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Sample records for silicone tube intubation

  1. A modified bicanalicular intubation procedure to repair canalicular lacerations using silicone tubes

    PubMed Central

    Liang, X; Lin, Y; Wang, Z; Lin, L; Zeng, S; Liu, Z; Li, N; Wang, Z; Liu, Y

    2012-01-01

    Purpose To explore a modified technique for silicone intubation for the repair of canalicular lacerations. Methods The surgery was performed on 35 eyes in 35 adult patients from October 2007 to September 2009. Using a modified soft probe, silicone tubes were inserted through the lacrimal punctum and left in the bicanaliculi for 3–10 months. Results The surgery was performed successfully in all cases. The tubes were removed after 3–10 months (mean 5.3±1.8 months). The mean follow-up time after tube removal was 13.8 months (range, 6–22 months). Lower punctum splitting occurred in one case (2.86%) after the surgery. No other complications associated with the silicone tubes occurred. All the tubes were removed successfully without any difficulty. No iatrogenic injuries occurred during tube removal. Conclusions The modified bicanalicular intubation procedure described here is an effective and atraumatic procedure for the management of canalicular lacerations in adults, and it is associated with fewer complications than the traditional sutures of canalicular lacerations. PMID:23060024

  2. Endotracheal Tube Cuff Pressure Following Intubation

    DTIC Science & Technology

    2005-09-08

    inflated ETT cuff. This method may lead to erroneous cuff pressures. Fernandez, Blanch, Mancebo, Bonsoms, and Artigas studied the accuracy of...Laryngologica, 345, suppl: 1-71. 10. Fernandez, R., Blanch, L., Mancebo, J., Bonsoms, N., Artigas , A. (1990). Endotracheal tube cuff pressure assessment

  3. Comparison of the Efficacies of 0.94 mm and Double Silicone Tubes for Treatment of Canalicular Obstruction

    PubMed Central

    Choi, Seong Chan; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo

    2017-01-01

    Purpose To compare the clinical effects of the single wide-diameter bicanalicular silicone tube and the double bicanalicular silicone tube in endonasal dacryocystorhinostomy (DCR) with canalicular trephinization for canalicular obstruction. Methods We retrospectively reviewed the records of 121 patients with monocanalicular or common canalicular obstruction who had undergone endonasal DCR with random bicanalicular insertion of either double silicone tubes (insertion of two tubes into each canaliculus) or a single wide-diameter (0.94 mm) silicone tube. The tubes were removed at around 3 months after surgery. Results This study included 79 eyes of 61 patients in the double-tube intubation group and 68 eyes of 60 patients in the single wide-diameter tube intubation group. Anatomical success, evaluated by syringing, was achieved in 72 of the 79 eyes (91.1%) in the double-tube intubation group and 60 of the 68 eyes (88.2%) in the single wide-diameter tube intubation group. Functional success was achieved in 65 of the 79 eyes (82.3%) in the double-tube intubation group and 61 of the 68 (89.7%) eyes in the single wide-diameter tube intubation group. There were no significant differences in the success rates of surgery between the two groups. One patient in the double-tube intubation group underwent conjunctivodacryocystorhinostomy (CDCR) and two in the wide-diameter tube intubation group underwent CDCR or reintubation to treat recurrence. Conclusions Intubation using a single wide-diameter tube during endonasal DCR is as effective as double-tube intubation for the treatment of canalicular obstruction, with a lower rate of complications such as inflammation or patient discomfort. PMID:28243017

  4. McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation

    PubMed Central

    Wan, Li; Liao, Mingfeng; Li, Li; Qian, Wei; Hu, Rong; Chen, Kun; Zhang, Chuanhan; Yao, Wenlong

    2016-01-01

    Abstract Background: Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. Methods: Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. Results: The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05). Conclusions: When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty. PMID:28002347

  5. 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

    2016-02-04

    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.

  6. Tracheal intubation with a camera embedded in the tube tip (Vivasight(™) ).

    PubMed

    Huitink, J M; Koopman, E M; Bouwman, R A; Craenen, A; Verwoert, M; Krage, R; Visser, I E; Erwteman, M; van Groeningen, D; Tijink, R; Schauer, A

    2013-01-01

    We studied tracheal intubation in manikins and patients with a camera embedded in the tip of the tracheal tube (Vivasight(™) ). Four people in two teams and two individuals attempted intubation of a manikin through an i-gel(™) 10 times each. The tracheas of 12 patients with a Mallampati grade of 1 were intubated with a Vivasight tracheal tube through a Berman airway, passed over a Frova(™) introducer. All 60 manikin intubations were successful, taking a mean (SD) time of 1.4 (0.5) s. The fastest intubation was performed in 0.5 s. All 12 participants' tracheas were successfully intubated in a median (IQR [range]) time of 90 (70-120 [50-210]) s. Seven participants complained of a sore throat, comparable with earlier findings for standard laryngoscopy and intubation: five mild; one moderate; and one severe. Tracheal intubation with the Vivasight through the i-gel or Berman airway is an alternative to existing techniques, against which it should be compared in randomised controlled trials in human participants. It has potential as a fast airway rescue technique.

  7. 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

  8. Quality control in QuantiFERON-TB gold in-tube for screening latent tuberculosis infection in health care workers.

    PubMed

    Igari, Hidetoshi; Watanabe, Akira; Ichimura, Yasunori; Sakurai, Takayuki; Taniguchi, Toshibumi; Ishiwada, Naruhiko

    2017-04-01

    QuantiFERON-TB gold in-tube has been used for screening latent tuberculosis infection in newly employed health care workers in Japan. There have been a few studies concerning quality control. We retrospectively analysed QuantiFERON-TB gold in-tube results in a hospital in Japan. Interferon-γ values in three blood collection tubes for QuantiFERON-TB gold in-tube were analysed in association with the positivity rate. The data set consisted of health care workers aged 20-29 years during the 7 years between 2010 and 2016. The yearly QuantiFERON-TB gold in-tube positivity rate was 0.9%, 16.4%, 3.0%, 39.3%, 2.8%, 0.9% and 1.5%, and was extremely high in 2011 and 2013. The interferon-γ values in the tuberculosis antigen tube were elevated in these two years, as indicated by higher median and wider interquartile range. The interferon-γ value in the negative control tube was also higher in 2011. The higher interferon-γ values in collection tubes (tuberculosis antigen tube and/or negative control tube) resulted in higher QuantiFERON-TB gold in-tube positivity rate. The distribution of interferon-γ in tuberculosis antigen tube and negative control tube, as evaluated by median and interquartile range, proved to be an effective index for the quality control of QuantiFERON-TB gold in-tube.

  9. A Novel and Innovative Way of Nasogastric Tube Insertion in Anesthetized Intubated Patient

    PubMed Central

    Sahu, Sandeep; Kishore, Kamal; Sachan, Vertika; Chatterjee, Arnidam

    2017-01-01

    Nasogastric tube (NGT) placement in anesthetized and intubated is sometimes very challenging with more than 50% failure rate in the first attempt. We describe a newer innovative Sahu's three in one, technique with use of GlideScope and forward placement of intubated trachea by external laryngeal maneuver, these both techniques lead to separation of trachea from esophagus so that endoscopic jejunal feeding tube guide wire strengthen NGT can be guided and manipulated to esophagus under direct vision. After informed consent, we used Sahu's three in one combo technique to insert NGT in adult anesthetized and intubated patients of both the sexes with high success in the first attempt. We found this technique easy, helpful, less time consuming with high success rate. PMID:28298795

  10. Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method

    PubMed Central

    2012-01-01

    Background The “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion. Methods A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated. Results Successful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a “Rusch” intubation stylet. Conclusions The “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients. Trial registration Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910) PMID:22853453

  11. Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope.

    PubMed

    Rajendram, R; McGuire, N

    2006-10-01

    Although tracheostomy tube displacement is uncommon, the management is often difficult and the associated mortality is high. It is important to ensure that the airway is secure and then either replace or reposition the tracheostomy tube. This case report describes the use of an Aintree intubation catheter (C-CAE-19.0-56-AIC, William Cook Europe, Denmark) mounted on an intubating fibre-optic bronchoscope (11302BD1, Karl Storz Endoskope, Germany) to reposition a partially displaced tracheostomy tube.

  12. Early laryngeal outcome of prolonged intubation using an anatomical tube: a double blind, randomised study.

    PubMed

    Nordang, Leif; Lindholm, Carl-Eric; Larsson, Jan; Linder, Arne

    2016-03-01

    The objective of this study was to study the short-term impact on larynx by a newly designed anatomical tube. A prospective randomised trial of a newly designed anatomical tube versus a standard endotracheal tube in patients operated under general anaesthesia for at least 12 h. Seventy adults were included and randomised to either type of tube. The patients were evaluated by means of fibre-optic laryngoscopy and VAS-rating of symptoms on two occasions in the first post-operative week. The evaluating investigators and the patients were blinded to the type of tube used. 27 cases and 23 controls had complete data for evaluation. Age, gender and intubation times were comparable. Symptoms such as hoarseness, coughing, and pain were rated above 30 % of maximum during at least one of the first post-operative days by 21 and 19 patients, respectively. At the first examination (within 24 h), 38 % of patients in the anatomical tube group stated no hoarseness; compared to 13 % of the controls (p = 0.057). Fibre-optic laryngoscopy showed some kind of pathology in all the patients examined within 24 h of extubation. After 3-6 days, seven patients with the anatomical tube and four patients in the control group showed complete resolution of the lesions, and the changes were limited to redness in the vocal process area in another seven and four, respectively. The differences between the groups did not attain statistical significance. The study shows considerable short-term laryngeal morbidity after prolonged intubation, and the anatomical tube only showed an advantage concerning hoarseness. Further improvement of the endotracheal tubes and intubation routines are still needed.

  13. A comparison of augmentation techniques during in-tube evaporation of R-113

    SciTech Connect

    Reid, R.S. ); Pate, M.B. ); Bergles, A.E. )

    1991-05-01

    An experimental study was conducted to determine the potential of three techniques for augmenting in-tube evaporation of refrigerants: high-fin tubes, microfin tubes, and twisted tape inserts. Five tubes with internal fins and one smooth tube with a twisted-tape insert were tested. Additionally, experiments were performed with two reference smooth tubes having diameters similar to the maximum inside diameters of the finned tubes. All experiments involved evaporating Refrigerant 113 (R-113) by direct electrical heating of the tube wall. Local evaporation heat transfer coefficients were measured as a function of quality for a range of mass fluxes and heat fluxes. Enhancement factors were calculated by forming ratios of the heat transfer coefficient for the augmented tube and a smooth tube of the same maximum inside diameter. Mass fluxes, pressure levels, and qualities were fixed when enhancement factors were calculated. For the internally finned tubes the enhancement factors varied from 1.1 to 2.8. An internally finned tube having helical spiral angles of 16 deg produced the largest enhancement of heat transfer. The tube with the twisted-tape insert typically had an enhancement factor of about 1.5. Pressure gradient ratios and enhancement performance ratios are also presented.

  14. Sampling Artifacts from Conductive Silicone Tubing

    SciTech Connect

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

    2009-05-15

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

  15. Numerical Simulation of Laser-Driven In-Tube Accelerator Operation

    SciTech Connect

    Ohnishi, N.; Ogino, Y.; Sawada, K.; Ohtani, T.; Mori, K.; Sasoh, A.

    2006-05-02

    To achieve a higher thrust performance in the laser-driven in-tube accelerator operation, numerical analysises have been carried out. The computational code covers from the generation of the blast wave to its interactions with the projectile and the acceleration wall. The thrust history and the momentum coupling coefficient evaluated from the numerical simulation depend on the fill pressure and the projectile shape. The confinement effect can be clearly found using the projectile attached with a shroud.

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

    SciTech Connect

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

    2004-03-30

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

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

    PubMed

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

    2013-01-01

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

  18. [Determination of alkyl-phenols in textiles by in-tube capillary solid-phase extraction-gas chromatography].

    PubMed

    Zhang, Luohong; Du, Ting; Zhong, Jiayu

    2015-10-01

    An in-tube capillary solid-phase extraction (SPE) -gas chromatography (GC) method was developed for confirmation and quantitative determination of octylphenol (OP) and nonylphenol (NP) in textiles. To make the in-tube capillary SPE column, the best SPE cartridge was chosen from four kinds of SPE cartridges. The adsorbent in the cartridge was used as the filling material to make the in-tube capillary SPE column. The nature, volume used, flow rate and adsorption capacity of the eluent were compared. Finally, the in-tube capillary solid-phase extraction was combined with gas chromatography to detect the alkyl phenols (APs). Abselut NEXUS extraction cartridge was chosen as the best solid phase extractant. The optimal in-tube capillary SPE extraction conditions were as follows: 1.2 μL methanol and 1.2 μL ultra-pure water for activating the extraction column, 1.2 μL methanol for eluting, 0.4 μL/min for solution loading. The method showed a good linear relationship in the low concentration range, and the enrichment ratios for the APs were about 100 times. The detection limits of octylphenol and nonylphenol were 3.7 μg/L and 4.5 μg/L, respectively. The recoveries of octylphenol were 85.6%-98.2%, and those of nonylphenol were 83.8%-95.7%. The experimental results demonstrated that the method is simple, rapid, and useful for detecting APs in textiles.

  19. 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.

  20. 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.

  1. Randomized study comparing the efficacy of a self-retaining bicanaliculus intubation stent with Crawford intubation in patients with canalicular obstruction

    PubMed Central

    Tabatabaie, Syed Ziaeddin; Rajabi, Mohammad Taher; Rajabi, Mohammad Bagher; Eshraghi, Bahram

    2012-01-01

    Background The purpose of this study was to compare the efficacy of self-retaining stent (SRS) bicanalicular intubation with bicanalicular silicone (Crawford) intubation in patients with canalicular and punctal obstruction. Methods In this prospective, randomized clinical trial, 38 patients with canalicular or punctal obstruction (25 partial, 13 complete) and epiphora were randomized into two groups. Twenty-one patients (14 with partial and seven with complete obstruction) underwent SRS intubation and 17 patients underwent bicanalicular silicon intubation in a randomized fashion. Results After a mean follow-up of 6 months following tube removal, 16 (76%, 12 partial, four complete) of the 21 eyes in the SRS intubation group and 13 (76%, 10 partial, three complete) in the bicanalicular silicon intubation group had a successful outcome and remained symptom-free. For partial obstructions, the success rate was 85% and 90% for the SRS and bicanalicular silicon intubation groups, respectively. The corresponding values for complete obstruction were 63% and 50% for the SRS and bicanalicular silicon intubation groups, respectively. Conclusion SRS could effectively substitute for a more extensive procedure such as bicanalicular silicon intubation in patients with canalicular obstruction, particularly those with partial obstruction. The newly developed SRS intubation procedure has the advantages of simple, easy implementation and extubation, low cost, and a lower rate of trauma when compared with bicanalicular silicon intubation. PMID:22259230

  2. [Intubation of a patient with rheumatoid arthritis with a 7.5-mm-ID armored endotracheal tube using a laryngeal mask airway].

