievement

    ERIC Educational Resources Information Center

    Lemberger, Matthew E.; Brigman, Greg; Webb, Linda; Moore, Molly M.

    2012-01-01

    An overview of the Student Success Skills program is offered, including descriptions of the curricular structure, extant research support related to SSS effectiveness for academic achievement and improved school behaviors, and a theory of change for student development. Recent research has demonstrated the value of the SSS program as it connects…

  18. Achieving Higher Levels of Success for A.D.H.D. Students Working in Collaborative Groups

    ERIC Educational Resources Information Center

    Simplicio, Joseph S. C.

    2007-01-01

    This article explores a new and innovative strategy for helping students with Attention Deficit Hyperactivity Disorder (A.D.H.D.) achieve higher levels of academic success when working in collaborative groups. Since the research indicates that students with this disorder often have difficulty in maintaining their concentration this strategy is…

  19. Courageous Conversations: Achieving the Dream and the Importance of Student Success

    ERIC Educational Resources Information Center

    Change: The Magazine of Higher Learning, 2009

    2009-01-01

    Achieving the Dream: Community Colleges Count is a national initiative dedicated to the premise that community colleges should be as successful at student retention and graduation, particularly for students of color and low-income, as they are at enrollment. On campus, the initiative is focused on creating a culture of evidence, one in which data…

  20. The Achieving Success Everyday Group Counseling Model: Fostering Resiliency in Middle School Students

    ERIC Educational Resources Information Center

    Rose, Joy; Steen, Sam

    2015-01-01

    This article discusses a group counseling intervention used to develop and foster resiliency in middle school students by implementing the Achieving Success Everyday (ASE) group counseling model. The authors aimed to discover what impact this group counseling intervention, which focused on resiliency characteristics, would have on students'…

  1. The Achieving Success Everyday Group Counseling Model: Implications for Professional School Counselors

    ERIC Educational Resources Information Center

    Steen, Sam; Henfield, Malik S.; Booker, Beverly

    2014-01-01

    This article presents the Achieving Success Everyday (ASE) group counseling model, which is designed to help school counselors integrate students' academic and personal-social development into their group work. We first describe this group model in detail and then offer one case example of a middle school counselor using the ASE model to…

  2. Gender and Achievement: Are Girls the "Success Stories" of Restructured Education Systems?

    ERIC Educational Resources Information Center

    Skelton, Christine

    2010-01-01

    There is a popular perception that girls' academic success means that they have taken up the kinds of gender performances in the classroom previously associated with boys. However, research into classrooms show that, amongst even the highest achieving pupils, girls are anxious about doing well and concerned about their relationships with other…

  3. Effects of Mastery Learning Strategies on Community College Mathematics Students' Achievement and Success Rate.

    ERIC Educational Resources Information Center

    Abadir, Laila; And Others

    The effects of mastery learning strategies, interactive video mathematics (IVM), individualized instruction (IND), and the lecture method on mathematics achievement of community college students was studied. Interactions among instructional methods, gender, and age were examined; and the grade success rate was determined for each instructional…

  4. Success Despite Socioeconomics: A Case Study of a High-Achieving, High-Poverty School

    ERIC Educational Resources Information Center

    Tilley, Thomas Brent; Smith, Samuel J.; Claxton, Russell L.

    2012-01-01

    This case study of a high-achieving, high-poverty school describes the school's leadership, culture, and programs that contributed to its success. Data were collected from two surveys (the School Culture Survey and the Vanderbilt Assessment of Leadership in Education), observations at the school site, and interviews with school personnel. The…

  5. Achieving professional success in US government, academia, and industry: an EMGS commentary.

    PubMed

    Poirier, Miriam C; Schwartz, Jeffrey L; Aardema, Marilyn J

    2014-08-01

    One of the goals of the EMGS is to help members achieve professional success in the fields they have trained in. Today, there is greater competition for jobs in genetic toxicology, genomics, and basic research than ever before. In addition, job security and the ability to advance in one's career is challenging, regardless of whether one works in a regulatory, academic, or industry environment. At the EMGS Annual Meeting in Monterey, CA (September, 2013), the Women in EMGS Special Interest Group held a workshop to discuss strategies for achieving professional success. Presentations were given by three speakers, each representing a different employment environment: Government (Miriam C. Poirier), Academia (Jeffrey L. Schwartz), and Industry (Marilyn J. Aardema). Although some differences in factors or traits affecting success in the three employment sectors were noted by each of the speakers, common factors considered important for advancement included networking, seeking out mentors, and developing exceptional communication skills. PMID:24788591

  6. 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

  7. 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

  8. TotalTrack video intubating laryngeal mask in super-obese patients – series of cases

    PubMed Central

    Gaszynski, Tomasz

    2016-01-01

    Background Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods Twenty-four super-obese patients (body mass index >50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. PMID:27042078

  9. Visions of success and achievement in recreation-related USDA Forest Service NEPA processes

    SciTech Connect

    Stern, Marc J.; Blahna, Dale J.; Cerveny, Lee K.; Mortimer, Michael J.

    2009-07-15

    The National Environmental Policy Act (NEPA) is incorporated into the planning and decision-making culture of all natural resource agencies in the U.S. Yet, we know little about how the attitudes and internal interactions of interdisciplinary (ID) teams engaged in NEPA processes influence process outcomes. We conducted a web-based survey of 106 ID team leaders involved with environmental analyses (EA) or environmental impact statements (EIS) for projects dealing with recreation and travel management on national forests. We explore how they define success in these processes and identify factors most powerfully associated with perceptions of positive outcomes. The survey revealed a tremendous diversity in definitions of success. Strong correlations between the perceived importance of particular indicators of success and their achievement suggest that pre-conceived notions may often help to shape process outcomes. Regression analyses revealed the following factors as the best predictors of ID team leaders' perception of an 'excellent outcome': achievement of the agency mission, whether compromise had taken place between the interested parties, team satisfaction and harmony, timely process completion, and project implementation. Yet, respondents consistently ranked compromise with interested parties and team member satisfaction among the least important measures of successful NEPA processes. Results suggest that clarifying appropriate measures of success in NEPA processes across the agency could make ID team performance more consistent. The research also suggests that greater attention to ID team interactions, both internally and between teams and interested publics, could result in better outcomes.

  10. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful delivery

    PubMed Central

    Manisco, Gianfranco; Potì’, Marcello; Maggiulli, Giuseppe; Di Tullio, Massimo; Losappio, Vincenzo; Vernaglione, Luigi

    2015-01-01

    Pregnancy in women with chronic kidney disease has always been considered as a challenging event both for the mother and the fetus. Over the years, several improvements have been achieved in the outcome of pregnant chronic renal patients with increasing rates of successful deliveries. To date, evidence suggests that the stage of renal failure is the main predictive factor of worsening residual kidney function and complications in pregnant women. Moreover, the possibility of success of the pregnancy depends on adequate depurative and pharmacological strategies in patients with end-stage renal disease. In this paper, we propose a review of the current literature about this topic presenting our experience as well. PMID:26034591

  11. Parental Involvement and Adolescents' Educational Success: The Roles of Prior Achievement and Socioeconomic Status.

    PubMed

    Benner, Aprile D; Boyle, Alaina E; Sadler, Sydney

    2016-06-01

    Parental educational involvement in primary and secondary school is strongly linked to students' academic success; however; less is known about the long-term effects of parental involvement. In this study, we investigated the associations between four aspects of parents' educational involvement (i.e., home- and school-based involvement, educational expectations, academic advice) and young people's proximal (i.e., grades) and distal academic outcomes (i.e., educational attainment). Attention was also placed on whether these relations varied as a function of family socioeconomic status or adolescents' prior achievement. The data were drawn from 15,240 10th grade students (50 % females; 57 % White, 13 % African American, 15 % Latino, 9 % Asian American, and 6 % other race/ethnicity) participating in the Education Longitudinal Study of 2002. We observed significant links between both school-based involvement and parental educational expectations and adolescents' cumulative high school grades and educational attainment. Moderation analyses revealed that school-based involvement seemed to be particularly beneficial for more disadvantaged youth (i.e., those from low-SES families, those with poorer prior achievement), whereas parents' academic socialization seemed to better promote the academic success of more advantaged youth (i.e., those from high-SES families, those with higher prior achievement). These findings suggest that academic interventions and supports could be carefully targeted to better support the educational success of all young people. PMID:26847424

  12. Emergent retrograde tracheal intubation in a 3-year-old with stevens-johnsons syndrome.

    PubMed

    He, Michael

    2014-01-01

    A 3-year-old girl suffering from Stevens-Johnsons Syndrome with severe sloughing of the oropharyngeal mucosa was brought to the operating room for an emergent tracheostomy after multiple failed attempts to intubate the trachea in the pediatric intensive care unit. However, a retrograde tracheal intubation was successfully performed in the operating room to secure her airway, after which a tracheostomy was performed. Retrograde intubation can be a quick and effective method for securing the difficult airway. PMID:25612259

  13. 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

  14. Value of real life (in situ) simulation training for tracheal intubation skills in medical undergraduates during short duration anesthesia rotation

    PubMed Central

    Minai, Fauzia; Shafiq, Faraz; Ul Haq, Muhammad Irfan

    2014-01-01

    Background and Aims: Skill of a successful endotracheal intubation needs to be acquired by training and attaining several competencies simultaneously. It becomes more challenging when we have to deliver the key concepts in a limited period of time. The medium fidelity simulator is a valuable tool of training for such scenarios. For this purpose we aim to compare the efficacy of structured training in endotracheal intubation between real life simulation and the conventional teaching method. Materials and Methods: The year 4 medical students had their attachment in anaesthesia for a period of 6 months from Jun — Dec 2009 were randomly divided into Group (Gp) A who had conventional teaching and Group B who were taught by four simulated sessions of endotracheal intubation. Performance of both the groups was observed by a person blinded to the study against a checklist on a 7 point rating scale in anaesthetized patient. Results: Total 57 students, 29 in Gp A and 28 in Gp B were rotated in the anaesthesia during the study period. Evaluation of the individual component tasks revealed that simulated group achieved a significant difference in the scoring for laryngoscope and intubation technique. (P = 0.026, 0.012) The comparison of overall competence again showed that the 64.3% of student in Gp B achieved an excellent score in comparison to Gp A in which only 41.4% achieved excellent. (P = 0.049). Similarly the lesser number of students in Gp B (14.3%) require remediation as compared to the Gp A, in which the requirement was 40% (P=0.04). Conclusion: We conclude that all essential skills components of tracheal intubation in correct flow and sequence are acquired more efficiently by real life simulated training. PMID:25425771

  15. Use of a lighted stylet for guided orotracheal intubation in the prehospital setting.

    PubMed

    Vollmer, T P; Stewart, R D; Paris, P M; Ellis, D; Berkebile, P E

    1985-04-01

    Management of the airway in acutely injured patients demands special skills of the emergency physician. A technique of light-guided orotracheal intubation has been described in the literature and was performed under protocol by resident physicians in an urban mobile intensive care system. The method utilizes a flexible lighted stylet to provide a guide to correct placement through transillumination of the soft tissues of the neck. During the 12-month period of the study, 24 intubations were attempted in 21 patients using this technique. Twenty-one attempts (88%) were successful. The average time for intubation was 20 seconds, with none requiring more than 45 seconds. Fourteen intubations (67%) were successful on the first attempt. Of the three unsuccessful procedures, two were attempted in bright sunlight, and all three patients had vomited prior to the attempts. Trauma to the soft tissues in one successfully intubated patient was the only complication reported with the technique. The advantages of this method, including rapidity of intubation, ability to intubate without manipulation of the head or neck, and the apparently few complications, make it particularly attractive to emergency personnel. We conclude that guided orotracheal intubation using a lighted stylet is an effective and safe method of emergency intubation, even in the adverse prehospital environment. PMID:3985444

  16. 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

  17. Endotracheal intubation with thiopental/succinylcholine or sevoflurane-nitrous oxide anesthesia in adults: a comparative study.

    PubMed

    Iamaroon, A; Pitimana-aree, S; Prechawai, C; Anusit, J; Somcharoen, K; Chaiyaroj, O

    2001-02-01

    We performed a double-blinded, prospective, randomized controlled trial to compare intubating conditions facilitated by succinylcholine or sevoflurane. One hundred twenty patients were randomized to receive either succinylcholine or sevoflurane for tracheal intubation. For the Succinylcholine group, patients were induced with thiopental 5 mg. kg(-1) and tracheally intubated after administration of succinylcholine 1.5 mg. kg(-1) IV. Patients receiving sevoflurane took three vital capacity breaths of 8% sevoflurane and 66% N(2)O in O(2). At the loss of eyelash reflex, ventilation was assisted to establish end-tidal CO(2) between 25-30 mm Hg, and intubation was performed when end-tidal sevoflurane was approximately 6%. Criteria of jaw relaxation, vocal cords position, and intubating response were used to assess intubation condition. If the intubation score was < or = 6 of 12, it was described as acceptable, otherwise it was described as an unacceptable intubation condition. Tracheal intubation was successful in all patients. Intubator and observer blinded as to patient group judged that four patients (6.7%) in the Sevoflurane group and only one patient (1.7%) in the Succinylcholine group had an unacceptable intubation condition. However, there was no significant difference between groups (P > 0.05). Therefore, the three vital capacity breaths inhalation technique with sevoflurane may be an alternative for endotracheal intubation in adults. PMID:11159262

  18. 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

  19. Stories of Success: Understanding Academic Achievement of Hispanic Students in Science

    NASA Astrophysics Data System (ADS)

    Harris, Amanda

    A review of the literature shows that there is much evidence to suggest the challenges facing Hispanic students in American public schools. Hispanic enrollment in K--12 public schools has increased from 6 to 19% in the last thirty years, yet schools have not made adequate adjustments to accommodate this changing population. Issues such as remedial tracking and cultural differences have led to low high school graduate rates for Hispanic students and inequities in schooling experiences (Gay, 2000). Particularly in the area of science, Hispanic students struggle with academic success (Cole & Espinoza, 2008). Despite these obstacles, some Hispanic students are academically successful (Rochin & Mello, 2007; Merisotis & Kee, 2006). This dissertation tells the stories of these Hispanic students who have been successful in science in secondary public schools. This study followed a grounded theory methodology and utilized individual interviews to collect data about Hispanics who have demonstrated achievement in the area of science. Through the analysis of these interviews, factors were identified which may have contributed to the success of these Hispanics in the field of science. Implications for future practice in public schools are also discussed.

  20. 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

  1. 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

  2. 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

  3. 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

  4. Rural treatment of acute cardiogenic pulmonary edema: applying the evidence to achieve success with failure.

    PubMed

    Bosomworth, John

    2008-01-01

    Rural management of acute cardiogenic pulmonary edema should be based on avoidance of adverse outcomes such as in-hospital mortality, the need for intensive care unit care, and the need for intubation and mechanical ventilation. Current evidence suggests that early noninvasive continuous positive airway pressure and early aggressive preload reduction with intravenous nitroglycerin are first-line interventions. Afterload reduction with sublingual captopril, with or without nitroglycerin, improves outcomes and is a second-line intervention. Furosemide is associated with adverse outcomes when used alone and should be given only after vasodilator therapy as a third-line intervention. Inotropes should be used only with demonstrably poor perfusion as they do not improve outcomes and may indeed be associated with increased mortality. Concurrent vasodilator therapy should be considered as soon as possible. Morphine should not be used as it is associated with adverse outcomes. If sedation is desirable, benzodiazepines should be considered. PMID:18796257

  5. A comparison of an integrated suction blade versus a traditional videolaryngoscope blade in the endotracheal intubation of a hemorrhagic cadaver model - a pilot study.

    PubMed

    Wadman, Michael; Nicholas, Thomas A; Bernhagen, Mary A; Kuper, Gail M; Miljkovic, Nikola; Schmidt, Steven; Massignan, Jason; Boedeker, Ben H

    2012-01-01

    In this pilot study, we evaluated two types of videolaryngoscope blades (integrated suction vs. traditional) with the Storz CMAC videolaryngoscope in the intubation of a lightly embalmed hemorrhagic cadaver model. No significant differences were found between the devices in the success rates for the intubations. The study subjects indicated a preference for the integrated suction blade in hemorrhagic airway intubation. PMID:22357052

  6. From Failure to Success: The Roles of Culture and Cultural Conflict in the Academic Achievement of Chicano Students. Chapter 6.

    ERIC Educational Resources Information Center

    Trueba, Henry T.

    This chapter discusses current theories in educational anthropology that attempt to explain Chicano low academic achievement and changes in achievement as a result of successful educational interventions. Educational researchers have not been able to present adequate justification for the differential achievement levels of minorities. Recent…

  7. 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

  8. Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

    PubMed

    Ul Haq, Muhammad Irfan; Shamim, Faisal; Lal, Shankar; Shafiq, Faraz

    2015-12-01

    Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope. PMID:26691367

  9. Parker Flex-It stylet is as effective as GlideRite Rigid stylet for orotracheal intubation by Glidescope

    PubMed Central

    Sheta, Saad A.; Abdelhalim, Ashraf A.; ElZoughari, Ismail A.; AlZahrani, Tariq A.; Al-Saeed, Abdulhamid H.

    2015-01-01

    Objectives: To evaluate Parker Flex-It stylet as an alternative to GlideRite Rigid stylet to aid tracheal intubation with the Glidescope. Methods: This prospective randomized trial was conducted at King Abdulaziz University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia between May and December 2014. Sixty American Society of Anesthesiologists I-II patients were randomly assigned to one of 2 equal groups receiving intubation by Glidescope using either GlideRite Rigid stylet (Group GS) or Parker Flex-It stylet (Group PS). The total intubation time, ease of intubation, incidences of successful intubation at first attempt, number of intubation attempts, use of optimization maneuvers, and possible complications were recorded. Results: No significant differences between both groups regarding the total intubation time (p=0.08) was observed. Intubation was significantly easier in group PS compared with group GS as measured by visual analogue scale (p=0.001) with no significant differences between the groups regarding the rate of successful tracheal intubation from first attempt (p=0.524). However, the number of attempts at intubation and usage of external laryngeal manipulation were similar in both groups (p>0.05). The incidence of sore throat, dysphagia, hoarseness, and trauma were significantly higher in group GS (p<0.05). Conclusion: Parker Flex-It stylet is as effective as GlideRite Rigid stylet when used by experienced operators in patients with normal airways using Glidescope; however, it is easier and less traumatic. PMID:26620987

  10. 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

  11. Qualitative research study of high-achieving females' life experiences impacting success

    NASA Astrophysics Data System (ADS)

    Butcher, Ann Patrice

    2003-07-01

    This qualitative study investigated the life experiences of five academically gifted female students in math and science in reflection of their elementary learning prior to enrollment at a prestigious science and mathematics high school. The elite high school limits admission to the state of Illinois' top students. The purpose of this study is to unfold the story of five academically gifted females in attendance at the elite high school reflecting on their life experiences in elementary school that contributed to their current academic success. Twelve female students, who at the time of this study were currently in their senior year (12th grade) of high school, were solicited from the top academic groups who are regarded by their teachers as highly successful in class. Students were selected as part of the study based on academic status, survey completion and interest in study, Caucasian and Asian ethnicity, locale of elementary school with preference given to the variety of school demographics---urban, suburban, and rural---further defined the group to the core group of five. All female participants were personally interviewed and communicated via Internet with the researcher. Parents and teachers completing surveys as well met the methodological requirements of triangulation. An emergent theme of paternal influence came from the research. Implications supported in the research drawn from this study to increase achievement of academically gifted females include: (a) proper early identification of learner strengths plays a role; (b) learning with appropriate intellectual peers is more important than learning with their age group; (c) teachers are the greatest force for excellent instruction; (d) effective teaching strategies include cooperative learning, multi-sensory learning, problem-based learning, and hands-on science; (e) rigor in math is important; (f) gender and stereotypes need not be barriers; (g) outside interests and activities are important for self

  12. 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

  13. 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

  14. [Endotracheal intubation in an adult patient fitted with a Leksell frame using a Pentax Airwayscope with a pediatric-type INTLOCK blade (ITL-P)].

    PubMed

    Takeuchi, Risa; Hoshijima, Hiroshi; Horikoshi, Yuta; Nakamura, China; Iwase, Yoshinori; Nagasaka, Hiroshi

    2014-08-01

    Several previous reports have established the Pentax Airwayscope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for tracheal intubation in adult patients. The Pentax AWS is often successfully used with an INTLOCK blade; to date, however, INTLOCK blades have been released for neonatal and pediatric patients only. In this case, we performed tracheal intubation using a Pentax AWS attached to a pediatric-type INTLOCK blade (ITL-P) in an adult patient fitted with a Leksell Stereotactic frame (Elekta, Sweden). The patient weighed 45 kg and was 154 cm tall, and was scheduled for a tumor biopsy due to glioblastoma in the brain stem. The patient was preoperatively fitted with a Leksell frame on her head. The patient was not premedicated and was monitored with electrocardiography (ECG), noninvasive blood pressure, and pulse oximetry. Following pre-oxygenation, general anesthesia was induced using propofol 4.0 microg x ml with target-controlled infusion and remifentanil 0.25 microg x kg(-1) hr(-1). After loss of consciousness, we administered 30-mg rocuronium boluses. We initially attempted tracheal intubation first using a Macintosh laryngoscope and then a Pentax AWS, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-P, we successfully achieved tracheal intubation without any complications. Anesthesia was maintained uneventfully with 3.0 microg x ml(-1) propofol and remifentanil 0.10 to 0.25 microg x kg(-1) x hr(-1) in oxygen and air. Further study is needed to facilitate the effective use of the Pentax AWS and the ITL-P in such cases. PMID:25199322

  15. 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

  16. Using the Achieving Success Everyday (ASE) Group Model to Promote Self-Esteem and Academic Achievement for English as a Second Language (ESL) Students

    ERIC Educational Resources Information Center

    Shi, Qi; Steen, Sam

    2012-01-01

    The Achieving Success Everyday (ASE) group model is used to promote self-esteem and academic performance of English as a second language (ESL) students. The findings from the preliminary data indicated that the participants' self-esteem was significantly improved after participation in the group. There was no significant improvement in the total…

  17. Strategies Employed by Middle School Principals Successful in Increasing and Sustaining the Mathematics Achievement of African American Students

    ERIC Educational Resources Information Center

    Clark, Rebecca

    2013-01-01

    This study approaches the problem of African American mathematics achievement from a strength-based perspective, identifying practices implemented by middle school principals successful in increasing and sustaining the mathematics achievement of African American students. The study was designed to answer questions regarding both school-wide…

  18. Closing the Achievement Gap: Oregon's Plan for Success for All Students

    ERIC Educational Resources Information Center

    Oregon Department of Education, 2005

    2005-01-01

    Susan Castillo, Superintendent of Public Instruction in Oregon, named closing the achievement gap as a top instructional priority in Oregon. Superintendent Castillo notes three aspects to the achievement gap: (1) Performance gap: The discrepancies between the educational achievement and performance of students of diverse races, ethnicities, income…

  19. Endotracheal intubation with a traditional videolaryngoscope blade versus an integrated suction blade in a hemorrhagic airway cadaver model.

    PubMed

    Wadman, Michael C; Nicholas, Thomas A; Bernhagen, Mary A; Kuper, Gail M; Schmidt, Steven; Massignan, Jason; Boedeker, Ben H

    2013-01-01

    Lightly embalmed hemorrhagic cadaver models and the Storz CMAC videolaryngoscope fitted with either an integrated suction blade vs. a traditional blade were used to determine efficacy of the instruments in hemorrhagic airway intubation. Significant differences were found between the devices in intubation success rates of the viscosity saliva and frothy blood models, as well as a significant difference in intubation times in the frothy blood model. Feedback provided by the study participants indicated preference for the integrated video suction blade in hemorrhagic airway intubation. PMID:23400204

  20. 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

  1. 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

  2. Most Likely to Achieve: Predicting Early Success of the Practical Nurse Student

    ERIC Educational Resources Information Center

    Cline, April P.

    2013-01-01

    It is important that practical nurse (PN) educators be able to identify which students are likely to be successful in their programs. However, the majority of literature related to predicting success of nursing students has been done on baccalaureate nursing students in the university setting. This study sought to determine whether the same…

  3. Successful Girls? Complicating Post-Feminist, Neoliberal Discourses of Educational Achievement and Gender Equality

    ERIC Educational Resources Information Center

    Ringrose, Jessica

    2007-01-01

    This paper examines how an ongoing educational panic over failing boys has contributed to a new celebratory discourse about successful girls. Rather than conceive of this shift as an anti-feminist feminist backlash, the paper examines how the successful girl discourse is postfeminist, and how liberal feminist theory has contributed to narrowly…

  4. Reducing the Gap: Success for All and the Achievement of African American Students

    ERIC Educational Resources Information Center

    Madden, Nancy A.

    2006-01-01

    "Success for All" is a comprehensive reform model, which applies cooperative learning, tutoring, family support services, and extensive professional development to help high-poverty schools succeed with their pupils. A review of research on "Success for All" with African American students focuses on evidence that the model reduces the achievement…

  5. Black Hegemony, a Significant Influence in the School Success of High-Achieving African Americans.

    ERIC Educational Resources Information Center

    Murphy, Jean C.

    This is an interpretive study of the influence of Black Hegemony on the academic success of three successful African Americans: Clifton L. Taulbert, Henry Louis Gates, Jr., and Margaret Morgan Lawrence. All three spent their youth in southern communities strongly influenced by Jim Crow laws and customs, and their academic accomplishments were…

  6. Relations between Personality Traits, Language Learning Styles and Success in Foreign Language Achievement

    ERIC Educational Resources Information Center

    Erton, Ismail

    2010-01-01

    The purpose of this paper is to show that the reflections of different personality types can be observed in students' developing different learning styles for themselves. It is hypothesized that personality may be a dominant factor in achieving the educational goals through several learning styles in foreign language achievement. To clarify this…

  7. Increasing Postsecondary Education Access and Success: Raising Achievement through Outreach Programs. Brief

    ERIC Educational Resources Information Center

    Broton, Katie

    2009-01-01

    Closing the achievement gap depends on highly effective public schools, strong community support, and family involvement. Raising the overall rates of achievement in Minnesota is a vital part of this goal. Research has shown that pre-college outreach programs improve college access for underrepresented groups, including low-income,…

  8. Student Achievement in Identified Workforce Clusters: Understanding Factors that Influence Student Success

    ERIC Educational Resources Information Center

    D'Amico, Mark M.; Morgan, Grant B.; Robertson, Thashundray C.

    2011-01-01

    This study blends elements from two South Carolina Technical College System initiatives--Achieving the Dream and a workforce cluster strategy. Achieving the Dream is a national non-profit organization created to help technical and community college students succeed, particularly low-income students and students of color. This initiative, combined…

  9. Literacy Achievement and Diversity: Keys to Success for Students, Teachers, and Schools. Multicultural Education Series

    ERIC Educational Resources Information Center

    Au, Kathryn H.

    2011-01-01

    "Literacy Achievement and Diversity" is the indispensable collection to the wisdom of respected literacy researcher Kathy Au. In this timely book, Au addresses the question of what educators can do to close the literacy achievement gap. She begins by outlining theory and research and then provides practical strategies to help teachers improve the…

  10. Gaining Retention and Achievement for Students Program (GRASP): A Faculty Development Program To Increase Student Success.

    ERIC Educational Resources Information Center

    McShannon, Judith

    This study investigated the effects of a faculty development program offered to increase positive interactions between students and faculty and the effects of these interactions on student achievement and retention. The Gaining Retention and Achievement for Students (GRASP) program supports the accreditation process of the Accreditation Board of…

  11. Foundations for Success: Case Studies of How Urban School Systems Improve Student Achievement [and] Abstract.

    ERIC Educational Resources Information Center

    Snipes, Jason; Doolittle, Fred; Herlihy, Corinne

    This report examines the experiences of three large urban school districts (and part of a fourth) that raised academic performance for their districts as a whole, while also reducing racial differences in achievement. Educational challenges included low achievement, political conflict, inexperienced teachers, low expectations, and lack of…

  12. 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

  13. Differential Validity and Utility of Successive and Simultaneous Approaches to the Development of Equivalent Achievement Tests in French and English

    ERIC Educational Resources Information Center

    Rogers, W. Todd; Gierl, Mark J.; Tardif, Claudette; Lin, Jie; Rinaldi, Christina

    2003-01-01

    Described in this paper are the first three activities of a research program designed to assess the differential validity and utility of successive and simultaneous approaches to the development of equivalent achievement tests in the French and English languages. Two teams of multilingual/multicultural French-English teachers used the simultaneous…

  14. An In-Service Program to Assist the Henderson City and Henderson County School Systems in Achieving Successful Total Desegregation.

    ERIC Educational Resources Information Center

    Henderson County Public Schools, Henderson, KY.

    This report is a result of a four week In-Service Training Program conducted by the Henderson County-Henderson City School Systems to assist in achieving successful total desegregation under the provisions of Title IV of the Civil Rights Act of 1964. This program was designed to assist in solving the special educational problems for the 1965-66…

  15. Evaluation of Achieving Collegiate Excellence and Success Program: Student Outcomes Year One, Grades 11 and 12. Evaluation Brief

    ERIC Educational Resources Information Center

    Wolanin, Natalie; Modarresi, Shahpar

    2015-01-01

    The Office of Shared Accountability in Montgomery County (Maryland) Public Schools (MCPS) is conducting a multiyear evaluation of the "Achieving Collegiate Excellence and Success" (ACES) program. ACES is a collaboration between MCPS, Montgomery College (MC), and the Universities at Shady Grove (USG) to create a seamless pathway from high…

  16. Navajo Culture and Family Influences on Academic Success: Traditionalism Is Not a Significant Predictor of Achievement among Navajo Youth.

    ERIC Educational Resources Information Center

    Willeto, Angela A. A.

    1999-01-01

    A study of 451 Navajo youths attending 11 high schools in the Navajo Nation found no relationship between their academic achievement and their cultural attachments and practices. Families modestly influenced educational outcomes, but being female was a stronger predictor of academic success. An appendix describes study variables. (Contains 42…

  17. Helping Middle School Girls at Risk for School Failure Recover Their Confidence and Achieve School Success: An Experimental Study

    ERIC Educational Resources Information Center

    Mann, Michael J.

    2013-01-01

    Middle school girls who are at risk have experienced a disproportionate number of intense and disruptive traumatic life events. Such events can adversely affect healthy development and often contribute to higher levels of school failure and problem behavior. Few programs focus on helping at-risk middle school girls achieve school success through…

  18. Orotracheal intubation of morbidly obese patients, comparison of GlideScope® video laryngoscope and the LMA CTrach™ with direct laryngoscopy

    PubMed Central

    Yousef, Gamal T.; Abdalgalil, Dief A.; Ibrahim, Tamer H.

    2012-01-01

    Background: Morbidly obese patients are at increased risk of difficult mask ventilation and intubation as well as increased risk of hypoxemia during tracheal intubation. Recently, new video-assisted intubation devices have been developed. The GlideScope® videolaryngoscope and LMA CTrach™ (CT) allows continuous video-endoscopy of the tracheal intubation procedure. Objective: this study is to determine whether the GlideScope® videolaryngoscope (GVL) and the LMA CTrach™ (CT) provide the best airway management, measured primarily in intubation difficulty scale (IDS) scores, time and numbers of intubation attempts, and improvement in the intubation success rate of morbidly obese patients when compared with the direct Macintosh laryngoscope (DL). Materials and Methods: After Ethics’ Committee approval, 90 morbidly obese patients (BMI > 35 kg/m2) scheduled for general, gynecological, and bariatric surgery were included in this prospective study. Patients were randomly assigned in three groups: tracheal intubation using direct laryngoscopy (DL), GlideScope® videolaryngoscope (GVL) or the LMA CTrach™ (CT). Characteristics and consequences of airway management were evaluated. The primary outcome was the intubation difficulty scale score (IDS), Secondary outcomes were theintubation time, overall success rate, number of attempts, Cormack–Lehane grade, subjective difficulty of intubation, desaturation and upper airway morbidity. Results: Difficulty in facemask ventilation was similar in the three groups. IDS scores were significantly lower with GVL and CT than with DL. The mean TTI was 14 s faster in patients intubated with the GVL (86 s, IQR: 68-115) compared with DL (100 s, IQR; 80-150), and was 34 s faster when compared with CT (120 s, IQR; 95-180). The success rate of tracheal intubation was lower with the DL (80%) compared with the GVL (100%) or the CT (100%). Six cases of failed intubation occurred in group DL, four patients from the six patients were

  19. Research Considerations and Theoretical Application for Best Practices in Higher Education: Latina/os Achieving Success

    ERIC Educational Resources Information Center

    Castellanos, Jeanett; Gloria, Alberta M.

    2007-01-01

    This scholarly article addresses the Latina/o undergraduate experiences proposing a (re)definition of educational success. Discussing strength-based practices of "familia", mentorship, cultural congruity, and professional development from a psychosociocultural (PSC) approach, the article presents practical recommendations and directions for…

  20. A Plan for Academic Success: Helping Academically Dismissed Students Achieve Their Goals

    ERIC Educational Resources Information Center

    Cherry, Lynn; Coleman, Lindy

    2010-01-01

    This article describes a unique process which allows a select few students who have been dismissed for academic deficiency the opportunity to create a Plan for Academic Success (Plan), which, if accepted, reverses the academic dismissal for one semester. If the Plan is accepted, the individual student assumes responsibility for taking action to…

  1. Facilitating High Achievement: High School Principals' Reflections on Their Successful Leadership Practices

    ERIC Educational Resources Information Center

    Crum, Karen S.; Sherman, Whitney H.