    PubMed

    Mashio, H; Kojima, T; Goda, Y; Kawahigashi, H; Ito, Y; Kato, M

    1997-12-01

    A 71-year-old male patient with rheumatoid arthritis was scheduled for posterior fusion of the cervical spine. He showed limited cervical movement and atrophic mandible. Tracheal intubation was difficult in his last anesthetic management for the same surgery. This time, we planned a special procedure for predicted difficult tracheal intubation. After induction of general anesthesia, a size-4 laryngeal mask airway was inserted. Next, a flexible fiberscope sheathed with a 6.0-mm-ID cuffed endotracheal tube was inserted through a laryngeal mask airway into the trachea, and the fiberscope was withdrawn. Then, an endotracheal tube changer was inserted through the endotracheal tube. The laryngeal mask airway and the endotracheal tube were withdrawn simultaneously leaving the tube changer. Finally, a 7.5-mm-ID armored endotracheal tube was inserted through the tube changer. The procedure applied in this case is a safe and reliable intubating method in patients with difficult tracheal intubation.

  3. Identifying and Managing a Malpositioned Endotracheal Tube Bite Block in an Orotracheally Intubated Patient: A Case Report.

    PubMed

    Chou, Hui-Ling; Ruan, Sheng-Yuan; Wu, Huey-Dong

    2016-03-01

    The universal bite block is increasingly used in orotracheally intubated patients. Here, we report a case of pilot tube dysfunction caused by a malpositioned universal bite block in an orotracheally intubated patient. We summarize the key points on identifying and managing a malpositioned universal bite block from this case and literature review.A 74-year-old woman was emergently intubated during an episode of hyperkalemia-related cardiac arrest. A universal bite block was used for fixing the endotracheal tube. After her condition stabilized, ventilator weaning was attempted; however, a positive cuff-leak test result was observed.The cuff-leak test revealed a lack of elasticity of the pilot balloon, which was completely deflated after 2 mL of air was removed. Pilot tube dysfunction was highly suspected. The bite block was slightly pulled out, and 8 mL of air was aspirated from the pilot tube. The patient was successfully extubated without stridor and respiratory distress.Our case highlighted that a malpositioned bite block may obstruct the pilot tube, causing unfavorable consequences. While fixing the bite block on an endotracheal tube, it is crucial to ensure that the takeoff point of the pilot tube is located within the C-notch of the bite block.

  4. An in-tube radar for detecting cracks in metal tubing

    SciTech Connect

    CAFFEY,THURLOW W. H.; NASSERSHARIF,BAHRAM; GARCIA,GABE V.; SMITH,PHILLIP R.; JEDLICKA,RUSSELL P.; HENSEL,EDWARD C.

    2000-06-12

    A major cause of failures in heat exchangers and steam generators in nuclear power plants is degradation of the tubes within them. The tube failure is often caused by the development of cracks that begin on the outer surface of the tube and propagate both inwards and laterally. A new technique will be described for detection of defects using a continuous-wave radar device within metal tubing. The technique is 100% volumetric, and may find smaller defects, find them more rapidly, and find them less expensively than present methods. Because this project was started only recently, there is no demonstrated performance to report so far. However, the basic engineering concepts will be presented together with a description of the milestone tasks and dates.

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

    PubMed

    Manbohi, Ahmad; Ahmadi, Seyyed Hamid

    2015-07-23

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

  6. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    PubMed Central

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-01-01

    Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

  7. Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet.

    PubMed

    Warner, Matthew A; Fox, Jonathan F

    2016-02-15

    Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.

  8. Array capillary in-tube solid-phase microextraction: a rapid preparation technique for water samples.

    PubMed

    Yan, Xiaohui; Wu, Dapeng; Peng, Hong; Ding, Kun; Duan, Chunfeng; Guan, Yafeng

    2012-06-29

    A rapid sample preparation technique, namely array capillary in-tube solid-phase microextraction (ACIT-SPME) for direct extraction of organic pollutants from water samples, was developed and evaluated. The ACIT-SPME cartridge consisted of a bundle of glass capillary tubes of 0.5 mm I.D. × 30mm contained inside a quartz liner of 4 mm I.D. The high ratio of cross-section area of channel-to-wall allowed water sample flow through the cartridge just under gravity. Both the internal/external surfaces of the array capillary tubing were coated with extraction phase of 2-5 μm in thickness, which provided large extraction surface area up to 30 cm² for a cartridge containing 19 glass capillaries. The large surface area and thin extraction phase improved greatly both the mass transfer process of extraction and the thermo desorption process, leading to fast extraction and fast desorption. The extracted analytes were thermally desorbed in a homemade thermal desorption unit (TDU), which was coupled to a gas chromatograph equipped with a flame ionization detector for analysis. By using polydimethylsiloxane (PDMS) as the extraction phase and polycyclic aromatic hydrocarbons (PAHs) as the model analytes, the performance of the ACIT-SPME cartridge was systematically investigated. The extraction time was 2 min for 350 mL of water sample, and detection limits were between 0.8 and 1.7 ng/L with deviation of 2.8-9.7% RSD. Relative recoveries of analytes for real water samples were between 65.0% and 116%. The extraction time can even be further shortened to 10s for 250 mL sample by applying vacuum at the outlet of the cartridge, with detection limits of 2.2-5.3 ng/L and deviation of 4.0-12% RSD.

  9. Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).

    PubMed

    Radesic, Brian P; Winkelman, Chris; Einsporn, Richard; Kless, Jack

    2012-10-01

    Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

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

    SciTech Connect

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

    2006-05-02

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

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

    SciTech Connect

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

    2009-06-01

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

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

    PubMed

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

    2016-02-02

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

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

    PubMed

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

    2016-02-01

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

  14. Novel and simple headspace in-tube microextraction coupled with capillary electrophoresis.

    PubMed

    Lee, Hye Ryeo; Cho, Sung Min; Kim, Jihye; Chung, Doo Soo

    2014-06-13

    In liquid phase microextraction, high enrichment factors can be obtained using an acceptor phase of small volume. By hanging an acceptor drop at the separation capillary tip, single drop microextraction (SDME) can be in-line coupled with capillary electrophoresis (CE). The small surface-to-volume ratio of the drop enables high enrichment factors to be obtained in a short time. One practical issue in SDME is how to keep the drop attached to the capillary stable. Here, we present novel but extremely simple in-tube microextraction (ITME) using the liquid inside the capillary as an acceptor phase, without forming a drop at the capillary tip. As a first example, ITME has been combined with headspace (HS) extraction. Simply by placing a capillary filled with a basic run buffer in the HS above an acidic donor solution, volatile acidic analytes were extracted into the acceptor phase in the capillary. After extraction, electrophoresis of the extracts in the capillary was carried out. Owing to the robust nature of the acceptor phase, the extraction temperature and time ranges of HS-ITME can be extended significantly, compared to HS-SDME. The enrichment factors for chlorophenols in a standard solution were up to 1100 under an optimal HS-ITME condition of 80°C for 15min and the limits of detections (LODs) obtained by monitoring the absorbance at 214nm were about 4nM. The whole procedures of HS-ITME-CE were carried out automatically using built-in programs of a commercial CE instrument.

  15. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.

    PubMed

    Hsieh, Shao-Wei; Chen, Hung-Shu; Chen, Yi-Ting; Hung, Kuo-Chuan

    2017-04-01

    This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.

  16. Nanostructured-silver-coated polyetheretherketone tube for online in-tube solid-phase microextraction coupled with high-performance liquid chromatography.

    PubMed

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

    2015-07-14

    Polyetheretherketone tube is a better substrate for in-tube solid-phase microextraction than fused-silica capillary and metal tube because of its resistance to high pressure and good flexibility. It was modified with a nanostructured silver coating, and characterized by scanning electron microscopy and energy dispersive X-ray spectroscopy. It was connected into high-performance liquid chromatography equipment to build the online analysis system by replacing the sample loop of a six-port injection valve. To get the highest extraction capacity, the preparation conditions of the coating was investigated. Important extraction conditions including length of tube, sample volume, and desorption time were optimized using eight polycyclic aromatic hydrocarbons as model analytes. The tube exhibits excellent extraction efficiency toward them, with enrichment factors from 52 to 363. The online analysis method provides good linearity (0.5-100 or 1.0-100 μg/L) and low detection limits (0.15-0.30 μg/L). It has been used to determine polycyclic aromatic hydrocarbons in water samples, with relative recoveries in the range of 92.3-120%. The tube showed highest extraction ability for polycyclic aromatic hydrocarbons, higher extraction ability for hydrophobic phthalates and anilines, and almost no extraction ability for low hydrophobic phenols, due to the possible extraction mechanism including hydrophobic and electron-rich element-metal interactions.

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

    PubMed

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

    2016-02-01

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

  18. 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

  19. Analysis of phthalate contamination in infusion solutions by automated on-line in-tube solid-phase microextraction coupled with high-performance liquid chromatography.

    PubMed

    Mitani, Kurie; Izushi, Fumio; Kataoka, Hiroyuki

    2004-10-01

    Contamination of infusion solutions with phthalates was analyzed, and its origin was determined. Phthalates were determined by on-line in-tube solid-phase microextraction coupled with high-performance liquid chromatography (in-tube SPME-HPLC) with UV detection. In-tube SPME is an extraction technique for organic compounds in aqueous samples, in which analytes are extracted from the sample directly into an open tubular capillary by repeated draw/eject cycles of sample solution. The infusion solutions were used without any pretreatment, and the phthalates in these solutions were automatically analyzed by the on-line in-tube SPME-HPLC system. The limits of detection of phthalates in the infusion solutions were 1-10 ng/mL. With a few exceptions, the recoveries of phthalates added to the infusion solutions were above 80%. Di-n-butyl phthalate (DBP) was detected at a concentration of 7-60 ng/mL in most infusion solutions in plastic containers but was not detected in those in glass bottles. On the other hand, no other phthalates were detected in infusion solutions in either plastic or glass containers. Large amounts of DBP were detected in the adhesive used to affix the paper labels to the plastic bottles and bags, but not in the plastic containers themselves. Furthermore, DBP was shown to be readily eluted from the adhesive into water and alcohol and easily pass through the plastic. These results indicated that the source of the DBP was the adhesive used to affix the paper labels, and DBP contaminated the infusion solutions by passing through the plastic. The in-tube SPME-HPLC method is simple and rapid and provides a useful tool for the screening and determination of phthalate contamination in infusion solutions.

  20. Comparison of rabbit facial nerve regeneration in nerve growth factor-containing silicone tubes to that in autologous neural grafts.

    PubMed

    Spector, J G; Lee, P; Derby, A; Roufa, D G

    1995-11-01

    Previous reports suggest that nerve growth factor (NGF) enhanced nerve regeneration in rabbit facial nerves. We compared rabbit facial nerve regeneration in 10-mm silicone tubes prefilled with NGF or cytochrome C (Cyt C), bridging an 8-mm nerve gap, to regeneration of 8-mm autologous nerve grafts. Three weeks following implantation, NGF-treated regenerates exhibited a more mature fascicular organization and more extensive neovascularization than Cyt C-treated controls. Morphometric analysis at the middle of the tube of 3- and 5-week regenerates revealed no significant difference in the mean number of myelinated or unmyelinated axons between NGF- and Cyt C-treated implants. However, when the numbers of myelinated fibers in 5-week regenerates were compared to those in their respective preoperative controls, NGF-treated regenerates had recovered a significantly greater percentage of myelinated axons than Cyt C-treated implants (46% versus 18%, respectively). The number of regenerating myelinated axons in the autologous nerve grafts at 5 weeks was significantly greater than the number of myelinated axons in the silicone tubes. However, in the nerve grafts the majority of the axons were found in the extrafascicular connective tissue (66%). The majority of these myelinated fibers did not find their way into the distal nerve stump. Thus, although the number of regenerating myelinated axons within the nerve grafts is greater than that of axons within silicone tube implants, functional recovery of autologous nerve graft repairs may not be superior to that of intubational repairs.

  1. Tube-Furnace Production of Silicon

    NASA Technical Reports Server (NTRS)

    Farrier, E. G.; Rexer, J.; Timmel, P. J.

    1982-01-01

    Packed-bed reactor produces silicon by decomposing ultrapure silane gas in temperature gradient. Based on previous experiments with relatively low decomposition temperatures and with temperature gradients, heterogeneous decomposition will produce few fines. Fines produced are screened out and reinserted into furnace.

  2. Custom built bite-block endotracheal tube holder for prolonged intubation.

    PubMed

    Sung, E C; Chung, E M; Park, J H

    2004-04-01

    This case report describes an intensive care patient with recurrent endotracheal tube occlusion due to biting. The use and fabrication of a new form of custom built bite-block to resolve these problems is described. The device described may also provide better access for mouth care and simplify airway management compared with bite-blocks commonly used.

  3. Determination of ochratoxins in nuts and grain samples by in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Saito, Keita; Ikeuchi, Risa; Kataoka, Hiroyuki

    2012-01-13

    A simple and sensitive method for the determination of ochratoxins A and B in nuts and grain samples was developed using an automated in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). Ochratoxins were separated within 5 min by high-performance liquid chromatography using an Inertsil ODS-3 column with 5mM anmonium acetate/acetonitrile (65/35, v/v) as the mobile phase. Electrospray ionization conditions in the positive ion mode were optimized for mass spectrometric detection of ochratoxins. The pseudo molecular ion [M+H](+) was used to detect ochratoxins with selected ion monitoring (SIM) mode. The optimum in-tube SPME conditions were 20 draw/eject cycles of 40 μL of sample using a Carboxen-1006 PLOT capillary column as an extraction device. The extracted ochratoxins were easily 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 linearities of the calibration curves (r=0.9993 for ochratoxin A and r=0.9989 for ochratoxin B) were obtained in the concentration range from 0.5 to 20 ng/mL. The detection limits (S/N=3) for ochratoxins A and B were 92 and 89 pg/mL, respectively. The in-tube SPME method showed above 15-19-fold greater sensitivity than the direct injection method (10 μL injection). The within-day and between-day precisions (relative standard deviations) were below 5.1% and 7.7% (n=6), respectively. This method was applied successfully to analysis of nuts and grain samples without interference peaks. The recoveries of ochratoxins spiked into extraction solution from nut samples were above 88%. Ochratoxins were detected at 0.7-8.8 ng/g levels in various nuts and grain samples.

  4. 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.

  5. 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. PMID:27621880

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

    PubMed Central

    Saray, Aydin

    2004-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  8. Sensitivity of the Quantiferon-Gold In-Tube Assay in Sputum Smear Positive TB Cases in Indonesia

    PubMed Central

    Rutherford, Merrin; Alisjahbana, Bachti; Maharani, Winni; Sampurno, Hedy; van Crevel, Reinout; Hill, Philip C.