    2008-01-01

    Purpose: The burden for school improvement in a time of accountability falls squarely on the shoulders of principals as new requirements demand that they act as instructional leaders. The purpose of this study is to discover the common themes of school leadership and instructional practices of high school principals at successful schools in…

  2. Coeliac disease and infertility: making the connection and achieving a successful pregnancy.

    PubMed

    Hin, Harold; Ford, Fiona

    2002-01-01

    Undiagnosed coeliac disease is not uncommon in adults in the UK and can be a cause of unexplained infertility in women. Studies suggest that dietary treatment of women with coeliac disease may result in successful conception. The diet of a woman with coeliac disease during pregnancy is discussed and agencies offering support are listed. PMID:12416015

  3. High Enrollment Course Success Factors in Virtual School: Factors Influencing Student Academic Achievement

    ERIC Educational Resources Information Center

    Liu, Feng; Cavanaugh, Cathy

    2011-01-01

    This paper describes a study of success factors in high enrollment courses in a K-12 virtual school learning environment. The influence of variables: time student spent in the learning management system (LMS), number of times logged into the LMS, teacher comment, participation in free or reduced lunch programs, student status in the virtual school…

  4. Exploring the Role and Influence of Expectations in Achieving VLE Benefit Success

    ERIC Educational Resources Information Center

    Jackson, Stephen; Fearon, Colm

    2014-01-01

    The aim of this paper is to investigate the role and influence of expectations management in realising benefit success when adopting a virtual learning environment (VLE). Based on a discussion of findings from a further and higher education college in the UK, a conceptual expectations management model is developed that explores the factors…

  5. Creativity and Education: Personal Reflections on Achieving Success by Working outside the Box.

    ERIC Educational Resources Information Center

    Rowan, Paul

    2003-01-01

    A successful businessman developed his creativity in spite of his school experiences. Creativity is essential to compete in the global market. For that reason, he supports creative education in Canada through internships and design competitions and as advisor to a college school of design. Partnerships between education and industry stimulate…

  6. Effects of Success for All on the Achievement of English Language Learners.

    ERIC Educational Resources Information Center

    Slavin, Robert E.; Madden, Nancy A.

    The Success for All model of instruction, which seeks to prevent academic problems in elementary school by addressing reading difficulties with early, intensive intervention, is described. The approach, begun with native English-speaking students at risk academically, provides tutoring from prekindergarten or kindergarten onward, particularly…

  7. The Study Experiences of the High Achievers in a Competitive Academic Environment: A Cost of Success?

    ERIC Educational Resources Information Center

    Nordmo, Ivar; Samara, Akylina

    2009-01-01

    The present paper is a case study that explores the study experiences and possible costs of success for the students accepted into the professional program in psychology at the University of Bergen in Norway. In this highly competitive environment, between 500 and 1000 students compete for 36 places during the introduction year. The study is based…

  8. Examining the Success Factors of High-Achieving Puerto Rican Male High-School Students

    ERIC Educational Resources Information Center

    Garrett, Tomas; Antrop-Gonzalez, Rene; Velez, William

    2010-01-01

    This article works to dispel the myth that Latino urban high-school students are not capable of performing at high academic levels. Whereas much educational research emphasizes the academic underachievement of urban Latino students, this article counteracts this research by describing the four success factors that three working-class Puerto Rican…

  9. Guide to Success for Organisations in Achieving Employment Outcomes for Aboriginal and Torres Strait Islander People

    ERIC Educational Resources Information Center

    Giddy, Kristine; Lopez, Jessica; Redman, Anne

    2009-01-01

    Helping Aboriginal and Torres Strait Islander job-seekers find and keep a job has been the focus of recent reforms announced by the Australian Government. This guide describes seven essential characteristics of employment service organisations that lead to successful employment outcomes for their Indigenous clients. Based on a selection of…

  10. Gender Differences in Planning, Attention, Simultaneous, and Successive (PASS) Cognitive Processes and Achievement.

    ERIC Educational Resources Information Center

    Naglieri, Jack A.; Rojahn, Johannes

    2001-01-01

    Examined 1,100 boys and 1,100 girls who matched the U.S. population using the Planning, Attention, Simultaneous, Successive (PASS) cognitive-processing theory, built on the neuropsychological work of A.R. Luria (1973). Results illustrate that the PASS theory offers a useful way to examine gender differences in cognitive performance. (BF)

  11. Achieving the Dream: A Look at Hispanic Student Success at Community Colleges in Texas

    ERIC Educational Resources Information Center

    Williams, Audrey R.

    2013-01-01

    In the last decade, higher education institutions have come under attack for their inability to enhance graduation rates. Although community colleges are known for their open-door enrollment policy, they are currently challenged to improve student success. This study was designed to determine which strategies have been most effective in…

  12. Children's Casual Attributions for Success and Failure in Achievement Settings: A Meta-Analysis.

    ERIC Educational Resources Information Center

    Whitley, Bernard E., Jr.; Frieze, Irene Hanson

    1985-01-01

    A meta analysis of research on children's attributions for success and failure was conducted to test the adequacy of the egotistic bias hypothesis for children in grades one to seven. Results supported the egotism hypothesis and indicated that both question wording and research context are important determinants of children's attributions.…

  13. The Interplay between Educational Achievement, Occupational Success, and Well-Being

    ERIC Educational Resources Information Center

    Samuel, Robin; Bergman, Manfred Max; Hupka-Brunner, Sandra

    2013-01-01

    Many studies have examined the effect of life events, education, and income on well-being. Conversely, research concerning well-being as a predictor of life course outcomes is sparse. Diener's suggestion "to inquire about the effects of well-being on future behavior and success" has, with some exceptions, not yet come to fruition. This article…

  14. Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials

    PubMed Central

    Suppan, L.; Tramèr, M. R.; Niquille, M.; Grosgurin, O.; Marti, C.

    2016-01-01

    Background. Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear. Methods. We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials comparing any intubation device with the Macintosh laryngoscope in human subjects with cervical spine immobilization. The primary outcome was the risk of tracheal intubation failure at the first attempt. Secondary outcomes were quality of glottis visualization, time until successful intubation, and risk of oropharyngeal complications. Results. Twenty-four trials (1866 patients) met inclusion criteria. With alternative intubation devices, the risk of intubation failure was lower compared with Macintosh laryngoscopy [risk ratio (RR) 0.53; 95% confidence interval (CI) 0.35–0.80]. Meta-analyses could be performed for five intubation devices (Airtraq, Airwayscope, C-Mac, Glidescope, and McGrath). The Airtraq was associated with a statistically significant reduction of the risk of intubation failure at the first attempt (RR 0.14; 95% CI 0.06–0.33), a higher rate of Cormack–Lehane grade 1 (RR 2.98; 95% CI 1.94–4.56), a reduction of time until successful intubation (weighted mean difference −10.1 s; 95% CI −3.2 to −17.0), and a reduction of oropharyngeal complications (RR 0.24; 95% CI 0.06–0.93). Other devices were associated with improved glottis visualization but no statistically significant differences in intubation failure or time to intubation compared with conventional laryngoscopy. Conclusions. In situations where the spine is immobilized, the Airtraq device reduces the risk of intubation failure. There is a lack of evidence for the usefulness of other intubation devices. PMID:26133898

  15. Preadmission Academic Achievement Criteria as Predictors of Nursing Program Completion and NCLEX-RN Success

    ERIC Educational Resources Information Center

    Rogers, Tanya L.

    2009-01-01

    Admission policies and practices in higher education, including those in nursing programs, are diverse; yet administrators have traditionally relied upon preadmission academic achievement for selection of qualified students. Higher education administrators have the responsibility to serve the institution and all of its constituents, ensuring that…

  16. Leveraging Quality Improvement to Achieve Student Learning Assessment Success in Higher Education

    ERIC Educational Resources Information Center

    Glenn, Nancy Gentry

    2009-01-01

    Mounting pressure for transformational change in higher education driven by technology, globalization, competition, funding shortages, and increased emphasis on accountability necessitates that universities implement reforms to demonstrate responsiveness to all stakeholders and to provide evidence of student achievement. In the face of the demand…

  17. Strategies for Success: Links to Increased Mathematics Achievement Scores of English-Language Learners

    ERIC Educational Resources Information Center

    Pray, Lisa; Ilieva, Vessela

    2011-01-01

    This research investigates the link between mathematic teachers' use of English-language learner (ELL) strategies and the mathematics achievement of their students who are ELLs. Interviews and observations of mathematic teachers who taught ELLs were used to document instructional strategies use. The findings from the interviews and observations…

  18. Disabled and Successful: Education in the Life Stories of Disabled High Achievers

    ERIC Educational Resources Information Center

    Shah, Sonali; Travers, Cheryl; Arnold, John

    2004-01-01

    There has been much debate concerning the pros and cons of special and mainstream education for young people with a disability. This paper adds data to this debate by reporting the educational experiences of 20 high-achievers with congenital disabilities who live in the United Kingdom and were born between 1950 and 1970. It presents personal…

  19. Urban Professional Development Working to Create Successful Teachers and Achieving Students

    ERIC Educational Resources Information Center

    Yost, Deborah S.; Vogel, Robert

    2007-01-01

    With the advent of No Child Left Behind Act of 2001, schools are being held accountable for measurable increases in student academic achievement as evidenced by performance on standardized tests. This movement has significant implications for the professional development of teachers who are ultimately responsible for ensuring that their…

  20. Friends' Responses to Children's Disclosure of an Achievement-Related Success: An Observational Study

    ERIC Educational Resources Information Center

    Altermatt, Ellen Rydell; Ivers, Ivy E.

    2011-01-01

    This study examined social support processes in the context of positive events. The conversations of fourth-grade through sixth-grade focal children and their friends (N = 116) were observed after focal children outperformed their friend on an achievement-related task. Changes in focal children's performance-related positive affect from…

  1. Closing the Achievement Gap: Principles for Improving the Educational Success of All Students. ERIC Digest.

    ERIC Educational Resources Information Center

    Schwartz, Wendy

    This digest reviews educational policies and practices that have been proven effective in closing the achievement gap, offering a list of resources with detailed information about them. The digest focuses on state and district roles (e.g., developing and implementing educational goals, rigorous standards, and accountability standards and providing…

  2. Achievement Goals and Persistence across Tasks: The Roles of Failure and Success

    ERIC Educational Resources Information Center

    Sideridis, Georgios D.; Kaplan, Avi

    2011-01-01

    The focus of this study is on the role of achievement goals in students' persistence. The authors administered 5 puzzles to 96 college students: 4 unsolvable and 1 relatively easy (acting as a hope probe). They examined whether and how persistence may deteriorate as a function of failing the puzzles, as well as whether and how persistence may…

  3. Marked for Success: Secondary School Performance and University Achievement in Biology

    ERIC Educational Resources Information Center

    Comer, Keith; Broght, Erik; Sampson, Kaylene

    2011-01-01

    Building on Shulruf, Hattie and Tumen (2008), this work examines the capacity of various National Certificate in Educational Achievement (NCEA)-derived models to predict first-year performance in Biological Sciences at a New Zealand university. We compared three models: (1) the "best-80" indicator as used by several New Zealand…

  4. The Achievement Gap among Newcomer Immigrant Adolescents: Life Stressors Hinder Latina/o Academic Success

    ERIC Educational Resources Information Center

    Patel, Sita G.; Barrera, Alinne Z.; Strambler, Michael J.; Muñoz, Ricardo F.; Macciomei, Erynn

    2016-01-01

    This study compares life stressors and school outcomes among newcomer immigrant adolescents from Latin America, Asia, and the Caribbean. Participants attended a predominantly low-income, urban international public high school in the northeast. The Latina/o students were exposed to more life stressors and had lower attendance and achievement than…

  5. School Counseling to Close the Achievement Gap: A Social Justice Framework for Success

    ERIC Educational Resources Information Center

    Holcomb-McCoy, Cheryl

    2007-01-01

    School counselors can play a powerful role in closing the achievement gap when they incorporate the principles of social justice into their practice. In this much-needed resource for preservice and inservice counselors, the author addresses factors (such as racism, sexism, heterosexism, and classism) that can contribute to academic failure, and…

  6. Saving for Success: Financial Education and Savings Goal Achievement in Individual Development Accounts

    ERIC Educational Resources Information Center

    Grinstead, Mary L.; Mauldin, Teresa; Sabia, Joseph J.; Koonce, Joan; Palmer, Lance

    2011-01-01

    Using microdata from the American Dream Demonstration, the current study examines factors associated with savings and savings goal achievement (indicated by a matched withdrawal) among participants of individual development account (IDA) programs. Multinomial logit results show that hours of participation in financial education programs, higher…

  7. [Intubation treatment of acute laryngeal obstruction: a case report].

    PubMed

    Guo, Xingguang; Liu, Shibo; Li, Huilian

    2015-11-01

    Acute laryngeal obstruction is one of the most common diseases in Department of ENT, and it can cause suffocation without prompt treatment. Methods by using Nasopharyngofiberoscope guided tracheal intubation treatment of a case of acute laryngeal obstruction patients in a timely manner. This method is well tolerated, less trauma, high success rate, in the shortest time to improve the patient's ventilation, for the next step of the treatment to win the time. PMID:26911075

  8. GlideScope Video Laryngoscope for Difficult Intubation in Emergency Patients: a Quasi-Randomized Controlled Trial.

    PubMed

    Ahmadi, Koorosh; Ebrahimi, Mohsen; Hashemian, Amir Masoud; Sarshar, Saeed; Rahimi-Movaghar, Vafa

    2015-12-01

    Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL) has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05). In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036), overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P<0.001) and first attempt intubation time (28.43 ± 12.51 vs. 21.48±7.8; P=0.001) between direct laryngoscopy and GVL. These variables were not significantly different between two methods in easy airway group. According to the results, GVL can be a useful alternative to direct laryngoscopy in emergency situations and especially in cases with a difficult airway. PMID:26749229

  9. A Mentoring Program to Help Junior Faculty Members Achieve Scholarship Success

    PubMed Central

    2014-01-01

    The University of North Carolina Eshelman School of Pharmacy launched the Bill and Karen Campbell Faculty Mentoring Program (CMP) in 2006 to support scholarship-intensive junior faculty members. This report describes the origin, expectations, principles, and best practices that led to the introduction of the program, reviews the operational methods chosen for its implementation, provides information about its successes, and analyzes its strengths and limitations. PMID:24672062

  10. Recipe for Success: An Updated Parents' Guide to Improving Colorado Schools and Student Achievement. Second Edition.

    ERIC Educational Resources Information Center

    Taher, Bonnie; Durr, Pamela

    This guide describes ways that parents can help improve student achievement and school quality. It answers such questions as how to choose the right early-education opportunity for a preschooler, how to make sure a 5-year-old is ready for school, how to help a daughter do well in school, how to work with a daughter's or son's teachers, how to help…

  11. Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study

    PubMed Central

    Saraçoğlu, Ayten; Dal, Didem; Baygın, Ömer; Göğüş, Fevzi Yılmaz

    2016-01-01

    Objective Training students on simulators before allowing their direct contact with patients is well accepted. There is no clinical or manikin-based simulation study in the literature comparing tracheal intubation with Airtraq, laryngeal mask airway (LMA) CTrach and Macintosh laryngoscopes performed by medical students having no prior intubation experience. Methods After obtaining written informed consents, 123 participants were included in the study. The participants were asked to intubate the manikin five times with each device randomly. After all the participants had completed their fifth intubations, the measurements were performed. The primary outcome variables were the first-attempt success rate and the time for a successful intubation, while the secondary outcome variables were to determine the scores of dental trauma, the difficulty visual analogue scale and the optimization manoeuvres. Results The LMA CTrach group revealed a significantly higher number of intubation attempts. The mean time for a successful intubation was the longest in the LMA CTrach group (17.66±8.22 s, p<0.05). Students defined the Airtraq as the easiest to use and the Macintosh laryngoscope as the most difficult device to use and learn. Dental trauma severity was significantly lower in the Airtraq group than in the other groups (p<0.05), and it was found to be 0 in 81.1% in the Airtraq group. The head extension optimization manoeuvre rate was significantly higher with the Macintosh laryngoscope than with the Airtraq laryngoscope (p<0.05). Conclusion This study, in which different types of laryngoscopes were compared, revealed that the Airtraq laryngoscope has advantages, such as shorter intubation duration, less additional optimization manoeuvres, less dental trauma intensity and is easier to learn compared with the LMA CTrach and Macintosh laryngoscopes. PMID:27366562

  12. Enhancing physics demonstration shows: where physics and the arts meet to achieve success

    NASA Astrophysics Data System (ADS)

    Hammer, Donna; Uher, Tim

    2015-04-01

    Physics demonstrations are widely used by universities in undergraduate education and public outreach to engage students and teach physics concepts. At the University of Maryland, the Physics is Phun public demonstration programs are a vehicle for public outreach with longstanding success (dating back to 1982). A recent program, ``Out of the Dark,'' presented the evolution of the fields of electricity and magnetism by merging physics demonstrations with history and performing arts. In this session, we will discuss methods by which these outside fields can be utilized in a demonstration program. We will also discuss the outcomes of these methods in enhancing engagement of audience members and undergraduate majors alike.

  13. Mismatched partners that achieve postpairing behavioral similarity improve their reproductive success

    PubMed Central

    Laubu, Chloé; Dechaume-Moncharmont, François-Xavier; Motreuil, Sébastien; Schweitzer, Cécile

    2016-01-01

    Behavioral similarity between partners is likely to promote within-pair compatibility and to result in better reproductive success. Therefore, individuals are expected to choose a partner that is alike in behavioral type. However, mate searching is very costly and does not guarantee finding a matching partner. If mismatched individuals pair, they may benefit from increasing their similarity after pairing. We show in a monogamous fish species—the convict cichlid—that the behavioral similarity between mismatched partners can increase after pairing. This increase resulted from asymmetrical adjustment because only the reactive individual became more alike its proactive partner, whereas the latter did not change its behavior. The mismatched pairs that increased their similarity not only improved their reproductive success but also raised it up to the level of matched pairs. While most studies assume that assortative mating results from mate choice, our study suggests that postpairing adjustment could be an alternative explanation for the high behavioral similarity between partners observed in the field. It also explains why interindividual behavioral differences can be maintained within a given population. PMID:26973869

  14. [Awake intubation with landiolol and dexmedetomidine in a patient with anxiety neurosis].

    PubMed

    Nagamine, Tatsunari; Komasawa, Nobuyasu; Fujitate, Yasutaka; Kuzukawa, Yosuke; Kitano, Manabu; Minami, Toshiaki

    2014-08-01

    We report a successful case of awake intubation in a patient with anxiety neurosis via continuous administration of landiolol and dexmedetomidine. A 52-year-old woman weighing 46.8 kg with anxiety neurosis experienced postoperative bleeding after left-side thyroidectomy and was scheduled for emergent hemostasis under general anesthesia Due to swelling of the neck, we anticipated a difficult airway and decided to perform awake intubation. She showed extreme insecurity and shivering, and initially did not agree to the procedure. To calm her anxiety and panic, we continuously administered 10 microg x kg(-1). min(-1) landiolol and 1.0 microg x kg(-1) hr(-1) dexmedetomidine. After 10 minutes, her shivering disappeared, and she agreed to undergo awake intubation, which was performed with the Pentax-AWS Airwayscope and thin Intlock blade. The patient bucked slightly during intubation but hemodynamic changes were minimal. PMID:25199332

  15. The Development of Computational Biology in South Africa: Successes Achieved and Lessons Learnt

    PubMed Central

    Mulder, Nicola J.; Christoffels, Alan; de Oliveira, Tulio; Gamieldien, Junaid; Hazelhurst, Scott; Joubert, Fourie; Kumuthini, Judit; Pillay, Ché S.; Snoep, Jacky L.; Tastan Bishop, Özlem; Tiffin, Nicki

    2016-01-01

    Bioinformatics is now a critical skill in many research and commercial environments as biological data are increasing in both size and complexity. South African researchers recognized this need in the mid-1990s and responded by working with the government as well as international bodies to develop initiatives to build bioinformatics capacity in the country. Significant injections of support from these bodies provided a springboard for the establishment of computational biology units at multiple universities throughout the country, which took on teaching, basic research and support roles. Several challenges were encountered, for example with unreliability of funding, lack of skills, and lack of infrastructure. However, the bioinformatics community worked together to overcome these, and South Africa is now arguably the leading country in bioinformatics on the African continent. Here we discuss how the discipline developed in the country, highlighting the challenges, successes, and lessons learnt. PMID:26845152

  16. The Development of Computational Biology in South Africa: Successes Achieved and Lessons Learnt.

    PubMed

    Mulder, Nicola J; Christoffels, Alan; de Oliveira, Tulio; Gamieldien, Junaid; Hazelhurst, Scott; Joubert, Fourie; Kumuthini, Judit; Pillay, Ché S; Snoep, Jacky L; Tastan Bishop, Özlem; Tiffin, Nicki

    2016-02-01

    Bioinformatics is now a critical skill in many research and commercial environments as biological data are increasing in both size and complexity. South African researchers recognized this need in the mid-1990s and responded by working with the government as well as international bodies to develop initiatives to build bioinformatics capacity in the country. Significant injections of support from these bodies provided a springboard for the establishment of computational biology units at multiple universities throughout the country, which took on teaching, basic research and support roles. Several challenges were encountered, for example with unreliability of funding, lack of skills, and lack of infrastructure. However, the bioinformatics community worked together to overcome these, and South Africa is now arguably the leading country in bioinformatics on the African continent. Here we discuss how the discipline developed in the country, highlighting the challenges, successes, and lessons learnt. PMID:26845152

  17. 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

  18. 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

  19. [Combined Use of a Videolaryngoscope and a Transilluminating Device for Intubation with Two Difficult Airways].

    PubMed

    Saima, Shunsuke; Asai, Takashi; Kimura, Rie; Terada, Satoshi; Arai, Takerou; Okuda, Yasuhisa

    2015-10-01

    Videolaryngoscope is useful in patients with difficult airways, but it may not be in some patients. We report the use of a lighted stylet to facilitate tracheal intubation in 2 patients in whom laryngoscopy with a videolaryngoscope was difficult. Case 1: A 52-year-old female with loose teeth and lockjaw presented for a scoliosis surgery under general anesthesia. Laryngoscopy using a blade 3 of a Glide-Scope® (Laerdal Medical Corporation, New York, NY, USA) videolaryngoscope (GVL) showed a Cormack-Lehanne grade 3 view. Bag mask ventilation was easily achieved. By using the Trachilight™ (Saturn Biomedical System Burnaby, BC, Canada) with the GVL, we could intubate the trachea succesfully. Case 2: A 16-year-old male with a history of difficult tracheal intubation due to a limited cervical spine movement presented for an external fixation of a femur under general anesthesia. After induction of anaesthesia, bag mask ventilation was easily achieved but the GVL laryngoscopy did not provide a good view of the glottis (Cormack-Lehanne grade 3). Combined use of the Trachilight™ with the GVL, facilitated tracheal intubation. The Trachilight™ is a recognized aid to facilitate trachal intubation but the device is now commercially not available. Neverthless, we believe that a lighted stylet is potentially useful for tracheal intubation when the view of the glottis with a videolaryngoscopy is not ideal. PMID:26742405

  20. Direct Versus Video Laryngoscopy for Intubating Adult Patients with Gastrointestinal Bleeding

    PubMed Central

    Carlson, Jestin N.; Crofts, Jason; Walls, Ron M.; Brown, Calvin A.

    2015-01-01

    Introduction Video laryngoscopy (VL) has been advocated for several aspects of emergency airway management; however, there are still concerns over its use in select patient populations such as those with large volume hematemesis secondary to gastrointestinal (GI) bleeds. Given the relatively infrequent nature of this disease process, we sought to compare intubation outcomes between VL and traditional direct laryngoscopy (DL) in patients intubated with GI bleeding, using the third iteration of the National Emergency Airway Registry (NEARIII). Methods We performed a retrospective analysis of a prospectively collected national database (NEARIII) of intubations performed in United States emergency departments (EDs) from July 1, 2002, through December 31, 2012. All cases where the indication for intubation was “GI bleed” were analyzed. We included patient, provider and intubation characteristics. We compared data between intubation attempts initiated as DL and VL using parametric and non-parametric tests when appropriate. Results We identified 325 intubations, 295 DL and 30 VL. DL and VL cases were similar in terms of age, sex, weight, difficult airway predictors, operator specialty (emergency medicine, anesthesia or other) and level of operator training (post-graduate year 1, 2, etc). Proportion of successful first attempts (DL 261/295 (88.5%) vs. VL 28/30 (93.3%) p=0.58) and Cormack-Lehane grade views (p=0.89) were similar between devices. The need for device change was similar between DL [2/295 (0.7%) and VL 1/30 (3.3%); p=0.15]. Conclusion In this national registry of intubations performed in the ED for patients with GI bleeds, both DL and VL had similar rates of success, glottic views and need to change devices. PMID:26759653

  1. 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

  2. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia

    PubMed Central

    Timanaykar, Ramesh T; Anand, Lakesh K; Palta, Sanjeev

    2011-01-01

    Background: The Truview EVO2™ laryngoscope is a recently introduced device with a unique blade that provides a magnified laryngeal view at 42° anterior reflected view. It facilitates visualization of the glottis without alignment of oral, pharyngeal, and tracheal axes. We compared the view obtained at laryngoscopy, intubating conditions and hemodynamic parameters of Truview with Macintosh blade. Materials and Methods: In prospective, randomized and controlled manner, 200 patients of ASA I and II of either sex (20–50 years), presenting for surgery requiring tracheal intubation, were assigned to undergo intubation using a Truview or Macintosh laryngoscope. Visualization of the vocal cord, ease of intubation, time taken for intubation, number of attempts, and hemodynamic parameters were evaluated. Results: Truview provided better results for the laryngeal view using Cormack and Lehane grading, particularly in patients with higher airway Mallampati grading (P < 0.05). The time taken for intubation (33.06±5.6 vs. 23.11±57 seconds) was more with Truview than with Macintosh blade (P < 0.01). The Percentage of Glottic Opening (POGO) score was significantly higher (97.26±8) in Truview as that observed with Macintosh blade (83.70±21.5). Hemodynamic parameters increased after tracheal intubation from pre-intubation value (P < 0.05) in both the groups, but they were comparable amongst the groups. No postoperative adverse events were noted. Conclusion: Tracheal intubation using Truview blade provided consistently improved laryngeal view as compared to Macintosh blade without the need to align the oral, pharyngeal and tracheal axes, with equal attempts for successful intubation and similar changes in hemodynamics. However, the time taken for intubation was more with Truview. PMID:21772680

  3. Evaluation of pollutants removal efficiency to achieve successful urban river restoration.

    PubMed

    Cha, Sung Min; Ham, Young Sik; Ki, Seo Jin; Lee, Seung Won; Cho, Kyung Hwa; Park, Yongeun; Kim, Joon Ha

    2009-01-01

    Greater efforts to provide alternative scenarios are key to successful urban stream restoration planning. In this study, we discuss two different aspects of water quality management schemes, biodegradation and human health, which are incorporated in the restoration project of original, pristine condition of urban stream at the Gwangju (GJ) Stream, Korea. For this study, monthly monitoring of biochemical oxygen demand (BOD(5)) and fecal indicator bacteria (FIB) data were obtained from 2003 to 2008 and for 2008, respectively, and these were evaluated to explore pollutant magnitude and variation with respect to space and time window. Ideal scenarios to reduce target pollutants were determined based on their seasonal characteristics and correlations between the concentrations at a water intake and discharge point, where we suggested an increase of environmental flow and wetland as pollutants reduction drawing for BOD(5) and FIB, respectively. The scenarios were separately examined by the Qual2E model and hypothetically (but planned) constructed wetland, respectively. The results revealed that while controlling of the water quality at the intake point guaranteed the lower pollution level of BOD(5) in the GJ Stream, a wetland constructed at the discharge point may be a promising strategy to mitigate mass loads of FIB. Overall, this study suggests that a combination of the two can be plausible scenarios not only to support sustainable urban water resources management, but to enhance a quality of urban stream restoration assignment. PMID:19494448

  4. Combustion Module-2 Achieved Scientific Success on Shuttle Mission STS-107

    NASA Technical Reports Server (NTRS)

    Over, Ann P.

    2004-01-01

    The familiar teardrop shape of a candle is caused by hot, spent air rising and cool fresh air flowing behind it. This type of airflow obscures many of the fundamental processes of combustion and is an impediment to our understanding and modeling of key combustion controls used for manufacturing, transportation, fire safety, and pollution. Conducting experiments in the microgravity environment onboard the space shuttles eliminates these impediments. NASA Glenn Research Center's Combustion Module-2 (CM-2) and its three experiments successfully flew on STS-107/Columbia in the SPACEHAB module and provided the answers for many research questions. However, this research also opened up new questions. The CM-2 facility was the largest and most complex pressurized system ever flown by NASA and was a precursor to the Glenn Fluids and Combustion Facility planned to fly on the International Space Station. CM-2 operated three combustion experiments: Laminar Soot Processes (LSP), Structure of Flame Balls at Low Lewis-Number (SOFBALL), and Water Mist Fire Suppression Experiment (Mist). Although Columbia's mission ended in tragedy with the loss of her crew and much data, most of the CM-2 results were sent to the ground team during the mission.

  5. Achieving 90–90–90 in paediatric HIV: adolescence as the touchstone for transition success

    PubMed Central

    Lee, Sonia; Hazra, Rohan

    2015-01-01

    Introduction The number of children less than 15 years estimated to be living with HIV globally approximated 3.2 million in 2013. Young people aged 15 to 24 years living with HIV approximated 4 million. The survival of these children and adolescents into adulthood poses new and urgent challenges of transition from the paediatric to adolescent to adult healthcare settings due to emerging developmental, psychosocial and comorbid issues. In order to achieve treatment targets of 90–90–90 across the continuum of care for paediatric HIV by 2020, focused efforts on the implementation of appropriate healthcare transition plans across the lifespan, with a focus on adolescence, should be prioritized. Discussion Published data or empirical evidence examining implementation of transition models and association with clinical outcomes are limited. While some guidelines do exist that offer recommendations about how to promote seamless transitions, very few data are available to assess the adequacy of these guidelines and whether they are effectively adhered to in clinical care settings globally. Furthermore, paediatric and adolescent HIV infection, either acquired perinatally or behaviourally, is set apart from other chronic illnesses as a highly stigmatizing disease that disproportionately affects poor, minority and often marginalized populations. Focused efforts on adolescence as the touchstone for transition practices and policies need to be implemented. Conclusions Optimal healthcare for these vulnerable populations, particularly in resource-limited settings, will require HIV-specific transitional care services and programmes that are coordinated, collaborative, integrated and, importantly, evidence-based. PMID:26639113

  6. Arytenoid dislocation after uneventful endotracheal intubation: a case report

    PubMed Central

    Oh, Tak Kyu; Ryu, Chang Hwan; Park, Yu Na; Kim, Nam Woo

    2016-01-01

    Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation. PMID:26885311

  7. Arytenoid dislocation after uneventful endotracheal intubation: a case report.

    PubMed

    Oh, Tak Kyu; Yun, Jung-Yeon; Ryu, Chang Hwan; Park, Yu Na; Kim, Nam Woo

    2016-02-01

    Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation. PMID:26885311

  8. [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

  9. A comparative study on the usefulness of the Glidescope or Macintosh laryngoscope when intubating normal airways

    PubMed Central

    Choi, Guen Seok; Lee, Eun-Ha; Lim, Chae Seong

    2011-01-01

    Background The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. Methods This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. Results There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). Conclusions GVL could be a first-line tool in normal airways. PMID:21716906

  10. Comparison between remifentanil and dexmedetomidine for sedation during modified awake fiberoptic intubation

    PubMed Central

    LIU, HUI-HUI; ZHOU, TAO; WEI, JIAN-QI; MA, WU-HUA

    2015-01-01

    Cricothyroid membrane injections and the application of a coarse fiberoptic bronchoscope (FOB) below the vocal cords for topical anesthesia have a number of limitations for certain patients. Thus, the aim of the present observational study was to assess the effect of a novel modified topical anesthesia method using the effective sedation drugs, remifentanil (Rem) or dexmedetomidine (Dex), during awake fiberoptic orotracheal intubation (AFOI). In total, 90 adult patients, who had been classified as American Society of Anesthesiologists I–II, were included in the study. The patients had anticipated difficult airways and were to undergo orotracheal intubation for elective surgery. The patients were enrolled in the double-blinded randomized pilot study and received Rem or Dex for sedation during the modified AFOI procedure. The two groups received 2% lidocaine for topical anesthesia via an epidural catheter, which was threaded through the suction channel of the FOB. The main clinical outcomes were evaluated by graded scores representing the conditions for intubation and post-intubation. Additional parameters analyzed included airway obstruction, hemodynamic changes, time required for intubation, amnesia level and subjective satisfaction. All 90 patients were successfully intubated using the modified AFOI technique. The comfort scores and airway events during intubation did not significantly differ between the two groups. However, the Rem group experienced less coughing, and less time was required for tracheal intubation when compared with the Dex group. No statistically significant differences were observed in the changes to the mean arterial pressure and heart rate at any time point between the two groups. Therefore, the current study demonstrated that the modified AFOI method is feasible and effective for difficult airway management, and that Dex and Rem exhibit similar efficacy as adjuvant therapies. PMID:25780419

  11. 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

  12. 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.

  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. Balloon Catheter Dilation and Nasolacrimal Intubation for Treatment of Nasolacrimal Duct Obstruction Following a Failed Probing

    PubMed Central

    2009-01-01

    Objective To compare the outcome of balloon catheter dilation and nasolacrimal intubation as treatments for congenital nasolacrimal duct obstruction (NLDO) after a failed probing in children less than 4 years of age Methods We conducted a prospective, non-randomized multicenter study which enrolled 159 children aged 6 to <48 months who had a history of a single failed nasolacrimal duct probing and had at least one of the following clinical signs of NLDO present: epiphora, mucous discharge and/or increased tear lake. One hundred ninety-nine eyes underwent either balloon catheter nasolacrimal duct dilation or nasolacrimal duct intubation. Treatment success was defined as no epiphora, mucous discharge or increased tear lake present at the outcome visit six months after surgery. Results Treatment success was reported in 65 of 84 eyes (77%, 95% CI = 65% to 85%) in the balloon group compared with 72 of 88 eyes (84%, 95% CI = 74% to 91%) eyes in the intubation group (risk ratio for success for intubation vs. balloon = 1.08, 95% CI = 0.95 to 1.22). Conclusions Balloon catheter dilation and nasolacrimal duct intubation each alleviate the clinical signs of persistent nasolacrimal duct obstruction in a similar proportion of patients. PMID:19433712

  15. 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

  16. 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

  17. Paramedic intubation of patients with severe head injury: a review of current Australian practice and recommendations for change.

    PubMed

    Bernard, Stephen A

    2006-06-01

    Secondary brain injury may occur early after severe traumatic brain injury due to hypoxia and/or hypotension. Prehospital care by ambulance paramedics has the goal of preventing and treating these complications and, thus, improving outcomes. In Australia, most ambulance services recommend paramedics attempt endotracheal intubation in patients with severe head injury. Even though most patients with severe head injury retain airway reflexes, most states do not allow the use of appropriate drugs to facilitate intubation. In contrast, recent evidence from trauma registries suggests that this approach may be associated with significantly worse outcomes compared with no intubation. Two states allow intubation facilitated by sedative (but not relaxant) drugs, but this has a low success rate and could worsen brain injury because of a decrease in cerebral perfusion pressure. For road-based paramedics, the role of rapid sequence intubation is uncertain. Given the risks of this procedure and the lack of proven benefit, this procedure should not be introduced without supportive evidence from randomised, controlled trials. In contrast, for safety reasons, comatose patients transported by helicopter should undergo rapid sequence intubation prior to flight. However, this is not authorised in most states, despite good supportive evidence that this can be safely and effectively undertaken by paramedics. Finally, there is evidence that inadvertent hyperventilation is associated with adverse outcome, yet only two ambulance services use waveform capnography in head injury patients who are intubated. Overall, current paramedic airway practice in most states of Australia is not supported by the evidence and is probably associated with worse patient outcomes after severe head injury. For road-based paramedics, rapid transport to hospital without intubation should be regarded as the current standard of care. Rapid sequence intubation should be limited to use within appropriate clinical

  18. 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

  19. Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial

    PubMed Central

    Li, Hui; Wang, Wu; Lu, Ya-Ping; Wang, Yan; Chen, Li-Hua; Lei, Li-Pei; Fang, Xiang-Ming

    2016-01-01

    Background: There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery. Methods: Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student's t-test, Mann–Whitney U-test, or Chi-square test. Results: The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02). Conclusion: Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position. Trial Registration: Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj.aspx?proj=13183. PMID:27569229

  20. Non-intubated combined with video-assisted thoracoscopic in carinal reconstruction

    PubMed Central

    Peng, Guilin; Cui, Fei; Ang, Keng Leong; Zhang, Xin; Yin, Weiqiang; Shao, Wenlong; Dong, Qinglong; Liang, Lixia

    2016-01-01

    Carinal reconstruction is a difficult technique combined with video-assisted thoracoscopic surgery (VATS). It has a high requirement on the operator's skills in operating thoracoscope and meanwhile requires the close cooperation from anesthesiologists. Tracheal intubation and ventilator-assisted ventilation are key steps to ensure the success of surgery. However, tracheal intubation itself may influence the exposure of surgical field and increase the difficulty of anastomosis. In close cooperation of anesthesiologists, we did not perform tracheal intubation; rather, we carried out non-intubated complete VATS carinal reconstruction in a patient with adenoid cystic carcinoma (ACC) of the lower trachea. The awake complete VATS carinal reconstruction was successfully performed. The anastomosis lasted about 36 hours, and the whole surgical procedure lasted 230 min. The intraoperative blood loss was about 80 mL. The patient recovered well 100 min after surgery. A semi-solid diet began 6 hours following the surgery. This non-intubated anesthesia method makes the surgery easier, especially during the anastomosis of stumps. It is feasible and safe to apply this anesthesia technique in carinal reconstruction. PMID:27076956

  1. The Reciprocal Relations between Self-Concept, Motivation and Achievement: Juxtaposing Academic Self-Concept and Achievement Goal Orientations for Mathematics Success

    ERIC Educational Resources Information Center

    Seaton, Marjorie; Parker, Philip; Marsh, Herbert W.; Craven, Rhonda G.; Yeung, Alexander Seeshing

    2014-01-01

    Research suggests that motivated students and those with high academic self-concepts perform better academically. Although substantial evidence supports a reciprocal relation between academic self-concept and achievement, there is less evidence supporting a similar relation between achievement goal orientations and achievement. There is also a…

  2. 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

  3. Achieving successful evidence-based practice implementation in juvenile justice: The importance of diagnostic and evaluative capacity.

    PubMed

    Walker, Sarah Cusworth; Bumbarger, Brian K; Phillippi, Stephen W

    2015-10-01

    Evidence-based programs (EBPs) are an increasingly visible aspect of the treatment landscape in juvenile justice. Research demonstrates that such programs yield positive returns on investment and are replacing more expensive, less effective options. However, programs are unlikely to produce expected benefits when they are not well-matched to community needs, not sustained and do not reach sufficient reach and scale. We argue that achieving these benchmarks for successful implementation will require states and county governments to invest in data-driven decision infrastructure in order to respond in a rigorous and flexible way to shifting political and funding climates. We conceptualize this infrastructure as diagnostic capacity and evaluative capacity: Diagnostic capacity is defined as the process of selecting appropriate programing and evaluative capacity is defined as the ability to monitor and evaluate progress. Policy analyses of Washington State, Pennsylvania and Louisiana's program implementation successes are used to illustrate the benefits of diagnostic and evaluate capacity as a critical element of EBP implementation. PMID:26141970

  4. Remifentanil for endotracheal intubation in premature infants: A randomized controlled trial

    PubMed Central

    Badiee, Zohreh; Vakiliamini, Mazyar; Mohammadizadeh, Majid

    2013-01-01

    Objective: Endotracheal intubation is a common procedure in neonatal care. The objective of this study was to determine whether the premedication with remifentanil before intubation has analgesic effects in newborn infants. Methods: A total of 40 premature infants who needed endotracheal intubation for intubation-surfactant-extubation method were randomly assigned in two groups of an equal number at two university hospitals. The control group was given 10 μg/kg atropine IV infusions in 1 min and then 2 ml normal saline. In the case group, the atropine was given with the same method and then remifentanil was administered 2 μg/kg IV infusions in 2 min. Findings: For remifentanil and control groups, the mean birth weight were 1761 ± 64 and 1447 ± 63 grams (P = 0.29), and the mean gestational ages were 31.69 ± 3.5 and 30.56 ± 2.8 weeks (P = 0.28), respectively. Using premature infant pain profile score, infants who received remifentanil felt significantly less pain than the control group (15.1 ± 1.6 vs. 7.5 ± 1.4; P < 0.001). There were no significant differences in the duration of endotracheal intubation procedure (20.8 ± 6 vs. 22.8 ± 7.3 s; P = 0.33), the number of attempts for successful intubation and oxygen desaturation between groups. Conclusion: Premedication with remifentanil has good analgesic effects for endotracheal intubation in premature infants without significant derangements in mean blood pressure and oxygen saturation. PMID:24991608

  5. 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

  6. 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

  7. 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

  8. Tracheal intubation with volatile induction and target bispectral index of 25 versus 40: A randomized clinical trial

    PubMed Central

    Khandelwal, Purva; Gombar, Kanti Kumar; Ahuja, Vanita; Gombar, Satinder

    2016-01-01

    Background and Aims: A target bispectral index (BIS) value of 40 is considered adequate for depth of anesthesia, but no consensus exists regarding BIS value for tracheal intubation without neuromuscular blocking drugs. The aim of this randomized, double-blinded study was to compare the total duration from sevoflurane induction to tracheal intubation at a BIS value of 25 or 40. Material and Methods: This study was a prospective, randomized and observer-blinded clinical trial. After approval of the Institutional Ethics Committee and written informed consent, 80 patients of American Society of Anesthesiologists physical status I-II, aged 20-60 years, of either sex, requiring general anesthesia with tracheal intubation were enrolled. The patients were randomized to either Group BIS40-intubation at a target BIS value of 40 ± 5 or group BIS25-intubation at a target BIS value of 25 ± 5. The intubating conditions, hemodynamic, and adverse effects were observed in both the groups. Results: This study showed that the total time required from induction to tracheal intubation was 4.9 ± 0.9 min in group BIS40 as compared to 6.3 ± 0.5 min in group BIS25 (P = 0.001) using two-tailed sample t-test. The mean intubation score was 6.5 ± 0.9 in group BIS40, and 5.1 ± 0.7 in group BIS25 (P = 0.001) using Mann-Whitney U-test. Conclusion: The time to achieve target BIS value of 25 was greater as compared to target BIS value of 40 during sevoflurane induction but provided better intubating conditions in the absence of neuromuscular agents. PMID:27625484

  9. [Awake Nasotracheal Intubation for a 4-Year-old Boy with an Oral Penetrating Toothbrush Injury].

    PubMed

    Kobayashi, Naoya; Ando, Kokichi; Saito, Kazutomo; Toyama, Hiroaki; Fudeta, Hiroto; Yamauchi, Masanori

    2015-09-01

    We report a case of an oral penetrating injury caused by a toothbrush in a 4-year-old 17-kg boy. The toothbrush was lodged in the right cervical region through the oral cavity, and emergency surgery for removal was planned under general anesthesia. Although mask ventilation was not possible because of the protruding toothbrush handle, awake nasotracheal intubation was successfully performed with a fiber-scope and intravenous fentanyl 25 μg. We conclude that appropriate analgesics could facilitate awake intubation in pediatric patients. PMID:26466500

  10. Achievement Emotions as Predictors of High School Science Success among African-American and European American Students

    ERIC Educational Resources Information Center

    Bowe, Marilyn Louise Simmons

    2012-01-01

    The literature includes few studies of the interrelations of achievement goals and achievement emotions with respect to minority students and science achievement. The objective of this study was to test the control-value theory (CVT) of achievement emotions to determine if the eight discrete achievement emotions would be predictive of test scores…

  11. 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

  12. Prior esophagogastroduodenoscopy does not affect the cecal intubation time at bidirectional endoscopies

    PubMed Central

    Öner, Osman Zekai; Demirci, Rojbin Karakoyun; Gündüz, Umut Rıza; Aslaner, Arif; Koç, Ümit; Bülbüller, Nurullah

    2013-01-01

    Bidirectional endoscopy (BE) is often used to assess patients for the reason of anemia or to screen asymptomatic population for malignancy. Limited clinical data favors to perform first the upper gastrointestinal system endoscopy, but its effect to the duration of colonoscopy is yet to be determined. The aim of this retrospective study is to evaluate the effect of upper gastrointestinal system endoscopy on the time to achieve cecal intubation during colonoscopy in patients undergoing BE. Patients of four endoscopists at similar experience levels were retrospectively identified and categorized into the upper gastrointestinal system endoscopy before colonoscopy group (group 1) or the colonoscopy only group (group 2). The demographics, clinical data and the time to achieve cecal intubation for each patient were analyzed. The mean time to achieve cecal intubation in the first group that included 319 cases was 8.4 ± 0.93 minutes and the mean time in the second group that included 1672 cases was 8.56 ± 1.16 minutes. There was no statistically significant difference between the groups. There was also no significant difference between the Group 1 and Group 2 when compared according to which of the four endoscopists performed the procedures. Performing the upper gastrointestinal system endoscopy prior to colonoscopy did not affect the time to achieve cecal intubation. Considering that performing the upper gastrointestinal system endoscopy prior to the colonoscopy is more advantageous in terms of patient comfort and analgesic requirement, beginning to BE with it seems more favorable. PMID:23936601

  13. Intubation of a Paediatric Manikin in Tongue Oedema and Face-to-Face Simulations by Novice Personnel: a Comparison of Glidescope, Airtraq and Direct Laryngoscopy

    PubMed Central

    Arslan, Zehra İpek; Turna, Canan; Gümüş, Nevin Esra; Toker, Kamil; Solak, Mine

    2016-01-01

    Objective Glidescope and Airtraq were designed for facilitating intubation and for teaching regarding the airway anatomy. We aimed to evaluate their efficacy in normal airway, tongue oedema and face-to-face orotracheal intubation models when used by novice personnel. Methods After the local human research ethics committee approval, 36 medical students who were in the beginning of their third year were enrolled in this study. After watching a video regarding intubation using one of these devices, the students intubated a paediatric manikin with a Glidescope or Airtraq via the normal airway, tongue oedema and face-to-face approach. Results Although the insertion and intubation times were similar among the groups, the intubation success rate of the Glidescope was higher in the normal airway (100% vs 67%) and tongue oedema (89% vs. 50%) compared with the Airtraq (p=0.008 and p=0.009). The success rates with the paediatric manikin by the face-to-face approach were similar among the groups (50%) (p=0.7). The need for manoeuvres in the Glidescope was lower in the normal and tongue oedema models (p=0.02 and p=0.002). In addition, oesophageal intubation was low in the control and tongue oedema models with the Glidescope (p=0.03 and p<0.001). Conclusion Novice personnel could more easily intubate the trachea with the Glidescope than with the Airtraq. Intubation with the Glidescope was superior to that with the Airtraq in the normal and tongue oedema models. The face-to-face intubation success rates were both low with both the Glidescope and Airtraq groups. PMID:27366561

  14. The Path to Career Success: High School Achievement, Certainty of Career Choice, and College Readiness Make a Difference. Issues In College Success

    ERIC Educational Resources Information Center

    ACT, Inc., 2009

    2009-01-01

    It is essential for all students to be ready for college and career when they graduate from high school. Postsecondary educators expect high school graduates to be prepared academically for success in postsecondary education, which in turn influences success in the work world. Employers continue to call for workers to have the tools needed to…

  15. Achieving Success in Small Business: A Self-Instruction Program for Small Business Owner-Managers. Success in Small Business: Luck or Pluck?

    ERIC Educational Resources Information Center

    Virginia Polytechnic Inst. and State Univ., Blacksburg. Div. of Vocational-Technical Education.

    This self-instructional module on success in small business is the first in a set of twelve modules designed for small business owner-managers. Competency objectives for this module are (1) ability to evaluate chances of success based upon one's personality and knowledge of good business practices and (2) ability to determine one's commitment to…

  16. Achieving College Success: The Impact of the College Success/STEM Program on Students' Matriculation to and Persistence in College. Research Brief

    ERIC Educational Resources Information Center

    Lane, Brett; Souvanna, Phomdaen

    2014-01-01

    This College Success Research Brief is one of a series of briefs documenting the implementation and impact of Mass Insight's College Success/STEM program. The research briefs are intended to share key findings, highlight ongoing questions and lines of inquiry, and inform the thinking of practitioners and policymakers on how to scale up efforts to…

  17. 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

  18. 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

  19. 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

  20. Narrowing the Achievement Gap and Sustaining Success: A Qualitative Study of the Norms, Practices, and Programs of a Successful High School with Urban Characteristics

    ERIC Educational Resources Information Center

    Senesac, Donald Raymond

    2010-01-01

    The academic achievement gap is the manifestation of differential learning outcomes for students typified by membership in an ethnic minority sub group or economically disadvantaged sub group. Addressing the achievement gap has become vital for the nation as a whole, and even more critical for the state of California because the majority of…

  1. A Study of Home Environment, Academic Achievement and Teaching Aptitude on Training Success of Pre-Service Elementary Teachers of India

    ERIC Educational Resources Information Center

    Rani, Sunita; Siddiqui, M. A.

    2015-01-01

    The primary intend of the study was to explore the relationship of Arts, Science and Commerce stream and training success and the influence of Home Environment, Academic Achievement and Teaching Aptitude on training success of ETE trainees. The study analyzed the numerical data from a survey of 380 teacher trainees of three DIETs of Delhi, India.…

  2. The Use of a Plastic Guide Improves the Safety and Reduces the Duration of Endotracheal Intubation in the Pig

    PubMed Central

    JANISZEWSKI, Adrian; PASŁAWSKI, Robert; SKRZYPCZAK, Piotr; PASŁAWSKA, Urszula; SZUBA, Andrzej; NICPOŃ, Józef

    2014-01-01

    ABSTRACT The successful endotracheal intubation of pigs using the standard orotracheal method is challenging and technically difficult, because of the pig’s oral anatomy and the presence of excess tissue in the oropharyngeal region. Hence, the operator, who is usually an anesthetist, requires extensive training in order to successfully perform the procedure in pigs. In this report, we describe a safe and quick method of successful endotracheal intubation in the pig using an 80-cm blunt-tipped plastic vascular catheter, when the pig is placed in ventral recumbency. Specifically, the use of this plastic guide wire shortened the duration of the procedure and reduced the risks of the procedure. Since the use of the guide wire also improves the ease of the procedure, its use will also enable inexperienced operators to perform successful first-time endotracheal intubation of pigs without causing injury. PMID:24931644

  3. 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

  4. 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

  5. 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

  6. The Superintendent Beliefs and Leadership Practices in a School District that Has Successfully Increased the Achievement of Traditionally Marginalized Students

    ERIC Educational Resources Information Center

    Fairbanks-Schutz, Jo-Ellen M.

    2010-01-01

    Superintendent leadership can influence student achievement and with the alarming gap between the academic achievement of traditionally marginalized students and their peers, superintendents have an ethical duty to lead their districts in closing these achievement gaps. Spillane, Halverson, and Diamond (2001) suggested that to have a more complete…

  7. A prospective comparison of laser therapy and intubation in endoscopic palliation for malignant dysphagia.

    PubMed

    Loizou, L A; Grigg, D; Atkinson, M; Robertson, C; Bown, S G

    1991-05-01

    There is little objective long-term follow-up comparing laser therapy with intubation for palliation of malignant dysphagia. In a prospective, nonrandomized two-center trial 43 patients treated with the neodymium:yttrium-aluminum-garnet laser were compared with 30 patients treated by endoscopic intubation; the two groups were comparable for mean age and tumor position, length, and histology. Dysphagia was graded from 0 to 4 (0, normal swallowing; 4, dysphagia for liquids). Pretreatment mean dysphagia grades were similar: laser-treated group, 2.9 (SD, 0.6); intubated group, 3.2 (SD, 0.55). For thoracic esophageal tumors, the percentage of patients achieving an improvement in dysphagia grade by greater than or equal to 1 grade initially and over the long term was similar (laser, 95% and 77%; intubation, 100% and 86%). For tumors crossing the cardia, intubation was significantly better (laser, 59% and 50%; intubation, 100% and 92%, respectively; P less than 0.001). In patients palliated over a long period, however, the mean dysphagia grade over the remainder of their mean dysphagia grade over the remainder of their lives (mean survival: laser, 6.1 months; intubation, 5.1 months) was better in the laser group (1.6 vs. 2.0; P less than 0.01); 33% of laser-treated and 11% of intubated patients could eat most or all solids (P less than 0.05). For long-term palliation, laser-treated patients required on average more procedures (4.6 vs. 1.4; P less than 0.05) and days in the hospital (14 vs. 9; P less than 0.05). The perforation rate was lower in the laser-treated group (2% vs. 13%; P less than 0.02); no treatment-related deaths occurred in either group. For individual patients, the best results are likely to be achieved when the two techniques are used in a complementary fashion in specialist centers. PMID:1707386

  8. Cap-assisted retrograde single-balloon enteroscopy results in high terminal ileal intubation rate

    PubMed Central

    Dufault, Darin L.; Brock, Andrew S.

    2016-01-01

    Background and study aims: Retrograde single-balloon enteroscopy (RSBE) facilitates evaluation of the distal small bowel and provision of appropriate therapy when necessary. Intubation of the terminal ileum (TI) is a major rate-limiting step, with failure rates as high as 30 %. Cap-assisted endoscopy has proven beneficial in other aspects of endoscopy. We have noticed that it similarly aids in TI intubation during RSBE by facilitating opening of the ileocecal valve (ICV). The primary aim of this study was to measure the TI intubation rate using cap-assisted RSBE. Other procedural details and outcomes were also measured. Patients and methods: A total of 36 consecutive RSBEs performed between July 2011 and May 2014 at the Medical University of South Carolina were retrospectively reviewed. All procedures were performed or supervised by our center’s small bowel endoscopist (ASB). Outcomes measured included TI intubation rate, procedure time, depth of maximal insertion (DMI), diagnostic yield (DY), therapeutic yield (TY), and complications. Results: The TI intubation rate was 97 % (35 /36). The one failure was due to stool completely obscuring the cecum. Median procedure time was 54 minutes, with a mean DMI of 68 cm beyond the ICV. The technical success rate was 86 %, whereas DY and TY were 61 % and 25 %, respectively. There were no complications. The study was limited in that it involved a single endoscopist at a single center. Conclusions: Cap-assisted RSBE results in a high TI intubation rate, without compromise to safety or procedural yield. PMID:26878050

  9. A comparison of the BURP and conventional and modified jaw thrust manoeuvres for orotracheal intubation using the Clarus Video System.

    PubMed

    Lee, A R; Yang, S; Shin, Y H; Kim, J A; Chung, I S; Cho, H S; Lee, J J

    2013-09-01

    We evaluated the effects of three airway manipulation manoeuvres: (a) conventional (single-handed chin lift); (b) backward, upward and right-sided pressure (BURP) manoeuvre; and (c) modified jaw thrust manoeuvre (two-handed aided by an assistant) on laryngeal view and intubation time using the Clarus Video System in 215 patients undergoing general anaesthesia with orotracheal intubation. In the first part of this study, the laryngeal view was recorded as a modified Cormack-Lehane grade with each manoeuvre. In the second part, intubation was performed using the assigned airway manipulation. The primary outcome was the time to intubation, and the secondary outcomes were the modified Cormack-Lehane grade, the number of attempts and the overall success rate. There were significant differences in modified Cormack-Lehane grade between the three airway manipulations (p < 0.0001). Post-hoc analysis indicated that the modified jaw thrust improved the laryngeal view compared with the conventional (p < 0.0001) and the BURP manoeuvres (p < 0.0001). The BURP worsened the laryngeal view compared with the conventional manoeuvre (p = 0.0132). The time to intubation in the modified jaw thrust group was shorter than with the conventional manoeuvre (p = 0.0004) and the BURP group (p < 0.0001). We conclude that the modified jaw thrust is the most effective manoeuvre at improving the laryngeal view and shortening intubation time with the Clarus Video System. PMID:23841798

  10. 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

  11. A Climate for Academic Success: How School Climate Distinguishes Schools That Are Beating the Achievement Odds. Full Report

    ERIC Educational Resources Information Center

    Voight, Adam; Austin, Gregory; Hanson, Thomas

    2013-01-01

    This report, written by WestEd's Adam Voight, Gregory Austin, and Thomas Hanson, describes a study that examines what makes successful schools different from other schools. Rather than define success in absolute terms, this study's definition is based on whether or not a school is performing better than predicted given the characteristics of the…

  12. A Canonical Analysis of Successful and Unsuccessful High Schools: Accommodating Multiple Sources of Achievement Data in School Leadership

    ERIC Educational Resources Information Center

    Knoeppel, Robert C.; Rinehart, James S.

    2010-01-01

    What distinguishes successful schools from unsuccessful schools? This question has relevance for the practice of educational leadership as well as the preparation of leaders. Successful schools are led by principals who set the direction and influence student learning, and who change the instructional process by focusing deliberately on teaching…

  13. A Climate for Academic Success: How School Climate Distinguishes Schools That Are Beating the Achievement Odds. Report Summary

    ERIC Educational Resources Information Center

    Voight, Adam; Austin, Gregory; Hanson, Thomas

    2013-01-01

    This report, written by WestEd's Adam Voight, Gregory Austin, and Thomas Hanson, describes a study that examines what makes successful schools different from other schools. Rather than define success in absolute terms, this study's definition is based on whether or not a school is performing better than predicted given the characteristics of the…

  14. Beginning Mathematics Teachers from Alternative Certification Programs: Their Success in the Classroom and How They Achieved It

    ERIC Educational Resources Information Center

    Ham, Edward

    2011-01-01

    This dissertation focuses on beginning mathematics teachers from alternative certification programs and their perceptions of what is required to be successful. A mixed-methods research study was completed with several goals in mind: (1) identifying how beginning mathematics teachers define success in the classroom during their earliest years, (2)…

  15. Randomised controlled trial comparing the Ambu® aScope™2 with a conventional fibreoptic bronchoscope in orotracheal intubation of anaesthetised adult patients.

    PubMed

    Chan, J K; Ng, I; Ang, J P; Koh, S M; Lee, K; Mezzavia, P; Morris, J; Loh, F; Segal, R

    2015-07-01

    Fibreoptic intubation remains an essential skill for anaesthetists to master. In addition to the reusable fibrescope, an alternative disposable videoscope is available (aScope(™)2, Ambu®, Ballerup, Denmark). A total of 60 anaesthetised adult patients were randomised to either having orotracheal intubation using the aScope 2 or a Karl Storz fibrescope. Intubations were performed by experienced operators who were familiar with both devices. The primary outcome was the Global Rating Scale score. Secondary outcomes included intubation success, number of intubation attempts and intubation time. Other subjective outcomes including practicality, useability and image quality were also recorded. There was no significant difference in the Global Rating Scale score, intubation success orintubation time between the aScope 2 or Karl Storz fibrescope. Global Rating Scale scores were three and two in the aScope 2 and Karl Storz groups respectively (P=0.14). All of the other subjective outcomes were similar between the two groups, except that operators found it easier to use the aScope 2 compared to the fibrescope. There was no significant difference in clinical performance between the aScope 2 and the Karl Storz fibreoptic bronchoscope. The aScope's practicality, disposability and recently improved version (aScope(™)3) potentially make it an acceptable alternative to the reusable fibrescope. PMID:26099760

  16. Bright and Beautiful: High Achieving Girls, Ambivalent Femininities, and the Feminization of Success in the Primary School

    ERIC Educational Resources Information Center

    Renold, Emma; Allan, Alexandra

    2006-01-01

    This paper refocuses attention on and problematizes girls' experiences of school achievement and the construction of schoolgirl femininities. In particular, it centres on the relatively neglected experiences and identity work of high achieving primary school girls. Drawing upon ethnographic data (observations, interviews, and pupil diaries) from a…

  17. A Reflection on Adaptability, Achievement Motivation and Success of Central and Eastern European Students in One English University

    ERIC Educational Resources Information Center

    Jankowska, Maja

    2011-01-01

    This article reflects on and discusses Central and Eastern European (CEE) learners' adaptability and achievement in one English post-1992 university. There appears to be a scarcity of studies of values, beliefs, attitudes and needs as well as achievement (and factors contributing to it) between CEE and other learners. Since the expansion of the…

  18. The use of the Airtraq® optical laryngoscope for routine tracheal intubation in high-risk cardio-surgical patients

    PubMed Central

    2011-01-01

    Background The Airtraq® optical laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel disposable device facilitating tracheal intubation in routine and difficult airway patients. No data investigating routine tracheal intubation using the Airtaq® in patients at a high cardiac risk are available at present. Purpose of this study was to investigate the feasibility and hemodynamic implications of tracheal intubation with the Aitraq® optical laryngoscope, in high-risk cardio-surgical patients. Methods 123 consecutive ASA III patients undergoing elective coronary artery bypass grafting were routinely intubated with the Airtraq® laryngoscope. Induction of anesthesia was standardized according to our institutional protocol. All tracheal intubations were performed by six anesthetists trained in the use of the Airtraq® prior. Results Overall success rate was 100% (n = 123). All but five patients trachea could be intubated in the first attempt (95,9%). 5 patients were intubated in a 2nd (n = 4) or 3rd (n = 1) attempt. Mean intubation time was 24.3 s (range 16-128 s). Heart rate, arterial blood pressure and SpO2 were not significantly altered. Minor complications were observed in 6 patients (4,8%), i.e. two lesions of the lips and four minor superficial mucosal bleedings. Intubation duration (p = 0.62) and number of attempts (p = 0.26) were independent from BMI and Mallampati score. Conclusion Tracheal intubation with the Airtraq® optical laryngoscope was feasible, save and easy to perform in high-risk patients undergoing cardiac surgery. In all patients, a sufficient view on the vocal cords could be obtained, independent from BMI and preoperative Mallampati score. Trial Registration DRKS 00003230 PMID:22011403

  19. 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

  20. Achievement Emotions as Predictors of High School Science Success Among African-American and European American Students

    NASA Astrophysics Data System (ADS)

    Bowe, Marilyn Louise Simmons

    The literature includes few studies of the interrelations of achievement goals and achievement emotions with respect to minority students and science achievement. The objective of this study was to test the control-value theory (CVT) of achievement emotions to determine if the eight discrete achievement emotions would be predictive of test scores on the High School Graduation Test (GHSGT)-Science for African-American compared to European-American science students. Convenience cluster sampling was employed to select 160 students who were all juniors in the same public high school at the time that they took the GHSGT-Science. The central research question for this study aimed to uncover whether any of the eight achievement emotions identified in CVT would contribute significantly to the predictability of science achievement as measured by GHSGT-Science scores. Data were collected using a nonexperimental, cross sectional design survey. Data were analyzed using a hierarchal, forced entry, multiple regression analysis. Key results indicated that the eight achievement emotions were predictive of GHSGT-Science score outcomes. Positive social change at the individual level could reflect a boost in confidence for African American science students and help decrease the achievement gap in science, technology, engineering, and mathematics (STEM) endeavors between European Americans and African-American students. Educators may consider the importance of achievement emotions in science outcomes by including social emotional learning (SEL) as a part of the regular science curriculum. Future researchers should repeat the study in a school district where the population is available to support the desired cluster sample of equal parts European Americans to African Americans and male to female students.

  1. 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

  2. AIRTRAQ8 OPTICAL LARYNGOSCOPE FOR TRACHEAL INTUBATION IN A PATIENT WITH AN UNCOMMON GIANT LIPOMA ON THE POSTERIOR ASPECT OF NECK AND ADDITIONAL RISK FACTORS OF ANTICIPATED DIFFICULT AIRWAY: A CASE REPORT.

    PubMed

    Dimitriou, Vassilios; El Kouny, Amr; Al Harbi, Mohammed; Wambi, Freddie; Tawfeeq, Nasser; Tanweer, Aziz; Al Atassi, Abdulallem; Geldhof, Georges

    2015-10-01

    Patients with restricted neck movement present a difficult airway situation because of improper positioning and inadequate extension of the atlanto-occipital joint. The Airtraq optical laryngoscope is a new single use device that permits an indirect view of the glottis without the need to achieve a direct line of sight by conventional use of the 'sniffing position'. We present and discuss a case of uncommon giant lipoma (16 x 12 x 10 cm) in the posterior aspect of the neck in addition with other independent factors of anticipated difficult airway, intubated successfully in the semi-lateral position with the use of Airtraq. PMID:26860029

  3. 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

  4. 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

  5. Submental/Transmylohyoid Route for Endotracheal Intubation in Maxillofacial Surgical Procedures: A Review

    PubMed Central

    Prakash, V Jeevan; Chakravarthy, Chitra; Attar, Abdul Hameed

    2014-01-01

    Patients with severe panfacial injuries usually require long-term airway management. Nasal intubation may be contraindicated in case of nasoorbitoethmoidal fractures and also there may be a need for intraoperative and short-term postoperative intermaxillary fixation to achieve optimum reduction of fractures. The need for unobstructed access to the perinasal area during bimaxillary orthognathic procedures is felt many a time and to avoid a tracheostomy with its attending morbidity, many techniques have evolved that involve a submandibular/transmylohyoid or submental approach for temporary oroendotracheal intubation. In this article, we present our experience of patients by using submental/transmylohyoid route for endotracheal intubation. technique gives the surgeon and the anesthetist comfortable control over their respective domains, is easy to learn and implement in the operating protocol with no added costs. How to cite the article: Prakash VJ, Chakravarthy C, Attar AH. Submental/transmylohyoid route for endotracheal intubation in maxillofacial surgical procedures: A review. J Int Oral Health 2014;6(3):125-8. PMID:25083048

  6. The Relationship of Home-Career Conflict, Fear of Success, and Sex-Role Orientation to Achievement and Career Motivation Given Different Levels of Perceived Environmental Support.

    ERIC Educational Resources Information Center

    Farmer, Helen S.