    2010-01-01

    Background As part of a formal evaluation of the Quantiferon-Gold in-tube assay (QFT-IT) for latent TB infection we compared its sensitivity to the tuberculin skin test (TST) in confirmed adult TB cases in Indonesia. Smear-positive TB disease was used as a proxy gold standard for latent TB infection. Methods and Findings We compared the sensitivity of QFT-IT and TST in 98 sputum smear and chest x-ray positive TB cases and investigated risk factors for negative and discordant results in both tests. Both tests showed high sensitivity; (QFT-IT; 88.7%: TST; 94.9%), not significantly different from each other (p value 0.11). Very high sensitivity was seen when tests were combined (98.9%). There were no variables significantly associated with discordant results or with a negative TST. For QFT-IT which particular staff member collected blood was significantly associated with test positivity (p value 0.01). Study limitations include small sample size and lack of culture confirmation or HIV test results. Conclusions The QFT-IT has similar sensitivity in Indonesian TB cases as in other locations. However, QFT-IT, like the TST cannot distinguish active TB disease from LTBI. In countries such as Indonesia, with high background rates of LTBI, test specificity for TB disease will likely be low. While our study was not designed to evaluate the QFT-IT in the diagnosis of active TB disease in TB suspects, the data suggest that a combination of TST and QFT-IT may prove useful for ruling out TB disease. Further research is required to explore the clinical role of QFT-IT in combination with other TB diagnostic tests. PMID:20711257

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

    PubMed

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

    2016-07-29

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2012-03-23

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

  12. Inorganic-organic hybrid coating material for the online in-tube solid-phase microextraction of monohydroxy polycyclic aromatic hydrocarbons in urine.

    PubMed

    Wang, ShuLing; Xu, Hui

    2016-12-01

    An inorganic-organic hybrid nanocomposite (zinc oxide/polypyrrole) that represents a novel kind of coating for in-tube solid-phase microextraction is reported. The composite coating was prepared by a facile electrochemical polymerization strategy on the inner surface of a stainless-steel tube. Based on the coated tube, a novel online in-tube solid-phase microextraction with liquid chromatography and mass spectrometry method was developed and applied for the extraction of three monohydroxy polycyclic aromatic hydrocarbons in human urine. The coating displayed good extraction ability toward monohydroxy polycyclic aromatic hydrocarbons. In addition, long lifespan, excellent stability, and good compression resistance were also obtained for the coating. The experimental conditions affecting the extraction were optimized systematically. Under the optimal conditions, the limits of detection and quantification were in the range of 0.039-0.050 and 0.130-0.167 ng/mL, respectively. Good linearity (0.2-100 ng/mL) was obtained with correlation coefficients larger than 0.9967. The repeatability, expressed as relative standard deviation, ranged between 2.5% and 9.4%. The method offered the advantage of process simplicity, rapidity, automation, and sensitivity in the analysis of human urinary monohydroxy polycyclic aromatic hydrocarbons in two different cities of Hubei province. An acceptable recovery of monohydroxy polycyclic aromatic hydrocarbons (64-122%) represented the additional attractive features of the method in real urine analysis.

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

    PubMed Central

    Dahlin, Lars B.

    2014-01-01

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

  14. Determination of anabolic steroids in human urine by automated in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Saito, Keita; Yagi, Katsuharu; Ishizaki, Atsushi; Kataoka, Hiroyuki

    2010-09-05

    A simple, rapid and sensitive method was developed for determining the presence of seven anabolic steroids (boldenone, nandrolone, testosterone, methyltestosterone, epiandrosterone, androsterone, and atnozolol) in human urine. Glucuronide-conjugates of these compounds were hydrolyzed with beta-glucuronidase. The anabolic steroids were analyzed by on-line in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). The steroids were separated within 14 min by high performance liquid chromatography using a Chromolith RP-18e column and 5 mM ammonium formate/methanol (35/65, v/v) as a mobile phase at a flow rate of 1.0 mL/min. Electrospray ionization conditions in the positive ion mode were optimized for the MS detection of these compounds. The optimum in-tube SPME conditions were 20 draw/eject cycles with a sample size of 40 microL using a Supel-Q PLOT capillary column for the extraction. The extracted compounds could be desorbed readily from the capillary column by flow of the mobile phase, and no carryover was observed. Using the in-tube SPME LC-MS with SIM mode detection, good linearity of the calibration curve (r>0.995) was obtained in the concentration range of 0.5-20 ng/mL, except for stanozolol. The detection limits (S/N=3) of anabolic steroids were in the range 9-182 pg/mL and the proposed method showed 20-33-fold higher sensitivity than the direct injection method. The within-day and between-day precisions were below 4.0% and 7.3% (n=5), respectively. This method was applied successfully to the analysis of urine samples without the interference peaks. The recovery rates of anabolic steroids spiked into urine samples were above 85%. This method is useful to analyze the urinary levels of these compounds in anti-doping tests.

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

    SciTech Connect

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

    1993-08-01

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

  16. Poly(methacrylic acid-ethylene glycol dimethacrylate) monolith in-tube solid phase microextraction coupled to high performance liquid chromatography and analysis of amphetamines in urine samples.

    PubMed

    Fan, Yi; Feng, Yu-Qi; Zhang, Jian-Tao; Da, Shi-Lu; Zhang, Min

    2005-05-13

    In-tube solid-phase microextraction (SPME) based on a poly(methacrylic acid-ethylene glycol dimethacrylate) monolithic capillary column was investigated for the extraction of amphetamine, methamphetamine and their methylenedioxy derivatives. The monolithic capillary column showed high extraction efficiency towards target analytes, which could be attributed to its larger loading amount of extraction phase than conventional open-tubular extraction capillaries and the convective mass transfer procedure provided by its monolithic structure. The extraction mechanism was studied, and the results indicated that the extraction process of the target analytes was involved with hydrophobic interaction and ion-exchange interaction. The polymer monolith in-tube SPME-HPLC system with UV detection was successfully applied to the determination of amphetamine, methamphetamine and their methylenedioxy derivatives in urine samples, yielding the detection limits of 1.4 - 4.0 ng/mL. Excellent method reproducibility (RSD < 2.9%) was found over a linear range of 0.05-5 microg/mL, and the time for the whole analysis was only approximately 25 min. The monolithic capillary column was reusable in coping with the complicated urine samples.

  17. Determination of Ochratoxin A in wine by packed in-tube solid phase microextraction followed by high performance liquid chromatography coupled to tandem mass spectrometry.

    PubMed

    Andrade, Mariane A; Lanças, Fernando M

    2017-04-14

    Ochratoxin A (OTA), a widely studied mycotoxin, can be found in a variety of food matrices. As its concentration in food is generally low (in the order of μg kg(-1)), sample preparation techniques are necessary for the analyte purification and pre-concentration in order to achieve the required low detection limits. The separation and detection methods used for OTA analysis should also offer proper sensitivity in order to allow the adequate quantification of the analyte. This manuscript addresses the development of a methodology aiming the analysis of OTA in wine samples by packed in-tube SPME in flow through extraction mode coupled to HPLC-MS/MS. The in-tube SPME set up utilized a PEEK tube packed with C18 particles as the extraction column. The method was optimized by a central composite design 2(2)+3 extra central points, having as factors the percentage of ACN and time in the sample load step. The functionalities of the method were attested and its analytical conditions, enhanced by using 22% of ACN and 6min in the sample load step. Validation of the method was also accomplished prior to analyses of both dry red wine and dry white wine samples. The method demonstrated proper sensitivity, with detection and quantification limits equal to 0.02 and 0.05μgL(-1), respectively. Linearity and precision exhibited a 0.996 correlation coefficient and RSD under 6%, respectively. The method proved to be accurate at medium and higher concentration levels with a maximum recovery of 73% at higher concentration levels. OTA was not detected in either dry red and dry white wine samples evaluated in this work. If present, it would be at concentrations lower than the detection and quantification limits established for the proposed method, and considered not a potential danger to human health according to our present knowledge.

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

    PubMed Central

    Wei, Bin; Chen, Lin

    2015-01-01

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

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

    PubMed

    Hong, Feng; Wei, Bin; Chen, Lin

    2015-01-01

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

  20. Awake intubation.

    PubMed

    Peiris, Kawshala; Frerk, Chris

    2008-03-01

    Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Awake intubation can be achieved via several methods. Using the fibreoptic laryngoscope is the most widely used technique in the UK with minimal patient discomfort and a wide margin of safety. When compared with attempts at difficult direct laryngoscopy, awake fibreoptic intubation provides excellent cardiovascular stability when performed under good topical anaesthesia and conscious sedation. Understanding the equipment used as well as preparing the patient and being aware of potential pitfalls are important elements to performing a successful awake intubation.

  1. Determination of nicotine, cotinine, and related alkaloids in human urine and saliva by automated in-tube solid-phase microextraction coupled with liquid chromatography-mass spectrometry.

    PubMed

    Kataoka, Hiroyuki; Inoue, Reiko; Yagi, Katsuharu; Saito, Keita

    2009-01-15

    A simple, rapid and sensitive method for the determination of nicotine, cotinine, nornicotine, anabasine, and anatabine in human urine and saliva was developed. These compounds were analyzed by on-line in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-mass spectrometry (LC-MS). Nicotine, cotinine and related alkaloids were separated within 7 min by high performance liquid chromatography (HPLC) using a Synergi 4u POLAR-RP 80A column and 5 mM ammonium formate/methanol (55/45, v/v) as a mobile phase at a flow-rate of 0.8 mL/min. Electrospray ionization conditions in the positive ion mode were optimized for MS detection of these compounds. The optimum in-tube SPME conditions were 25 draw/eject cycles with a sample size of 40 microL using a CP-Pora PLOT amine capillary column as the extraction device. The extracted compounds could be desorbed easily from the capillary by passage of the mobile phase, and no carryover was observed. Using the in-tube SPME LC-MS method, the calibration curves were linear in the concentration range of 0.5-20 ng/mL of nicotine, cotinine and related compounds in urine and saliva, and the detection limits (S/N=3) were 15-40 pg/mL. The method described here showed 20-46-fold higher sensitivity than the direct injection method (5 microL injection). The within-run and between-day precision (relative standard deviations) were below 4.7% and 11.3% (n=5), respectively. This method was applied successfully to analysis of urine and saliva samples without interference peaks. The recoveries of nicotine, cotinine and related compounds spiked into urine and saliva samples were above 83%, and the relative standard deviations were below 7.1%. This method was used to analyze urinary and salivary levels of these compounds in nicotine intake and smoking.

  2. Physical Processes of the Interaction Between Laser-Generated Plasma and Blast Wave Appearing in Laser-Driven In-Tube Accelerator Configuration

    SciTech Connect

    Sasoh, Akihiro; Mori, Koichi; Ohtani, Toshiro; Ohnishi, Naofumi; Ogino, Yosuke; Sawada, Keisuke

    2006-05-02

    Flow visualizations of the interaction between a laser-pulse-generated plasma and a shock wave driven by it have been experimentally conducted. The configuration of the experimental set-up corresponds to the laser-driven, in-tube accelerator. Primary-mode deformation of the plasma is governed by Richtmyer-Meshkov instability which is produced by the vector product between the pressure and density gradients, which in turn correspond to a reflected shock wave and to the plasma, respectively. Higher-mode contact surface deformations are supposedly originated in Rayleigh-Taylor instability in the shrinkage phase of the plasma, and is enhanced due to the passage of the reflected shock wave.

  3. Silica supported Fe(3)O(4) magnetic nanoparticles for magnetic solid-phase extraction and magnetic in-tube solid-phase microextraction: application to organophosphorous compounds.

    PubMed

    Moliner-Martinez, Y; Vitta, Yosmery; Prima-Garcia, Helena; González-Fuenzalida, R A; Ribera, Antonio; Campíns-Falcó, P; Coronado, Eugenio

    2014-03-01

    This work demonstrates the application of silica supported Fe3O4 nanoparticles as sorbent phase for magnetic solid-phase extraction (MSPE) and magnetic on-line in-tube solid-phase microextraction (Magnetic-IT-SPME) combined with capillary liquid chromatography-diode array detection (CapLC-DAD) to determine organophosphorous compounds (OPs) at trace level. In MSPE, magnetism is used as separation tool while in Magnetic-IT-SPME, the application of an external magnetic field gave rise to a significant improvement of the adsorption of OPs on the sorbent phase. Extraction efficiency, analysis time, reproducibility and sensitivity have been compared. This work showed that Magnetic-IT-SPME can be extended to OPs with successful results in terms of simplicity, speed, extraction efficiency and limit of detection. Finally, wastewater samples were analysed to determine OPs at nanograms per litre.

  4. In situ hydrothermal growth of polyaniline coating for in-tube solid-phase microextraction towards ultraviolet filters in environmental water samples.

    PubMed

    Bu, Yanan; Feng, Juanjuan; Wang, Xiuqin; Tian, Yu; Sun, Min; Luo, Chuannan

    2017-02-03

    A facile, low cost, sensitive and environmentally friendly polyaniline (PANI) coating was prepared onto the basalt fibers (BFs) by in situ hydrothermal growth method. PANI functionalized BFs were placed into a poly(ether ether ketone) (PEEK) tube as a fibers-in-tube solid-phase microextraction (SPME) device. The extraction and analysis processes were carried out by connecting it to high performance liquid chromatography (HPLC). Three ultraviolet filters including 2-hydroxy-4-methoxybenzophenone, phenyl salicylate and 2,4-dihydroxybenzophenone were employed as model analytes. Under the optimal extraction and desorption conditions, online in-tube SPME-HPLC analysis method was established and afforded satisfactory enrichment factors (1323-1555), wide linear ranges (0.06-100μgL(-1)) with correlation coefficients ranging from 0.9995 to 0.9999, low limits of detection (0.02-0.05μgL(-1)) and acceptable extraction repeatability (RSD<7.8%, n=6) and preparation repeatability (RSD<9.7%, n=3). The proposed method was successfully applied to the determination of the three ultraviolet filters in two environmental water samples.

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

    SciTech Connect

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

    1982-01-21

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

  6. Timing for Removal of Asymptomatic Long-Term Ventilation Tube in Children.

    PubMed

    Abdel-NabyAwad, Osama G

    2016-12-01

    Otitis media with effusion (OME) is the most frequent illness in children. Surgical treatment options include ventilation tube insertion, adenoidectomy or both. Opinions regarding the risks, benefits and intubation period of ventilation tube insertion vary greatly. To determine the appropriate time for when to remove asymptomatic longterm ventilation T-tubes in children. In this prospective study, we analyzed the results of 120 pediatric patients (6-12 years) (240 ears) with persistent OME; we employed the Goode T-silicone tubes. We intentionally planned to remove the tubes at different time points of the study and divided our patients randomly into four subgroups with 30 patents (60 ears in each) according to the intubation period; group I: intubation for 6 months, group II: intubation for 12 months, group III: intubation for 18 months and group IV: intubation for 24 months. The relationship between intubation period and OME recurrence, the rate of persistent tympanic membrane (TM) perforation, granulation tissue or discharge near the tympanostomy tubes, normalization of Eustachian tube function and change of hearing level was analyzed in each patient group. The χ(2) analysis showed that the rate of normalization of ET function was significantly higher when tubes were removed after 12-months of intubation (P = 0.002), the rate of OME recurrence was significantly higher when tubes were removed before 12-months of intubation (P = 0.004), The rate of otorrhea significantly increased after 12-months of intubation, development of granulation around tubes was significantly higher after 18-months of tube insertion. The rate of appearance of permanent TM perforation significantly increased after 18-months from tube insertion (P = 0.008). Adenoidectomy did not significantly influence the recurrence rate of OME or the rate of persistent TM peroration after tube removal. Our present results suggest that the appropriate intubation period for healing OME in

  7. Headspace in-tube extraction gas chromatography-mass spectrometry for the analysis of hydroxylic methyl-derivatized and volatile organic compounds in blood and urine.