    The purpose of the study was to investigate the relationship between Home-Career (H-C) conflict, Fear of success (FOS), achievement (n Ach) and Career motivation (CM) for women of differing sex role orientations. In addition, measures of self-esteem, risk-taking, perceived community support and early socialization were obtained. A positive…

  7. Achieving the Dream in Connecticut: State Policies Affecting Access to, and Success in, Community Colleges for Students of Color and Low-Income Students

    ERIC Educational Resources Information Center

    Dougherty, Kevin J.; Reid, Monica

    2006-01-01

    This report provides an audit of state policies in Connecticut affecting access to, and success in, community colleges for students of color and low-income students. It was commissioned by Lumina Foundation for Education as part of a series of policy audits of the states involved in Achieving the Dream. Lumina Foundation is the primary funder of…

  8. Achieving the Dream in Ohio: State Policies Affecting Access to, and Success in, Community Colleges for Students of Color and Low-Income Students

    ERIC Educational Resources Information Center

    Dougherty, Kevin J.; Marshall, James; Soonachan, Andrea

    2006-01-01

    This report provides an audit of state policies in Ohio affecting access to, and success in, community colleges for students of color and low-income students. It was commissioned by Lumina Foundation for Education as part of a series of policy audits of the states involved in Achieving the Dream. Lumina Foundation is the primary funder of the…

  9. Using School Reform Models to Improve Reading Achievement: A Longitudinal Study of Direct Instruction and Success for All in an Urban District

    ERIC Educational Resources Information Center

    Ross, Steven M.; Nunnery, John A.; Goldfeder, Elizabeth; McDonald, Aaron; Rachor, Robert; Hornbeck, Matthew; Fleischman, Steve

    2004-01-01

    This research examined the effectiveness in an urban school district of 2 of the most widely used Comprehensive School Reform (CSR) programs-Direct Instruction (DI), implemented in 9 district elementary schools, and Success for All (SFA), implemented in 2 elementary schools. In examining impacts on student achievement and school change outcomes…

  10. I Know Who I Am, Do You?: Identity and Academic Achievement of Successful African American Male Adolescents in an Urban Pilot High School in the United States

    ERIC Educational Resources Information Center

    Wright, Brian L.

    2011-01-01

    This study explores racial-ethnic identity and academic achievement of five young African American men in 11th and 12th grade in an urban pilot high school. Data gathered through individual and group interviews and a questionnaire were analyzed to understand how academically successful African American male adolescents interpret their social and…

  11. The Impact of Interpersonal Interaction on Academic Engagement and Achievement in a College Success Strategies Course with a Blended Learning Instructional Model

    ERIC Educational Resources Information Center

    Mosser, Brent Steven

    2010-01-01

    A quasi-experiment was carried out in a college success strategies course to evaluate the impact of structured interpersonal interaction on undergraduate students' Academic Engagement and Academic Achievement. The course, EPL 259: Individual Learning and Motivation, employs a blended learning instructional model that requires students to spend the…

  12. The Impacts of Success for All on Reading Achievement in Grades 3-5: Does Intervening during the Later Elementary Grades Produce the Same Benefits as Intervening Early?

    ERIC Educational Resources Information Center

    Hanselman, Paul; Borman, Geoffrey D.

    2013-01-01

    We evaluate the impact of Success for All literacy instruction in grades 3 through 5 using data from the same cluster randomized trial used to evaluate effects in the earlier grades (K-2). In contrast to the early benefits, there is no effect on reading achievement in the later grades, either overall or for students and schools with high or low…

  13. School Improvement in Petersburg: A Comprehensive Three-Year Study of the Partnership for Achieving Successful Schools Initiative Model IV Intervention. Final Evaluation Report

    ERIC Educational Resources Information Center

    Edwards, Joanna; Smith, Karen; Marr, Linda; Wyshynski, Laura

    2005-01-01

    Dr. Jo Lynne DeMary, Virginia's state superintendent of public instruction, requested that the Appalachia Educational Laboratory at Edvantia work in partnership with the Virginia Department of Education and Petersburg City Schools to design and test the Partnership for Achieving Successful Schools Initiative (PA+SS) Model IV Intervention. The goal…

  14. Addressing Achievement Gaps: Advancing Success for Black Men in College. Policy Notes. Volume 22, Number 1, Spring 2015

    ERIC Educational Resources Information Center

    Yaffe, Deborah

    2015-01-01

    This issue of ETS Policy Notes (Vol. 22, No. 1) provides highlights from a recent symposium sponsored by ETS and the Children Defense Fund (CDF), "Advancing Success for Black Men in College," held on June 23, 2014, in Washington, DC. The symposium is part of a two-conference series: It was the 18th of ETS's "Addressing Achievement…

  15. A Methodology to Assist Faculty in Developing Successful Approaches for Achieving Learner Centered Information Systems Curriculum Outcomes: Team Based Methods

    ERIC Educational Resources Information Center

    Wagner, Teresa A.; Longenecker, Herbert E., Jr.; Landry, Jeffrey P.; Lusk, C. Scott; Saulnier, Bruce M.

    2008-01-01

    All industries face the interrelated challenges of identifying and training the critical skills needed to be successful in the workplace. Specifically of interest to the information systems field is that any newly trained IS professional has to be equipped to solve increasingly difficult problems with great confidence and competence. In this paper…

  16. How to Survive and Prosper in the Real World after Graduation: An Unconventional Approach to Achieving Your Success.

    ERIC Educational Resources Information Center

    Connors, Shawn M.

    Unconventional advice to help college graduates be successful is offered. Ways to find sources of money (i.e., jobs) are described, including: using services or products offered through the mail, making phone calls to build a network of contacts in a particular industry, attending seminars to further one's knowledge of a field, learning about…

  17. "If You Can Dream It, You Can Achieve It." Parent Memorable Messages as Indicators of College Student Success

    ERIC Educational Resources Information Center

    Kranstuber, Haley; Carr, Kristen; Hosek, Angela M.

    2012-01-01

    This study investigated various aspects of parents' memorable messages about college as they relate to indicators of college student success. Findings revealed that parents' memorable messages about college focused on working (and playing) hard, the necessity of attending college, providing encouragement and support, and general advice based on…

  18. Report on Workstation Uses: Effects of Success for All on the Reading Achievement of First Graders in California Bilingual Programs.

    ERIC Educational Resources Information Center

    Dianda, Marcella R.; Flaherty, John F.

    A study assessed the effectiveness of the Success for All Program for grade-one English-as-a-Second-Language (ESL) learners in bilingual or ESL programs in three California elementary schools. The reading instruction program provides both native (in this case, Spanish) language support as well as English language instruction and materials. The…

  19. Effects of Resource Allocation on Student Academic Achievement and Self-Perceptions of Success in an Urban Setting

    ERIC Educational Resources Information Center

    Harris, Kimberly

    2014-01-01

    Civil Rights legislation, now 50 years old, "de facto" segregation based on socioeconomic factors, such as poverty and ethnicity in urban areas translates into the surrounding schools, with a legacy of limited funding, reduced services, and teachers with limited training to successfully engage students in high poverty areas. This study…

  20. Giving Students a Chance to Achieve: Getting Off to a Fast and Successful Start in Grade Nine

    ERIC Educational Resources Information Center

    Bottoms, Gene; Timberlake, Allison

    2007-01-01

    Students who successfully complete grade nine are substantially more likely to graduate from high school than are students who fail the freshman year. However, many middle grades students are not academically prepared for ninth grade. This report addresses five questions that can help school leaders ensure that middle grades students know the…

  1. Syntheses of Research and Practice: Implications for Achieving Schooling Success for Children at Risk. Publication Series #93-5.

    ERIC Educational Resources Information Center

    Alves-Zervos, K. L., Ed.; Shafer, J. R., Ed.

    This six-article document examines the research base that can be used in formulating plans to improve the chances of schooling success for all students. Each article summarizes well-confirmed knowledge in a particular area, giving attention first to the research literature, and then to the tested experiences and practices of leading professionals.…

  2. Picturing Success: Young Femininities and the (Im)Possibilities of Academic Achievement in Selective, Single-Sex Education

    ERIC Educational Resources Information Center

    Allan, Alexandra

    2010-01-01

    Over the last decade it is young women who have come to be widely understood as the bearers of educational qualifications. It is girls who are now seen to have "the world at their feet" and to be able to attain the glittering prizes of academic success associated with elite universities and top occupations. And it is upper-middle-class girls, in…

  3. Interdisciplinary collaboration: the slogan that must be achieved for models of delivering critical care to be successful.

    PubMed

    Irwin, Richard S; Flaherty, Helen M; French, Cynthia T; Cody, Shawn; Chandler, M Willis; Connolly, Ann; Lilly, Craig M

    2012-12-01

    There is wide acceptance of the concept that interdisciplinary collaboration is an essential building block for successful health-care teams. This belief is grounded in our understanding of how teams function to address complex care needs that change with acute illness or injury. This general agreement has been validated in studies that have reported favorable outcomes associated with successfully implementing interdisciplinary models of health-care delivery in non-critical care settings. The very short time frames over which the care needs of critically ill or injured adults change and the team approach taken by nearly all ICUs strongly suggest that interdisciplinary collaboration is also beneficial in this setting. In this commentary, we define interdisciplinary collaboration and share the story of how we successfully redesigned and transformed our system-wide, interdisciplinary collaborative model for delivering critical care in order to share the lessons we learned as the process evolved with those who are about to embark on a similar challenge. We anticipate that those health-care systems that successfully implement interdisciplinary collaboration will be ahead of the curve in providing high-quality care at as low a cost as possible. Such institutions will also potentially be better positioned for improving teaching and providing a better foundation for critical care research in their institutions. PMID:23208334

  4. Determining Minimum Cognitive Scores for the First-Time Academic Achievement Success on the Education Doctoral Comprehensive Examination

    ERIC Educational Resources Information Center

    Cavil, Jafus Kenyatta

    2009-01-01

    This purpose of the present study was to estimate minimum admission requirements using cognitive measures that will maximize candidate success on the doctoral comprehensive examination. Moreover, the present study established minimum scores on the Graduate Record Examinations (verbal and quantitative components) that will maximize doctoral student…

  5. A Validation Study of the Planning, Attention, Simultaneous, and Successive (PASS) Theory and Its Relationship to Reading Achievement in Adults

    ERIC Educational Resources Information Center

    Walker, Justin Moore

    2010-01-01

    This study set out to determine if the Planning, Attention, Simultaneous, Successive (PASS) cognitive processing model, a model previously investigated with children, would hold its factorial structure with adults. A collection of PASS experimental tasks were analyzed through Maximum Likelihood Factor Analysis. A four-factor solution consistent…

  6. Dressed for Success? The Effect of School Uniforms on Student Achievement and Behavior. NBER Working Paper No. 17337

    ERIC Educational Resources Information Center

    Gentile, Elisabetta; Imberman, Scott A.

    2011-01-01

    Uniform use in public schools is rising, but we know little about how they affect students. Using a unique dataset from a large urban school district in the southwest United States, we assess how uniforms affect behavior, achievement and other outcomes. Each school in the district determines adoption independently, providing variation over schools…

  7. The Effect of Poverty on the Achievement of Urban African American Male Students Successfully Completing High School

    ERIC Educational Resources Information Center

    Welch, Amy L.

    2013-01-01

    The purpose of this study was to determine the impact of poverty on the achievement of African American male high school students attending the same large Midwest urban school district. Cumulative grade point average (GPA) at the tenth grade level were compared to the level of poverty provided through census data of African American male tenth…

  8. Striving for Success: A Qualitative Exploration of Competing Theories of High-Achieving Black College Students' Academic Motivation

    ERIC Educational Resources Information Center

    Griffin, Kimberly

    2006-01-01

    Research on the academic performance of Black students has focused on low-achievers, framing their academic motivation as maladaptive and driven by externally (e.g., competition or compliance) rather than internally (e.g., love of learning) generated forces. This qualitative study challenges this mono-dimensional deficit framework, examining the…

  9. A Positive Psychological Viewpoint for Success at School--10 Characteristic Strengths of the Finnish High-Achieving Students

    ERIC Educational Resources Information Center

    Salmela, Mari; Uusiautti, Satu

    2015-01-01

    People who exploit their strengths flourish; they are not only engaged with their goals, but also to their well-being and the content of life. In this study, interest focused on the high-achieving students in the Finnish general upper secondary education, in other words, on straight-A graduates' characteristic strengths. This was a narrative study…

  10. Challenge and Success: A Qualitative Study of the Career Development of Highly Achieving Women With Physical and Sensory Disabilities

    ERIC Educational Resources Information Center

    Noonan, Brigid M.; Gallor, Susanna M.; Hensler-McGinnis, Nancy F.; Fassinger, Ruth E.; Wang, Shihwe; Goodman, Jennifer

    2004-01-01

    This qualitative study examined the career development experiences of 17 highly achieving women with physical and sensory disabilities. Interviews were conducted and data were analyzed using modified grounded theory strategies (A. L. Strauss & J. Corbin, 1998). The emergent theoretical model was conceptualized as a system of influences organized…

  11. A Successful Application of Latent Trait Theory to Tailored Achievement Testing. Research Report No. 80-1.

    ERIC Educational Resources Information Center

    McKinley, Robert L.; Reckase, Mark D.

    A live tailored achievement testing study was conducted to compare procedures based on the one- and three-parameter logistic models. Previous studies yielded inconclusive results because of the procedures by which item calibrations were linked and because of the item selection procedures. Using improved procedures, 83 college students were tested…

  12. Achieving Business Success by Developing Clients and Community: Lessons from Leading Companies, Emerging Economies and a Nine Year Case Study

    ERIC Educational Resources Information Center

    Bernardez, Mariano

    2005-01-01

    Empirical evidence and recent revisions of conventional business doctrine indicate that companies that actively promote social performance and develop their clients' markets and skills as part of business strategy have a better chance of achieving sustainable profitability and growth than those that do not. This article discusses how landmark…

  13. Early Reading Success and Its Relationship to Reading Achievement and Reading Volume: Replication of "10 Years Later"

    ERIC Educational Resources Information Center

    Sparks, Richard L.; Patton, Jon; Murdoch, Amy

    2014-01-01

    Cunningham and Stanovich reported a longitudinal investigation over 10 years that examined the unique influence of exposure to print in explaining individual differences on various measures of reading achievement and declarative (general) knowledge. The present study replicated their investigation with a larger number of participants and…

  14. Daily Practices Elementary Principals Utilize to Increase Student Reading Achievement: A Case Study of Successful Michigan Elementary Schools

    ERIC Educational Resources Information Center

    Johnson, Susan L.

    2010-01-01

    This case study examined three K-5 schools, one 3-5 school, and two K-2 schools that implemented Michigan's Behavior and Learning Support Initiative (MiBLSi) and showed improvement trends in third grade reading achievement as measured by MEAP results over four years. Each of the six schools completed the three years of MiBLSi training and are…

  15. A Phenomenological Investigation of Student Achievement: Perceptions of Academic Success as Told by Single African American and Hispanic Mothers

    ERIC Educational Resources Information Center

    Stewart, Shawn M.

    2010-01-01

    A number of factors seem to contribute to low student achievement in the organization of education. Some of these factors exist prior to children reaching school age. It seems as though a vast quantity of minority students struggle academically. Research supports the belief that socioeconomic status, ethnicity, and single-parent families have an…

  16. Drivers of Success: One District's Process for Closing Achievement Gaps in a Post-No Child Left Behind Context

    ERIC Educational Resources Information Center

    O'Doherty, Ann; Ovando, Martha N.

    2009-01-01

    In this original qualitative study, we examined the processes employed by a school district that had made progress in closing achievement gaps in a post-No Child Left Behind context. The district served more than 26,000 students in an economically and ethnically diverse community. Secondary analysis of the findings uncovered a primary…

  17. Explaining the Success of High-Achieving 2nd-Generation Latino Students at Elite Colleges and Universities

    ERIC Educational Resources Information Center

    Kula, Stacy M.

    2013-01-01

    Latinos represent the largest minority population in the US, yet are one of the most underserved groups in the educational system. As such, they have been the focus of much attention by educational researchers. However, there is little work enabling researchers to understand how many factors might interactively support achievement. Moreover, the…

  18. The Mayor's Plan for Achieving Success in the DCPS: Is the Implementation Likely to Match the Vision?

    ERIC Educational Resources Information Center

    Council of the Great City Schools, 2007

    2007-01-01

    The Mayor Adrian Fenty's achievement plan for the District of Columbia Public Schools (DCPS) is divided into four major parts. The first section outlines the philosophical foundation undergirding the plan. The second section outlines the plan's goals and strategies. In preparing this commentary, the Council of the Great City Schools assessed how…

  19. [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

  20. A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fiberoptic nasotracheal intubation: A randomized controlled study

    PubMed Central

    Sinha, Sunil Kumar; Joshiraj, Bandi; Chaudhary, Lalita; Hayaran, Nitin; Kaur, Manpreet; Jain, Aruna

    2014-01-01

    Background and Aims: We designed a study to compare the effectiveness of dexmedetomidine plus ketamine combination with dexmedetomidine alone in search of an ideal sedation regime, which would achieve better intubating conditions, hemodynamic stability, and sedation for awake fiberoptic nasotracheal intubation. Materials and Methods: A total of 60 adult patients of age group 18-60 years with American Society of Anesthesiologists I and II posted for elective surgery under general anesthesia were randomly divided into two groups of 30 each in this prospective randomized controlled double-blinded study. Groups I and II patients received a bolus dose of dexmedetomidine at 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. Upon completion of the dexmedetomidine bolus, Group I patients received 15 mg of ketamine and an infusion of ketamine at 20 mg/h followed by awake fiberoptic nasotracheal intubation, while Group II patients upon completion of dexmedetomidine bolus received plain normal saline instead of ketamine. Hemodynamic variables like heart rate (HR) and mean arterial pressure (MAP), oxygen saturation, electrocardiogram changes, sedation score (modified Observer assessment of alertness/sedation score), intubation score (vocal cord movement and coughing), grimace score, time taken for intubation, amount of lignocaine used were noted during the course of study. Patient satisfaction score and level of recall were assessed during the postoperative visit the next day. Results: Group I patients maintained a stable HR and MAP (<10% fall when compared with the baseline value). Sedation score (3.47 vs. 3.93) and patient satisfaction score were better in Group I patients. There was no significant difference in intubation scores, grimace scores, oxygen saturation and level of recall when compared between the two groups (P > 0.05). Conclusion: The use of dexmedetomidine plus ketamine combination in awake fiberoptic nasotracheal

  1. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

    PubMed Central

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-01-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how

  2. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics.

    PubMed

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-11-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to

  3. 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

  4. 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

  5. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail.

    PubMed

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured. PMID:26240555

  6. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail

    PubMed Central

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured. PMID:26240555

  7. Endotracheal intubation using i-gel® and lightwand in a patient with difficult airway: a case report

    PubMed Central

    Choi, Chun Gil; Yang, Ki-Hwan; Jung, Jong-Kwon; Han, Jeong Uk; Lee, Choon Soo; Cha, Young-Deog

    2015-01-01

    This case report involves tracheal intubation using i-gel® in combination with a lightwand in a patient with a difficult airway, classified as Cormack-Lehane grade 3. I-gel® was used during anesthesia induction to properly maintain ventilation. The authors have previously reported successful tracheal intubation on a patient with a difficult airway through the use of i-gel® and a fiberoptic bronchoscope. However, if the use of a fiberoptic bronchoscope is not immediately available in a patient with a difficult airway, tracheal intubation may be performed by using i-gel® and a lightwand in a patient with difficult airway, allowing the safe induction of anesthesia. PMID:26495062

  8. 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

  9. 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

  10. 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

  11. Successful management of H1N1 related severe acute respiratory distress syndrome with noninvasive positive pressure ventilation

    PubMed Central

    Mohamed, Abdulla Ismaeel; Chaari, Anis; Abulfateh, Fatima N.; Alshaikh, Khalid A.; Casey, William Francis

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a life threatening complication of H1N1 pneumonia. According to the Berlin conference guidelines, severe ARDS requires management with early invasive mechanical ventilation. Whether noninvasive positive pressure ventilation (NIPPV) should be attempted in patients with H1N1 pneumonia is still a matter of debate. We report the case of one patient with severe ARDS without other organ failure. The patient was managed successfully using NIPPV. Endotracheal intubation was avoided and the patient was discharged from the intensive care unit (ICU) after 10 days with a successful outcome. NIPPV can be useful in patients with isolated severe H1N1 ARDS provided early improvement of the oxygenation parameters is achieved. Patients with multiple organ failure or with persistent severe hypoxemia under noninvasive ventilation should be electively intubated and started on invasive mechanical ventilation. PMID:27275488

  12. Faculty and student perceptions of the success of a hybrid-PBL dental curriculum in achieving curriculum reform benchmarks.

    PubMed

    Whitney, Eli M; Walton, Joanne N

    2010-12-01

    The dental education literature identifies eleven benchmark reform agenda curriculum qualities. The purpose of this study was to determine the extent to which the University of British Columbia D.M.D. curriculum was perceived by students and faculty as achieving these benchmarks and to note any differences in perceptions within and between the student and faculty groups. A WebEval survey consisting of twenty-one questions was delivered online in November 2007 to faculty members and D.M.D. students. The response rate was similar (~60 percent) for both students and faculty members. Comparisons were made between faculty members and students as well as within each group. For the faculty, we looked at the influence of appointment, focus, and teaching experience. For students, we looked at the influence of the year in the program, gender, and program track. Some differences (p<0.05) were identified within the faculty and student groups; however, there were many more differences between the faculty and the students, especially in areas related to curriculum redesign, collaborations with other health professions, preparation for independent practice, and creating a trust-based clinic environment. Faculty members were more optimistic about curriculum progress than were students. Improved communication of curriculum goals and explicit efforts at creating a safe and supportive learning environment could diminish these differences over time. PMID:21123500

  13. An analysis of predictors of enrollment and successful achievement for girls in high school Advanced Placement physics

    NASA Astrophysics Data System (ADS)

    Depalma, Darlene M.

    A problem within science education in the United States persists. U.S students rank lower in science than most other students from participating countries on international tests of achievement (National Center for Education Statistics, 2003). In addition, U.S. students overall enrollment rate in high school Advanced Placement (AP) physics is still low compared to other academic domains, especially for females. This problem is the background for the purpose of this study. This investigation examined cognitive and motivational variables thought to play a part in the under-representation of females in AP physics. Cognitive variables consisted of mathematics, reading, and science knowledge, as measured by scores on the 10th and 11th grade Florida Comprehensive Assessment Tests (FCAT). The motivational factors of attitude, stereotypical views toward science, self-efficacy, and epistemological beliefs were measured by a questionnaire developed with questions taken from previously proven reliable and valid instruments. A general survey regarding participation in extracurricular activities was also included. The sample included 12th grade students from two high schools located in Seminole County, Florida. Of the 106 participants, 20 girls and 27 boys were enrolled in AP physics, and 39 girls and 20 boys were enrolled in other elective science courses. Differences between males and females enrolled in AP physics were examined, as well as differences between females enrolled in AP physics and females that chose not to participate in AP physics, in order to determine predictors that apply exclusively to female enrollment in high school AP physics and predictors of an anticipated science related college major. Data were first analyzed by Exploratory Factor Analysis, followed by Analysis of Variance (ANOVA), independent t-tests, univariate analysis, and logistic regression analysis. One overall theme that emerged from this research was findings that refute the ideas that

  14. [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

  15. 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

  16. Intubation performance using different laryngoscopes while wearing chemical protective equipment: a manikin study

    PubMed Central

    Schröder, H; Zoremba, N; Rossaint, R; Deusser, K; Stoppe, C; Coburn, M; Rieg, A; Schälte, G

    2016-01-01

    Objectives This study aimed to compare visualisation of the vocal cords and performance of intubation by anaesthetists using four different laryngoscopes while wearing full chemical protective equipment. Setting Medical simulation center of a university hospital, department of anaesthesiology. Participants 42 anaesthetists (15 females and 27 males) completed the trial. The participants were grouped according to their professional education as anaesthesiology residents with experience of <2 years or <5 years, or as anaesthesiology specialists with experience of >5 years. Interventions In a manikin scenario, participants performed endotracheal intubations with four different direct and indirect laryngoscopes (Macintosh (MAC), Airtraq (ATQ), Glidescope (GLS) and AP Advance (APA)), while wearing chemical protective gear, including a body suit, rubber gloves, a fire helmet and breathing apparatus. Primary and secondary outcome measures With respect to the manikin, setting time to complete ‘endotracheal intubation’ was defined as primary end point. Glottis visualisation (according to the Cormack-Lehane score (CLS) and impairments caused by the protective equipment, were defined as secondary outcome measures. Results The times to tracheal intubation were calculated using the MAC (31.4 s; 95% CI 26.6 to 36.8), ATQ (37.1 s; 95% CI 28.3 to 45.9), GLS (35.4 s; 95% CI 28.7 to 42.1) and APA (23.6 s; 95% CI 19.1 to 28.1), respectively. Intubation with the APA was significantly faster than with all the other devices examined among the total study population (p<0.05). A significant improvement in visualisation of the vocal cords was reported for the APA compared with the GLS. Conclusions Despite the restrictions caused by the equipment, the anaesthetists intubated the manikin successfully within adequate time. The APA outperformed the other devices in the time to intubation, and it has been evaluated as an easily manageable device for anaesthetists with varying

  17. 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

  18. 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

  19. Examining brain structures associated with the motive to achieve success and the motive to avoid failure: A voxel-based morphometry study.

    PubMed

    Ming, Dan; Chen, Qunlin; Yang, Wenjing; Chen, Rui; Wei, Dongtao; Li, Wenfu; Qiu, Jiang; Xu, Zhan; Zhang, Qinglin

    2016-01-01

    The motive to achieve success (MAS) and motive to avoid failure (MAF) are two different but classical kinds of achievement motivation. Though many functional magnetic resonance imaging studies have explored functional activation in motivation-related conditions, research has been silent as to the brain structures associated with individual differences in achievement motivation, especially with respect to MAS and MAF. In this study, the voxel-based morphometry method was used to uncover focal differences in brain structures related to MAS and MAF measured by the Mehrabian Achieving Tendency Scale in 353 healthy young Chinese adults. The results showed that the brain structures associated with individual differences in MAS and MAF were distinct. MAS was negatively correlated with regional gray matter volume (rGMV) in the medial prefrontal cortex (mPFC)/orbitofrontal cortex while MAF was negatively correlated with rGMV in the mPFC/subgenual cingulate gyrus. After controlling for mutual influences of MAS and MAF scores, MAS scores were found to be related to rGMV in the mPFC/orbitofrontal cortex and another cluster containing the parahippocampal gyrus and precuneus. These results may predict that compared with MAF, the generation process of MAS may be more complex and rational, thus in the real world, perhaps MAS is more beneficial to personal growth and guaranteeing the quality of task performance. PMID:25895120

  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. A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased anesthesiologist discomfort compared to a pillow of 4 cm height during tracheal intubation in adult patients

    PubMed Central

    Hong, Hyo Ju; Kim, Sung Hoon; Hwang, Jung Won; Lee, Hyung Chul

    2016-01-01

    Background Neck flexion by head elevation using an 8 to 10 cm thick pillow and head extension has been suggested to align the laryngeal, pharyngeal and oral axis and facilitate tracheal intubation. Presently, the laryngeal view and discomfort for tracheal intubation were evaluated according to two different degrees of head elevation in adult patients. Methods This prospective randomized, controlled study included 50 adult patients aged 18 to 90 years. After induction of anesthesia, the Cormack Lehane grade was evaluated in 25 patients using a direct laryngoscope while the patient's head was elevated with a 4 cm pillow (4 cm group) and then an 8 cm pillow (8 cm group). In the other 25 patients, the grades were evaluated in the opposite sequence and tracheal intubation was performed. The success rate and anesthesiologist's discomfort score for tracheal intubation, and laryngeal, pharyngeal and oral axes were assessed. Results There were no differences in the laryngeal view and success rate for tracheal intubation between the two groups. The discomfort score during tracheal intubation was higher in the 8 cm group when the patient's head was elevated 4 cm first and then 8 cm. The alignment of laryngeal, pharyngeal and oral axes were not different between the two degrees of head elevation. Conclusions A pillow of 8 cm height did not improve laryngeal view and alignment of airway axes but increased the anesthesiologist discomfort, compared to a pillow of 4 cm height, during tracheal intubation in adult patients. PMID:27066204

  2. 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

  3. 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

  4. Applying SE Methods Achieves Project Success to Evaluate Hammer and Fixed Cutter Grinders Using Multiple Varieties and Moistures of Biomass Feedstock for Ethanol Production

    SciTech Connect

    Larry R. Zirker; Christopher T. Wright, PhD; R. Douglas Hamelin

    2008-06-01

    Applying basic systems engineering (SE) tools to the mission analysis phases of a 2.5-million dollar biomass pre-processing project for the U.S. Department of Energy directly assisted the project principal investigator understand the complexity and identify the gaps of a moving-target project and capture the undefined technical/functional requirements and deliverables from the project team and industrial partners. A creative application of various SE tools by non-aerospace systems engineers developed an innovative “big picture” product that combined aspects of mission analysis with a project functional flow block diagram, providing immediate understanding of the depth and breath of the biomass preprocessing effort for all team members, customers, and industrial partners. The “big picture” diagram became the blue print to write the project test plan, and provided direction to bring the project back on track and achieve project success.

  5. Failed intubation of an unanticipated postintubation tracheal stenosis: a case report.

    PubMed

    Youn, Ann Misun; Yoon, Seok-Hwa; Park, Soo-Yong

    2016-04-01

    Encountering a patient with unanticipated laryngotracheal stenosis (LTS) during anesthetic induction is challenging for an anesthesiologist. Because routine history taking and pre-anesthetic evaluation cannot rule out the possibility of LTS, other measures should be taken. Perioperative airway maintenance is considered crucial for avoiding complications such as airway edema, bleeding, obstruction, collapse, and ultimately respiratory failure and arrest. We report an unanticipated tracheal stenosis discovered during anesthetic induction that hindered endotracheal intubation. Because airway maintenance was difficult, we postponed surgery until determining the cause of the difficult entry, considered possible therapeutic approaches (both anesthetic and surgical), and provided successful surgery with a continuous epidural block. PMID:27064682

  6. Anchor balloons assisted deep intubation of 5F catheters for uncrossable lesions.

    PubMed

    Zhang, S; Xu, K; Yang, N; Li, C

    2016-01-01

    A number of treatment strategies for complex coronary lesions have been utilized in varying clinical settings over the last decade. However, cardiologists still encounter some difficult scenarios such as variant coronary artery origins, severely calcified and highly tortuous lesions. We report four cases in which the stents failed to cross lesions using the conventional percutaneous coronary intervention techniques, but all the target lesions were successfully stented finally using a new combined technique of anchor balloon assisted deep intubation of 5F "child-in-mother" catheter. PMID:27022813

  7. 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.

  8. 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.

  9. Endotracheal intubation under local anesthesia and sedation in an infant with difficult airway

    PubMed Central

    Saxena, Kirti N; Bansal, Parul

    2012-01-01

    Management of the difficult airway in an infant is a challenge for the anesthesiologist. A 10-month-old infant presented to an otolaryngologist with nasopharyngeal mass since birth, which had increased rapidly in size in the last 1 month and was hanging through the cleft palate into the oropharynx. The infant was scheduled for excision of the nasopharyngeal mass through a maxillary approach and the tongue mass through an oral approach under general anesthesia. This case report describes endotracheal intubation performed successfully under sedation and local anesthesia in an infant with a nasal mass protruding through the cleft palate into the oropharynx. PMID:22869945

  10. Failed intubation of an unanticipated postintubation tracheal stenosis: a case report

    PubMed Central

    Park, Soo-Yong

    2016-01-01

    Encountering a patient with unanticipated laryngotracheal stenosis (LTS) during anesthetic induction is challenging for an anesthesiologist. Because routine history taking and pre-anesthetic evaluation cannot rule out the possibility of LTS, other measures should be taken. Perioperative airway maintenance is considered crucial for avoiding complications such as airway edema, bleeding, obstruction, collapse, and ultimately respiratory failure and arrest. We report an unanticipated tracheal stenosis discovered during anesthetic induction that hindered endotracheal intubation. Because airway maintenance was difficult, we postponed surgery until determining the cause of the difficult entry, considered possible therapeutic approaches (both anesthetic and surgical), and provided successful surgery with a continuous epidural block. PMID:27064682

  11. 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

  12. Carrots and Sticks: A Comprehensive Business Model for the Successful Achievement of Energy Efficiency Resource Standards Environmental Energy Technologies DivisionMarch 2011

    SciTech Connect

    Satchwell, Andrew; Cappers, Peter; Goldman, Charles

    2011-03-22

    Energy efficiency resource standards (EERS) are a prominent strategy to potentially achieve rapid and aggressive energy savings goals in the U.S. As of December 2010, twenty-six U.S. states had some form of an EERS with savings goals applicable to energy efficiency (EE) programs paid for by utility customers. The European Union has initiated a similar type of savings goal, the Energy End-use Efficiency and Energy Services Directive, where it is being implemented in some countries through direct partnership with regulated electric utilities. U.S. utilities face significant financial disincentives under traditional regulation which affects the interest of shareholders and managers in aggressively pursuing cost-effective energy efficiency. Regulators are considering some combination of mandated goals ('sticks') and alternative utility business model components ('carrots' such as performance incentives) to align the utility's business and financial interests with state and federal energy efficiency public policy goals. European countries that have directed their utilities to administer EE programs have generally relied on non-binding mandates and targets; in the U.S., most state regulators have increasingly viewed 'carrots' as a necessary condition for successful achievement of energy efficiency goals and targets. In this paper, we analyze the financial impacts of an EERS on a large electric utility in the State of Arizona using a pro-forma utility financial model, including impacts on utility earnings, customer bills and rates. We demonstrate how a viable business model can be designed to improve the business case while retaining sizable ratepayer benefits. Quantifying these concerns and identifying ways they can be addressed are crucial steps in gaining the support of major stakeholder groups - lessons that can apply to other countries looking to significantly increase savings targets that can be achieved from their own utility-administered EE programs.