    PubMed

    Rasanen, Ilpo; Viinamäki, Jenni; Vuori, Erkki; Ojanperä, Ilkka

    2010-04-01

    A novel headspace in-tube extraction gas chromatography-mass spectrometry (ITEX-GC-MS) approach was developed for broad-scale analysis of low molecular weight organic compounds in blood and/or urine. One sample was analyzed following in-vial derivatization with dimethyl sulfate for ethylene glycol (EG), glycolic acid (GA), formic acid (FA), other hydroxylic compounds, and another sample for underivatized volatile organic compounds. Tenax adsorbent resin was used in the microtrap, and a porous layer, open tubular GC capillary column was used for separation. MS was operated in the full-scan mode, identification was based on the Automated Mass Spectral Deconvolution and Identification System, and quantification was based on extracted ions. The limits of quantification for EG, GA, and FA in blood were 10, 50, and 30 mg/L, respectively, and the expanded uncertainties of measurement were 20%, 16%, and 14%, respectively. The procedure allowed for the first time the inclusion of EG and GA as their methyl derivatives within a quantitative HS analysis. The ITEX method described here was more sensitive for analysis of volatile organic compounds than the corresponding static headspace analysis as demonstrated for 11 representative compounds.

  8. Selective and sentivive method based on capillary liquid chromatography with in-tube solid phase microextraction for determination of monochloramine in water.

    PubMed

    Pla-Tolós, J; Moliner-Martínez, Y; Molins-Legua, C; Herráez-Hernández, R; Verdú-Andrés, J; Campíns-Falcó, P

    2015-04-03

    Due to the difficulties of working with chloramines, a critical examination of monochloramine standard preparation has been performed in order to select the best synthesis conditions. The analyte has been determined by in-tube solid phase extraction coupled to capillary liquid chromatography with UV detection (IT-SPME Capillary LC DAD). Potential factors affecting the response of monochloramine such as the pH of mobile phase and the volume of sample processed by IT-SPME Capillary LC DAD have been investigated and optimized. According to the results of the study, 0.1 mL or 4.0 mL of sample at neutral pH were loaded in the chromatographic system. A sensitive and selective method has been developed for the determination of monochloramine in water. Validation of the method has been performed. The linear range was 0.09-5mg/L with linear regression coefficients (R(2)) greater than 0.995. Method reproducibility expressed as relative standard deviation (RSD, %), was lower than 15%. The limits of detection (LODs) were 0.029 and 0.01 mg/L by processing 0.100mL or 4 mL of the samples, respectively, being below the maximum residues levels allowed for this compound. The sensitivity achieved by the developed method was better than that obtained by the reference method. The developed method was applied to water samples (tap and swimming pool water).

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

    PubMed

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

    2015-06-04

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

  10. Modification of the QuantiFERON-TB Gold (In-Tube) assay for the diagnosis of Mycobacterium bovis infection in African buffaloes (Syncerus caffer).

    PubMed

    Parsons, Sven D C; Cooper, David; McCall, Alicia J; McCall, Warren A; Streicher, Elizabeth M; le Maitre, Nicholas C; Müller, Annélle; Gey van Pittius, Nicolaas C; Warren, Robin M; van Helden, Paul D

    2011-07-15

    African buffaloes (Syncerus caffer) are the most significant wildlife maintenance hosts of Mycobacterium bovis, the causative organism of bovine tuberculosis (BTB). Current diagnostic tests for the detection of M. bovis infection in free-ranging buffaloes have numerous limitations and we wished to evaluate a modification to a human TB assay, the QuantiFERON-TB Gold (In-Tube) assay (QFT), as a practical diagnostic test for BTB in buffaloes. One hundred and seventy-five buffaloes were tested using the single intradermal comparative tuberculin test (SICTT) and a modified QFT (mQFT). An appropriate cut-off point for the mQFT was derived from SICTT results using receiver operator characteristic curve analysis. Twenty-six SICTT-positive buffaloes were killed and subjected to necropsy, and selected tissues were processed for mycobacterial culture and speciation. An optimal cut-off point for the mQFT was calculated as 66pg/ml. The assay correctly detected 39/40 SICTT-positive buffaloes and 129/134 TST-negative buffaloes and M. bovis was cultured from 21/26 slaughtered SICTT/mQFT-positive animals. The mQFT shows promise as a practical test for M. bovis infection in buffaloes and shows a sensitivity and specificity at least similar to that of the TST.

  11. A new on-line, in-tube pre-column derivatization technique for high performance liquid chromatographic determination of azithromycin in human serum.

    PubMed

    Bahrami, Gholamreza; Mohammadi, Bahareh

    2006-01-18

    Pre-column derivatization methods for high performance liquid chromatographic assay of specific pharmaceutical agents using 9-fluorenylmethyl chloroformate (FMOC-Cl) have received special attention because highly fluorescent and stable adducts are provided by these methods. However, unlike the post-column on-line techniques, long derivatization time is needed and the reaction cannot be well controlled. A new, sensitive and fast pre-column on-line derivatization technique coupled with high-performance liquid chromatography using FMOC-Cl as labeling agent is described and validated for determination of azithromycin in human serum. After extraction of the drug from serum, the residue was reconstituted in mixture of acetonitrile-phosphate buffer (3:1, v/v; pH 8.5) and directly injected onto the chromatographic system. Continuous on-line derivatization and analysis of the compounds were successfully performed using in-tube elution of FMOC-Cl. The total time needed for derivatization and chromatographic analysis of the drug was 13 min. The assay was reliable and reproducible, with limit of quantification of 10 ng/ml. The described technique may offer significant advantages over existing off-line derivatization methods using FMOC-Cl.

  12. In-tube solid-phase microextraction coupled by in valve mode to capillary LC-DAD: Improving detectability to multiresidue organic pollutants analysis in several whole waters.

    PubMed

    Campíns-Falcó, P; Verdú-Andrés, J; Sevillano-Cabeza, A; Herráez-Hernández, R; Molins-Legua, C; Moliner-Martinez, Y

    2010-04-16

    A simple and fast capillary chromatographic method has been developed to identify and quantify organic pollutants at sub-ppb levels in real water samples. The major groups of pesticides (organic halogens, organic phosphorous, and organic nitrogen compounds), some hydrocarbons (polycyclic aromatic hydrocarbons), phthalates and some phenols such as phenol and bisphenol A (endocrine disruptors) were included in this study. The procedure was based on coupling, in-tube solid-phase microextraction (IT-SPME) by using a conventional GC capillary column (95% methyl-5% phenyl substituted backbone, 80cmx0.32mm i.d., 3microm film thickness) in the injection valve to capillary liquid chromatography with diode array detection. A comparative study between the IT-SPME manifold and a column-switching device using a C(18) column (35mmx0.5mm i.d., 5microm particle size) has been performed. The IT-SPME procedure was optimal, it allows reaching limits of detection (LODs) between 0.008 and 0.2microg/L. No matrix effect was found and recoveries between 70 and 116% were obtained. The precision of the method was good, and the achieved intra- and inter-day variation coefficients were between 2 and 30%. This procedure has been applied to the screening analysis of 28 compounds in whole waters from several points of the Mediterranean coast (Valencia Community, Spain).

  13. Nasal intubation: A comprehensive review

    PubMed Central

    Chauhan, Varun; Acharya, Gaurav

    2016-01-01

    Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It is the most common method used for giving anesthesia in oral surgeries as it provides a good field for surgeons to operate. The anatomy behind nasal intubation is necessary to know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure. PMID:27994382

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

    PubMed

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

    2015-09-04

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

  15. Endotracheal intubation

    MedlinePlus

    ... RF, McGill JW, Clinton JE. Tracheal intubation. In: Roberts JR, ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine . 6th ... commercial use must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer ...

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

    NASA Astrophysics Data System (ADS)

    Versteeg, Christo; Scarpim de Souza, Marcio

    2014-06-01

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

  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.

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

    PubMed

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

    2016-08-03

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

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

    PubMed Central

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

    2016-01-01

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

  20. Effect of prolonged incubation time on results of the QuantiFERON TB gold in-tube assay for diagnosis of latent tuberculosis infection.

    PubMed

    Min, Joo-Won; Lee, Ha-Youn; Lee, Ji Sun; Lee, Jinwoo; Chung, Jae Ho; Han, Sung Koo; Yim, Jae-Joon

    2013-09-01

    Previous reports have shown that the sensitivity of the 6-day lymphocyte stimulation test is much higher than those of commercially available gamma interferon release assays (IGRAs). The aim of this study was to elucidate the effect of prolonged incubation on the results of the QuantiFERON TB Gold in-tube (QFT-GIT) assay. Patients aged >20 years with suspected tuberculosis (TB) were recruited prospectively from 1 May 2009 to 31 December 2010. In addition, healthy volunteers with no history of TB treatment were included as controls. For each participant, three sets of the QFT-GIT assay were performed using 24-, 48-, and 72-h incubation tests, and the results were compared. Thirty-seven patients with suspected pulmonary TB and 33 healthy controls were enrolled in the study. Of the 37 patients with suspected TB, the QFT-GIT assay results were positive for 28 (75.7%) after a 24-h incubation period. After prolonged incubation, the results differed in four (10.8%) of the 37 patients suspected of having TB. Among 27 patients with culture-confirmed TB, the sensitivities of the QFT-GIT assay after the 24-, 48-, and 72-h incubation tests were 85.2%, 81.5%, and 81.5%, respectively. Among the 33 healthy controls, the QFT-GIT assay results were positive in two (6.1%) after a 24-h incubation period. The results changed for two (6.1%) of the 33 healthy controls after prolonged incubation. The specificities of the QFT-GIT assay after 24, 48, and 72 h of incubation were 93.9%, 87.9%, and 90.9%, respectively. Prolonging the incubation time did not increase the sensitivity of the QFT-GIT assay. The manufacturer-recommended incubation time of 16 to 24 h should be respected because prolonged incubation can cause indeterminate or false-positive results.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-09-21

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

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

    PubMed Central

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

    2012-01-01

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

  4. High Proportion of Indeterminate QuantiFERON-TB Gold In-Tube Results in an Inpatient Population Is Related to Host Factors and Preanalytical Steps

    PubMed Central

    Fabre, Valeria; Shoham, Shmuel; Page, Kathleen R.; Shah, Maunank

    2014-01-01

    Background  QuantiFERON-TB Gold In-Tube test (QFT-GIT) can be used as an alternative to tuberculin skin testing (TST) for the targeted testing of latent tuberculosis. Due to many shortcomings with TST, QFT-GIT usage is increasing. QFT-GIT implementation in the inpatient setting remains unclear. Methods  We retrospectively identified patients admitted to a tertiary care academic center who received either a TST or a QFT-GIT in the 18 months prior to and after QFT-GIT implementation in March 2012. Risk factors associated with indeterminate results were evaluated. Results  The proportion of inpatients receiving a test for tuberculosis infection doubled following QFT-GIT implementation (1.4% vs 2.9%). After QFT-GIT became available, 75% of tested people received a QFT-GIT and 25% received a TST. We found indeterminate test results in 19.8%. Independent predictors of indeterminate results were female sex (adjusted odds ratio [AOR], 1.64), lymphopenia (AOR, 2.21), hypoalbuminemia (AOR, 6.81) and sample collection by nonphlebotomists (AOR, 3.0, vs phlebotomists). Of patients who had indeterminate results, 42% had a subsequent indeterminate result on repeat testing. All indeterminate results were due to a low mitogen response. Conclusions  QFT-GIT testing in the inpatient setting is associated with a high proportion of indeterminate results that is associated with host factors and preanalytical errors. Careful selection of patients to be tested and training on sample processing for QFT-GIT testing should be considered to decrease indeterminate results. PMID:25734154

  5. Advantages of monolithic over particulate columns for multiresidue analysis of organic pollutants by in-tube solid-phase microextraction coupled to capillary liquid chromatography.

    PubMed

    Moliner-Martínez, Y; Molins-Legua, C; Verdú-Andrés, J; Herráez-Hernández, R; Campíns-Falcó, P

    2011-09-16

    The performance of a monolithic C(18) column (150 mm×0.2 mm i.d.) for multiresidue organic pollutants analysis by in-tube solid-phase microextraction (IT-SPME)-capillary liquid chromatography has been studied, and the results have been compared with those obtained using a particulate C(18) column (150 mm×0.5 mm i.d., 5 μm). Chromatographic separation has been carried out under isocratic elution conditions, and for detection and identification of the analytes a UV-diode array detector has been employed. Several compounds of different chemical structure and hydrophobicity have been used as model compounds: simazine, atrazine and terbutylazine (triazines), chlorfenvinphos and chlorpyrifos (organophosphorous), diuron and isoproturon (phenylureas), trifluralin (dinitroaniline) and di(2-ethylhexyl)phthalate. The results obtained revealed that the monolithic column was clearly advantageous in the context of multiresidue organic pollutants analysis for a number of reasons: (i) the selectivity was considerably improved, which is of particular interest for the most polar compounds triazines and phenyl ureas that could not be resolved in the particulate column, (ii) the sensitivity was enhanced, and (iii) the time required for the chromatographic separation was substantially shortened. In this study it is also proved that the mobile-phase flow rates used for separation in the capillary monolithic column are compatible with the in-valve IT-SPME methodology using extractive capillaries of dimensions similar to those used in conventional scale liquid chromatography (LC). On the basis of these results a new method is presented for the assessment of pollutants in waters, which permits the characterization of whole samples (4 mL) in less than 30 min, with limits of detection in the range of 5-50 ng/L.

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

    PubMed

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

    2014-08-01

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

  7. Analysis of urinary 8-isoprostane as an oxidative stress biomarker by stable isotope dilution using automated online in-tube solid-phase microextraction coupled with liquid chromatography-tandem mass spectrometry.

    PubMed

    Mizuno, Keisuke; Kataoka, Hiroyuki

    2015-08-10

    We have developed a simple and sensitive method for the determination of the oxidative stress biomarker 8-isoprostane (8-IP) in human urine by automated online in-tube solid-phase microextraction (SPME) coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) using a Zorbax Eclipse XDB-8 column and 0.1% formic acid/methanol (25/75, v/v) as a mobile phase. Electrospray MS/MS for 8-IP was performed on an API 4000 triple quadruple mass spectrometer in negative ion mode. The optimum in-tube SPME conditions were 20 draw/eject cycles with a sample size of 40 μL using a Carboxen 1006 PLOT capillary column for the extraction. The extracted compounds were easily desorbed from the capillary by passage of the mobile phase, and no carryover was observed. Total analysis time of this method including online extraction and analysis was about 30 min for each sample. The in-tube SPME LC-MS/MS method showed good linearity in the concentration range of 20-1000 pg/mL with a correlation coefficient r = 0.9999 for 8-IP using a stable isotope-labeled internal standard, 8-IP-d4. The detection limit of 8-IP was 3.3 pg/mL and the proposed method showed 42-fold higher sensitivity than the direct injection method. The intra-day and inter-day precisions (relative standard deviations) were below 5.0% and 8.5% (n = 5), respectively. This method was applied successfully to the analysis of urine samples without pretreatment or interference peaks. The recovery rates of 8-IP spiked into urine samples were above 92%. This method is useful for assessing the effects of oxidative stress and antioxidant intake.

  8. 2-Hydroxypropyl-beta-cyclodextrin extracts 2-phenylphenol from silicone tubing.

    PubMed

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

    2004-07-08

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

  9. Use of the QuantiFERON-TB Gold In-Tube Test in the Diagnosis and Monitoring of Treatment Efficacy in Active Pulmonary Tuberculosis

    PubMed Central

    Chang, Ping-Chin; Wang, Pin-Hui; Chen, Kow-Tong

    2017-01-01

    The value of QuantiFERON in the diagnosis of tuberculosis disease and in the monitoring of the response to anti-tuberculosis treatment is unclear. The aims of this study were to evaluate the accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test in the diagnosis of tuberculosis and in the monitoring of the response to anti-tuberculosis treatment in patients with active pulmonary tuberculosis (PTB). Between January 2013 and December 2015, 133 cases with active PTB and 133 controls with no mycobacterial infection, matched by age (within 3 years) and by the week that they visited Tainan Chest Hospital, were enrolled in the study. Serial testing by QFT-GIT at baseline and after 2 and 6 months of treatment was performed. At these time points, a comparison of the performance of QFT-GIT with that of sputum culture status among study subjects was conducted. Compared to baseline, 116 (87.2%) cases showed a decreased response, whereas 17 (12.8%) showed persistent or stronger interferon-gamma (IFN-γ) responses at 2 months. PTB patients IFN-γ responses declined significantly from baseline to 2 months (median, 6.32 vs. 4.12; p < 0.005). The sensitivity values of the QFT-GIT test for the detection of pulmonary tuberculosis at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 74.4%, 78.2%, and 80.5%, respectively. The specificity values at cut-off points of 0.35 IU/mL, 0.20 IU/mL, and 0.10 IU/mL were 66.2%, 63.9%, and 57.1%, respectively. Our results support the QFT-GIT assay as a potential tool for diagnosing tuberculosis and for monitoring the efficacy of anti-tuberculosis treatment. PMID:28264462

  10. Comparison of the QuantiFERON-TB Gold In-Tube test with the tuberculin skin test for detecting latent tuberculosis infection prior to hematopoietic stem cell transplantation.

    PubMed

    Moon, S M; Lee, S-O; Choi, S-H; Kim, Y S; Woo, J H; Yoon, D H; Suh, C; Kim, D-Y; Lee, J-H; Lee, Je-H; Lee, K-H; Kim, S-H

    2013-02-01

    A total of 244 patients including 100 (41%) autologous hematopoietic stem cell transplant (HCT) recipients and 144 (59%) allogeneic HCT recipients were enrolled over a 28-month period. During the study period, no prophylaxis for latent tuberculosis (TB) infection was administrated. Of these, 201 (82%) had Bacillus Calmette-Guérin (BCG) scars or prior histories of BCG vaccination. The tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) test were performed simultaneously in all 244 patients. TST indurations were ≥ 5 mm in 39 of these patients (15%), and in 25 (10%) indurations were ≥ 10 mm. In addition, 40 (16%) had positive QFT-GIT outcomes, and 34 (14%) indeterminate outcomes. If the 34 patients with indeterminate QFT-GIT results were excluded from the overall agreement analysis, the agreement between the TST results (induration size ≥ 5 mm) and the QFT-GIT results in the 210 patients with clear QFT results was poor (κ = 0.08, 95% confidence interval [CI] -0.06 to 0.24), as it was for the patients with indurations ≥ 10 mm (κ = 0.15, 95% CI -0.004 to 0.31). During follow up, 2 patients developed TB after HCT. The incidence of TB in the patients with positive QFT-GIT outcomes was 2.80 per 100 person-years (95% CI 0.07-15.81), whereas among those with positive TST (≥ 5 mm) results, it was 0 per 100 person-years (95% CI 0-8.00). However, this finding should be cautiously interpreted because of the relatively short follow up and the fact that the sample size of the study cohort did not have adequate power. In conclusion, our data show that, although the frequencies of positive outcomes in the 2 TB screening tests were similar, the overall agreement between the TST and the QFT-GIT test was poor, regardless of BCG vaccination history.

  11. Diagnostic Values of the QuantiFERON-TB Gold In-Tube Assay Carried out in China for Diagnosing Pulmonary Tuberculosis

    PubMed Central

    Li, Fabin; Longuet, Christophe; Vernet, Guy; Goletti, Delia; Zhao, Yanlin; Lagrange, Philippe H.

    2015-01-01

    Background Interferon-release assays (IGRAs) for diagnosing active pulmonary tuberculosis (PTB) are not yet fully validated, particularly in high TB-endemic areas as the People's Republic of China (PRC). The aim of this report was to assess the performance of the QuantiFERON-TB Gold In-tube (QFT-GIT) and tuberculin skin test (TST), in addition to microbiological results, as contributors for diagnosing active PTB in the PRC. Methods/Principal Findings A total of 300 PTB patients, 41 disease controls (DC) and 59 healthy community controls (HCC) were included prospectively between May 2010 and April 2011 from two provinces of the PRC (Heilongjiang and Zhejiang). The QFT-GIT and TST yielded an overall sensitivity for active TB of 80.9% and 86.2%, and a specificity of 36.6% and 26.8%, respectively. The province of origin and smear microscopy status did not significantly impact the diagnostic values for PTB. However, using the TST with a 10 mm cut-off point, a significantly higher proportion of LTBI was observed in the DC than the HCC (p=0.01). Discordant results between the QFT-GIT and TST were found among 1/3 of the PTB, HCC and DC. Two-thirds of the individuals presented TST-positive/QFT-GIT-negative discordant results. The TST-negative/QFT-GIT-positive result was not associated with age or bacillary load. Cumulative QFT-GIT and TST positive results increased the overall sensitivity (95.9%), but it was associated with a dramatic decrease of the overall specificity (24.8%) leading to a suboptimal PPV (80.1%) and a low NPV (61.1%). Conclusions/Significance The usefulness of the QFT-GIT to diagnose active TB in high TB-endemic countries remains doubtful because like the TST, the QFT-GIT cannot distinguish between LTBI and active TB. Used as single stand-alone tests, both the QFT-GIT and TST have very limited roles in the diagnosis of active PTB. However, the combined use of SM, the TST and QFT-GIT may allow for the exclusion of ATB. PMID:25867946

  12. Agreement between QuantiFERON®-TB Gold In-Tube and the tuberculin skin test and predictors of positive test results in Warao Amerindian pediatric tuberculosis contacts

    PubMed Central

    2014-01-01

    Background Interferon-gamma release assays have emerged as a more specific alternative to the tuberculin skin test (TST) for detection of tuberculosis (TB) infection, especially in Bacille Calmette-Guérin (BCG) vaccinated people. We determined the prevalence of Mycobacterium tuberculosis infection by TST and QuantiFERON®-TB Gold In-Tube (QFT-GIT) and assessed agreement between the two test methods and factors associated with positivity in either test in Warao Amerindian children in Venezuela. Furthermore, progression to active TB disease was evaluated for up to 12 months. Methods 163 HIV-negative childhood household contacts under 16 years of age were enrolled for TST, QFT-GIT and chest X-ray (CXR). Follow-up was performed at six and 12 months. Factors associated with TST and QFT-GIT positivity were studied using generalized estimation equations logistic regression models. Results At baseline, the proportion of TST positive children was similar to the proportion of children with a positive QFT-GIT (47% vs. 42%, p = 0.12). Overall concordance between QFT-GIT and TST was substantial (kappa 0.76, 95% CI 0.46-1.06). Previous BCG vaccination was not associated with significantly increased positivity in either test (OR 0.68, 95% CI 0.32-1.5 for TST and OR 0.51, 95% CI 0.14-1.9 for QFT-GIT). Eleven children were diagnosed with active TB at baseline. QFT-GIT had a higher sensitivity for active TB (88%, 95% CI 47-98%) than TST (55%, 95% CI 24-83%) while specificities were similar (respectively 58% and 55%). Five initially asymptomatic childhood contacts progressed to active TB disease during follow-up. Conclusion Replacement of TST by the QFT-GIT for detection of M. tuberculosis infection is not recommended in this resource-constrained setting as test results showed substantial concordance and TST positivity was not affected by previous BCG vaccination. The QFT-GIT had a higher sensitivity than the TST for the detection of TB disease. However, the value of the QFT

  13. The Kepler intubation system.

    PubMed

    Hemmerling, Thomas M; Wehbe, Mohamad; Zaouter, Cedrick; Taddei, Riccardo; Morse, Joshua

    2012-03-01

    Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard videolaryngoscope via a robotic arm. Ninety intubations were performed by the Kepler Intubation System on an airway trainer mannequin by a single operator. The first group of 30 intubations was performed with the operator in direct view of the mannequin (direct view group). The second group of 30 intubations was performed with the operator unable to see the mannequin (indirect view group). Thirty semiautomated intubations were also performed during which the robotic system replayed a trace of a previously recorded intubation maneuver (semiautomated group). First-attempt success rates and intubation times for each trial were recorded. Trends were analyzed using linear regression. Data are presented as mean (SD). All intubations were successful at first attempt. The mean intubation times were 46 (18) seconds, 51 (19) seconds, and 41 (1) seconds for the direct view, indirect view, and semiautomated group, respectively. Both the direct and indirect view groups had a negative slope, denoting that each successive trial required less time. The semiautomated group had a slope of 0 and a low SD of 1 second, illustrating the high reproducibility of automated intubations. We concluded that a robotic intubation system has been developed that can allow remote intubations within 40 to 60 seconds.

  14. Submandibular intubation in awake patient of panfacial trauma

    PubMed Central

    Kamra, SK; Khandavilli, HK; Banerjee, P

    2016-01-01

    Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems. PMID:27833492

  15. Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

    PubMed

    Kontogeorgakos, Vasileios; Koutalos, Antonios; Hantes, Michael; Manoudis, Gregory; Badras, Leonidas; Malizos, Konstantinos

    2015-03-01

    A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

  16. Shock-tube studies of silicon-compound vapors

    NASA Technical Reports Server (NTRS)

    Park, C.; Fujiwara, T.

    1977-01-01

    Test gas mixtures containing SiO, SiO2, Si2, and SiH were produced in a shock tube by processing shock waves through a mixture of SiCl4 + N2O + Ar, SiH4 + Ar, or SiH4 + O2 + Ar. Absorption spectra of the test gases were studied photographically in the reflected shock region using a xenon flash lamp as the light source in the range of wavelengths between 250 and 600 nm. SiO was found to be a dominant species in the vapors produced by the SiCl4 + N2O and SiH4 + O2 mixtures. Spontaneous combustion was observed in the SiH4 + O2 + Ar mixture prior to the shock arrival, and the resulting solid SiO2 particles evaporated behind the shock wave. Spectral absorption characteristics of SiO, SiO2, Si2, and SiH were determined by studying the test gases.

  17. Extraction of o-phenylphenol from silicone tubing by a sulfobutylether cyclodextrin formulation.

    PubMed

    Zimmerman, Jeffrey A; Ballard, John M; Wang, Hai; Wu, Allen; Gallagher, Kimberly A

    2003-11-28

    During a compatibility study between a formulation containing sulfobutylether cyclodextrin (SBECD) and silicone tubing, an extraneous peak was observed in the HPLC chromatograms. The extraneous material was identified by LC/MS, MS/MS and UV as a previously unreported tubing extractable, o-phenylphenol (o-PP). Several studies were conducted to assess the impact of formulation and process-related variables on the amount of the o-PP extracted, including contact time, sulfobutylether cyclodextrin concentration, formulation pH, and tubing sterilization and storage conditions. Results show that the concentration of the SBECD, tubing processing and storage conditions and the duration of the study influenced the levels of o-PP extracted. However, the largest contributor to the amount extracted was the lot of tubing tested. The extracted levels varied widely from lot to lot (0.007-3.89microg/cm(2) of tubing surface area). A dynamic study conducted to simulate a manufacturing process also resulted in the extraction of o-PP by the formulation.

  18. Submental Intubation in Patients with Complex Maxillofacial Injuries

    PubMed Central

    Cheong, Yuseon; Kang, Seong Sik; Kim, Minsoo; Son, Hee Jeong; Park, Jaewoo; Kim, Jeong-Mo

    2016-01-01

    Airway management in patients with complex maxillofacial injuries is a challenge to anesthesiologists. Submental intubation is a useful technique that is less invasive than tracheostomy in securing the airways where orotracheal and nasotracheal intubation cannot be performed. This procedure avoids the use of tracheostomy and bypasses its associated morbidities. A flexible and kink-resistant reinforced endotracheal tube with detachable universal connector is commonly used for submental intubation. Herein, we report cases involving submental intubation using a reinforced endotracheal tube with a non-detachable universal connector in patients with complex maxillofacial injuries. PMID:27924286

  19. Enhanced rat sciatic nerve regeneration through silicon tubes filled with pyrroloquinoline quinone.

    PubMed

    Liu, Shiqing; Li, Haohuan; Ou Yang, Jingping; Peng, Hao; Wu, Ke; Liu, Yongming; Yang, Jingwei

    2005-01-01

    Pyrroloquinoline quinone (PQQ) is an antioxidant that also stimulates nerve growth factor (NGF) synthesis and secretion. In an earlier pilot study in our laboratory, Schwann cell growth was accelerated, and NGF mRNA expression and NGF secretion were promoted. The present study was designed to explore the possible nerve-inducing effect of PQQ on a nerve tube model over a 1-cm segmental deficit. An 8-mm sciatic nerve deficit was created in a rat model and bridged by a 1-cm silicone tube. Then,10 mul of 0.03 mmol/l PQQ were perfused into the silicone chamber in the PQQ group. The same volume of normal saline was delivered in the control group. Each animal underwent functional observation (SFI) at 2-week intervals and electrophysiological studies at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment, 12 weeks after tube implantation. Using a digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity and amplitude of activity potential), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the PQQ group and controls (P < 0.05). More mature, high-density, newly regenerated nerve was observed in the PQQ group. We conclude that PQQ is a potent enhancer for the regeneration of peripheral nerves.

  20. Serial T-SPOT.TB and quantiFERON-TB-Gold In-Tube assays to monitor response to antitubercular treatment in Italian children with active or latent tuberculosis infection.