  13. Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia—an observational cohort study

    PubMed Central

    Meressa, Daniel; Hurtado, Rocío M; Andrews, Jason R; Diro, Ermias; Abato, Kassim; Daniel, Tewodros; Prasad, Paritosh; Prasad, Rebekah; Fekade, Bekele; Tedla, Yared; Yusuf, Hanan; Tadesse, Melaku; Tefera, Dawit; Ashenafi, Abraham; Desta, Girma; Aderaye, Getachew; Olson, Kristian; Thim, Sok; Goldfeld, Anne E

    2015-01-01

    Background In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated, with poor outcomes reported for HIV-coinfected patients. Methods A standardised second-line drug (SLD) regimen was used in a non-governmental organisation–Ministry of Health (NGO-MOH) collaborative community and hospital-based programme in Ethiopia that included intensive side effect monitoring, adherence strategies and nutritional supplementation. Clinical outcomes for patients with at least 24 months of follow-up were reviewed and predictors of treatment failure or death were evaluated by Cox proportional hazards models. Results From February 2009 to December 2014, 1044 patients were initiated on SLD. 612 patients with confirmed or presumed MDR TB had ≥24 months of follow-up, 551 (90.0%) were confirmed and 61 (10.0%) were suspected MDR TB cases. 603 (98.5%) had prior TB treatment, 133 (21.7%) were HIV coinfected and median body mass index (BMI) was 16.6. Composite treatment success was 78.6% with 396 (64.7%) cured, 85 (13.9%) who completed treatment, 10 (1.6%) who failed, 85 (13.9%) who died and 36 (5.9%) who were lost to follow-up. HIV coinfection (adjusted HR (AHR): 2.60, p<0.001), BMI (AHR 0.88/kg/m2, p=0.006) and cor pulmonale (AHR 3.61, p=0.003) and confirmed MDR TB (AHR 0.50, p=0.026) were predictive of treatment failure or death. Conclusions We report from Ethiopia the highest MDR TB treatment success outcomes so far achieved in Africa, in a setting with severe resource constraints and patients with advanced disease. Intensive treatment of adverse effects, nutritional supplementation, adherence interventions and NGO-MOH collaboration were key strategies contributing to success. We argue these approaches should be routinely incorporated into programmes. PMID:26506854

  14. Comparison of intubation attempts and completion times before and after the initiation of a rapid sequence intubation protocol in an air medical transport program.

    PubMed

    Pearson, Scott

    2003-01-01

    The purpose of this study was to test the hypothesis that the initiation of a rapid sequence intubation (RSI) protocol would decrease the number of intubation attempts and completion times. In the summer of 2001, an RSI protocol was implemented using succinylcholine and etomidate. Before the RSI protocol, patients were sedated with versed and fentanyl for intubation and then paralyzed with succinylcholine to complete intubation, if needed. Retrospectively reviewed patient transport charts yielded 70 patients in the pre-RSI group and 70 patients in the RSI group. The number of attempts in the RSI group significantly dropped in the pre-RSI group, and the time from medication administration to intubation statistically decreased. In this study, the implementation of an RSI protocol resulted in fewer intubation attempts and more rapid intubations. PMID:14762994

  15. 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

  16. Intravenous lidocaine as a suppressant of coughing during tracheal intubation.

    PubMed

    Yukioka, H; Yoshimoto, N; Nishimura, K; Fujimori, M

    1985-12-01

    Effects of intravenously administered lidocaine on cough suppression during tracheal intubation under general anesthesia were evaluated in two studies. In study 1, 100 patients received either a placebo or 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. The incidence of coughing decreased as the dose of lidocaine increased. A dose of 1 mg/kg or more of intravenous lidocaine suppressed the cough reflex significantly (P less than 0.01). Coughing was suppressed completely by 2 mg/kg of intravenous lidocaine. In study 2, 108 patients received 2 mg/kg lidocaine intravenously or a placebo 1, 3, 5, 7, 10, or 15 min before intubation. The same criteria for determining whether a patient did or did not cough during tracheal intubation were used as in study 1. The incidence of coughing decreased significantly (P less than 0.01) when 2 mg/kg of lidocaine was injected intravenously between 1 and 5 min before our attempting intubation. Cough reflex was suppressed completely by plasma concentrations of lidocaine in excess of 3 micrograms/ml. PMID:4061901

  17. Conditions for endotracheal intubation after atracurium and suxamethonium.

    PubMed

    Famewo, C E

    1986-06-01

    Intubating conditions following 2 different dosage levels of atracurium, a new non-depolarising muscle relaxant was compared with suxamethonium. The dosage levels of atracurium were 0.5 mg/kg and 0.7 mg/kg while the dosage of suxamethonium chloride was 1 mg/kg. A total of 60 patients with 20 patients in each of the three groups were studied. Premedication was with oral diazepam 10 mg. Anesthesia was induced with fentanyl 1 microgram/kg and thiopentone 5 mg/kg and intubation performed in all cases by the same operator. Excellent intubation conditions were obtained in all patients within 60 seconds in the suxamethonium group, 90 seconds in the atracurium 0.7 mg/kg group, and 120 seconds in the atracurium 0.5 mg/kg group. No side effects were observed and there was circulatory stability. It is concluded that atracurium in a dose of 0.7 mg/kg allows more rapid intubation than the 0.5 mg/kg dose. It is however not as rapid as suxamethonium which remains the drug of choice when very rapid intubation is crucial. PMID:3755796

  18. 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

  19. [Lateral Approach Tracheal Intubation in a Semi-sitting Position Utilizing a Videolaryngoscope in a Patient with Respiratory Failure due to Septic Shock].

    PubMed

    Fujiwara, Atsushi; Komasawa, Nobuyasu; Nishihara, Isao; Minami, Toshiaki

    2015-05-01

    Here we report our success in performing lateral approach tracheal intubation in a patient with severe respiratory failure due to septic shock caused by shoulder joint abscess. A 71-year-old woman presented with severe respiratory difficulty due to sepsis from a shoulder joint abscess and was scheduled for emergent drainage and irrigation. She could not breathe sufficiently in the supine position and thus maintained a semi-sitting position. She was also unable to move from the ward bed to the operating table due to severe shoulder pain. We induced anesthesia in a semi-sitting position in the ward bed. Mask ventilation was performed using the two-hand technique from the lateral approach. Tracheal intubation was also performed with a left lateral approach utilizing the Pentax-AWS Airwayscope (AWS). Lateral approach for tracheal intubation utilizing AWS may be useful in patients who present with severe respiratory difficulty. PMID:26422963

  20. Peripartum general anasthesia without tracheal intubation: incidence of aspiration pneumonia.

    PubMed

    Ezri, T; Szmuk, P; Stein, A; Konichezky, S; Hagai, T; Geva, D

    2000-05-01

    This study estimated the incidence of pulmonary aspiration during general anasthesia for obstetric procedures performed in the peripartum period (Caesarean sections were not studied). The records of 1870 patients anasthetised without tracheal intubation were reviewed retrospectively. The diagnosis of aspiration was based on the anasthetist's written remarks and the postoperative course. Eighty per cent of patients received ketamine and a benzodiazepine, and the remaining 20% received methohexital or thiopental and fentanyl. No cricoid pressure or tracheal intubation was performed. A single case of mild aspiration was detected in a woman anasthetised with methohexital (an incidence of 0.053%). These results suggest that the risk of aspiration during general anasthesia without tracheal intubation, during and immediately after delivery, may not be higher in obstetric patients in the peripartum period, as has been reported previously. PMID:10792131

  1. Thoracotomy for tracheal disruption after traumatic intubation: a case report.

    PubMed

    Austin, Ryan D

    2010-10-01

    Tracheal dissection is an uncommon complication of endotracheal intubation. A large source of morbidity and mortality in anesthesia is associated with airway issues. Several airway complications can be avoided or minimized by proper technique and vigilance. Emergency thoracotomy surgery is required in patients who suffer lower tracheal trauma. A tracheal tear poses additional challenges to traditional airway management, demanding vigilant planning and collaboration among the entire operative team. This case report details the airway management strategies employed during an emergent thoracotomy for a patient who suffered tracheal perforation during endotracheal intubation. A discussion of airway anatomy, airway considerations, intubation complications, and one-lung ventilation techniques is provided. Airway management techniques for one-lung ventilation are highly variable, requiring an extensive knowledge of equipment, clinical implications, and technical challenges. It is important for clinicians to be skilled in the use of several airway devices and to be prepared for any unexpected situation such as the case being presented. PMID:21067088

  2. [Patient treated with sub-mental intubation for maxillofacial trauma].

    PubMed

    Ricour, C; Ferri, J; Nunes, F; Wiel, E; Raoul, G

    2014-11-01

    Maxillo-facial traumas are frequent and most often occur in young patients. Naso-tracheal or orotracheal intubation may be contraindicated in case of combined occlusal fracture and nasal or ethmoido-nasal fracture. This study was carried out a clinical case of a patient treated at the Lille University Hospital for a maxillofacial trauma associating fracture of nose and maxilla. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy. Submental intubation is a reliable single and safe technique allowing an one-stage surgical treatment in case of complex association of fractures without using tracheotomy. Its use should be implemented on a larger scale. PMID:25450733

  3. 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

  4. Developing competency in interns for endotracheal intubation: An educational article

    PubMed Central

    Makwana, Harsha Dhirubhai; Suthar, Nilay N; Gajjar, Mehul P; Thakor, Advait V

    2016-01-01

    Background: Our existing undergraduate curriculum lacks developing competency for endotracheal intubation. Even though it is a lifesaving procedure, interns are exposed only during their posting in anesthesia or emergency medicine and so, when need arises, they fail to perform endotracheal intubation and it leads to catastrophes. Aims and Objectives: The aim of this study was to develop competency in interns for endotracheal intubation. Materials and Methods: A study was conducted on fifty interns of medical college. Lecture and demonstration were used for cognitive domain and one-to-one training and practice on manikin for affective and psychomotor domains, respectively. Live demonstration on patients was done whenever possible. Gain in knowledge was evaluated by pre- and post-test using standardized validated questionnaire. Skills were assessed by direct observation of procedural skill on manikin, split in steps: Laryngoscopy, intubation, and ventilation. Session was evaluated using feedback questionnaire and Likert scale. Results: Interns showed mean marks of 8.12 ± 1.63 in pretest compared to 13.86 ± 1.06 of posttest with a gain of 34.8% (P = 0.0001), which is highly significant. Twenty-two percent interns completed all steps correctly in the first attempt, 62% in the second attempt, while 16% required third attempt to correctly complete all steps. Conclusion: This training developed competency for basic knowledge and practice of endotracheal intubation in interns adequately on manikin. Training for endotracheal intubation should be carried out at the beginning of internship before they go for clinical practice and repeated during their rotation of Anesthesia and Emergency Medicine Department, so they can retain their competency for it and can do later on whenever required. PMID:27563588

  5. Use of extraglottic airways in patients undergoing ambulatory laparoscopic surgery without the need for tracheal intubation

    PubMed Central

    Suhitharan, T.; Teoh, Wendy H.L.

    2013-01-01

    Background: Second generation extraglottic airway devices with gastric access and separate breathing channels have ushered in a new era where their use is increasingly prevalent in surgical patients who would have been traditionally intubated for general anesthesia. New innovations like the i-gel, which is constructed of a thermoplastic elastomer, provide an airtight seal around patient's perilaryngeal anatomy without the inflatable cuff mechanism found in the laryngeal mask airway supreme (LMAS). Methods: We conducted a randomized controlled trial comparing the LMAS with the i-gel in 70 anesthetized paralyzed patients undergoing laparoscopic female sterilization. Our primary outcome measure was the oropharyngeal leak pressure (OLP). We studied secondary outcomes of successful first attempt insertion rates, time and ease of the airway and gastric tube insertion, leak fractions and pharyngeal morbidity. Results: We found no difference in the OLP between LMAS and i-gel, 25.9 (4.2) versus 24.4 (4.3) s, P=0.153. Both devices had similar first attempt insertion rates (LMAS 94% vs. i-gel 91%) with similar ease and comparable times to achieve an effective airway, LMAS 14.7 (2.7) versus i-gel 16.5 (9.6) s, P=0.306, although gastric tube insertion was easier and faster for the LMAS, 7.9 (1.9) versus i-gel 14.8 (7.7) s, P<0.005. Intraoperatively, there was a significantly greater leak fraction with the i-gel of 0.06 (0.03) versus 0.04 (0.02) with the LMAS, P=0.013. Three patients (8.6%) with LMAS had mild sore throat; one patient (2.9%) had mucosal injury. No complications were documented in the i-gel group. Conclusions: Both these extraglottic airway devices offer similar OLPs, high insertion success rates at the first attempt with similar ease and insertion times (albeit longer gastric tube insertion with i-gel). Both provided effective ventilation despite a higher leak fraction with i-gel that was clinically inconsequential. PMID:24348297

  6. Attenuation of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation with Pre Induction IV Fentanyl Versus Combination of IV Fentanyl and Sub Lingual Nitroglycerin Spray

    PubMed Central

    Channaiah, Vijayalakshmi B.; Kurek, Nicholas S.; Moses, Ryder; Chandra, Sathees B.

    2014-01-01

    ABSTRACT Introduction: Endotracheal intubation is one of the most invasive stimuli in anesthesia and it's often accompanied by a hemodynamic pressor response. The purpose of this study was to investigate the efficacy of a single pre-induction 2 µg/kg bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray (400 µg /spray) with a thiopentone/suxamethonium sequence in the attenuation of the hemodynamic response to endotracheal intubation in normotensive patients. Material and methods: The study consisted of 80 randomly selected ASA physical status I/II male/female adults who were aged between 18 through 60 years and scheduled for elective surgery. Group I received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy followed by two puffs of nitroglycerin sub lingual spray (400 µg/spray) 2 minutes prior to intubation (n=40). Group II received a single 2 µg/kg IV bolus of fentanyl diluted to 5 ml with normal saline 5 min prior to laryngoscopy (n=40). Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and rate pressure product were compared to basal values at pre-induction, induction, intubation and post-intubation as well as at time increments of 1, 3, 5, 7 and 10 min. Results: Fentanyl combined with nitroglycerin did not attenuate hemodynamic pressor responses more than fentanyl alone. Increases of HR (7.9%), DBP (4.0%), MAP (3.6%) and RPP (6.0%) along with attenuation of SBP (2.7%) were observed in the fentanyl-nitroglycerin group as compared to the equivalent control measured values. Conclusions: A single pre-induction bolus injection of fentanyl followed by two puffs of nitroglycerin sub lingual spray in a thiopentone/suxamethonium anesthetic sequence neither successfully attenuates nor successfully suppresses the hemodynamic pressor response more effectively than fentanyl alone in normotensive patients resulting from endotracheal intubation. PMID

  7. Initial Release of Severe Post-Burn Contracture Scar of the Neck for Intubation Under Ketamine

    PubMed Central

    Al-Zacko, S.M.; Al-Kazzaz, D.A.

    2009-01-01

    Summary Background. Severe anterior post-burn contracture (PBC) of the neck poses the anaesthesiologist some difficult problems and results in difficult intubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the PBC scar released before other procedures are performed, in order to ensure airway control. Objectives. To show our experience with quick surgical neck release of patients with severe anterior PBC of the neck to facilitate direct laryngoscopy and orotracheal intubation (OTI). Material and methods. A prospective study of patients with severe anterior PBC of the neck was carried out from January 2003 to December 2007 in the Burns Unit of Mosul Teaching Hospital in Mosul, Iraq. The patients were given ketamine, after which a release incision was made over the anterior PBC of the neck scar. OTI was then performed successfully. Results. Twelve patients with severe neck PBC (3 males, 9 females; age range, 7-37 yr; mean age, 20 yr) all had successful OTI after PBC release under intravenous ketamine. None showed any complications attributed to the anaesthesia. PMID:21991181

  8. Simulation analysis of three intubating supraglottic devices during infant chest compression.

    PubMed

    Kohama, Hanako; Komasawa, Nobuyasu; Ueki, Ryusuke; Kaminoh, Yoshiroh; Nishi, Shin-ichi

    2015-01-01

    Current guidelines for pediatric cardiopulmonary resuscitation suggest that supraglottic devices are alternatives for tracheal intubation with minimal interruption of chest compression. We examined the utility of three intubating supraglottic devices, air-Q® (air-Q), Ambu® aura-i (aura-i), and i-gel® (i-gel), utilizing manikin simulation. Twenty-two novice physicians performed securing of airway on an infant manikin with the three devices. We measured the rate of success on ventilation and the insertion time with or without chest compression. Successful ventilation rate did not significantly decrease with chest compression in the three devices (without chest compression: air-Q, 21/22; aura-i, 20/22; i-gel, 20/22, during chest compression: air-Q, 20/22; aura-i, 20/22; i-gel, 18/22). The insertion time with air-Q and aura-i did not extend significantly for chest compression. In contrast, the insertion time with i-gel was significantly extended in chest compression (P < 0.05). Air-Q and aura-i are more useful for airway management during chest compression than i-gel. PMID:25711262

  9. Laryngeal Radiation Fibrosis: A Case of Failed Awake Flexible Fibreoptic Intubation

    PubMed Central

    Huitink, Johannes M.; Zijp, Lambert

    2011-01-01

    Awake fibreoptic intubation is accepted as the gold standard for intubation of patients with an anticipated difficult airway. Radiation fibrosis may cause difficulties during the intubation procedure. We present an unusual severe case of radiation induced changes to the larynx, with limited clinical symptoms, that caused failure of the fibreoptic intubation technique. A review of the known literature on radiation fibrosis and airway management is presented. PMID:22606397

  10. Designing Technology to Decrease Pneumonia in Intubated Trauma Patients.

    PubMed

    Swearer, Jillian Nichole; Hammer, Ciara Lucinda; Matthews, Susan Marie; Meunier, Jennifer Lynn; Medler, Krisie Lee; Kamer, Genevieve Stella; Fiedler, Dana Marie; Johnston, Courtney Lynn; Schmitt, Kami Rebekah; Sawyer, Angela Jane

    2015-01-01

    Trauma patients are at increased risk for developing ventilator-associated pneumonia. Sixty adult trauma intensive care unit patients were audited 3 months prepractice change, and 30 were audited postpractice change. Quality improvement interventions included staff education of a redesigned electronic medical record ventilator bundle and chlorhexidine gluconate administration timing practice change. Postpractice change audits revealed 2-hour chlorhexidine gluconate documentation increased from 38.3% to 73.3% and incidence of pneumonia in intubated patients decreased by 62%. Early initiation of chlorhexidine gluconate mouth care utilizing electronic medical record technology may help reduce pneumonia in intubated patients, hospital length of stay, overall health costs, and improve documentation. PMID:26352660

  11. 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

  12. Central venous catheter malposition in the azygos vein and difficult endotracheal intubation in severe ankylosing spondylitis: a case report

    PubMed Central

    Moon, Eunjin; Jeong, Hyungmo; Chung, Junyoung; Yi, Jaewoo

    2015-01-01

    Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devices have been developed to address difficult intubation, in this case, fiberoptic bronchoscopy was the only applicable safe alternative because of the patient’s extremely severe chin on chest deformity and temporomandibular joint disease. We report a successful awake fiberoptic bronchoscopic intubation in a patient with extremely severe AS and recommend that the catheter placement should be confirmed with radiology to ensure proper positioning for severe AS patients. PMID:26885138

  13. Tracheal intubation without neuromuscular relaxants for thymectomy in myasthenic patients.

    PubMed

    Narimatsu, Eichi; Munemura, Yuki; Kawamata, Mikito; Imaizumi, Hitoshi; Namiki, Akiyoshi; Iwasaki, Hiroshi

    2003-01-01

    The purpose of the present study was to evaluate in detail the suitability of the combined use of fentanyl and propofol for endotracheal oral intubation without non-depolarizing muscle relaxants (NDMRs) for myasthenic patients. We evaluated orotracheal intubation, without using an NDMR, having induced anesthesia with 2 microg x kg(-1) fentanyl and 2.5 mg x kg(-1) propofol in myasthenic (Osserman's classification: I-IIb) and non-myasthenic patients. Using this technique, intubation was easily performed, the vocal cords remained opened, and any increase in blood pressure was satisfactorily suppressed in both myasthenic and non-myasthenic patients. In non-myasthenic patients, whose train-of-four ratio recorded immediately before intubation was 95-100%, a cough of moderate or severe intensity occurred. In myasthenic patients, no or only a slight cough occurred if the ratio was less than 75%, and a cough of moderate intensity occurred if the ratio was more than 90%. All of th coughing reflexes observed in myasthenic patients were considered to be clinically acceptable. The results indicate that the combined fentanyl and propofol technique, without NDMR, provides satisfactory intubatin conditions in myasthenic patients. PMID:17682311

  14. Intubated, ventilating patients with complete tracheal transection: a diagnostic challenge.

    PubMed Central

    Bowley, Douglas M. G.; Plani, Frank; Murillo, Dennis; Smith, Martin; Degiannis, Elias

    2003-01-01

    Tracheal transection is a rare injury after blunt trauma. The presence of complete tracheal transection in the intubated, ventilating patient is even more rare and constitutes a major diagnostic challenge. The liberal use of computed tomography (CT) scans as an adjunct to endoscopy is paramount. PMID:12855026

  15. Bronchoscopic intubation during continuous nasal positive pressure ventilation in the treatment of hypoxemic respiratory failure.

    PubMed

    Barjaktarevic, Igor; Berlin, David

    2015-03-01

    Endotracheal intubation is difficult in patients with hypoxemic respiratory failure who deteriorate despite treatment with noninvasive positive pressure ventilation (NIPPV). Maintaining NIPPV during intubation may prevent alveolar derecruitment and deterioration in gas exchange. We report a case series of 10 nonconsecutive patients with NIPPV failure who were intubated via a flexible bronchoscope during nasal mask positive pressure ventilation. All 10 patients were intubated in the first attempt. Hypotension was the most frequent complication (33%). Mean decrease in oxyhemoglobin saturation during the procedure was 4.7 ± 3.1. This method of intubation may extend the benefits of preoxygenation throughout the whole process of endotracheal intubation. It requires an experienced operator and partially cooperative patients. A prospective trial is necessary to determine the best intubation method for NIPPV failure. PMID:24243561

  16. 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.

  17. Lessons in Success: A Multi-Campus Study of Factors Influencing Academic Accomplishment among High-Achieving African American Students at Private Liberal Arts Colleges

    ERIC Educational Resources Information Center

    Johnson, Ryan A.

    2013-01-01

    The purpose of this study was to explore the academic experiences of highly successful African-American male graduates of small, private liberal arts colleges using a qualitative approach. Fourteen highly successful alumni from selective, private colleges were purposefully selected for the study, including seven African-American males and seven…

  18. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

    PubMed Central

    Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing

    2016-01-01

    Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860

  19. The Role of Stanford Achievement Test 10[TM] Subtests in Sixth Grade as a Predictor of Success on ACT's Eighth Grade Explore Exam[TM

    ERIC Educational Resources Information Center

    Potts, Jeffrey D.

    2011-01-01

    The purpose of this study was to determine if there was a predictive correlation between a specific sixth grade achievement test known as the Stanford Achievement Test 10 and the eighth grade college readiness assessment instrument known as the Explore Exam for a group of North Texas students. Following an assessment during sixth grade, via the…

  20. Comparison of laryngeal mask airway use with endotracheal intubation during anesthesia of western lowland gorillas (Gorilla gorilla gorilla).

    PubMed

    Cerveny, Shannon N; D'Agostino, Jennifer J; Davis, Michelle R; Payton, Mark E

    2012-12-01

    The laryngeal mask airway is an alternative to endotracheal intubation that achieves control of the airway by creating a seal around the larynx with an inflatable cuff. This study compared use of the laryngeal mask airway with endotracheal intubation in anesthetized western lowland gorillas (Gorilla gorilla gorilla). Eight adult gorillas were immobilized for routine and diagnostic purposes for a total of nine anesthetic events. During each anesthetic event, gorillas were either intubated (n = 4; group A) or fitted with a laryngeal mask airway (n= 5; group B). Time required to place each airway device, physiologic parameters, and arterial blood gas were measured and compared between the two groups. There were no significant differences between the two groups for time required to place airway device, heart rate, hemoglobin oxygen saturation, end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, or arterial pH between the two groups. Mean arterial partial pressure of oxygen was significantly greater in group B, 15 (group A: 94 +/- 44 mm Hg; group B: 408 +/- 36 mm Hg; P= 0.0025) and 45 (group A: 104 +/- 21 mm Hg; group B: 407 +/- 77 mm Hg; P = 0.0026) min after airway device placement. Mean respiratory rate was significantly greater in group A at multiple time points. Mean arterial pressure (group A: 129 +/- 16 mm Hg; group B: 60 +/- 8 mm Hg) and diastolic blood pressure (group A: 115 +/- 21 mm Hg; group B: 36 +/- 10 mm Hg) were significantly greater in group A at the time of airway device placement. The laryngeal mask airway maintained oxygenation and ventilation effectively in all gorillas and is a useful alternative to endotracheal intubation in western lowland gorillas. PMID:23272342

  1. Sonographically guided superior laryngeal nerve block during awake fiberoptic intubation.

    PubMed

    Sawka, Andrew; Tang, Raymond; Vaghadia, Himat

    2015-04-15

    We report 5 patients who underwent ultrasound-guided superior laryngeal nerve block before awake intubation and general anesthesia. We used a 8- to 15-MHz hockey stick-shaped ultrasound transducer (HST15-8/20 linear probe, Ultrasonix) to visualize the superior laryngeal nerve. A 3.8-cm 25-G needle was inserted in real time and directed toward the superior laryngeal nerve followed by circumferential placement of local anesthetic. All 5 patients tolerated subsequent awake fiberoptic intubation with either minimal or no sedation. Sonographically guided superior laryngeal nerve block may be useful in patients where identification of landmarks in the neck is difficult as a result of patient anatomy. PMID:25867195

  2. Comparison of morning versus afternoon cecal intubation rates

    PubMed Central

    Wells, Christopher D; Heigh, Russell I; Sharma, Virender K; Crowell, Michael D; Gurudu, Suryakanth R; Leighton, Jonathan A; Mattek, Nora; Fleischer, David E

    2007-01-01

    Background Many factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy. Methods Retrospective, single-center study comparing cecal intubation rates for colonoscopies performed in the morning (begun prior to 12 noon) and colonoscopies performed in the afternoon (begun after 12 noon) over an approximately 12 month period. Univariate and multivariate analyses were performed evaluating patient demographics, procedure indication(s), endoscopist, bowel preparation type and quality, and participation by a gastroenterology fellow. Results 6087 colonoscopies were evaluated in this study. Colonoscopies (n = 3729) performed in the morning were compared to colonoscopies performed in the afternoon (n = 2358). The crude completion rate to the cecum was 95.0% in the morning group while the completion rate to the cecum was 93.6% of the afternoon exams (p = 0.02). The morning colonoscopies had better bowel preparation quality (p < 0.001). The multivariate analyses demonstrated that gender, age, and bowel preparation quality impacted completion rates. After correcting for these factors, there was no significant difference in completion rates in the morning versus afternoon. Conclusion Uncorrected cecal intubation rates were lower in the afternoon compared to the morning in outpatients undergoing colonoscopy. Bowel preparation quality was worse in the afternoon compared with the morning. Efforts at improving afternoon bowel preparation may improve the outcome of afternoon colonoscopies. PMID:17559669

  3. May we practise endotracheal intubation on the newly dead?

    PubMed Central

    Ardagh, M

    1997-01-01

    Endotracheal intubation (ETI) is a valuable procedure which must be learnt and practised, and performing ETI on cadavers is probably the best way to do this, although lesser alternatives do exist. Performing ETI on a cadaver is viewed with a real and reasonable repugnance and if it is done without proper authorisation it might be illegal. Some form of consent is required. Presumed consent would preferably be governed by statute and should only occur if the community is well informed and therefore in a position of being able to decline. Currently neither statute nor adequate informing exists. Endotracheal intubation on the newly dead may be justifiable according to a Guttman scale if the patient has already consented to organ donation and if further research supports the relevance of the Guttman scale to this question. A "mandated choice" with prior individual consent as a matter of public policy is the best of these solutions, however until such a solution is in place we may not practise endotracheal intubation on the newly dead. PMID:9358348

  4. Evaluation of a smartphone camera system to enable visualization and image transmission to aid tracheal intubation with the Airtraq(®) laryngoscope.

    PubMed

    Lee, Delice Weishan; Thampi, Swapna; Yap, Eric Peng Huat; Liu, Eugene Hern Choon

    2016-06-01

    Using three-dimensional printing, we produced adaptors to attach a smartphone with camera to the eyepiece of the Airtraq(®) laryngoscope. This low-cost system enabled a team to simultaneously view the laryngoscopy process on the smartphone screen, and also enabled image transmission. We compared the Airtraq(®) with the smartphone Airtraq(®) system in a crossover study of trainee anesthesiologists performing tracheal intubation in a manikin. We also evaluated the smartphone Airtraq(®) system for laryngoscopy and tracheal intubation in 30 patients, including image transmission to and communication with a remote instructor. In the manikin study, the smartphone Airtraq(®) system enabled instruction where both trainee and instructor could view the larynx simultaneously, and did not substantially increase the time required for intubation. In the patient study, we were able to view the larynx in all 30 patients, and the remote instructor was able to receive the images and to respond on correctness of laryngoscopy and tracheal tube placement. Tracheal intubation was successful within 90s in 19 (63 %) patients. In conclusion, use of a smartphone with the Airtraq(®) may facilitate instruction and communication of laryngoscopy with the Airtraq(®), overcoming some of its limitations. PMID:26825311

  5. An Examination of Successful Leadership Behaviors Exhibited by Middle School Principals in Stimulating and Sustaining African-American Students' Achievement on the California Standards Test in Mathematics

    ERIC Educational Resources Information Center

    Williams, Jacqueline

    2013-01-01

    The purpose of this research study was to examine leadership behaviors of middle school principals who have been successful in stimulating and sustaining African-American students' mathematics achievement on the California Standards Test. Specifically, this research sought to answer the following questions: 1) How do middle school principal…

  6. Addressing Achievement Gaps: Black Male Teens--Moving to Success in the High School Years. Policy Notes. Volume 21, Number 3, Winter 2013

    ERIC Educational Resources Information Center

    Yaffe, Deborah

    2013-01-01

    This issue of ETS Policy Notes (Vol. 21, No. 3) provides highlights from the symposium, "Black Male Teens: Moving to Success in the High School Years" held on June 24, 2013, in Washington, DC. The third in a series of four symposia cosponsored by ETS and the Children's Defense Fund (CDF), the seminar examined the education and status of…

  7. Achieving Successful Employment Outcomes with the Use of Assistive Technology. Report from the Study Group, Institute on Rehabilitation Issues (24th, Washington, DC, May 1998).

    ERIC Educational Resources Information Center

    Radtke, Jean, Ed.

    Developed as a result of an institute on rehabilitation issues, this document is a guide to assistive technology as it affects successful competitive employment outcomes for people with disabilities. Chapter 1 offers basic information on assistive technology including basic assumptions, service provider approaches, options for technology…

  8. [Prostaglandin E1 (PGE1) prevents the pressure responses to tracheal intubation in hypertensive patients].

    PubMed

    Kito, T; Otagiri, T; Ina, H; Harashima, N; Sakaki, J

    1991-11-01

    Forty-five hypertensive patients for elective abdominal surgery were investigated regarding the effects of PGE1 on the cardiovascular responses to tracheal intubation. Administration of PGE1 at the dose of 0.10 or 0.20 micrograms.kg-1.min-1 for 10 minutes before tracheal intubation significantly reduced the blood pressure responses immediately after the intubation and 2 minutes later. The increases in heart rate were not altered with and without the administration of PGE1. So the increases in rate pressure products were markedly reduced with PGE1 compared with the control values. Plasma concentration of catecholamines was measured before and after tracheal intubation. Norepinephrine was elevated markedly immediately after the intubation and this change was not affected by the infusion of PGE1. These results demonstrate that PGE1 ameliorates the pressure responses by the release of norepinephrine and thus reduces the increases in rate pressure products immediately after tracheal intubation. PMID:1766115

  9. Making a Way to Success: Self-Authorship and Academic Achievement of First-Year African American Students at Historically Black Colleges

    ERIC Educational Resources Information Center

    Strayhorn, Terrell L.

    2014-01-01

    The purpose of the study was to estimate the relationship between academic achievement in college, as defined by first-year grade point average (GPA), and self-authorship among African American first-year students at an HBCU (N = 140), using hierarchical linear regression techniques. A single research question guided this investigation: What is…

  10. Reading Achievement: Characteristics Associated with Success and Failure: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," July through September 1978 (Vol. 39 Nos. 1 through 3).