    PubMed

    Chiappini, Elena; Bonsignori, Francesca; Mangone, Giusi; Galli, Luisa; Mazzantini, Rachele; Sollai, Sara; Azzari, Chiara; de Martino, Maurizio

    2012-09-01

    We performed a prospective study to investigate T-SPOT.TB and QuantiFERON-TB Gold In-Tube (QFT-G-IT) dynamics during antitubercular treatment in active tuberculosis (TB) or latent TB. Eighteen children with latent TB and 26 with TB were enrolled. At 6 months of follow-up reversion rate was 5.88% (95% CI:0-13.79) for QFT-G-IT; 9.09% (95% CI:0.59-17.58) for T-SPOT.TB (P=0.921) in TB cases. Significant decline in quantitative response was observed exclusively in TB cases. Our results suggest that serial IGRA have limited use in children receiving antitubercular treatment.

  1. In vivo monitoring of quantum dots in the extracellular space using push-pull perfusion sampling, online in-tube solid phase extraction, and inductively coupled plasma mass spectrometry.

    PubMed

    Su, C K; Huang, C W; Yang, C S; Wang, Y J; Sun, Y C

    2010-09-01

    To monitor the dynamic changes of extracellular quantum dots (QDs) in vivo in the livers of anesthetized rats, we developed an automatic online analytical system comprising push-pull perfusion (PPP) sampling, the established in-tube solid phase extraction (SPE) procedure, and inductively coupled plasma mass spectrometry (ICPMS). The method takes advantage of the retention of QDs onto the interior surface of a polytetrafluoroethylene (PTFE) tube as a means of extracting the QDs from complicated push-pull perfusates. For the injected QDs present in the liver extracellular fluid (ECF) at low picomolar levels, a temporal resolution of 10 min was required to collect sufficient amounts of QDs to meet the sensitivity requirements of the ICPMS system. To the best of our knowledge, this study is the first to exploit the PPP technique for the collection of QDs from living animals and PTFE tubing as a SPE adsorbent for the online extraction of QDs and the removal of biological matrix prior to ICPMS analysis of cadmium-containing inorganic nanocrystal. We confirmed the analytical reliability of this method from measurements of the spike recoveries of saline samples; in addition, we demonstrated the systems' applicability through in vivo monitoring of the time-dependent concentration profile of liver extracellular QDs in living rats after intravenous administration.

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

    PubMed

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

    2013-07-01

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

  3. In-tube solid-phase microextraction based on NH2-MIL-53(Al)-polymer monolithic column for online coupling with high-performance liquid chromatography for directly sensitive analysis of estrogens in human urine.

    PubMed

    Luo, Xialin; Li, Gongke; Hu, Yufei

    2017-04-01

    In this work, a novel NH2-MIL-53(Al) incorporated poly(styrene-divinylbenzene-methacrylic acid) (poly(St-DVB-MAA)) monolith was prepared via chemical fabrication. Moreover, it has been efficiently applied to the in-tube solid-phase microextraction (SPME) for online coupling with high-performance liquid chromatography (HPLC) to the direct determination of five estrogens in human urine samples. The NH2-MIL-53(Al)-polymer monolith was suitable for in-tube SPME owing to its good permeability, high extraction efficiency, chemical stability, good reproducibility and long lifetime. The extraction conditions including extraction solvent, pH of sample solution, flow rate of extraction and desorption, and desorption volume were investigated. Under the optimum conditions, the enrichment factors were 180-304 and saturated amounts of extraction were 2326-21393 pmol for estriol, 17β-estradiol, estrone, ethinyl estradiol and progesterone, respectively. The adsorption mechanism was also explored which contributed to its strong extraction to target compounds. The proposed method had low limit of detection (2.0-40ng/L) and good linearity (with R(2) between 0.9908 and 0.9978). Four endogenous estrogens were detected in urine samples and the recoveries of all five analytes were ranged from 75.1-120% with relative standard deviations (RSDs) less than 8.7%. The results showed that the proposed online SPME-HPLC method based on NH2-MIL-53(Al)-polymer monolithic column was highly sensitive for directly monitoring trace amount of estrogens in human urine sample.

  4. Endotracheal intubation in swine.

    PubMed

    Chum, Helen; Pacharinsak, Cholawat

    2012-11-01

    Swine are commonly used as research models for cardiovascular surgery and disease, gastrointestinal disease, organ transplantation and intra-renal surgery. These surgical models require anesthesia and, consequently, endotracheal intubation in order to protect the airway; prevent aspiration of saliva, blood and foreign materials; and maintain positive pressure ventilation of the animal. Successful intubation is vital to the stable maintenance of swine under inhalational anesthesia. Here we discuss key features of swine anatomy that make intubation challenging, equipment necessary for successful intubation and techniques for endotracheal intubation in swine.

  5. Prosthodontic Approach in Management of Prolonged Neonatal Intubation

    PubMed Central

    Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-01-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation. PMID:28050517

  6. Prosthodontic Approach in Management of Prolonged Neonatal Intubation.

    PubMed

    Kamble, Vikas B; Shah, Shital K; Rathod, Vishnu B; Ambadkar, Priyanka S; Patil, Charudutt N

    2016-11-01

    Intubation is a routine intervention in the Neonatal Intensive Care Unit (NICU) for preterm neonates with respiratory distress, inadequate gag reflex, poor sucking and swallowing. Prolonged intubation in neonates can be done by nasal or oral route. Although naso-tracheal intubation may reduce movement of the tube, it may contribute to airway obstruction, possible hypoxia, and occlusion of the nasal aperture during a crucial period of development further contributing to laboured breathing. Being obligate nasal breathers, oro-tracheal route is the preferred method of intubation in premature infants as oral mucosa is less susceptible to damage than nasal mucosa. Ineffective stabilization of the tubes is a frequent problem often resulting in accidental extubation and displacement of orotracheal and orogastric tube. Hence, these tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Complications of prolonged endotracheal intubation include palatal groove formation by pressure against the hard palate, infection, accidental extubation, malposition, laryngeal or tracheal edema and ulceration, tracheal stenosis, vocal cord injury. Various oral appliances are used for infants to stabilize the tubes and prevent complications associated with long term intubation. This case report describes a prosthodontic approach in management of prolonged neonatal intubation.

  7. Assessment of intubation in croup and epiglottitis.

    PubMed

    Zulliger, J J; Schuller, D E; Beach, T P; Garvin, J P; Birck, H G; Frank, J E

    1982-01-01

    Nasotracheal intubation for the management of airway obstruction in acute epiglottitis has become a well-received practice. However, the same technique has not received widespread support in laryngotracheobronchitis. The purpose of this study was to update the series of nasotracheal intubations in croup and epiglottitis from Columbus Children's Hospital with the specific intent to evaluate its effectiveness. All patients were evaluated for any immediate and delayed complications. Delayed complications were evaluated using parent interviews and measuring expiratory flow rates. This study of 45 children intubated for epiglottitis and 83 intubations for croup reconfirms the earlier report from this institution about its safety in both conditions. However, it has identified a subset of the croup patients who are definitely at risk to develop complications of the technique. In those children under 1 year of age, a disturbingly high incidence of subglottic stenosis was identified and this appeared to be related to the patient's age, tube size, serial intubations (dilatations), and duration of intubation. Suggested guidelines for airway management in the light of the new information are presented.

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

    SciTech Connect

    Boss, D.E.

    1996-06-07

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

  9. Optimisation of stir bar sorptive extraction and in-tube derivatisation-thermal desorption-gas chromatography-mass spectrometry for the determination of several endocrine disruptor compounds in environmental water samples.

    PubMed

    Iparraguirre, Arantza; Prieto, Ailette; Navarro, Patricia; Olivares, Maitane; Fernández, Luis-Ángel; Zuloaga, Olatz

    2011-07-01

    The analysis of organic pollutants in environmental water samples requires a pre-concentration step. Pre-concentration techniques such as stir bar sorptive extraction (SBSE) have gained popularity since they minimise the use of toxic organic solvents and can be considered as green analytical techniques. Similar to other pre-concentration techniques, one of the problems when SBSE is used is the matrix effect, which often occurs during the analysis of environmental water samples such as estuarine or wastewater samples. The present work studied the matrix effect during SBSE coupled to in-tube derivatisation-thermal desorption (TD)-gas chromatography-mass spectrometry for the determination of several endocrine disruptor compounds, such as alkylphenols, bisphenol A, estrogens and sterols, in environmental water samples, after optimisation of the major variables affecting the determination. Variables such as the addition of methanol or an inert salt to the donor phase, the extraction temperature, the volume of the donor phase, the stirring rate and the extraction time were studied during the SBSE optimisation. In the case of the in-tube derivatisation and TD step, the volume of the derivatisation reagent (N,O-bis(trimethylsilyl)triufloroacetamide with 1% of trimethylchlorosilane (BSTFA + 1% TMCS)) and the cryo-focusing temperature were fixed (2 μL and -50 °C, respectively) according to a consensus between maximum signal and optimal operation conditions. Good apparent recovery values (78-124%) were obtained for most of the analytes in Milli-Q water, except for 4-tert-octylphenol (4-tOP), which showed apparent recovery values exceeding 100%. Precision (n = 4) was in the 2-27%, and method detection limits were in the low nanogrammes per litre level for most of the analytes studied. The matrix effect was studied using two different approaches. On the one hand, Milli-Q water samples were spiked with humic acids, and apparent recovery values were studied with and

  10. Ischemic subglottic damage following a short-time intubation.

    PubMed

    Silva, Marta João; Aparício, José; Mota, Teresa; Spratley, Jorge; Ribeiro, Augusto

    2008-12-01

    The objective of this study is to report a case of ischemic subglottic damage after a short-time intubation with a large, overinflated endotracheal tube cuff in a child. The study uses individual case report. A 6-year-old boy was admitted to the pediatric intensive care unit after a head trauma intubated with a 5.5-mm inner diameter cuffed endotracheal tube overinflated with 16 ml of air that produced a pressure of more than 120 cm H2O. The endotracheal tube cuff pressure produced by inflation was reduced after 4 h. The child presented postextubation stridor with subglottic edema. Inappropriate handling of tracheal intubation without accurate measurement of endotracheal tube size and intracuff pressures of endotracheal tubes, can cause airway trauma and place patients at risk.

  11. Enhanced rat sciatic nerve regeneration through silicon tubes implanted with valproic acid.

    PubMed

    Wu, Fei; Xing, Danmou; Peng, Zhengren; Rao, Ting

    2008-05-01

    Valproic acid (VPA) is an effective antiepileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal-regulated kinase pathway, and increase B-cell lymphoma/leukemia-2 (bcl-2)and growth cone-associated protein 43 (GAP-43) levels in spinal cord. We hypothesized that VPA could enhance axonal regeneration in the rat. In the present research, we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function through a silicon tube implanted with VPA. The left sciatic nerves were exposed through dorsal-splitting incisions, and 8-mm nerve sections were excised at the middle of the thigh. Then, a 1.0-cm-long silicone tube (internal diameter,1.0 mm; exterior diameter, 2.0 mm) was used to bridge the nerve deficit, anchored to the proximal and distal terminals of the excised deficit of sciatic nerves with 9-0 nylon epineural suture. Sterile petroleum jelly was used to seal the ends of the tubes to avoid leakage. The rats in the VPA group and control group were locally delivered 10 muL VPA injection (400 mg/5 mL) and normal saline, respectively, after the operation. The sciatic nerve index (SFI) was observed in each animal at 2-week intervals and electrophysiology was studied at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment (12 weeks after the operation). Using the digital image-analysis system, the thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity, amplitude of activity potential), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls ( P < 0.05). The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential

  12. Substantial reduction of the heat losses to ambient air by natural convection from horizontal in-tube flows: impact of an axial bundle of passive baffles

    NASA Astrophysics Data System (ADS)

    Campo, A.; Cortés, C.

    This paper is concerned with a distinct and effective technique to insulate horizontal tubes carrying hot fluids without using the variety of insulating materials traditionally utilized in industry. The tubes transport hot fluids and are exposed to a natural convection environment of air at standard atmospheric temperature and pressure. Essentially, an ``equivalent quantity of insulation'' is provided by an envelope of straight symmetric baffles made from a low conductivity material that is affixed to the outer surface of the horizontal tubes. A simple 1-D lumped model of comparable precision to the customary 2-D differential model serves to regulate the thermal interaction between the two perpendicular fluid streams, one horizontal due to internal forced convection and the other vertical due to external natural convection in air. All computations are algebraic and lead to a rapid determination of the two quantities that are indispensable to design engineers: the mean bulk temperatures of the internal hot fluid moving either laminarly or turbulently, together with the degraded levels of heat transfer rates.

  13. Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube (QFT-G) test for the diagnosis of latent tuberculosis infection in dialysis patients.

    PubMed

    Al Jahdali, Hamdan; Ahmed, Anwar E; Balkhy, Hanan H; Baharoon, Salim; Al Hejaili, Fayez F; Hajeer, Ali; Memish, Ziad; Binsalih, Salih; Al Sayyari, Abdullah A

    2013-06-01

    Dialysis patients are more likely than the general population to develop active tuberculosis (TB). In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube (QFT-G) test was compared with the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI) among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 (13%) were TST positive, and 65 (32.5%) were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% (k=0.34) being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 (66.7%) were positive by the QTF-G test, resulting in an overall agreement of 33.3% (k=0). A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve (AUC) obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis.

  14. Online coupling of in-tube solid-phase microextraction with direct analysis in real time mass spectrometry for rapid determination of triazine herbicides in water using carbon-nanotubes-incorporated polymer monolith.

    PubMed

    Wang, Xin; Li, Xianjiang; Li, Ze; Zhang, Yiding; Bai, Yu; Liu, Huwei

    2014-05-20

    Online coupling of in-tube solid phase microextraction (IT-SPME) with direct analysis in real time mass spectrometry (DART-MS) was realized for the first time and applied in the analysis of triazine herbicides in lake water and orange juice. We incorporated single-wall carbon nanotubes (SWNTs) into a polymer monolith containing methacrylic acid (MAA) and ethylene dimethacrylate (EDMA) to form a novel poly(methacrylic acid-co-ethylene dimethacrylate-co-single wall carbon nanotubes) (poly(MAA-EDMA-SWNT)) monolith, which was then used in IT-SPME for enrichment of six triazine herbicides from water samples. With the online combination of IT-SPME with DART-MS, the analytes desorbed from the monolith were directly ionized by DART and transferred into MS for detection, thus rapid determination was achieved. Compared with regular DART-MS method, this online IT-SPME-DART-MS method was more sensitive and reproducible, because of the IT-SPME procedures and the isotope-labeled internal standard used in the experiment. Six triazine herbicides were determined simultaneously using this method with good linearity (R(2) > 0.998). The limit of quantification (signal-to-noise ratio of S/N = 10) of the six herbicides were only 0.06-0.46 ng/mL. The proposed method has been applied to determine triazine herbicides in lake water and orange juice, showing satisfactory recovery (85%-106%) and reproducibility (relative standard deviation of RSD = 3.1%-10.9%).

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

    PubMed

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

    2013-03-12

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

  16. Radiation grafting of N-vinylpyrrolidone into silicone tubes. Synthesis of polymers with improved hemocompatibility and implantation tests in lambs

    NASA Astrophysics Data System (ADS)

    Chapiro, A.; Domurado, D.; Foëx-Milléquant, M.; Jendrychowska-Bonamour, A.-M.