    ERIC Educational Resources Information Center

    ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

    This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 25 titles deal with a variety of topics, including the following: reading achievement as it relates to child dependency, the development of phonological coding, short-term memory and associative learning, variables available in…

  11. Successful Family Engagement in the Classroom: What Teachers Need to Know and Be Able to Do to Engage Families in Raising Student Achievement

    ERIC Educational Resources Information Center

    Spielberg, Lela

    2011-01-01

    There is widespread agreement that family engagement leads to increased student achievement, reduced drop-out rates, and a host of other positive outcomes for kids. Teachers are rarely trained or supported in engaging families, and, according to the 2005 MetLife Survey of the American Teacher, find family engagement to be their biggest challenge.…

  12. An Examination of the Influence of Inquiry-Based Laboratory Activities and Success on Standards Based Achievement Tests in a Suburban High School

    ERIC Educational Resources Information Center

    Vilardi, Virginia A.

    2013-01-01

    The purpose of this study was to examine whether there is a difference in high school students' achievement and retention on standardized tests between students who participate in inquiry-based laboratory activities and those that participate in traditional style laboratory activities. Additionally, student and teacher opinions of…

  13. Reading Achievement: Characteristics Associated with Success and Failure: Abstracts of Doctoral Dissertations Published in "Dissertation Abstracts International," January through June 1980 (Vol. 40 Nos. 7 through 12).

    ERIC Educational Resources Information Center

    ERIC Clearinghouse on Reading and Communication Skills, Urbana, IL.

    This collection of abstracts is part of a continuing series providing information on recent doctoral dissertations. The 25 titles deal with a variety of topics, including the following: (1) reading comprehension and visual creativity; (2) family interaction and reading achievement in high school males; (3) conceptual tempo, Piagetian level of…

  14. A Qualitative Study: The Impact of Selected Non-Cognitive Variables on the Academic Success and Achievement of Culturally Diverse Academic Scholarship Students

    ERIC Educational Resources Information Center

    Wilson, Linda Louise

    2009-01-01

    The study examined whether select non-cognitive variables such as, (Sedlacek, 1989, 1991, 1993, 2004; Tracey & Sedlacek 1984, 1985, 1987, 1989) impacted the academic achievement, retention and graduation rates of culturally diverse academic scholarship students at a predominantly white higher education institutions. The subjects of the study were…

  15. 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

  16. Minimizing Trauma to the Upper Airway: A Ferret Model of Neonatal Intubation

    PubMed Central

    Kircher, Sara S; Murray, Len E; Juliano, Michael L

    2009-01-01

    Our objective was to determine whether an adult ferret can be intubated as many as 10 times per training session without resulting in trauma to the upper airway. In this program, 8 male ferrets rotated through intubation laboratories, limiting the use of each animal to once every 3 mo. Animals were examined by the veterinary staff after intubations to assess for trauma to upper airway tissue. Each examination was given a trauma grade of 0 for no visible signs of trauma, 1 if erythema of the larynx was present, 2 if visible excoriation of the mucus membranes was present, and 3 if bleeding (frank hemorrhage) was observed. The number of intubation attempts was restricted to 10 per animal per training session. A total of 170 intubations were completed on the ferrets during a 12-mo period. The average number of intubations per laboratory was 8.1 intubations per ferret. In addition, 1.8% of the intubations resulted in erythema (score, 1) after training, and 0.6% of the intubations resulted in excoriation (score, 2). Frank hemorrhage (score, 3) was not noted. The overall percentage of intubations resulting in any trauma during a training session was 0.02%. None of the animals have experienced any major complications to date. This ongoing training program has been used to teach neonatal intubation skills to emergency medicine residents for the past 12 mo. Ensuring the health and safety of the ferrets was paramount. Our results suggest that as many as 10 intubation attempts per session can be performed safely on each ferret without causing excessive trauma. PMID:19930827

  17. Dexmedetomidine-midazolam versus Sufentanil-midazolam for Awake Fiberoptic Nasotracheal Intubation: A Randomized Double-blind Study

    PubMed Central

    Li, Cheng-Wen; Li, Yan-Dong; Tian, Hai-Tao; Kong, Xian-Gang; Chen, Kui

    2015-01-01

    Background: Awake fiberoptic intubation (AFOI) is usually performed in the management of the predicted difficult airway. The aim of this study was to evaluate the feasibility of dexmedetomidine with midazolam (DM) and sufentanil with midazolam (SM) for sedation for awake fiberoptic nasotracheal intubation. Methods: Fifty patients with limited mouth opening scheduled for AFOI were randomly assigned to two groups (n = 25 per group) by a computer-generated randomization schedule. All subjects received midazolam 0.02 mg/kg as premedication and airway topical anesthesia with a modified “spray-as-you-go” technique. Group DM received dexmedetomidine at a loading dose of 0.5 μg/kg over 10 min followed by a continuous infusion of 0.25 μg·kg−1·h−1, whereas Group SM received sufentanil at a loading dose of 0.2 μg/kg over 10 min followed by a continuous infusion of 0.1 μg·kg−1·h−1. As necessary, since the end of the administration of the loading dose of the study drug, an additional dose of midazolam 0.5 mg at 2-min intervals was given to achieve a modified Observers’ Assessment of Alertness/Sedation of 2–3. The quality of intubation conditions and adverse events were observed. Results: The scores of ease of the AFOI procedure, patient's reaction during AFOI, coughing severity, tolerance after intubation, recall of the procedure and discomfort during the procedure were comparable in both groups (z = 0.572, 0.664, 1.297, 0.467, 0.895, and 0.188, respectively, P > 0.05). Hypoxic episodes similarly occurred in the two groups, but the first partial pressure of end-tidal CO2 after intubation was higher in Group SM than that in Group DM (45.2 ± 4.2 mmHg vs. 42.2 ± 4.3 mmHg, t = 2.495, P < 0.05). Conclusions: Both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is still a potential risk in the sufentanil regimen. PMID:26612286

  18. Evaluation of safety and usefulness of submental intubation in panfacial trauma surgery

    PubMed Central

    2016-01-01

    Objectives Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. Materials and Methods In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. Results We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. Conclusion Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients. PMID:27162750

  19. 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

  20. A prospective, randomised, clinical study to compare the use of McGrath®, Truview® and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists

    PubMed Central

    Bakshi, Sumitra G; Vanjari, Vinayak S; Divatia, Jigeeshu V

    2015-01-01

    Background and Aims: Video laryngoscopy has been recommended as an alternative during difficult conventional direct laryngoscopy using the Macintosh blade (MAC). However, successful visualisation of the larynx and tracheal intubation using some of the indirect laryngoscopes or video laryngoscopes (VL) requires hand-eye coordination. We conducted this study to determine whether non-channel VLs are easy to use for novices and whether there is any association between expertise with MAC and ease of tracheal intubation with VLs. Methods: Anaesthesiologists participating in the study were divided into three groups: Group novice to intubation (NTI), Group novice to videoscope (NVL)- experienced with MAC, novice to VLs and Group expert (EXP) experienced in all. Group NTI, NVL received prior mannequin training. VLs- Truview® and McGrath series 5 (MGR) were compared with MAC. One hundred and twenty six adult patients with normal airway were randomised to both, the intubating anaesthesiologist and laryngoscope. The time taken to intubate (TTI) and participants’ rating of the ease of use was recorded on a scale of 1–10 (10-most difficult). Results: In Group NTI, there was no difference in mean TTI with the three scopes (P = 0.938). In Group NVL, TTI was longer with the VLs than MAC (P < 0.001). In Group EXP, TTI with VL took 20 s more (P < 0.001). There was significant difference in participants’ rating of ease of use of laryngoscope in Group NVL (P = 0.001) but not in the NTI (P = 0.205), EXP (P = 0.529) groups. A high failure was seen with MGR in Group NTI and NVL. Conclusion: In Group NTI, TTI and the ease of use were similar for all scopes. Expertise with standard direct laryngoscopy does not translate to expertise with VLs. Separate training and experience with VLs is required. PMID:26257415

  1. A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation.

    PubMed

    Mendonca, C; Mesbah, A; Velayudhan, A; Danha, R

    2016-08-01

    We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml(-1) and midazolam. The airway was anaesthetised with lidocaine spray and gargle. The total procedure time - a composite of sedation time, topical anaesthesia time and intubation time - was recorded. The operator's impression of the ease of the procedure and the patients' reported comfort were recorded on a 0-100 mm visual analogue scale. The median (IQR [range]) for total procedure time was 900 (739-1059 [616-1215]) s with the fibrescope and 651 (601-720 [498-900]) s with the Pentax Airway Scope (p = 0.0001). The median (IQR [range]) intubation time was 420 (283-480 [120-608]) s with the fibrescope and 183 (144-220 [107-420]) s with the Pentax Airway Scope (p = 0.0002). The median (IQR [range]) visual analogue scores for the operator's ease of intubation for the fibrescope and Pentax Airway Scope were 83.6 (72.0-98.0 [49.0-100.0]) and 86.8 (84.0-91.0 [61.0-100.0]), respectively (p = 0.3507). The median (IQR [range]) visual analogue score for patient comfort was 85.5 (81.0-97.0 [69.0-100.0]) and 79.4 (74.0-85.0 [59.0-100.0]) for the fibrescope and Pentax Airway Scope, respectively (p = 0.06). Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort. PMID:27228959

  2. Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study

    PubMed Central

    Dhanger, Sangeeta; Gupta, Suman Lata; Vinayagam, Stalin; Bidkar, Prasanna Udupi; Elakkumanan, Lenin Babu; Badhe, Ashok Shankar

    2016-01-01

    Background: Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation. Aims: The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation. Settings and Design: In this study, 200 patients belonging to age group 18–60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled. Patients with upper airway pathology, neck mass, and cervical spine injury were excluded from the study. Materials and Methods: An attending anesthesiologist conducted preoperative assessment and recorded parameters such as body mass index, modified Mallampati grading, inter-incisor distance, neck circumference, and thyromental distance (NC/TMD). After standard anesthetic induction, laryngoscopy was performed, and intubation difficulty assessed using intubation difficulty scale on the basis of seven variables. Statistical Analysis: The Chi-square test or student t-test was performed when appropriate. The binary multivariate logistic regression (forward-Wald) model was used to determine the independent risk factors. Results: Among the 200 patients, 26 patients had difficult intubation with an incidence of 13%. Among different variables, the Mallampati score and NC/TMD were independently associated with difficult intubation. Receiver operating characteristic curve showed a cut-off point of 3 or 4 for Mallampati score and 5.62 for NC/TMD to predict difficult intubation. Conclusion: The diagnostic accuracy of NC/TM ratio and Mallampatti score were better compared to other bedside tests to predict difficult intubation in Indian population. PMID:26957691

  3. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  4. 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.

  5. Addressing the Achilles' Heel in the HIV Care Continuum for the Success of a Test-and-Treat Strategy to Achieve an AIDS-Free Generation

    PubMed Central

    Nachega, Jean B.; Uthman, Olalekan A.; del Rio, Carlos; Mugavero, Michael J.; Rees, Helen; Mills, Edward J.

    2014-01-01

    Mathematical models and recent data from ecological, observational, and experimental studies show that antiretroviral therapy (ART) is effective for both treatment and prevention of HIV, validating the treatment as prevention (TasP) approach. Data from a variety of settings, including resource-rich and -limited sites, show that patient attrition occurs at each stage of the human immunodeficiency virus (HIV) treatment cascade, starting with the percent unaware of their HIV infection in a population and linkage to care after diagnosis, assessment of ART readiness, receipt of ART, and finally long-term virologic suppression. Therefore, in order to implement TasP, we must first define practical and effective linkage to care, acceptability of treatment, and adherence and retention monitoring strategies, as well as the cost-effectiveness of such strategies. Ending this pandemic will require the combination of political will, resources, and novel effective interventions that are not only feasible and cost effective but also likely to be used in combination across successive steps on the HIV treatment cascade. PMID:24926028

  6. The efficacy of combined regional nerve blocks in awake orotracheal fiberoptic intubation

    PubMed Central

    Chatrath, Veena; Sharan, Radhe; Jain, Payal; Bala, Anju; Ranjana; Sudha

    2016-01-01

    Aims of Study: To evaluate the efficacy, hemodynamic changes, and patient comfort during awake fiberoptic intubation done under combined regional blocks. Materials and Methods: In the present observational study, 50 patients of American Society of Anesthesiologists ( ASA) Grade I–II, Mallampati Grade I–IV were given nerve blocks - bilateral glossopharyngeal nerve block, bilateral superior laryngeal nerve block, and recurrent laryngeal nerve block before awake fiberoptic intubation using 2% lidocaine. Results: Procedure was associated with minimal increases in hemodynamic parameters during the procedure and until 3 min after it. Most of the intubations were being carried out within 3 min. Patient comfort was satisfactory with 90% of patients having favorable grades. Discussion: The most common cause of mortality and serious morbidity due to anesthesia is from airway problems. One-third of all anesthetic deaths are due to failure to intubate and ventilate. Awake flexible fiberoptic intubation under local anesthesia is now an accepted technique for managing such situations. In awake patient's anatomy, muscle tone, airway protection, and ventilation are preserved, but it is essential to sufficiently anesthetize the upper airway before the performance of awake fiberoptic bronchoscope-guided intubation to ensure patient comfort and cooperation for which in our study we used the nerve block technique. Conclusion: A properly performed technique of awake fiberoptic intubation done under combined regional nerve blocks provides good intubating conditions, patient comfort and safety and results in minimal hemodynamic changes. PMID:27212757

  7. An unexpected difficult intubation in a patient with myasthenia gravis undergoing video-assisted transcervical thymectomy

    PubMed Central

    Grasso, Nadia; Celestre, Chiara; Borrata, Francesco; Migliore, Marcello

    2013-01-01

    Although there are different methods to evaluate predictive parameters of difficult intubation in apparently normal patients, sometimes this event is unpredictable.We herein report a clinical case of difficult intubation during anaesthesia for video-assisted thymectomy in non-thymomatous myasthenia gravis. PMID:23749836

  8. Difficult intubation in an infant with Pierre Robin syndrome and concomitant tongue tie.

    PubMed

    Jones, S E; Derrick, G M

    1998-01-01

    Intubation and airway difficulties may be assumed in infants with Pierre Robin syndrome. We report a case of a six month old cleft palate repair who also had a tongue tie which compounded the problem. He was eventually intubated using the two anaesthetist technique. The contribution of the tongue tie is assessed. PMID:9836218

  9. Development of a Quality Improvement Bundle to Reduce Tracheal Intubation-Associated Events in Pediatric ICUs.

    PubMed

    Li, Simon; Rehder, Kyle J; Giuliano, John S; Apkon, Michael; Kamat, Pradip; Nadkarni, Vinay M; Napolitano, Natalie; Thompson, Ann E; Tucker, Craig; Nishisaki, Akira

    2016-01-01

    Advanced airway management in the pediatric intensive care unit (PICU) is hazardous, with associated adverse outcomes. This report describes a methodology to develop a bundle to improve quality and safety of tracheal intubations. A prospective observational cohort study was performed with expert consensus opinion of 1715 children undergoing tracheal intubation at 15 PICUs. Baseline process and outcomes data in tracheal intubation were collected using the National Emergency Airway Registry for Children reporting system. Univariate analysis was performed to identify risk factors associated with adverse tracheal intubation-associated events. A multidisciplinary quality improvement committee was formed. Workflow analysis of tracheal intubation and pilot testing were performed to develop the Airway Bundle Checklist with 4 parts: (1) risk factor assessment, (2) plan generation, (3) preprocedure time-out to ensure that providers, equipment, and plans are prepared, (4) postprocedure huddle to identify improvement opportunities. The Airway Bundle Checklist developed may lead to improvement in airway management. PMID:25143411

  10. Clinical dysphagia risk predictors after prolonged orotracheal intubation

    PubMed Central

    de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Mangilli, Laura Davison; Zilberstein, Bruno; de Andrade, Claudia Regina Furquim

    2014-01-01

    OBJECTIVES: To elucidate independent risk factors for dysphagia after prolonged orotracheal intubation. METHODS: The participants were 148 consecutive patients who underwent clinical bedside swallowing assessments from September 2009 to September 2011. All patients had received prolonged orotracheal intubations and were admitted to one of several intensive care units of a large Brazilian school hospital. The correlations between the conducted water swallow test results and dysphagia risk levels were analyzed for statistical significance. RESULTS: Of the 148 patients included in the study, 91 were male and 57 were female (mean age, 53.64 years). The univariate analysis results indicated that specific variables, including extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking, and other signs, were possible significant high-risk indicators of dysphagia onset. The multivariate analysis results indicated that cervical auscultation and coughing were independent predictive variables for high dysphagia risk. CONCLUSIONS: Patients displaying extraoral loss, multiple swallows, cervical auscultation, vocal quality, cough, choking and other signs should benefit from early swallowing evaluations. Additionally, early post-extubation dysfunction recognition is paramount in reducing the morbidity rate in this high-risk population. PMID:24473554

  11. Endotracheal suctioning in intubated newborns: an integrative literature review

    PubMed Central

    Gonçalves, Roberta Lins; Tsuzuki, Lucila Midori; Carvalho, Marcos Giovanni Santos

    2015-01-01

    Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected. PMID:26465249

  12. Effect of Thoracentesis on Intubated Patients with Acute Lung Injury.

    PubMed

    Bloom, Matthew B; Serna-Gallegos, Derek; Ault, Mark; Khan, Ahsan; Chung, Rex; Ley, Eric J; Melo, Nicolas; Margulies, Daniel R

    2016-03-01

    Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios. PMID:27099064

  13. Endotracheal suctioning in intubated newborns: an integrative literature review.

    PubMed

    Gonçalves, Roberta Lins; Tsuzuki, Lucila Midori; Carvalho, Marcos Giovanni Santos

    2015-01-01

    Evidence-based practices search for the best available scientific evidence to support problem solving and decision making. Because of the complexity and amount of information related to health care, the results of methodologically sound scientific papers must be integrated by performing literature reviews. Although endotracheal suctioning is the most frequently performed invasive procedure in intubated newborns in neonatal intensive care units, few Brazilian studies of good methodological quality have examined this practice, and a national consensus or standardization of this technique is lacking. Therefore, the purpose of this study was to review secondary studies on the subject to establish recommendations for endotracheal suctioning in intubated newborns and promote the adoption of best-practice concepts when conducting this procedure. An integrative literature review was performed, and the recommendations of this study are to only perform endotracheal suctioning in newborns when there are signs of tracheal secretions and to avoid routinely performing the procedure. In addition, endotracheal suctioning should be conducted by at least two people, the suctioning time should be less than 15 seconds, the negative suction pressure should be below 100 mmHg, and hyperoxygenation should not be used on a routine basis. If indicated, oxygenation is recommended with an inspired oxygen fraction value that is 10 to 20% greater than the value of the previous fraction, and it should be performed 30 to 60 seconds before, during and 1 minute after the procedure. Saline instillation should not be performed routinely, and the standards for invasive procedures must be respected. PMID:26465249

  14. Poisonings Associated with Intubation: US National Poison Data System Exposures 2000-2013.

    PubMed

    Beauchamp, G A; Giffin, S L; Horowitz, B Z; Laurie, A L; Fu, R; Hendrickson, R G

    2016-06-01

    Patients may be intubated after exposure to a variety of substances because of respiratory failure, CNS sedation, pulmonary pathology, or cardiovascular instability. However, there is little data describing the types of substances that are associated with endotracheal intubation or the rates of intubation after these exposures. Evaluation of this association may inform future research on intubation after exposures to specific substances and guide poison prevention education. Our objective was to determine which exposures were commonly associated with intubation using the data from National Poison Data System (NPDS). The NPDS tracks data from potential exposures to substances reported to all American Association of Poison Control Centers. We performed a retrospective analysis of NPDS data from January 1st, 2000 to December 31st, 2013 to identify human exposures to substances that were associated with endotracheal intubation. Descriptive statistics were used to analyze the data. There were 93,474 single substance exposures and 228,507 multiple substance exposures that were associated with intubation. The most common exposures to substances that were associated with intubation were atypical antipsychotics (7.4 %) for single exposures and benzodiazepines (27.4 %) for multiple exposures. Within each age group, the most common known exposures to substances were for patients under 6 years, clonidine for single and multiple exposures; for patients aged 6-12 years, clonidine for single exposures and atypical antipsychotics for multiple exposures; for patients aged 13-19 years, atypical antipsychotics for single and multiple exposures; and for patients over 19 years, atypical antipsychotics for single exposures and benzodiazepines for multiple exposures. From 2000-2013, the exposures to substances most commonly associated with intubation varied by single versus multiple exposures and by age. This study helps clarify the exposures to substances that are associated with

  15. Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    Ahn, Eun Jin; Choi, Geun Joo; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Woo, Young Cheol; Bang, Si Ra

    2016-01-01

    Air-Q® (air-Q) is a supraglottic airway device which can be used as a guidance of intubation in pediatric as well as in adult patients. We evaluated the efficacy and safety of air-Q compared to other airway devices during general anesthesia in pediatric patients by conducting a systematic review and meta-analysis. A total of 10 studies including 789 patients were included in the final analysis. Compared with other supraglottic airway devices, air-Q showed no evidence for a difference in leakage pressure and insertion time. The ease of insertion was significantly lower than other supraglottic airway devices. The success rate of intubation was significantly lower than other airway devices. However, fiberoptic view was better through the air-Q than other supraglottic airway devices. Therefore, air-Q could be a safe substitute for other airway devices and may provide better fiberoptic bronchoscopic view. PMID:27419134

  16. Comparison of the glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study

    PubMed Central

    2014-01-01

    Background Smart phone technology is becoming increasingly integrated into medical care. Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario. Methods Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, comparing a normal and difficult airway scenario for each device. Primary endpoints were time to view the vocal cords (TVC), time to successful intubation (TSI) and number of failed intubations with each device. Secondary outcomes included participant rated device usability and preference for each scenario. Advantages and disadvantages of the iPhone modified bronchoscope were also discussed. Results There was no significant difference in TVC with the iPhone modified bronchoscope compared with the Macintosh blade (P = 1.0) or unmodified bronchoscope (P = 0.155). TVC was significantly shorter with the Glidescope compared with the Macintosh blade (P < 0.001), iPhone (P < 0.001) and unmodified bronchoscope (P = 0.011). The iPhone bronchoscope TSI was significantly longer than all other devices (P < 0.001). There was no difference between anaesthetic consultant or registrar TVC (P = 1.0) or TSI (P = 0.252), with both being less than the nurses (P < 0.001). Consultant anaesthetists and nurses had a higher intubation failure rate with the iPhone modified bronchoscope compared with the registrars. Although more difficult to use, similar proportions of consultants (14/21), registrars (15/21) and nurses (15/21) indicated that they would be prepared to use the iPhone modified bronchoscope in their clinical practice. The Glidescope was rated easiest to use (P < 0.001) and was the preferred device by all participants for the difficult airway scenario

  17. Nasotracheal Intubation Using the Airtraq Versus Macintosh Laryngoscope: A Manikin Study

    PubMed Central

    Hirabayashi, Yoshihiro; Seo, Norimasa

    2008-01-01

    The Airtraq laryngoscope is a new intubation device that provides a non–line-of-sight view of the glottis. We evaluated this device by comparing the ease of nasotracheal intubation on a manikin with the use of Airtraq versus the Macintosh laryngoscope with and without Magill forceps. Nasotracheal intubation on a manikin was performed by 20 anesthesiologists and 20 residents with the Airtraq or Macintosh laryngoscope. The mean (± SD) time required for nasotracheal intubation by the residents was significantly shorter with the Airtraq laryngoscope than with the Macintosh laryngoscope (16 ± 7 sec vs 22 ± 10 sec; P < .001), but no difference in intubation time was observed between Airtraq (15 ± 11 sec) and Macintosh (13 ± 6 sec) laryngoscopy by the anesthesiologists. The Magill forceps was used more frequently to facilitate intubation with the Macintosh laryngoscope than with the Airtraq laryngoscope in both groups of operators 7(P < .001). The Airtraq laryngoscope scored better on the visual analog scale than did the Macintosh laryngoscope in both groups of operators (P < .05). The Airtraq laryngoscope offers potential advantages over standard direct laryngoscopy for nasotracheal intubation. PMID:18788842

  18. [Post-mortem study of laryngotracheal lesions produced by prolonged intubation and/or tracheotomy].

    PubMed

    Esteller Moré, E; Ibáñez-Nolla, J; García-Hernández, F; Carrasco-García, M A; León-Regidor, M A; Díaz-Boladeras, R M; Orus-Dotu, C; Ademà-Alcover, J M; Nolla-Salas, M

    1997-10-01

    Injuries of the laryngotracheal axis caused by prolonged intubation in critically ill patients raise the issue of the timing of tracheotomy in intubated patients. In 1992 a prospective study was begun in intensive care patients with intubation lasting more than 48 hours. Eight months later, post-mortem data on the laryngotracheal axis of deceased patients was added to our prospective study protocol. The study was closed with 125 cases (52 deceased). The clinical data of 73 surviving patients was compared with that of 18 post-mortem cases. The macroscopic results of the post-mortem study are summarized by grading the lesions according to a personal modification of the Lindholm classification. All cases had laryngotracheal injuries. Only 15% of the lesions were located in the tracheal region. Five cases were classified as grade 2, with an average orotracheal intubation of 9 days, 9 cases as grade 3 with 15 days intubation, and 4 cases as grade 4 with 21 days intubation. We concluded that the severity of laryngotracheal injuries in the early post-mortem exploration was related with the duration of intubation. PMID:9489156

  19. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy

    PubMed Central

    Kanchi, Muralidhar; Nair, Hema C; Banakal, Sanjay; Murthy, Keshava; Murugesan, C

    2011-01-01

    Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randomly allocated to undergo either conventional laryngoscopy (group A) or video laryngoscopy (group B). The time taken to perform endotracheal intubation and haemodynamic changes associated with intubation were noted in both the groups at different time points. The duration of laryngoscopy and intubation was significantly longer in group B (video laryngoscopy) when compared to group A patients. However, haemodynamic changes were no different between the groups. There were no events of myocardial ischaemia as monitored by surface electrocardiography during the study period in either of the groups. In conclusion, video laryngoscopy did not provide any benefit in terms of haemodynamic response to laryngoscopy and intubation in patients undergoing primary CABG with a Mallampatti grade of <2. PMID:21808398

  20. Nasotracheal intubation using the Airtraq versus Macintosh laryngoscope: a manikin study.

    PubMed

    Hirabayashi, Yoshihiro; Seo, Norimasa

    2008-01-01

    The Airtraq laryngoscope is a new intubation device that provides a non-line-of-sight view of the glottis. We evaluated this device by comparing the ease of nasotracheal intubation on a manikin with the use of Airtraq versus the Macintosh laryngoscope with and without Magill forceps. Nasotracheal intubation on a manikin was performed by 20 anesthesiologists and 20 residents with the Airtraq or Macintosh laryngoscope. The mean (+/- SD) time required for nasotracheal intubation by the residents was significantly shorter with the Airtraq laryngoscope than with the Macintosh laryngoscope (16 +/- 7 sec vs 22 +/- 10 sec; P < .001), but no difference in intubation time was observed between Airtraq (15 +/- 11 sec) and Macintosh (13 +/- 6 sec) laryngoscopy by the anesthesiologists. The Magill forceps was used more frequently to facilitate intubation with the Macintosh laryngoscope than with the Airtraq laryngoscope in both groups of operators (P < .001). [corrected] The Airtraq laryngoscope scored better on the visual analog scale than did the Macintosh laryngoscope in both groups of operators (P < .05). The Airtraq laryngoscope offers potential advantages over standard direct laryngoscopy for nasotracheal intubation. PMID:18788842

  1. 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

  2. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery?

    PubMed

    Gonzalez-Rivas, Diego; Bonome, Cesar; Fieira, Eva; Aymerich, Humberto; Fernandez, Ricardo; Delgado, Maria; Mendez, Lucia; de la Torre, Mercedes

    2016-03-01

    Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated

  3. Tracheoesophageal fistula - a complication of prolonged tracheal intubation

    PubMed Central

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results. PMID:25713612

  4. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    PubMed

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results. PMID:25713612

  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. Fetal Endoscopic Tracheal Intubation: A New Fetoscopic Procedure to Ensure Extrauterine Tracheal Permeability in a Case with Congenital Cervical Teratoma.

    PubMed

    Cruz-Martinez, Rogelio; Moreno-Alvarez, Oscar; Garcia, Maritza; Méndez, Antonio; Pineda, Hugo; Cruz-Martinez, Miriam Alejandra; Cruz, Miriam A; Martinez-Morales, Cecilia

    2015-01-01

    Congenital neck masses are associated with high perinatal mortality and morbidity secondary to airway obstruction due to a mass effect of the tumor with subsequent neonatal asphyxia and/or neonatal death. Currently, the only technique designed to establish a secure neonatal airway is the ex utero intrapartum treatment (EXIT) procedure, which involves neonatal tracheal intubation while fetal oxygenation is maintained by the uteroplacental circulation in a partial fetal delivery under maternal general anesthesia. We present a case with a giant cervical teratoma and huge displacement and compression of the fetal trachea that was treated successfully at 35 weeks of gestation with a novel fetoscopic procedure to ensure extrauterine tracheal permeability by means of a fetal endoscopic tracheal intubation (FETI) before delivery. The procedure consisted of a percutaneous fetal tracheoscopy under maternal epidural anesthesia using an 11-Fr exchange catheter covering the fetoscope that allowed a conduit to introduce a 3.0-mm intrauterine orotracheal cannula under ultrasound guidance. After FETI, a conventional cesarean section was performed uneventfully with no need for an EXIT procedure. This report is the first to illustrate that in cases with large neck tumors involving fetal airways, FETI is feasible and could potentially replace an EXIT procedure by allowing prenatal airway control. PMID:25228387

  7. PASS and Reading Achievement.

    ERIC Educational Resources Information Center

    Kirby, John R.

    Two studies examined the effectiveness of the PASS (Planning, Attention, Simultaneous, and Successive cognitive processes) theory of intelligence in predicting reading achievement scores of normally achieving children and distinguishing children with reading disabilities from normally achieving children. The first study dealt with predicting…

  8. BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation.

    PubMed

    Rabinstein, Alejandro; Wijdicks, Eelco F M

    2002-11-26

    Noninvasive mechanical ventilation using bilevel positive pressure ventilation (BiPAP) has not been studied in acute respiratory failure caused by MG. Eleven episodes in nine patients were initially managed with BiPAP, and endotracheal intubation was avoided in seven of these trials. Presence of hypercapnia (PaCO2 greater than 50 mm Hg) at onset predicted BiPAP failure and subsequent intubation. Results of this preliminary study suggest that a trial of BiPAP may prevent intubation in patients with myasthenic crisis without overt hypercapnia. PMID:12451217

  9. Intubation Difficile Chez le Brule de la Face et du Cou a la Phase de Sequelles

    PubMed Central

    Siah, S.; El Wali, A.; Ababou, K.; Nassim Sabah, T.; Drissi, N.K.; Ihrai, I.

    2006-01-01

    Summary L'intubation trachéale chez le brûlé de la face et du cou au stade de séquelles peut être difficile voire impossible chez certains patients. La technique de ventilation à l'aide d'un masque laryngé ou d'intubation avec un fibroscope bronchique permet de résoudre la plupart des problèmes d'intubation difficile. Les Auteurs rapportent deux observations chez deux patientes porteuses de séquelles de brûlures de la face et du cou. PMID:21991028

  10. [Successful Tracheal Intubation Using Videolaryngoscope in an Infant with Massive Tongue Swelling].

    PubMed

    Miyazaki, Yu; Komasawa, Nobuyasu; Majima, Nozomi; Kusaka, Yusuke; Tatsumi, Shinichi; Minami, Toshiaki

    2015-02-01

    We report use of videolaryngoscope for difficult airway management in an infant with severe tongue swelling after laceration repair. A 3-month-old male infant was transferred to our hospital for respiratory difficulty. He could not open his mouth sufficiently, and the examination revealed massive swelling of the left side of the tongue. Emergent surgical repair of the tongue was scheduled, anticipating a difficult airway. The venous line was kept patent preoperatively, and 8% sevoflurane was administered maintaining spontaneous ventilation. We then inserted the Pentax Airway Scope with an infant-sized Intlock (AWS-I) from the right side of the mouth and obtained a good view at laryngoscopy. A 3.5-mm tracheal tube was passed uneventfully under the view of AWS-I. The AWS-I is useful for difficult airway management in infants, preserving spontaneous ventilation. PMID:26121815

  11. Dermal Fillers: Tips to Achieve Successful Outcomes

    PubMed Central

    Vedamurthy, Maya; Vedamurthy, Amar

    2008-01-01

    Fillers have become a common aesthetic treatment for several cosmetic problems. Several types of fillers are available from different sources and of different longevities. It is important that the treating physician be aware of the different techniques of administration and their possible side effects. This article reviews the available literature on the subject. PMID:20300346

  12. Strategies for achieving orthopedic service line success.

    PubMed

    Lang, Stacey; Powers, Kristi

    2013-12-01

    Healthcare finance leaders can work with orthopedic surgeons to support better outcomes, clinically and financially, by: Establishing innovative partnerships among hospital leaders, orthopedic surgeons, and implant vendors. Developing and enforcing expectations around contracting and vendor behavior. Establishing a forum for open communication. Building a bundled payment structure. Finding ways to differentiate from the competition. PMID:24380256

  13. Talking about Success: Implications for Achievement Motivation

    ERIC Educational Resources Information Center

    Heyman, Gail D.

    2008-01-01

    Three studies investigated the influence of verbal descriptions concerning the performance of others on children's ability conceptions among 177 elementary school children ranging in age from 8 to 12 years. Study 1 showed that when high-performing characters were described with labels such as "math whiz," children tended to view the character's…

  14. Utilizing Modality Theory to Achieve Academic Success

    ERIC Educational Resources Information Center

    Lister, Dena; Ansalone, George

    2006-01-01

    Education accompanied by social mobility is the cornerstone of the American dream. Yet, each year scores of children, especially those from the underprivileged class, fail to meet even the most modest academic expectations and subsequently never reach their academic potential. This research rejects earlier explanations of academic failure and…

  15. [Pentax-AWS Airwayscope for awake tracheal intubation in the face-to-face sitting position in an emergency patient with acute exacerbation of aortic stenosis].

    PubMed

    Seno, Hisayo; Komasawa, Nobuyasu; Tatsumi, Shinichi; Ohchi, Fumihiro; Miyazaki, Yu; Minami, Toshiaki

    2014-08-01

    We report a successful awake tracheal intubation in an emergency patient with acute exacerbation of aortic stenosis using the Pentax-AWS Airwayscope (AWS). An 83-year-old woman was admitted to our emergency department for severe dyspnea due to exacerbation of aortic stenosis. Her Sp(O2) was 92-93% even after administration of 10 l x min(-1) oxygen through a reservoir-attached face mask. As she could not remain in the supine position, emergency tracheal intubation in the sitting position was required. After topical anesthesia with 8% lidocaine and careful administration of midazolam, the AWS was inserted into her mouth in the sitting, face-to-face position. The AWS allowed for visualization of the glottis and safe placement of the tracheal tube. Sufficient spontaneous ventilation was maintained during interventions with minimum vital sign changes. Awake intubation in the sitting position with the AWS may be helpful in resolving cardiovascular crisis in patients unable to maintain the supine position. PMID:25199329

  16. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

    PubMed Central

    Gaszynski, Tomasz; Gaszynska, Ewelina; Szewczyk, Tomasz

    2014-01-01

    Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2) female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM) as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using “awake intubation” method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in “opioid-free anesthesia method”. PMID:25045249

  17. Attitudes of Success.

    ERIC Educational Resources Information Center

    Pendarvis, Faye

    This document investigates the attitudes of successful individuals, citing the achievement of established goals as the criteria for success. After offering various definitions of success, the paper focuses on the importance of self-esteem to success and considers ways by which the self-esteem of students can be improved. Theories of human behavior…

  18. Submental intubation: alternative short-term airway management in maxillofacial trauma

    PubMed Central

    Kumar, Ravi Raja; Vyloppilli, Suresh; Thangavelu, Annamala; Joseph, Benny; Ahsan, Auswaf

    2016-01-01

    Objectives To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications. PMID:27429937

  19. 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

  20. Nasotracheal intubation with three indirect laryngoscopes assisted by standard or modified Magill forceps.

    PubMed

    Staar, S; Biesler, I; Müller, D; Pförtner, R; Mohr, C; Groeben, H

    2013-05-01

    We assessed the effect of modifying standard Magill forceps on the laryngeal introduction of an Eschmann stylet during nasotracheal intubations with three indirect laryngoscopes (Airtraq™, C-MAC(®) or GlideScope(®)) in patients with predicted difficult intubation. We allocated 50 participants to each laryngoscope. The stylet was advanced by one forceps followed by the other (standard or modified), with each sequence allocated to 25/50 for each laryngoscope. There were no differences in rates of failed tracheal intubation with the allocated laryngoscopes: 6/50, 5/50 and 5/50, respectively. An Eschmann stylet was advanced into the trachea less often with the standard forceps (65% vs 93%, p < 0.0001). Mean (SD) time for stylet advancement was longer with the standard forceps, 38 (30) vs 19 (19) s, p < 0.0001. In conclusion, the modified Magill forceps facilitated nasotracheal intubation, independent of the type of indirect laryngoscope. PMID:23480441

  1. 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

  2. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax

    PubMed Central

    Bolufer, Sergio; Navarro-Martinez, Jose; Lirio, Francisco; Corcoles, Juan Manuel; Rodriguez-Paniagua, Jose Manuel

    2015-01-01

    Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation. PMID:26046045

  3. Effect of a single dose of esmolol on the bispectral index to endotracheal intubation during desflurane anesthesia

    PubMed Central

    Choi, Eun Mi; Min, Kyeong Tae; Lee, Jeong Rim; Lee, Tai Kyung

    2013-01-01

    Background In this prospective, randomized, double-blind, placebo-controlled trial, we investigated the effect of a single dose of esmolol on the bispectral index (BIS) to endotracheal intubation during desflurane anesthesia. Methods After induction of anesthesia, 60 patients were mask-ventilated with desflurane (end-tidal 1 minimum alveolar concentration) for 5 min and then received either normal saline, esmolol 0.5 or 1 mg/kg, 1 min prior to intubation (control, esmolol-0.5 and esmolol-1 groups, n = 20/group). BIS, mean arterial pressure, and heart rate were measured prior to anesthesia induction and esmolol administration, immediately preceding intubation (time point 0), and every minute for 5 min after intubation (time point 1 to 5). At time point 0, 1 and 5, 5 ml of arterial blood was taken to measure plasma concentrations of norepinephrine and epinephrine. Results BIS increased significantly at 1 min after intubation when compared with pre-intubation values in all groups. Both mean arterial pressure and heart rate increased significantly 1 min after intubation when compared with preintubation values for all groups. Plasma epinephrine concentrations did not increase significantly after tracheal intubation in any of the groups. Norepinephrine increased at 1 min after intubation when compared with the preintubation values in the esmolol groups (P < 0.05). Conclusions A single bolus of esmolol was unable to blunt the increase in BIS to endotracheal intubation during desflurane anesthesia. PMID:23741564

  4. 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

  5. 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

  6. Continuous posterior lumbar plexus and continuous parasacral and intubation with lighted stylet for ankylosing spondylitis.

    PubMed

    Imbelloni, Luiz Eduardo; Lucena, Neli

    2015-01-01

    Ankylosing spondylitis is characterized by progressive ossification of the spinal column with resultant stiffness. Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway and performing neuraxial blockade. We describe a case of intubation with lighted stylet, and use of the continuous lumbosacral plexus for THA and postoperative analgesia with an elastomeric pump. Key words: Airways difficult anticipated, anesthesia, ankoylosing spondylitis, arthroplasty, conduction, continuous lumbosacral plexus, hip, infusion pumps, intubation awake, replacement. PMID:25886430

  7. Non-intubated laparoscopic repair of giant Morgagni’s hernia for a young man

    PubMed Central

    Zhang, Miao; Wang, Heng; Liu, Dong; Pan, Xuefeng; Wu, Wenbin; Hu, Zhengqun

    2016-01-01

    An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni’s hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH.

  8. Non-intubated laparoscopic repair of giant Morgagni's hernia for a young man.

    PubMed

    Zhang, Miao; Wang, Heng; Liu, Dong; Pan, Xuefeng; Wu, Wenbin; Hu, Zhengqun; Zhang, Hui

    2016-08-01

    An asymptomatic patient was admitted as his chest photograph and computed tomography scans showed a giant Morgagni's hernia (MH). And it was repaired by laparoscopic approach under epidural anesthesia without endotracheal intubation. The hernia content of omentum was repositioned back into the abdominal cavity, and the diaphragmatic defect was repaired with composite mesh. Which indicated that non-intubated laparoscopic mesh repair via epidural anesthesia is reliable and satisfactory for MH. PMID:27621903

  9. Non-intubated video-assisted thoracic surgery: where does evidence stand?

    PubMed Central

    Tacconi, Federico

    2016-01-01

    In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients’ management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients’ well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet. PMID:27195134

  10. Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients.

    PubMed

    Yukioka, H; Hayashi, M; Terai, T; Fujimori, M

    1993-08-01

    The effects of intravenously administered lidocaine on cough suppression in elderly patients over the age of 60 yr during tracheal intubation under general anesthesia were evaluated in two studies. In the first study, 100 patients received a placebo of either 0.5, 1.0, 1.5, or 2.0 mg/kg lidocaine intravenously 1 min before tracheal intubation. All visible coughs were classified as coughing. The incidence of coughing decreased as the dose of lidocaine increased. A dose of 1.5 mg/kg or more of intravenous lidocaine suppressed the cough reflex significantly (P < 0.01). In the second study, 108 patients received 2 mg/kg lidocaine intravenously or a placebo 1, 3, 5, 7, 10, or 15 min before intubation. The same criteria for determining whether a patient did or did not cough during tracheal intubation were used as in Study 1. The incidence of coughing decreased significantly (P < 0.01) when 2 mg/kg lidocaine was injected intravenously between 1 min and 3 min before attempting intubation. The cough reflex was almost entirely suppressed by plasma concentrations of lidocaine in excess of 4 micrograms/mL. The results suggest that intravenous administration of lidocaine is effective in suppressing the cough reflex during tracheal intubation in elderly patients under general anesthesia, but that relatively high plasma concentrations of lidocaine may be required for suppression of coughing. PMID:8346830

  11. A systematic review and meta-regression analysis of mivacurium for tracheal intubation.

    PubMed

    Vanlinthout, L E H; Mesfin, S H; Hens, N; Vanacker, B F; Robertson, E N; Booij, L H D J

    2014-12-01

    We systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people. PMID:25040541

  12. Endotracheal intubation influences respiratory water loss during heat stress in young lambs.

    PubMed

    Hammarlund, K; Norsted, T; Riesenfeld, T; Sedin, G

    1995-09-01

    To study the effect of intubation on respiratory water loss (RWL) during heat stress, 10 young nonsedated lambs were exposed to radiative heat stress both when intubated and when not. RWL, oxygen consumption (VO2), and carbon dioxide production were monitored continuously by using a flow-through system with a mass spectrometer for gas analysis. When the lambs were not intubated, heat stress caused RWL to increase by 218%, whereas VO2 and body temperature remained unchanged. When the lambs were intubated, heat stress caused RWL to increase by 131% and VO2 to increase by 36%. On extubation during heat stress, RWL increased by 117 +/- 48% (standard error of the estimate) of the preextubation value and body temperature started to fall. This study shows that intubation reduces the ability of the lamb to increase RWL and heat loss during heat stress in a warm environment, possibly as an effect of exclusion of the nose and a reduction in dead space. After extubation, RWL increases markedly, a finding that might also be valid for intubated infants. PMID:8567520

  13. Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients

    PubMed Central

    Heng, Lei; Wang, Ming-Yu; Sun, Hou-Liang; Zhu, Shan-Shan

    2016-01-01

    Abstract Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia. Sixty-two patients (ASA physical status I–II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure. Premedication with sedative and antisialagogue was followed by airway anesthesia with topical lidocaine; then, awake nasotracheal fiberoptic intubation was carried out. The patients then positioned themselves comfortably before induction of general anesthesia. The changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), incidence of coughing or gagging, and rate pressure product (RPP) were assessed. Statistical analysis was performed with repeated-measures one-way analysis of variance. Fifty-eight of the 62 patients completed prone self-positioning smoothly. Compared with values before intubation, SBP, DBP, HR, and RPP were slightly increased after intubation, although the difference was not statistically significant (P > 0.05). One patient had moderate coughing and 1 patient had gagging during prone self-positioning, which were tolerable. These findings indicated that awake nasotracheal fiberoptic intubation and self-positioning followed by induction of anesthesia is safe and feasible alternative to routine prone positioning after induction of general anesthesia. PMID:27512858

  14. 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

  15. 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

  16. Successful anesthetic management of a patient with thyroid carcinoma invading the trachea with tracheal obstruction, scheduled for total thyroidectomy.

    PubMed

    Liou, Jing-Yang; Chow, Lok-Hi; Chan, Kwok-Hon; Tsou, Mei-Yung

    2014-09-01

    We report a case of large thyroid carcinoma with tracheal and esophageal invasion who presented with preoperative stridor scheduled for total thyroidectomy and segmental tracheal resection. Careful and comprehensive preoperative anesthetic planning was done. Extracorporeal circulation membrane oxygenation (ECMO) was set up and running prior to induction under local anesthesia, due to an increased international normalized ratio (INR) and fear of bleeding in the airway. Fiberoptic bronchoscopy (FOB) is the first choice in many circumstances of difficult airway. However, we twice failed to intubate under FOB guidance. Successful intubation was done with traditional laryngoscopy and a Glidescope. The operative course was smooth. The oral endotracheal tube (ETT) was changed to a nasal ETT after surgery with the Glidescope. FOB-assisted intubation carries a chance of failure, and in critical patients, the presence of other intubating modalities such as video-assisted or fiberoptic-assisted technology or safety measures, including ECMO, will greatly increase the safety of anesthesia and surgery. PMID:25150647

  17. Comparison of the ease of tracheal intubation by postgraduate residents of anesthesiology using Airtraq™ and Macintosh laryngoscopes: An observational study

    PubMed Central

    Yallapragada, Srivishnu Vardhan; Parasa, Mrunalini; Vemuri, Nagendra Nath; Shaik, Mastan Saheb

    2016-01-01

    Context: Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which facilitates easy visualization of glottis through a matrix of sequentially arranged lenses and mirrors. In this observatory study, we sought to compare the ease of tracheal intubation with Airtraq™ and Macintosh laryngoscope when performed by 2nd year postgraduate residents of Anesthesiology in NRI Medical College, Mangalagiri. Aims: To compare the ease of tracheal intubation by Airtraq™ laryngoscope with that by Macintosh laryngoscope among the 2nd year postgraduate residents of anesthesiology in terms of time taken for intubation and the rise of rate-pressure product (RPP) with intubation. Settings and Design: Prospective randomized observational study. Subjects and Methods: Eighty adult and healthy patients with an easy airway, scheduled for general anesthesia were allocated into two groups A, and M. Patients in Group A were intubated with Airtraq™ laryngoscope and those in Group M were intubated with Macintosh laryngoscope by the 2nd year postgraduate residents of anesthesiology. The time taken for intubation, the RPPs at baseline, after induction of general anesthesia, postintubation, at 3 and 5 min after intubation, the rise of RPP to intubation and the occurrence of a sore throat were compared between the two groups. Statistical Analysis Used: Descriptive and inferential statistical methods were used to analyze the data. Results: The mean time for intubation in Macintosh group was 28.18 s and was 40.98 s in Airtraq group. The mean rise of RPP to intubation was 4644.83 in Airtraq group and 2829.27 in Macintosh group. The incidence of a sore throat was equal in both the groups. Conclusions: The time for intubation and the sympathetic response to airway instrumentation were more with Airtraq™ laryngoscope than with Macintosh laryngoscope. PMID:27212753

  18. Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial.

    PubMed

    Marashi, Seyed Mojtaba; Saeedinia, Seyed Mostafa; Sadeghi, Mostafa; Movafegh, Ali; Marashi, Shaqayeq

    2015-12-01

    A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4, respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200 mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG. PMID:26749228

  19. Does a single dose of intravenous nicardipine or nimodipine affect the bispectral index following rapid sequence intubation?

    PubMed Central

    Lee, Jeong Jin; Ahn, Hyun Joo; Kim, Jin-Kyoung; Yang, Mikyung; Choi, Soo Joo; Kim, Hyun-Soo; Yang, Soo Hyun

    2010-01-01

    Background Theoretically, L-type calcium channel blockers could modulate anesthetic effects. Nicardipine does not affect the bispectral index (BIS), but nimodipine, which can penetrate the blood-brain barrier, has not been studied. The aim of this study was to evaluate whether a single dose of intravenous nicardipine or nimodipine could affect BIS following rapid sequence intubation. Methods This study was done in a double-blind, randomized fashion. Anesthesia was induced with fentanyl 2 µg/kg, thiopental sodium 5 mg/kg, and 100% oxygen. After loss of consciousness, patients received rocuronium 1.0 mg/kg and either a bolus of 20 µg/kg nicardipine, nimodipine, or a comparable volume of normal saline (n = 20). Intubation was performed 1 min after study drug administration. BIS, mean blood pressure (MBP), and heart rate (HR) were measured before anesthetic induction, after loss of consciousness, before intubation, during intubation, and 1, 2 and 5 min after intubation. Results BIS dropped rapidly after induction but increased to 60 before intubation in all groups irrespective of study drug. In nimodipine, the increase in BIS during intubation was not significant compared to pre-intubation, in contrast to the other two groups, but there was no difference in BIS during intubation. HR significantly increased, but MBP just rose to pre-induction values after intubation in nicardipine and nimodipine groups. BIS, MBP, and HR following intubation increased in control group. Conclusions A single dose of intravenous nicardipine or nimodipine could attenuate blood pressure increases but not affect BIS increases in rapid sequence intubation. PMID:21057615

  20. Motion capture measures variability in laryngoscopic movement during endotracheal intubation: A preliminary report

    PubMed Central

    Carlson, Jestin N; Das, Samarjit; De la Torre, Fernando; Callaway, Clifton W; Phrampus, Paul E; Hodgins, Jessica

    2012-01-01

    Background Success rates with emergent endotracheal intubation (ETI) improve with increasing provider experience. Few objective metrics exist to quantify differences in ETI technique between providers of various skill levels. We tested the feasibility of using motion capture videography to quantify variability in the motions of the left hand and the laryngoscope in providers with various experience. Methods Three providers with varying levels of experience (attending physician (experienced), Emergency Medicine resident (intermediate), and post doctoral student with no previous ETI experience (novice)) each performed ETI four times on a mannequin. A Vicon, 16-camera system tracked the 3D orientation and movement of markers on the providers, handle of the laryngoscope, and mannequin. Attempt duration, path length of the left hand and the inclination of the plane of the laryngoscope handle (mean squared angular deviation from vertical) were calculated for each laryngoscopy attempt. We compared inter-attempt and inter-provider variability of each measure Results All ETI attempts were successful. Mean (SD) duration of laryngoscopy attempts in seconds differed between experienced 5.50 (0.68), intermediate 6.32 (1.13) and novice 12.38 (1.06) providers (p=0.021). Mean path length of the left hand did not differ between providers (p=0.37). Variability of the plane of the laryngoscope (degrees2) differed between providers: 8.3 (experienced), 28.7 (intermediate) and 54.5 (novice). Conclusion Motion analysis can detect inter-provider differences in hand and laryngoscope movements during ETI which may be related to provider experience. This technology has potential to objectively measure training and skill in ETI. PMID:22801254

  1. [Successful double-lumen tube insertion using Pentax-AWS Airwayscope with an infant-sized intlock in a rheumatoid arthritis patient with restricted mouth opening and head tilting].

    PubMed

    Ono, Naomi; Komasawa, Nobuyasu; Nakano, Shoko; Kuwamura, Ayumu; Tatsumi, Shinichi; Minami, Toshiaki

    2014-04-01

    Successful tracheal intubation with a double-lumen tube was achieved using Pentax-AWS Airwayscope (AWS) with an infant-size Intlock in a patient with restricted mouth opening and head tilting. A 78-year-old woman with rheumatoid arthritis was scheduled for extended thymectomy under general anesthesia, with anticipated difficult airway. Sufficient mask ventilation with the jaw-thrust maneuver was achieved. The laryngoscopic view was defined as grade III (Cormack & Lehane's classification)with Macintosh laryngoscope. The AWS with an infant-size Intlock facilitated visualization of the glottis, leading to a successful placement of a 32-Fr double-lumen tube under the guidance of the AWS image. Double-lumen tube insertion assisted by the AWS with an infant-size Intlock may be useful for difficult airway management in patients with restricted mouth opening and head tilting. PMID:24783604

  2. Inverting the Achievement Pyramid

    ERIC Educational Resources Information Center

    White-Hood, Marian; Shindel, Melissa

    2006-01-01

    Attempting to invert the pyramid to improve student achievement and increase all students' chances for success is not a new endeavor. For decades, educators have strategized, formed think tanks, and developed school improvement teams to find better ways to improve the achievement of all students. Currently, the No Child Left Behind Act (NCLB) is…

  3. Achievement-Based Resourcing.

    ERIC Educational Resources Information Center

    Fletcher, Mike; And Others

    1992-01-01

    This collection of seven articles examines achievement-based resourcing (ABR), the concept that the funding of educational institutions should be linked to their success in promoting student achievement, with a focus on the application of ABR to postsecondary education in the United Kingdom. The articles include: (1) "Introduction" (Mick…

  4. Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis

    PubMed Central

    Almashhrawi, Ashraf A.; Rahman, Rubayat; Jersak, Samuel T.; Asombang, Akwi W.; Hinds, Alisha M.; Hammad, Hazem T.; Nguyen, Douglas L.; Bechtold, Matthew L.

    2015-01-01

    AIM To evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients. METHODS UGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004–2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments. RESULTS Initial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11). CONCLUSION Pneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation

  5. Catastrophic neurological complications of emergent endotracheal intubation: report of 2 cases.

    PubMed

    Oppenlander, Mark E; Hsu, Forrest D; Bolton, Patrick; Theodore, Nicholas

    2015-05-01

    Although exceedingly rare, catastrophic neurological decline may result from endotracheal intubation of patients with preexisting cervical spine disease. The authors report on 2 cases of quadriplegia resulting from emergent endotracheal intubation in the intensive care unit. A 68-year-old man with ankylosing spondylitis became quadriplegic after emergent intubation. A new C6-7 fracturedislocation was identified, and the patient underwent emergent open reduction and C4-T2 posterior fixation and fusion. The patient remained quadriplegic and ultimately died of pneumonia 1 year later. This is the first report with radiographic documentation of a cervical fracture-dislocation resulting from intubation in a patient with ankylosing spondylitis. A 73-year-old man underwent posterior C6-T1 decompression and fixation for a C6-7 fracture. On postoperative Day 12, emergent intubation for respiratory distress resulted in C6-level quadriplegia. Imaging revealed acute spondyloptosis at C6-7, and the patient underwent emergent open reduction with revision and extension of posterior fusion from C-3 to T-2. He remained quadriplegic and ventilator dependent. Five days after the second operation, care was withdrawn. This is the first report of intubation as a cause of significant neurological decline related to disruption of a recently fixated cervical fracture. Risk factors are identified and pertinent literature is reviewed for cases of catastrophic neurological complications after emergent endotracheal intubation. Strategies for obtaining airway control in patients with cervical spine pathology are also identified. Awareness of the potential dangers of airway management in patients with cervical spine pathology is critical for all involved subspecialty team members. PMID:25723119

  6. Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases

    PubMed Central

    Sankar, Duraiswamy; Krishnan, Radhika; Veerabahu, Muthusubramanian; Vikraman, Bhaskara Pandian; Nathan, J. A.

    2016-01-01

    Aim: The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients. Settings and Design: A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications. Materials and Methods: Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded. Results: Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat. Conclusion: In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm. PMID:27563608

  7. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine—A Randomized Clinical Trial

    PubMed Central

    Kord Valeshabad, Ali; Nabavian, Omid; Nourijelyani, Keramat; Kord, Hadi; Vafainejad, Hossein; Kord Valeshabad, Reza; Reza Feili, Ali; Rezaei, Mehdi; Darabi, Hamed; Koohkan, Mohammad; Golbinimofrad, Poorya; Jafari, Samira

    2014-01-01

    The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P < 0.001). There were significant changes of HR in both groups after intubation (P < 0.02), but the trend of changes was different between two groups (P < 0.001). In group L, HR increased after intubation and its change was statistically significant within 9 minutes after intubation (P < 0.001), while in group P, HR remained stable after intubation (P = 0.8). Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation. PMID:24822063

  8. Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine-A Randomized Clinical Trial.

    PubMed

    Kord Valeshabad, Ali; Nabavian, Omid; Nourijelyani, Keramat; Kord, Hadi; Vafainejad, Hossein; Kord Valeshabad, Reza; Reza Feili, Ali; Rezaei, Mehdi; Darabi, Hamed; Koohkan, Mohammad; Golbinimofrad, Poorya; Jafari, Samira

    2014-01-01

    The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P < 0.001). There were significant changes of HR in both groups after intubation (P < 0.02), but the trend of changes was different between two groups (P < 0.001). In group L, HR increased after intubation and its change was statistically significant within 9 minutes after intubation (P < 0.001), while in group P, HR remained stable after intubation (P = 0.8). Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation. PMID:24822063

  9. Prehospital intubation of the moderately injured patient: a cause of morbidity? A matched-pairs analysis of 1,200 patients from the DGU Trauma Registry

    PubMed Central

    2011-01-01

    Introduction Hypoxia and hypoxemia can lead to an unfavorable outcome after severe trauma, by both direct and delayed mechanisms. Prehospital intubation is meant to ensure pulmonary gas exchange. Limited evidence exists regarding indications for intubation after trauma. The aim of this study was to analyze prehospital intubation as an independent risk factor for the posttraumatic course of moderately injured patients. Therefore, only patients who, in retrospect, would not have required intubation were included in the matched-pairs analysis to evaluate the risks related to intubation. Methods The data of 42,248 patients taken from the trauma registry of the German Association for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie (DGU)) were analyzed. Patients who met the following criteria were included: primary admission to a hospital; Glasgow Coma Scale (GCS) of 13 to 15; age 16 years or older; maximum injury severity per body region (AIS) ≤ 3; no administration of packed red blood cell units in the emergency trauma room; admission between 2005 and 2008; and documented data regarding intubation. The intubated patients were then matched with not-intubated patients. Results The study population included 600 matched pairs that met the inclusion criteria. The results indicated that prehospital intubation was associated with a prolonged rescue time (not intubated, 64.8 minutes; intubated, 82.3 minutes; P ≤ 0.001) and a higher volume replacement (not intubated, 911.3 ml; intubated, 1,573.8 ml; P ≤ 0.001). In the intubated patients, coagulation parameters, such as the prothrombin time ratio (PT) and platelet count, declined, as did the hemoglobin value (PT not intubated: 92.3%; intubated, 85.7%; P ≤ 0.001; hemoglobin not intubated, 13.4 mg/dl; intubated, 12.2 mg/dl; P ≤ 0.001). Intubation at the scene resulted in an elevated sepsis rate (not intubated, 1.5%; intubated, 3.7%; P ≤ 0.02) and an elevated prevalence of multiorgan failure (MOF) and organ

  10. Attenuation of pressor response following intubation: Efficacy of nitro-glycerine lingual spray

    PubMed Central

    Kumari, Indira; Naithani, Udita; Dadheech, Vinod Kumar; Pradeep, D. S.; Meena, Khemraj; Verma, Devendra

    2016-01-01

    Background and Aims: The role of nitro-glycerine (NTG) lingual spray for attenuation of the hemodynamic response associated with intubation is not much investigated. We conducted this study to evaluate the efficacy of NTG lingual pump or pen spray in attenuation of intubation induced hemodynamic responses and to elucidate the optimum dose. Material and Methods: In a prospective randomized controlled trial, 90 adult patients of ASA I, II, 18-60 year posted for elective general surgery under general anesthesia with intubation were randomly allocated to three groups as Group C (control) - receiving no NTG spray, Group N1 – receiving 1 NTG spray and Group N2 – receiving 2 NTG spray one minute before intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate were recorded at baseline, just before intubation (i.e., 60 s just after induction and NTG spray), immediately after intubation, at 1, 2, 5 and 10 min after intubation. Results: Incidence of hypertension was significantly higher in Group C (60%, n = 18) as compared to Group N1 and N2 (10%, n = 3 each), P < 0.01. Mean value of SBP, DBP and MAP showed a significant rise as compared to baseline, following intubation in control group (15.31% in SBP, 12.12% in DBP, 17.77% in MAP) that persisted till 5 min, while no significant rise was observed in Group N1 and N2. There was a trend toward fall in blood pressure in Group N2 (4.95% fall in SBP, 4.72% fall in MAP) 1-min following spray, which was clinically insignificant. Mean value of SBP, DBP and MAP was significantly higher in Group C than in Group N1, which was in turn greater than Group N2 (Group C > N1> N2), P < 0.05. However, incidence of tachycardia was comparable in three groups (70% in group C, 63.33% in Group N1 and 67.77% in Group N2, P > 0.05). Conclusions: We concluded that the NTG lingual spray in dose of 0.4 mg (1 spray) or 0.8 mg (2 sprays) was effective in attenuation of intubation induced

  11. Comparison of three manual ventilation devices using an intubated mannequin

    PubMed Central

    Hussey, S; Ryan, C; Murphy, B

    2004-01-01

    Objective: To compare three devices for manual neonatal ventilation. Design: Participants performed a two minute period of ventilation using a self inflating device, an anaesthesia bag with attached manometer, and a Neopuff device. An intubated neonatal mannequin, approximating a 1 kg infant with functional lungs, was used for the study. Target ventilation variables included a rate of 40 breaths per minute, peak inspiratory pressure (PIP) of 20 cm H2O, and positive end expiratory pressure (PEEP) of 4 cm H2O. The circuit was attached to a laptop computer for data recording. Results: Thirty five participants were enrolled, including consultant neonatologists, paediatricians, and anaesthetists, paediatric and anaesthetic registrars, and neonatal nurses. The maximum PIP recorded using the self inflating bag, anaesthetic bag, and Neopuff device were 75.9, 35.5, and 22.4 cm H2O respectively. There were significant differences between the devices for mean PIP (30.7, 18.1, and 20.1 cm H2O), mean PEEP (0.2, 2.8, and 4.4 cm H2O), mean airway pressure (7.6, 8.5, and 10.9 cm H2O), % total breaths ⩽ 21 cm H2O PIP (39%, 92%, and 98%), and % total breaths ⩾ 30 cm H2O PIP (45%, 0, and 0). There was no difference between doctors and allied health professionals for the variables examined. Conclusion: The anaesthetic bag with manometer and Neopuff device both facilitate accurate and reproducible manual ventilation. Self inflating devices without modifications are not as consistent by comparison and should incorporate a manometer and a PEEP device, particularly when used for resuscitation of very low birthweight infants. PMID:15499138

  12. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    PubMed

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery. PMID:27188111

  13. 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

  14. Prehospital versus Emergency Room Intubation of Trauma Patients in Qatar: A-2-year Observational Study

    PubMed Central

    Al-Thani, Hassan; El-Menyar, Ayman; Latifi, Rifat

    2014-01-01

    Background: The impact of prehospital intubation (PHI) in improving outcome of trauma patients has not been adequately evaluated in the developing countries. Aims: The present study analyzed the outcome of PHI versus emergency room intubation (ERI) among trauma patients in Qatar. Materials and Methods: Data were retrospectively reviewed for all intubated trauma patients between 2010 and 2011. Patients were classified according to location of intubation (PHI: Group-1 versus ERI: Group-2). Data were analyzed and compared. Results: Out of 570 intubated patients; 482 patients (239 in group-1 and 243 in group-2) met the inclusion criteria with a mean age of 32 ΁ 14.6 years Head injury (P = 0.003) and multiple trauma (P = 0.004) were more prevalent in group-1, whereas solid organ injury predominated in group-2 (P = 0.02). Group-1 had significantly higher mean injury severity scoring (ISS), lower Glasgow coma scale (GCS), greater head abbreviated injury score and longer activation, response, scene and total emergency medical services times. The mortality was higher in group-1 (53% vs. 18.5%; P = 0.001). Multivariate analysis showed that GCS [odds ratio (OR) 0.78, P = 0.005) and ISS (OR 1.12, P = 0.001) were independent predictors of mortality. Conclusions: PHI is associated with high mortality when compared with ERI. However, selection bias cannot be ruled out and therefore, PHI needs further critical assessment in Qatar. PMID:24678471

  15. Oral clonidine versus gabapentin as premedicant for obtunding hemodynamic response to laryngoscopy and tracheal intubation

    PubMed Central

    Singhal, Suresh K.; Kaur, Kiranpreet; Arora, Promila

    2014-01-01

    Background: We compared the effects of oral clonidine and gabapentin as premedicant in obtunding hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. Methods: A total of 100 patients of either sex enrolled in the study were randomly divided into two groups of 50 each. Group A patients received oral clonidine 200 μg and Group B patients received oral gabapentin 900 mg, 90 min prior to induction of anesthesia. Results: Both groups were matched for age, sex weight and intubation time. Anxiety score and sedation scores before induction were significantly better in Group A as compared with Group B. Heart rate rise was obtunded in Group A except at 1 min, as compared with Group B in which tachycardia persisted even at 3 and 5 min following intubation. Mean arterial pressure was maintained below baseline at all times in Group A as compared with Group B in which significant rise (+7.55%, P < 0.001) was seen at 1 min after intubation. Conclusion: Oral clonidine provided good attenuation of hemodynamic response to laryngoscopy and intubation as compared with oral gabapentin. PMID:24843327

  16. Hemodynamic Changes Following Endotracheal Intubation With Glidescope® Video-Laryngoscope in Patients With Untreated Hypertension

    PubMed Central

    Dashti, Majid; Amini, Shahram; Azarfarin, Rasoul; Totonchi, Ziae; Hatami, Maryam

    2014-01-01

    Background: Tracheal intubation can be associated with considerable hemodynamic changes, particularly in patients with uncontrolled hypertension. The GlideScope® video-laryngoscope (GVL) is a novel video laryngoscope that does not need direct exposure of the vocal cords, and it can also produce lower hemodynamic changes due to lower degrees of trauma and stimuli to the oropharynx than a Macintosh direct laryngoscope (MDL). Objectives: The aim of this clinical trial was to compare hemodynamic alterations following tracheal intubation with a GVL and MDL in patients with uncontrolled hypertension. Patients and Methods: Sixty patients who had uncontrolled hypertension and scheduled for elective surgery requiring tracheal intubation, were randomly assigned to receive intubated with either a GVL (n = 30) or a MDL (n = 30). Intubation time, heart rate, rate pressure product (RPP), and mean arterial blood pressure (MAP), were compared between the two groups at; baseline, following induction of anesthesia, after intubation, and at one minute intervals for 5 minutes. Results: A total of 59 patients finished the study. Intubation time was longer in the GVL group (9.80 ± 1.27 s) than in the MDL group (8.20 ± 1.17 s) (P < 0.05). MAP, pulse rate, and RPP were lower in the GVL than the MDL group after endotracheal intubation (P < 0.05). MAP, heart rate, and RPP returned to pre-intubation values at 3 and 4 minutes after intubation in the GVL and MDL groups, respectively (P < 0.05). Conclusions: Hemodynamic fluctuations in patients with uncontrolled hypertension after endotracheal intubation were lower with the GVL than the MDL technique. PMID:25478537

  17. 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

  18. Achieving Despite Adversity: Why Are Some Schools Successful in Spite of the Obstacles They Face? A Study of the Characteristics of Effective and Less Effective Elementary Schools in West Virginia Using Qualitative and Quantitative Methods.