    NVP was grafted onto silicone 2 mm I.D. tubes by the "direct" radiation method. Homogeneous bulk grafting was carried in toluene solutions, the best results were obtained in 70% monomer solution, so it was choosen for preparing the samples for the implantations (in vivo tests). In 7 days implantation test the significant improvement of blood-compatibility correspond to grafting ratios higher than 40%. Surface limited grafting is realized in dilute aqueous solutions of NVP. The thickness of the grafted layer inside and outside the tubes is measured after colouration and observation with a microscope. the surface grafting ratio determined by multiple reflection I.R. analysis.

  17. Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway

    PubMed Central

    Kwak, Hyun Jeong; Lee, Sook Young; Lee, Su Youn; Kim, Yong Beom; Kim, Jong Yeop

    2016-01-01

    Abstract Background: During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation. Methods: One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I–II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed. Results: Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695). Conclusion: This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation. PMID:27902612

  18. A novel fatty-acid-based in-tube dispersive liquid-liquid microextraction technique for the rapid determination of nonylphenol and 4-tert-octylphenol in aqueous samples using high-performance liquid chromatography-ultraviolet detection.

    PubMed

    Shih, Hou-Kuang; Shu, Ting-Yun; Ponnusamy, Vinoth Kumar; Jen, Jen-Fon

    2015-01-07

    In this study, a novel fatty-acid-based in-tube dispersive liquid-liquid microextraction (FA-IT-DLLME) technique is proposed for the first time and is developed as a simple, rapid and eco-friendly sample extraction method for the determination of alkylphenols in aqueous samples using high-performance liquid chromatography-ultraviolet detection (HPLC-UV). In this extraction method, medium-chain saturated fatty acids were investigated as a pH-dependent phase because they acted as either anionic surfactants or neutral extraction solvents based on the acid-base reaction caused solely by the adjustment of the pH of the solution. A specially designed home-made glass extraction tube with a built-in scaled capillary tube was utilized as the phase-separation device for the FA-IT-DLLME to collect and measure the separated extractant phase for analysis. Nonylphenol (NP) and 4-tert-octylphenol (4-tOP) were chosen as model analytes. The parameters influencing the FA-IT-DLLME were thoroughly investigated and optimized. Under the optimal conditions, the detector responses of NP and 4-tOP were linear in the concentration ranges of 5-4000 μg L(-1), with correlation coefficients of 0.9990 and 0.9996 for NP and 4-tOP, respectively. The limits of detection based on a signal-to-noise ratio of 3 were 0.7 and 0.5 μg L(-1), and the enrichment factors were 195 and 143 for NP and 4-tOP, respectively. The applicability of the developed method was demonstrated for the analysis of alkylphenols in environmental wastewater samples, and the recoveries ranged from 92.9 to 107.1%. The extraction process required less than 4 min and utilized only acids, alkalis, and fatty acids to achieve the extraction. The results demonstrated that the presented FA-IT-DLLME approach is highly cost-effective, simple, rapid and environmentally friendly in its sample preparation.

  19. Evaluation of Superparamagnetic Silica Nanoparticles for Extraction of Triazines in Magnetic in-Tube Solid Phase Microextraction Coupled to Capillary Liquid Chromatography

    PubMed Central

    González-Fuenzalida, R. A.; Moliner-Martínez, Y.; Prima-Garcia, Helena; Ribera, Antonio; Campins-Falcó, P.; Zaragozá, Ramon J.

    2014-01-01

    The use of magnetic nanomaterials for analytical applications has increased in the recent years. In particular, magnetic nanomaterials have shown great potential as adsorbent phase in several extraction procedures due to the significant advantages over the conventional methods. In the present work, the influence of magnetic forces over the extraction efficiency of triazines using superparamagnetic silica nanoparticles (NPs) in magnetic in tube solid phase microextraction (Magnetic-IT-SPME) coupled to CapLC has been evaluated. Atrazine, terbutylazine and simazine has been selected as target analytes. The superparamagnetic silica nanomaterial (SiO2-Fe3O4) deposited onto the surface of a capillary column gave rise to a magnetic extraction phase for IT-SPME that provided a enhancemment of the extraction efficiency for triazines. This improvement is based on two phenomena, the superparamegnetic behavior of Fe3O4 NPs and the diamagnetic repulsions that take place in a microfluidic device such a capillary column. A systematic study of analytes adsorption and desorption was conducted as function of the magnetic field and the relationship with triazines magnetic susceptibility. The positive influence of magnetism on the extraction procedure was demonstrated. The analytical characteristics of the optimized procedure were established and the method was applied to the determination of the target analytes in water samples with satisfactory results. When coupling Magnetic-IT-SPME with CapLC, improved adsorption efficiencies (60%–63%) were achieved compared with conventional adsorption materials (0.8%–3%).

  20. Evaluation of Superparamagnetic Silica Nanoparticles for Extraction of Triazines in Magnetic in-Tube Solid Phase Microextraction Coupled to Capillary Liquid Chromatography.

    PubMed

    González-Fuenzalida, R A; Moliner-Martínez, Y; Prima-Garcia, Helena; Ribera, Antonio; Campins-Falcó, P; Zaragozá, Ramon J

    2014-04-02

    The use of magnetic nanomaterials for analytical applications has increased in the recent years. In particular, magnetic nanomaterials have shown great potential as adsorbent phase in several extraction procedures due to the significant advantages over the conventional methods. In the present work, the influence of magnetic forces over the extraction efficiency of triazines using superparamagnetic silica nanoparticles (NPs) in magnetic in tube solid phase microextraction (Magnetic-IT-SPME) coupled to CapLC has been evaluated. Atrazine, terbutylazine and simazine has been selected as target analytes. The superparamagnetic silica nanomaterial (SiO₂-Fe₃O₄) deposited onto the surface of a capillary column gave rise to a magnetic extraction phase for IT-SPME that provided a enhancemment of the extraction efficiency for triazines. This improvement is based on two phenomena, the superparamegnetic behavior of Fe₃O₄ NPs and the diamagnetic repulsions that take place in a microfluidic device such a capillary column. A systematic study of analytes adsorption and desorption was conducted as function of the magnetic field and the relationship with triazines magnetic susceptibility. The positive influence of magnetism on the extraction procedure was demonstrated. The analytical characteristics of the optimized procedure were established and the method was applied to the determination of the target analytes in water samples with satisfactory results. When coupling Magnetic-IT-SPME with CapLC, improved adsorption efficiencies (60%-63%) were achieved compared with conventional adsorption materials (0.8%-3%).

  1. Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test.

    PubMed

    Duman, Nilay; Ersoy-Evans, Sibel; Karadağ, Omer; Aşçıoğlu, Sibel; Sener, Burçin; Kiraz, Sedat; Sahin, Sedef

    2014-10-01

    Since the introduction of biologic therapies for tuberculosis (TB), screening for latent TB infection has increased in importance, especially in countries in which TB is endemic. The aim of this study was to evaluate the effect of psoriasis on tuberculin skin test (TST) results and to compare two TB screening tests, the TST and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT) test, in psoriasis and psoriatic arthritis (PA) patients living in a TB-endemic country (Turkey). This prospective study included 61 psoriasis and 40 PA patients, and 58 healthy controls. Demographic data, medical history, human immunodeficiency virus (HIV) status, level of education, smoking status, exposure to TB, personal and family histories of TB, and bacillus Calmette-Guérin (BCG) vaccination status were recorded for all participants. The TST and QFT-GIT were performed in all participants. The mean ± standard deviation TST indurations in the patient and control groups were 12.6 ± 6.4 mm and 10.2 ± 6.5 mm, respectively (P = 0.051). The TST positivity rate was higher in patients than in controls (86.1% vs. 37.9%; P < 0.001), whereas QFT-GIT positivity did not differ significantly (patients: 20.8%; controls: 17.2%; P = 0.737). False positive results can lead to unnecessary prophylactic TB treatment; therefore, the cut-off point for TST positivity in psoriasis and PA patients should be re-evaluated, or other tests, such as the QFT-GIT, should be used.

  2. Ion-pair in-tube solid-phase microextraction and capillary liquid chromatography using a titania-based column: application to the specific lauralkonium chloride determination in water.

    PubMed

    Prieto-Blanco, M C; Moliner-Martínez, Y; López-Mahía, P; Campíns-Falcó, P

    2012-07-27

    A quick, miniaturized and on-line method has been developed for the determination in water of the predominant homologue of benzalkonium chloride, dodecyl dimethyl benzyl ammonium chloride or lauralkonium chloride (C(12)-BAK). The method is based on the formation of an ion-pair in both in-tube solid-phase microextraction (IT-SPME) and capillary liquid chromatography. The IT-SPME optimization required the study of the length and nature of the stationary phase of capillary and the processed sample volume. Because to the surfactant character of the analyte both, the extracting and replacing solvents, have played a decisive role in the IT-SPME optimized procedure. Conditioning the capillary with the mobile phase which contains the counter ion (acetate), using an organic additive (tetrabutylammonium chloride) added to the sample and a mixture water/methanol as replacing solvent (processed just before the valve is switched to the inject position), allowed to obtain good precision of the retention time and a narrow peak for C(12)-BAK. A reversed-phase capillary based TiO(2) column and a mobile phase containing ammonium acetate at pH 5.0 for controlling the interactions of cationic surfactant with titania surface were proposed. The optimized procedure provided adequate linearity, accuracy and precision at the concentrations interval of 1.5-300 μg L(-1) .The limit of detection (LOD) was 0.5 μg L(-1) using diode array detection (DAD). The applicability of proposed IT-SPME-capillary LC method has been assessed in several water samples.

  3. Comparison of QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for diagnosis of latent tuberculosis in haemodialysis (HD) patients: a meta-analysis of κ estimates.

    PubMed

    Ayubi, E; Doosti-Irani, A; Sanjari Moghaddam, A; Khazaei, S; Mansori, K; Safiri, S; Sani, M; Mostafavi, E

    2017-03-02

    Diagnosis of latent tuberculosis infection (LTBI) is a concern in haemodialysis (HD) patients. Many studies have compared QuantiFERON-TB Gold In-Tube (QFT-GIT) and tuberculin skin test (TST) for detecting LTBI and reported the κ statistic of agreement between QFT-GIT and TST in HD patients. The present study aimed to systematically review this literature and conduct meta-analysis of individual studies that estimated the κ between QFT-GIT with TST among HD patients. All relevant published studies that were available as full-text were obtained by searching Medline (1950), Web of Sciences (1945), Scopus (1973) through May 2016. The κ was re-estimated from the individual studies and pooled using random effect meta-analysis. Subgroup analysis and meta-regression were applied to evaluate the effect of Bacillus Calmette-Guérin (BCG) vaccination, TST cut-off points, quality of studies, sample size and age on variation of κ estimate. Eight studies involving 901 HD patients were included in meta-analysis. The pooled κ estimate was 0·28 (I 2 = 18·4%, P = 0·239, 95% confidence intervals 0·22-0·34). The discordance of TST-/QFT-GIT+ was more than TST+/QFT-GIT-. History of BCG vaccination, TST cut-off points and age are related to variation of κ estimates. TST and QFT-GIT are not comparable in detecting LTBI in HD patients. The higher TST-/QFT-GIT+ ratio compared with TST+/QFT-GIT- ratio, may indicate the superiority of QFT-GIT over TST for detection LTBI in HD patients.

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

    PubMed Central

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

    2014-01-01

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

  5. Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

    PubMed Central

    Rajabi, Mohammad Taher; Zavarzadeh, Najmeh; Mahmoudi, Alireza; Johari, Mohammad Karim; Hosseini, Seyedeh Simindokht; Abrishami, Yalda; Rajabi, Mohammad Bagher

    2016-01-01

    AIM To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing. METHODS This retrospective study was performed on 338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing. Intubation was performed under light sedation in operating room and the stent was left 3mo in place. Clinical outcome was investigated 3mo after tube removal. RESULTS Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation (P=0.00). In addition, Monoka intubation had better outcomes compared to Masterka technique (P=0.046). No difference was found between genders but the higher the age, the better the outcomes with bicanalicular technique rather than monocanalicular. CONCLUSION Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages. Also, based upon our clinical outcomes, Masterka intubation is not recommended in cases of failed probing. PMID:27803865

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

    NASA Astrophysics Data System (ADS)

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

    2015-12-01

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

  7. [The transillumination technique. An alternative to conventional intubation?].

    PubMed

    Lipp, M; de Rossi, L; Daubländer, M; Thierbach, A

    1996-10-01

    The technique of light-guided intubation is based on the principle that a source of light brought into the trachea results in clearly visible and defined transcutaneous illumination, while no illumination can be observed with the light source in the oesophagus (Fig. 1-7). The Trachlight is a reintroduced instrument for this alternative intubation technique. The essential developments are: a length-adjustable stylet with a removable internal metal wire, a brighter light source, a stable handle with tight fixation of the endotracheal tube, and a time-dependent warning device to avoid extended intubations. One hundred twenty patients (Mallampati I. ASA I-III) were included in the study (conventional intubation [group KL, n = 60]. Trachlight intubation [group TT, n = 60]. The goals of the investigation were to examine the handling, application, problems, limitations, and possible indications of the method. The recorded parameters were: number of intubation attempts: course and duration of intubation; complications; and difficulties. In 40 patients (20 in each group) the indication for invasive blood pressure measurement was given due to the surgical procedure, and circulatory parameters were recorded at defined moments during the intubation course. In group KL 55 patients were intubated in the attempt, 4 on the second, and 1 on the third (mean duration 23.6 +/- 10.4 s, range 12-60 s). Complications were: unilateral intubation (3 patients), bradycardia (2), asystole (1) and soft-tissue injury (1). Of the 60 patients in group TT. 54 were intubated successfully, the mean time needed being 29.9 +/- 14.8 s (range: 6-61 s). The remaining 6 were then intubated by the conventional method. Positive results in group TT included: easy handling and application, no injury to soft tissues or teeth, and invariably correct placement of the tube. Problems included: sufficient transillumination was achieved only after (entire) dimming of the room, insufficient control over the distal

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

    PubMed

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

    2016-06-01

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

  9. Delayed detection of subcutaneous emphysema following routine endotracheal intubation -A case report-

    PubMed Central

    Jo, Youn Yi; Park, Woo Young; Choi, Eunkyeong; Koo, Bon Nyeo

    2010-01-01

    A tracheal intubation-related tracheobronchial rupture is a relatively rare complication. We report a case of tracheobronchial rupture after single lumen endotracheal intubation. Twenty four hours after extubation of an endotracheal tube, subcutaneous emphysema developed on the patient's neck. A pneumomediastinum was also detected by computerized tomography (CT). The patient recovered uneventfully after conservative management. PMID:20877710

  10. Product technology and market assessment for silicon carbide whisker reinforced alumina heat-exchanger tubes. Final report

    SciTech Connect

    Loutfy, R.O.; Withers, J.C.; Chakravarti, D.