    ERIC Educational Resources Information Center

    Hughes, Mary F.

    A study of West Virginia elementary schools examined why similar types of elementary students differ greatly in academic achievement. In the first phase of the study, a comparison of 33 high- and 33 low-achieving elementary schools in West Virginia found that low-achieving schools had 2.5 times more low-income students than high-achieving schools,…

  19. Dexmedetomidine provides optimum conditions during awake fiberoptic intubation in simulated cervical spine injury patients

    PubMed Central

    Chopra, Pooja; Dixit, Madhu Bala; Dang, Aashish; Gupta, Vibhuti

    2016-01-01

    Background and Aims: We undertook this study to assess if a small-dose of dexmedetomidine (DEX) for conscious sedation during awake fiberoptic intubation (AFOI) in simulated cervical spine injury (CSI) patients provides optimum conditions and fulfills the need of postintubation neurological examination required in such patients. The aim was to assess the efficacy of DEX on arousability and patient's comfort during AFOI in simulated CSI patients. Material and Methods: In this prospective, randomized double-blind study, 100 American Society of Anesthesiologists Grade I-II patients aged between 18 and 65 years scheduled for elective surgery under general anesthesia underwent AFOI under conscious sedation with DEX. After locally anesthetizing the airway and applying a cervical collar, patients either received DEX 1 μg/kg over 10 min followed by 0.7 μg/kg/h maintenance infusion or normal saline in the same dose and rate during AFOI. Targeted sedation (Ramsay sedation score [RSS] ≥2) during AFOI was maintained with midazolam [MDZ] in both groups. Statistical Analysis was performed using unpaired Student's t-test, Chi-square test, Mann-Whitney test and Wilcoxon-w test. Results: The total number of patients requiring MDZ and the mean dose of MDZ required to achieve targeted sedation (RSS ≥2) was significantly less in DEX group compared to the placebo group (P < 0.001). Similarly, patient satisfaction score, heart rate, systolic, diastolic and mean arterial pressure and respiratory parameters were significantly better in DEX group (P < 0.001). Postintubation arousability in the two groups was comparable (P = 0.29). Conclusions: Dexmedetomidine provides optimum sedation without compromising airway or hemodynamic instability with better patient tolerance and satisfaction for AFOI. It also preserves patient arousability for the postintubation neurological assessment. PMID:27006542

  20. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    PubMed

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  1. Comparison of efficacy of labetalol and fentanyl for attenuating reflex responses to laryngoscopy and intubation.

    PubMed

    Meftahuzzaman, S M; Islam, M M; Ireen, S T; Islam, M R; Kabir, H; Rashid, H; Uddin, M Z

    2014-04-01

    Stress response due to laryngoscopy and intubation has been universally recognized phenomenon resulting in increase in heart rate, arterial, intracranial, and intraocular pressure. Various pharmacological approaches have been used to blunt or attenuate such pressure responses. This prospective, randomized, placebo controlled, double blinded study was designed to compare the efficacy of bolus dose of Labetalol and Fentanyl for attenuating reflex responses to laryngoscopy and intubation. Ninety patients with physical status of ASA I and II were scheduled for elective surgery under standard protocol of general anaesthesia, randomly allocated into three groups, consisting of 30 patients in each group, assigned as C (Control), L (Labetalol), and F (Fentanyl). In control group 10ml of 0.9% saline, in Labetalol group 0.25 mg/kg Labetalol and in Fentanyl group 2μgm/kg of Fentanyl were given intravenously at 3 minutes prior to laryngoscopy and intubation. Pulse rate, systolic, diastolic, mean arterial pressure and rate pressure products (RPP) were recorded before and after premedication, after administration of study drugs and at 1, 3, 5, 10 and 15 minutes after intubation. For statistical analysis of data, ANOVA tests were performed for comparison between groups. There were an increase in heart rate, systolic, diastolic, mean arterial pressures and rate pressure product in all the three groups after intubation in comparison to base line value. But the rise was minimum in L and F group as compared to C group which is statistically significant and also minimum in L group as compared to F group. So Labetalol is better agent for attenuation of laryngoscopic and intubation reflex. PMID:24858149

  2. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    PubMed Central

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  3. Comparison between dexmedetomidine and fentanyl on intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study

    PubMed Central

    Mondal, Sudeshna; Ghosh, Sarmila; Bhattacharya, Susmita; Choudhury, Brojen; Mallick, Suchismita; Prasad, Anu

    2015-01-01

    Background and Aims: Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them cause respiratory depression and airway obstruction leading to hypoxemia. The aim of this study was to compare intubation conditions, and incidence of desaturation between dexmedetomidine and fentanyl group during AFOI. Material and Methods: This randomized double-blind prospective study was conducted on a total of 60 patients scheduled for elective laparotomies who were randomly allocated into two groups: Group A received dexmedetomidine 1 mcg/kg and Group B received fentanyl 2 mcg/kg over 10 min. Patients in both groups received glycopyrrolate 0.2 mg intravenous, nebulization with 2% lidocaine 4 ml over 20 min and 10% lidocaine spray before undergoing AFOI. Adequacy of intubation condition was evaluated by cough score and post-intubation score. Incidence of desaturation, hemodynamic changes and sedation using Ramsay sedation scale (RSS) were noted and compared between two groups. Results: Cough Score (1-4), post-intubation Score (1-3) and RSS (1-6) were significantly favorable (P < 0.0001) along with minimum hemodynamic responses to intubation (P < 0.05) and less oxygen desaturation (P < 0.0001) in Group A than Group B. Conclusion: Dexmedetomidine is more effective than fentanyl in producing better intubation conditions, sedation along with hemodynamic stability and less desaturation during AFOI. PMID:25948903

  4. Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists: A Randomized Study.

    PubMed

    Liu, Zi-Jia; Yi, Jie; Guo, Wen-Juan; Ma, Chao; Huang, Yu-Guang

    2016-01-01

    Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack-Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack-Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation. PMID:26765472

  5. Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists

    PubMed Central

    Liu, Zi-Jia; Yi, Jie; Guo, Wen-Juan; Ma, Chao; Huang, Yu-Guang

    2016-01-01

    Abstract Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists. In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack–Lehane grade, associated complications and hemodynamic changes during intubation were recorded. We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack–Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05). We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation. PMID:26765472

  6. Predictors of Difficult Intubation Among Malay Patients in Indonesia

    PubMed Central

    Tantri, Aida Rosita; Firdaus, Riyadh; Salomo, Sahat Tumpal

    2016-01-01

    Background Failure to maintain an adequate airway can lead to brain damage and death. To reduce the risk of difficulty in maintaining an airway during general anesthesia, there are several known predictors of difficult intubation. People with a Malay background have different craniofacial structures in comparison with other individuals. Therefore, different predictors should be used for patients of Malay race. Objectives The aim of this study was to determine the ability to predict difficult visualization of the larynx (DVL) in Malay patients based on several predictors, such as the modified Mallampati test (MMT), thyromental distance (TMD), and hyomental distance ratio (HMDR). Patients and Methods This cross-sectional study included 277 consecutive patients requiring general anesthesia. All subjects were evaluated using the MMT, TMD, and HMDR, and the cut-off points for the airway predictors were Mallampati III and IV, < 6.5 cm, and < 1.2, respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack-Lehane (CL) classification. CL grades III and IV were considered difficult visualization. The area under the curve (AUC), sensitivity, and specificity for each predictor were calculated both as sole and combined predictors. Logistic regression analysis was used to determine independent predictors of DVL. Results Difficulty in visualizing the larynx was found in 28 (10.1%) patients. The AUC, sensitivity, and specificity for the three airway predictors were as follows: MMT: 0.614, 10.7%, and 99.2%; HMDR: 0.743, 64.2%, and 74%; and TMD: 0.827, 82.1%, and 64.7%. The combination providing the best prediction in our study involved the MMT, HMDR, and TMD with an AUC, sensitivity, and specificity of 0.835, 60.7%, and 88.8%, respectively. Logistic regression analysis showed that the MMT, HMDR, and TMD were independent predictors of DVL. Conclusions The TMD, with a cut-off point of 65 mm, had superior diagnostic value compared with the HMDR and

  7. Aberrant right subclavian artery-esophageal fistula: massive upper gastrointestinal hemorrhage secondary to prolonged intubation.

    PubMed

    Oliveira, Elsa; Anastácio, Margarida; Marques, Anabela

    2016-01-01

    Aberrant right subclavian artery-esophageal fistula is a rare but potentially fatal complication. It may be associated with procedures, such as tracheostomy and tracheal or esophageal intubation, and yields massive upper gastrointestinal bleeding difficult to identify and to control. A high index of suspicion is essential for early diagnosis and better prognosis. We report a rare case of a patient who survived after emergent surgical procedure for massive upper gastrointestinal bleeding secondary to aberrant right subclavian artery-esophageal fistula after prolonged intubation. PMID:27108831

  8. Nasotracheal intubation in a difficult airway using the Storz C-MAC Videolaryngoscope, the Boedeker Bougie endotracheal introducer, and the Boedeker curved forceps.

    PubMed

    Nicholas, Thomas A; Bernhagen, Mary A; Boedeker, Ben H

    2012-01-01

    Airway management has multiple indications for nasotracheal intubation. In this study, we focus on its indication in difficult airways. This work describes a modified procedure of nasotracheal intubation using the new Storz CMAC® Videolaryngoscope, the malleable Boedeker Bougie and the curved Boedeker Forceps in the intubation of a difficult airway manikin. PMID:22357008

  9. Successful Treatment of an Iatrogenic Tracheal Laceration With a Temporary Polyurethane-Coated Nitinol Stent.

    PubMed

    Lee, Benjamin E; Korst, Robert J

    2016-07-01

    We report the case of a 63-year-old woman who required emergent intubation after a choking episode at home. It resulted in a 5-cm tear in the membranous trachea. She was treated by placement of a temporary tracheal stent, which was successfully removed 3 months later. PMID:27343518

  10. Mivacurium compared with three different doses of suxamethonium for nasotracheal intubation.

    PubMed

    Hodgson, R; Harvey, P; Burrows, R

    1998-10-01

    Suxamethonium in the doses of 1.0, 0.5 and 0.25 mg/kg was compared with mivacurium 0.15 mg/kg in 80 patients requiring nasotracheal intubation for maxillofacial surgery in a double-blind randomized controlled trial. Anaesthesia was induced with thiopentone 5 mg/kg and alfentanil 15 micrograms/kg. Patients were randomly allocated to one of the four relaxant groups. Anaesthesia was maintained with enflurane in 70% nitrous oxide and 30% oxygen and analgesia provided with intravenous pethidine 0.5 to 1.5 mg/kg and rectal indomethacin 100mg. All patients given mivacurium or suxamethonium 1 mg/kg had acceptable intubating conditions. Significantly fewer patients given suxamethonium 0.5 mg or 0.25 mg/kg had acceptable intubating conditions (90% and 70% respectively) (P = 0.003). Poor intubating conditions requiring additional relaxation were seen in two patients given suxamethonium 0.25 mg/kg and two given 0.5 mg/kg, while no patients given suxamethonium 1.0 mg/kg or mivacurium 0.15 mg/kg required additional relaxation (P = 0.004). Only four patients had postoperative myalgia, all of whom were given suxamethonium 0.5 mg/kg or more but no significant difference between groups could be demonstrated. PMID:9807607

  11. The effect of the exit condition on the performance of intube condensers

    SciTech Connect

    Rabas, T.J.; Arman, B.

    1995-07-01

    Data collected from the open literature plus some new, unpublished data will be used to show that the exit condition can change the flow regimes, introduce certain types of instabilities, and alter flooding velocities with intube condensation. The major orientations will be considered: horizontal, vertical with vapor downflow, and vertical with vapor upflow (refluxing).

  12. 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

  13. Diffuse idiopathic skeletal hyperostosis of cervical spine - An unusual cause of difficult flexible fiber optic intubation

    PubMed Central

    Baxi, Vaibhavi; Gaiwal, Sucheta

    2010-01-01

    This is a report of anterior osteophytes on the cervical vertebra resulting in distortion of the airway and leading to difficulty during intubation. The osteophytes associated with the syndrome of diffuse idiopathic skeletal hyperostosis were at the C2-3 and C6-7, T1 level and resulted in anterior displacement of the pharynx and the trachea respectively. PMID:20668561

  14. 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.

  15. 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.

  16. 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

  17. The effect of alfentanil on maternal haemodynamic changes due to tracheal intubation in elective caesarean sections under general anaesthesia

    PubMed Central

    Hosseini Valami, Seyedeh Masoumeh; Hosseini Jahromi, Seyed Abbas; Masoodi, Niolofar

    2015-01-01

    Background and Aims: Endotracheal intubation can produce severe maternal haemodynamic changes during caesarean sections under general anaesthesia. However, administration of narcotics before endotracheal intubation to prevent these changes may affect the Apgar score in neonates. This study was designed to evaluate the effect of intravenous alfentanil on haemodynamic changes due to endotracheal intubation in elective caesarean sections performed under general anaesthesia. Methods: Fifty parturients were randomly divided into two equal groups. Patients in the first group received alfentanil 10 μg/kg and in the second group received placebo intravenously 1 min before induction of anaesthesia for elective caesarean section. Haemodynamic parameters and bispectral index system (BIS) in mothers, peripheral capillary oxygen saturation (SpO2) and Apgar score in the newborn were assessed. Results: Changes in systolic blood pressure were significant at 1, 5 and 10 min after intubation between two groups. Changes in diastolic blood pressure were significantly less in alfentanil group, 1 min after induction of anaesthesia and 1 min after endotracheal intubation. Mean heart rate at 1 min after induction and at 1 and 5 min after intubation also reduced significantly in this group. Conclusion: Alfentanil use was associated with decreases or minimal increases in maternal systolic and diastolic blood pressures and heart rate after endotracheal intubation. PMID:26755838

  18. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery

    PubMed Central

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance < 6 cm, upper lip bite test class 3, Wilson risk sum score ≥ 2, Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses. PMID:26379966

  19. The effects of intravenous dexmedetomidine premedication on intraocular pressure and pressor response to laryngoscopy and intubation

    PubMed Central

    Chandra, Alka; Ranjan, Reena; Kumar, Jay; Vohra, Ashima; Thakur, Vijay Kumar

    2016-01-01

    Background and Aims: Penetrating eye injuries are a challenge for the anesthesiologists in emergency due to increase in intraocular pressure (IOP). The aim of this study was to evaluate the effects of intravenous dexmedetomidine premedication on changes in IOP and hemodynamic response following laryngoscopy and tracheal intubation. Material and Methods: Hundred patients aged 18-60 years undergoing elective nonophthalmic surgery were divided into two groups of 50 each. Group D received a bolus dose of dexmedetomidine (0.4 μg/kg) diluted to 20 ml normal saline and Group C received normal saline (0.4 ml/kg) over 10 min as premedication. Heart rate (HR), systolic blood pressure (SBP) and IOP were measured and recorded before premedication (T1), 5 and 10 m after premedication (T2, T3), immediately after induction, intubation and then 1, 3, 5 min after intubation (T4, 5, 6, 7, 8). Results: HR was comparable in both groups at preoperative level, but it was significantly low in the drug group when compared with the control group at T4-T8 (P = 0.034, P < 0.001, 0.001, 0.036 and 0.001, respectively). The SBP was comparable in both the groups at baseline and till before induction. At T4-T8 there was a fall in SBP in Group D compared to the Group C (P = 0.045, P = 0.007, 0.001, 0.001 and 0.001, respectively). The baseline IOP was comparable in both the groups (P = NS). There was a significant fall in the IOP in Group D, 5 min after the drug infusion compared to Group C, which was sustained till 5 min after intubation (T8) (P < 0.001 at all intervals). Conclusion: Dexmedetomidine premedication in the dose of 0.4 μg/kg lowers the IOP and attenuates the pressor response to laryngoscopy and intubation. PMID:27275049

  20. Comparison of Mallampati test with lower jaw protrusion maneuver in predicting difficult laryngoscopy and intubation

    PubMed Central

    Ul Haq, Muhammad Irfan; Ullah, Hameed

    2013-01-01

    Background: Failure to maintain a patent airway is one of the commonest causes of anesthesia-related morbidity and mortality. Many protocols, algorithms, and different combinations of tested methods for airway assessment have been developed to predict difficult laryngoscopy and intubation. The reported incidence of a difficult intubation varies from 1.5% to 13%. The objective of this study was to compare Mallampati test (MT) with lower jaw protrusion (LJP) maneuver in predicting difficult laryngoscopy and intubation. Materials and Methods: Seven hundred and sixty patients were included in the study. All the patients underwent MT and LJP maneuver for their airway assessment. After a standardized technique of induction of anesthesia, primary anesthetist performed laryngoscopy and graded it according to the grades described by Cormack and Lehane. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both these tests with 95% confidence interval (CI) using conventional laryngoscopy as gold standard. Area under curve was also calculated for both, MT and LJP maneuver. A P < 0.05 was taken as significant. Results: LJP maneuver had higher sensitivity (95.9% vs. 27.1%), NPV (98.7% vs. 82.0%), and accuracy (90.1% vs. 80.3%) when compared to MT in predicting difficult laryngoscopy and intubation. Both tests, however, had similar specificity and PPV. There was marked difference in the positive and negative likelihood ratio between LJP and MT. Similarly, the area under the curve favored LJP maneuver over MT. Conclusion: The results of this study show that LJP maneuver is a better test to predict difficult laryngoscopy and tracheal intubation. We recommend the addition of this maneuver to the routine preoperative evaluation of airway. PMID:24106353

  1. 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

  2. Theme: Local Program Success.

    ERIC Educational Resources Information Center

    Camp, William G.; And Others

    1997-01-01

    Includes "Professional Propagation" (Camp); "Managing Human Resources with Local Program Success (LPS)" (Daley); "Profit Sharing with LPS" (Moses); "Partners for Success" (Mecey- Smith); "Achieving LPS by Collaborating with Partners, Allies and Volunteers" (Oglesby); LPS...Just What Agricultural Education Needs, Another Acronym" (Rist); "The…

  3. 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

  4. Effect of the McGRATH MAC® Video Laryngoscope on Hemodynamic Response during Tracheal Intubation: A Retrospective Study

    PubMed Central

    Yokose, Masashi; Kuwahara, Sayoko; Goto, Takahisa

    2016-01-01

    Background Hypertension often occurs after tracheal intubation using a Macintosh laryngoscope and may lead to rare but serious complications. The Macintosh laryngoscope may increase the incidence of hypertension because it requires forced alignment of the oral and pharyngeal axes in order to view the glottis. In contrast, the McGRATH MAC video laryngoscope does not require this manipulation. The objective of this study was to evaluate the incidence of hypertension after tracheal intubation using a McGRATH laryngoscope compared with a Macintosh laryngoscope. Methods Data of 360 consecutive patients who underwent general anesthesia with tracheal intubation by Macintosh laryngoscope or McGRATH video laryngoscope were obtained retrospectively. A total of 16 variables including patient characteristics, anesthetic drug used, and intubation techniques were extracted as potential factors affecting the incidence of hypertension after intubation. The incidence of hypertension after tracheal intubation was defined as an increase in systolic blood pressure (SBP) >20% of values immediately before intubation. Propensity scoring with inverse probability weighting was used to calculate the odds ratio for the incidence of hypertension after intubation with a McGRATH video laryngoscope as the primary outcome. The mean difference in SBP change between the two laryngoscopes was also calculated. Results A McGRATH laryngoscope was used in 68 of 360 patients (18%). The numbers of patients who increase in systolic blood pressure of more than 20% was 189 patients (53%). The odds ratio for the use of a McGRATH laryngoscope was 0.43 (95% confidence interval (CI), 0.19–0.96; P = 0.04). The mean difference in SBP change between the two laryngoscopes was -8.6 mmHg (95% CI, -17.4 to 0.2; P = 0.06). Conclusions The use of a McGRATH laryngoscope may reduce the incidence of hypertension after tracheal intubation compared to the Macintosh laryngoscope. PMID:27171225

  5. 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

  6. Success in a Hurry

    ERIC Educational Resources Information Center

    Martin, Harold L., Sr.

    2015-01-01

    Although a young program, the North Carolina A&T Honors Program illustrates how quickly and successfully honors can achieve its goals of providing a quality education to its high-achieving students, and how these students can benefit academically and personally from the experiences that honors provides for them. This article provides a brief…

  7. 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

  8. Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study

    PubMed Central

    Saeedi, Morteza; Hajiseyedjavadi, Houman; Seyedhosseini, Javad; Eslami, Vahid; Sheikhmotaharvahedi, Hojat

    2014-01-01

    Background: Emergency Medical Service (EMS) personnel manage the airway, but only a group of them are allowed to engage in Endotracheal Intubation (ETI). Our purpose was to evaluate if the use of laryngeal mask airway (LMA) or Combitube can be used by inexperienced care providers. Materials and Methods: A randomized, prospective manikin study was conducted. Fifty-nine participants were randomly assigned into two groups. Experienced group included 16 paramedics, eight anesthetic-technicians, and inexperienced group included 27 Emergency Medical Technician-Basic (EMT-B) and eight nurses. Our main outcomes were success rate and time to airway after only one attempt. Results: Airway success was 73% for ETI, 98.3% for LMA, and 100% for Combitube. LMA and Combitube were faster and had greater success than ETI (P = 0.0001). Inexperienced had no differences in time to securing LMA compared with experienced (6.05 vs. 5.4 seconds, respectively, P = 0.26). One failure in inexperienced, and no failure in experienced group occurred to secure the LMA (P = 0.59). The median time to Combitube placement in experienced and inexperienced was 5.05 vs. 5.00 seconds, P = 0.65, respectively. Inexperienced and experienced groups performed ETI in 19.15 and 17 seconds, respectively (P = 0.001). After the trial, 78% preferred Combitube, 15.3% LMA, and 6.8% ETI as the device of choice in prehospital setting. Conclusion: Time to airway was decreased and success rate increased significantly with the use of LMA and combitube compared with ETI, regardless of the experience level. This study suggests that both Combitube and LMA may be acceptable choices for management of airway in the prehospital setting for experienced and especially inexperienced EMS personnel. PMID:25625062

  9. Pneumothorax after tracheostomy closure with successful nonsurgical management.

    PubMed

    Lee, Bradley H; Sarah, Gabriel E; Rosbe, Kristina W; Alemi, Sean

    2016-06-01

    A 3-year-old girl presented for routine closure of her tracheostomy site. She was intubated easily for the procedure, and the wound was closed with a drain in place. In recovery, the mother noticed fullness in the patient's submandibular region, and on examination, the girl had subcutaneous emphysema in the neck bilaterally. She returned to the operating room for exploration, and air was released from the surgical site. The wound was again closed with a drain in place, and the patient was extubated uneventfully. After arriving to the pediatric intensive care unit for monitoring, the patient acutely developed respiratory distress and was found to have pneumomediastinum and pneumothorax and was emergently intubated. She was observed closely, and the following day, the pneumothorax improved, and she successfully extubated without further complication. PMID:27185690

  10. Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial

    PubMed Central

    Reade, Michael C; O'Sullivan, Kim; Bates, Samantha; Goldsmith, Donna; Ainslie, William RSTJ; Bellomo, Rinaldo

    2009-01-01

    Introduction Agitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives to control agitation can preclude extubation. Dexmedetomidine, a novel sedative and anxiolytic agent, may have particular utility in these patients. We sought to compare the efficacy of haloperidol and dexmedetomidine in facilitating extubation. Methods We conducted a randomised, open-label, parallel-groups pilot trial in the medical and surgical intensive care unit of a university hospital. Twenty patients undergoing mechanical ventilation in whom extubation was not possible solely because of agitated delirium were randomised to receive an infusion of either haloperidol 0.5 to 2 mg/hour or dexmedetomidine 0.2 to 0.7 μg/kg/hr, with or without loading doses of 2.5 mg haloperidol or 1 μg/kg dexmedetomidine, according to clinician preference. Results Dexmedetomidine significantly shortened median time to extubation from 42.5 (IQR 23.2 to 117.8) to 19.9 (IQR 7.3 to 24) hours (P = 0.016). Dexmedetomidine significantly decreased ICU length of stay, from 6.5 (IQR 4 to 9) to 1.5 (IQR 1 to 3) days (P = 0.004) after study drug commencement. Of patients who required ongoing propofol sedation, the proportion of time propofol was required was halved in those who received dexmedetomidine (79.5% (95% CI 61.8 to 97.2%) vs. 41.2% (95% CI 0 to 88.1%) of the time intubated; P = 0.05). No patients were reintubated; three receiving haloperidol could not be successfully extubated and underwent tracheostomy. One patient prematurely discontinued haloperidol due to QTc interval prolongation. Conclusions In this preliminary pilot study, we found dexmedetomidine a promising agent for the treatment of ICU-associated delirious agitation, and we suggest this warrants further testing in a definitive double-blind multi-centre trial. Trial registration Clinicaltrials.gov NCT00505804 PMID:19454032

  11. 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

  12. 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

  13. Submental intubation in paediatric oral and maxillofacial surgery: Review of the literature and report of four cases

    PubMed Central

    Taiwo, Olanrewaju Abdurrazaq; Ibikunle, Adebayo Aremu; Braimah, Ramat Oyebunmi; Suleiman, Musa Kallamu

    2015-01-01

    Several oral and maxillofacial surgery procedures require the simultaneous use of the oropharyngeal space by both the surgeons and the anaesthetists. This poses a lot of challenges especially in optimally securing the airway. Nasotracheal intubation or tracheostomy with their significant morbidity might even be contraindicated in these scenarios owing to several factors elucidated in the literature. Submental endotracheal intubation might be the last resort in adequately protecting the airway without interfering with the surgery. It also permits concurrent access to the dental occlusion and nasal pyramid without the risk associated with nasal intubation and morbidity of tracheostomy. Contraindications include patients who require long periods of assisted ventilation and a severe traumatic wound on the floor of the mouth. Complications include localised infection and sepsis, poor wound healing or scarring, and post-operative salivary fistula. The rationale for this study is to describe the indications, contraindications and the technique of submental endotracheal intubation as performed in our hospital. PMID:26712300

  14. The Pentax airway scope versus the Macintosh laryngoscope: Comparison of hemodynamic responses and concentrations of plasma norepinephrine to tracheal intubation

    PubMed Central

    2013-01-01

    Background The Pentax Airway Scope (AWS) is a video laryngoscope designed to facilitate tracheal intubation with a high-resolution image. The Pentax AWS has been reported to cause less hemodynamic stress than the Macintosh laryngoscope. The aims of this study are to investigate the differences in hemodynamic responses and norepinephrine concentrations to tracheal intubation between procedures using he Pentax AWS and the Macintosh laryngoscope. Methods Forty patients (American Society of Anesthesiologists class I-II, age range: 18-60 years) were randomly assigned to be intubated with either the Pentax AWS or the Macintosh laryngoscope while under general anesthesia. Routine monitoring, including invasive arterial blood pressure and bispectral index, were applied. Thiopental (4 mg/kg), fentanyl (1 µg/kg), midazolam (0.05 mg/kg), and rocuronium (0.6 mg/kg) were administered for anesthetic induction. Systolic, diastolic, and mean blood pressures and heart rates were recorded pre-intubation, immediately post-intubation (T0), and over the following 10 minutes at one minute intervals (T1, T2, T3, T4, T5…T10). Patient blood was sampled for norepinephrine concentrations pre-intubation (baseline) and post-intubation (T1). Evidence of sore throat was evaluated 30 min and 24 hr after extubation. Data were transformed to % basal and expressed as mean ± SD. Results The systolic, diastolic, and mean blood pressure, and heart rate at T0 and T4 were significantly different between the two groups. There was no significant difference in plasma norepinephrine between the two groups. The difference in incidence of sore throat was not significant between the two groups. Conclusions Pentax-AWS for tracheal intubation has greater hemodynamic stability than the Macintosh blade laryngoscope. PMID:23646240

  15. Effect of mild hypocapnia on hemodynamic and bispectral index responses to tracheal intubation during propofol anesthesia in children.

    PubMed

    Kwak, Hyun Jeong; Kim, Ji Young; Lee, Kyung Cheon; Kim, Hong Soon; Kim, Jong Yeop

    2015-02-01

    The purpose of this study was to investigate the effect of mild hypocapnia on hypertension and arousal response after tracheal intubation in children during propofol anesthesia. Forty-four children, American Society of Anesthesiologists physical status I-II patients, aged 3-9 years were randomly allocated to either the normocapnia group [end-tidal carbon dioxide tension (ETCO2=35 mmHg, n=22)] or the hypocapnia group (ETCO2=25 mmHg, n=22). Anesthesia was induced with propofol 2.5 mg/kg. Five minutes after the administration of rocuronium 0.6 mg/kg, laryngoscopy was attempted. The mean arterial pressure (MAP), heart rate (HR), SpO2 and bispectral index (BIS) were measured during induction and intubation periods. The maximal change in the BIS with tracheal intubation (ΔBIS) was defined as the difference between the baseline value and the maximal value within the first 5 min after intubation. Before tracheal intubation, the change in BIS over time was not different between the groups. After tracheal intubation, the changes in the MAP, HR and BIS over time were not significantly different between the groups. The mean value±SD of ΔBIS was 5.7±5.2 and 7.4±5.5 in the normocapnia and hypocapnia groups, respectively, without any intergroup difference. This study showed that mild hypocapnia did not attenuate hemodynamic and BIS responses to tracheal intubation in children during propofol anesthesia. Our results suggested that hyperventilation has no beneficial effect on hemodynamic and arousal responses to tracheal intubation in children. PMID:24526409

  16. Non-intubated resection and reconstruction of trachea for the treatment of a mass in the upper trachea

    PubMed Central

    Liu, Jun; Li, Shuben; Shen, Jianfei; Dong, Qinglong; Liang, Lixia; Pan, Hui

    2016-01-01

    Tumors of the upper trachea are typically treated by tracheal resection and reconstruction via neck incision under general anesthesia. In recent years, non-intubated thoracic surgery has been widely applied for the treatment of lung diseases due to its advantages including quick postoperative recovery. In this article, we describe the application of non-intubated tracheal resection and reconstruction in one patient for the treatment of a mass in upper trachea. PMID:27076957

  17. Evaluation of the Hemodynamic Response to Endotracheal Intubation Comparing the Airtraq® with Macintosh Laryngoscopes in Cardiac Surgical Patients

    PubMed Central

    Gavrilovska-Brzanov, Aleksandra; Jarallah, Mohhamed Al; Cogliati, Andrea; Mojsova-Mijovska, Maja; Mijuskovic, Dragan; Slaveski, Dimce

    2015-01-01

    Introduction: Cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation. The Airtraq® optical laryngoscope is a single-use rigid video laryngoscope that has been developed to facilitate tracheal intubation. There are limited studies comparing differences in the circulatory responses to Airtraq® and direct Macintosh larynngoscopy in cardiac patients. Aim: The purpose of our study was to evaluate whether there was clinically significant difference between the hemodynamic response to orotracheal intubation guided by either of the two devices (Airtraq® and Macintosh laryngoscopes) in patients who underwent coronary artery bypass grafting surgery. Material and methods: In this clinical study we analyzed the hemodynamic response to endotracheal intubation performed with Airtraq® or Macintosh laryngoscopes in patients who underwent elective coronary artery bypass graft surgery under general anesthesia. Results: We analyzed: blood pressure (systolic, diastolic, mean), heart rate and peripheral oxygen saturation (all notified before induction in anesthesia, immediately after induction, at the time of intubation and thereafter one and five minutes after intubation). We also recorded the maximal values of blood pressure and heart rate, as well as calculated the product of heart rate and systolic blood pressure. There were statistically significant differences in the hemodynamic response between the groups. At the time of intubation, there was significant inter-group difference in heart rate, systolic, diastolic and mean blood pressure. Endotracheal intubation with Macintosh laryngoscope was accompanied by significant increase in blood pressure and heart rate compared to Airtraq® group. Conclusion: The Airtraq® laryngoscope performed better than the Macintosh laryngoscope in terms of hemodynamic to the patient undergoing routine coronary artery bypass graft surgery. PMID:26635435

  18. Associations Between Prolonged Intubation and Developing Post-extubation Dysphagia and Aspiration Pneumonia in Non-neurologic Critically Ill Patients

    PubMed Central

    Kim, Min Jung; Park, Young Sook; Song, You Hong

    2015-01-01

    Objective To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. Methods This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed. Results Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively. Conclusion In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation. PMID:26605174

  19. 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

  20. 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