    1993-10-01

    This report describes a study designed to develop an assessment of key performance features, desirable technical specifications and market potential for silicon carbide whisker-reinforced alumina (henceforth SCWRA) tubes for heat exchanger applications in a number of industries. The results of the first stage of a Delphi study conducted in the US market are presented. The second phase of the study is in progress. The first stage results suggest that there is a small market for SCWRA tubes in heat exchanger applications. The market is expected to grow steadily during the 1990`s. With appropriate performance specifications and competitive pricing, growth should come from (a) new applications that permit recovery in cases that were previously infeasible and (b) selective, partial substitution and replacement of current ceramics and metal/ceramic composites in existing applications. We identify key performance factors and detailed specifications needed in six designated industries (primary metals, fabricated metals, chemicals, glass, utility and incinerators). Reliability, durability and low maintenance costs emerge as critical performance factors across these industries. The data show that although ceramics are recognized as having better properties, enhancing reliability and durability and thus improving maintenance cost performance is a key priority. Such improvements, reflected in the objectives for SCWRA tubes, should facilitate adoption in both new and existing applications. At this time, we are unable to assess market size directly. However, expert judgment provided indices tracking the projected market for heat exchanger tubes from 1990 to 2005.

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

    NASA Technical Reports Server (NTRS)

    Opila, Elizabeth

    1995-01-01

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

  12. Typing and subtyping of 83 clinical isolates purified from surgically implanted silicone feeding tubes by random amplified polymorphic DNA amplification.

    PubMed

    Dautle, Melanie P; Ulrich, Ricky L; Hughes, Thomas A

    2002-02-01

    In this study, 83 clinical isolates purified from biofilms colonizing 18 silicone gastrostomy devices (12 "buttons" and six tubes converted to skin level devices) were selected for subtype characterization utilizing genetic analysis. The tubes, previously used for feeding, remained in place for 3 to 47 months (mean, 20.0 months) in children ranging in age from 6 months to 17 years. Classification of specific microbes using random amplified polymorphic DNA (RAPD) analysis revealed genetic similarities and differences among isolates belonging to the same genus. Both gram-positive and -negative bacteria were investigated, including 2 isolates of Bacillus brevis, 4 isolates of Bacillus licheniformis, 2 isolates of Bacillus pumilus, 3 isolates of Enterococcus durans, 19 isolates of Enterococcus faecalis, 8 isolates of Enterococcus faecium, 2 isolates of Enterococcus hirae, 7 isolates of Escherichia coli, 8 isolates of Lactobacillus plantarum, 19 isolates of Staphylococcus aureus, 2 isolates of Staphylococcus epidermidis, and 7 isolates of Staphylococcus saprophyticus. Amplified DNA fragments (amplicons) provided species-specific fingerprints for comparison by agarose gel electrophoresis. A total of 62 distinct RAPD types were categorized from the five genera studied. Typing analysis suggested cross acquisition of E. coli, E. faecalis, and S. aureus in three patient pairs. Genomic polymorphism detection proved efficient and reliable for classifying bacterial subtypes isolated from biofilms adhering to various portions of commonly employed enteral access tubes.

  13. Swallowing dysfunction following endotracheal intubation

    PubMed Central

    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

    2016-01-01

    Abstract 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

  14. Successful Management of Rabbit Anesthesia Through the Use of Nasotracheal Intubation

    PubMed Central

    2009-01-01

    Although nasotracheal intubation in the rabbit has been briefly described, scientific assessment of the procedure has not been reported. In this report we describe nasotracheal intubation performed in 38 male New Zealand White rabbits (3.0 to 5.5 kg) used for a vascular patch study. The rabbits were placed under general anesthesia twice, with 2 mo between the initial and final intubations. Rabbits were intubated by the oral or nasotracheal route and compared. Previous literature dismissed nasotracheal intubation, citing the possibility of introducing pathogens into the lungs and the necessity of high oxygen flow rates (presumably greater than 3 L/min). However, no clinical signs of respiratory disease were noted among the study animals, nor were high oxygen flow rates necessary. Several key points collectively facilitated a successful procedure. Total relaxation was essential, modification of the classic blind approach eased placement, a correct approach was necessary, and our development of a unique method of securing the tube improved tube management. The findings suggest that nasotracheal intubation can be used as an easy, less traumatic method of rabbit intubation when compared with orotracheal intubation. PMID:19383213

  15. Numerical simulation of capacitively coupled RF plasma flowing through a tube for the synthesis of silicon nanocrystals

    NASA Astrophysics Data System (ADS)

    Le Picard, Romain; Song, Sang-Heon; Porter, David; Kushner, Mark; Girshick, Steven

    2014-10-01

    Silicon nanocrystals (SiNCs) are of interest for applications in the photonics, electronics, and biomedical areas. Nonthermal plasmas offer several potential advantages for synthesizing SiNCs. In this work, we have developed a numerical model of a capacitively coupled RF plasma used for the synthesis of SiNCs. The plasma, consisting of silane diluted in argon at a total pressure of about 2 Torr, flows through a narrow quartz tube with two ring electrodes. The numerical model is 2D, assuming axisymmetry. An aerosol sectional model is added to the Hybrid Plasma Equipment Model developed by Kushner and coworkers. The aerosol module solves for aerosol size distributions and size-dependent charge distributions. A detailed chemical kinetic mechanism considering silicon hydride species containing up to 5 Si atoms is used to model particle nucleation and surface growth. The sectional model calculates coagulation, particle transport by electric force, neutral drag and ion drag, and particle charging using orbital motion limited theory. Simulation results are presented for selected operating conditions, and are compared to experimental results. This work was partially supported by the US Dept. of Energy Office of Fusion Energy Science (DE-SC0001939), the US National Science Foundation (CHE-124752), and the Minnesota Supercomputing Institute.

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

    PubMed

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

    2009-02-20

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

  17. Palatopharyngeal wall perforation during Glidescope intubation.

    PubMed

    Leong, W L; Lim, Y; Sia, A T H

    2008-11-01

    We report a case of palatopharyngeal wall perforation during intubation with a GlideScope laryngoscope. The likely mechanism was advancing and rotating the endotracheal tube against a taut palatopharyngeal fold. This was missed during the initial laryngoscopy, because there is a potential blind-spot in the oropharynx when attention is focused on the GlideScope" monitor Fortunately, there were no sequelae other than minor bleeding and a mild sore throat and no surgical intervention was necessary. The use of unnecessary force during the endotracheal tube insertion, the use of too large a laryngoscope blade and the use of a rigid stylet could possibly also have been contributory factors to this complication.

  18. 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.

  19. Endotracheal intubation in the ICU.

    PubMed

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  20. 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

  1. Orotracheal Intubation Using the Retromolar Space: A Reliable Alternative Intubation Approach to Prevent Dental Injury

    PubMed Central

    Thakar, Sudip D.; Truong, Angela T.; Truong, Dam-Thuy

    2016-01-01

    Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation. Written consent for publication has been obtained from the patient. PMID:28116174

  2. 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.

  3. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

    PubMed

    Ulusoy, Hulya; Besir, Ahmet; Cekic, Bahanur; Kosucu, Muge; Geze, Sukran

    2014-01-01

    Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

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

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

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

  5. 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

  6. Cervical Spinal Motion During Intubation.

    DTIC Science & Technology

    2000-01-01

    Ten fresh human cadavers were intubated while recording cervical motion using a cinefluoroscopic technique. Segmental cervical motion from the...performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The data are currently being analyzed. A...paper entitled Segmental cervical spine motion during orotracheal intubation of the intact and injured spine with and without external stabilization was published in the Journal of Neurosurgery.

  7. Nasotracheal intubation: an unusual cause of palatal perforation in an insulin dependent diabetes mellitus patient.

    PubMed

    Bhowate, Rahul; Dubey, Alok

    2004-01-01

    A case of palatal perforation occurring in 7-year-old girl with IDDM due to nasotracheal intubation is reported. The child, who was not previously diagnosed of IDDM, was brought to hospital in comatose stage and was put on nasotracheal tube for maintaining respiration. This paper highlights the link between IDDM and palatal perforation communicating the nasal cavity due to naso-tracheal intubation.

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

    NASA Technical Reports Server (NTRS)

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

    1974-01-01

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

  9. Image Shutters: Gated Proximity-Focused Microchannel-Plate (MCP) Wafer Tubes Versus Gated Silicon Intensified Target (SIT) Vidicons

    NASA Astrophysics Data System (ADS)

    Yates, G. J.; King, N. S. P.; Jaramillo, S. A.; Ogle, J. W.; Noel, B. W.; Thayer, N. N.

    1983-03-01

    The imaging characteristics of two fast image shutters used for recording the spatial and temporal evolution of transient optical events in the nanosecond range have been studied. Emphasis is on the comparative performances of each shutter type under similar conditions. Response data, including gating speed, gain, dynamic range, shuttering efficiency, and resolution for 18 and 25-mm-diam proximity-focused microchannel-plate (MCP) intensifiers are com-pared with similar data for a prototype electrostatically-focused 25-mm-diam gated silicon-intensified-target (SIT) vidicon currently under development for Los Alamos National Laboratory. Several key parameters critical to optical gating speed have been varied in both tube types in order to determine the optimum performance attainable from each design. These include conductive substrate material and thickness used to reduce photocathode resistivity, spacing between gating electrodes to minimize interelectrode capacitance, the use of con-ductive grids on the photocathode substrate to permit rapid propagation of the electrical gate pulse to all areas of the photocathode, and different package geometries to provide a more effective interface with external biasing and gating circuitry. For comparable spatial resolution, most 18-mm-diam MCPs require gate times > 2.5 ns while the fastest SIT has demonstrated sub-nanosecond optical gates as short as r 400 ± 50 ps for full shuttering of the 25-mm-diam input window.

  10. Image shutters: Gated proximity-focused Microchannel Plate (MCP) wafer tubes versus gated Silicon Intensified Target (SIT) vidicons

    NASA Astrophysics Data System (ADS)

    Yates, G. J.; King, N. S. P.; Jaramillo, S. A.; Ogle, J. W.; Noel, B. W.; Thayer, N. N.

    Response data, including gating speed, gain, dynamic range, shuttering efficiency, and resolution for 18- and 25-mm-diam proximity-focused microchannel-plate (MCP) intensifiers are compared with similar data for a prototype electrostatically-focused 25-mm-diam gated silicon-intensified-target (SIT) vidicon. Conductive substrate material and thickness used to reduce photocathode resistivity, spacing between gating electrodes to minimize inter-electrode capacitance, the use of conductive grids on the photocathode substrate to permit rapid propagation of the electrical gate pulse to all areas of the photocathode, and different package geometries to provide a more effective interface with external biasing and gating circuitry were varied in both tube types to determine optimal performance from each design. For comparable spatial resolution, most 18-mm-diam MCPs require gate times 2.5 ns while the fastest SIT has demonstrated sub-nanosecond optical gates as short as approximately 400 + or - 50 ps for full shuttering of the 25-mm-diam input window.

  11. Bioactivity and electrochemical behavior of hydroxyapatite-silicon-multi walled carbon nano-tubes composite coatings synthesized by EPD on NiTi alloys in simulated body fluid.

    PubMed

    Khalili, V; Khalil-Allafi, J; Frenzel, J; Eggeler, G

    2017-02-01

    In order to improve the surface bioactivity of NiTi bone implant and corrosion resistance, hydroxyapatite coating with addition of 20wt% silicon, 1wt% multi walled carbon nano-tubes and both of them were deposited on a NiTi substrate using a cathodic electrophoretic method. The apatite formation ability was estimated using immersion test in the simulated body fluid for 10days. The SEM images of the surface of coatings after immersion in simulated body fluid show that the presence of silicon in the hydroxyapatite coatings accelerates in vitro growth of apatite layer on the coatings. The Open-circuit potential and electrochemical impedance spectroscopy were measured to evaluate the electrochemical behavior of the coatings in the simulated body fluid at 37°C. The results indicate that the compact structure of hydroxyapatite-20wt% silicon and hydroxyapatite-20wt% silicon-1wt% multi walled carbon nano-tubes coatings could efficiently increase the corrosion resistance of NiTi substrate.

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

    PubMed

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

    2015-08-03

    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.

  13. 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

  14. Teaching fibreoptic intubation in anaesthetised patients.

    PubMed

    Schaefer, H G; Marsch, S C; Keller, H L; Strebel, S; Anselmi, L; Drewe, J

    1994-04-01

    One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. 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

  16. The temporary effect of short-term endotracheal intubation on vocal function.

    PubMed

    Paulauskiene, Iveta; Lesinskas, Eugenijus; Petrulionis, Mindaugas

    2013-01-01

    The objective of the study was to assess and perceive the vocal and pharyngeal symptoms and acoustic changes of voice after short-term endotracheal intubation and to evaluate the relation between these changes and the endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. A total of 108 patients were evaluated preoperatively, 1-2 and 24 h after extubation. The vocal and pharyngeal symptoms, voice acoustic characteristics and maximum phonation time (MPT) were evaluated to find the relationship with endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. All vocal and pharyngeal symptoms increased significantly at 24 h and remained significantly increased at 24 h after general anaesthesia. The vocal acoustic parameters changed significantly at 1-2 h: decrease of MPT and increase relative average perturbation were recorded. The day after the short-term intubation: only noise to harmony ratio and habitual pitch remains significantly changed. The most important endotracheal tube parameters that affect significantly (P value <0.05) the vocal function were the size of tube, cuff volume and number of intubation attempts. In relation to the anaesthesia, the changes of the acoustic parameters did not associate significantly with the anaesthesia-related parameters. No statistically significant relationship between experience of an anaesthesiologist and changes of the voice after anaesthesia was detected. Though being short-term, endotracheal anaesthesia is an invasive procedure, and its temporary influence on vocal function is important.

  17. A canine model of tracheal stenosis induced by cuffed endotracheal intubation

    PubMed Central

    Su, Zhuquan; Li, Shiyue; Zhou, Ziqing; Chen, Xiaobo; Gu, Yingying; Chen, Yu; Zhong, Changhao; Zhong, Minglu; Zhong, Nanshan

    2017-01-01

    Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis. PMID:28349955

  18. TIVA-A Promising Approach to Anaesthetic Management of Montgomery T-tube Insertion

    PubMed Central

    Kurdi, Madhuri S.; Sindhupriya

    2015-01-01

    One of the treatment modalities for tracheal stenosis is tracheal dilatation and stenting using silicone Montgomery T-tube. Various techniques have been reported for this procedure. For safe anaesthetic management, anaesthesiologist must be aware of the surgical procedure, limitations of T-tube, likelihood of compromised airway besides the inherent problems of sharing the airway with surgeons. Total intravenous anaesthesia (TIVA) is a technique which has become very popular and possible now a days for various surgical procedures owing to its advantages. The anaesthetic technique should be based on the provider’s experience and severity of tracheal stenosis. We present here the anaesthetic management using TIVA technique with propofol and atracurium for the insertion of Montgomery T-tube in a case of post intubation tracheal stenosis. PMID:26436024

  19. 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

  20. Long term intubation and successful weaning in two children with Guillain-Barre syndrome.

    PubMed

    Javed, H; Nair, M P; Koul, R L; Chacko, A; Fazalullah, M

    2000-07-01

    No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.

  1. 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.

  2. Stylet angulation for routine endotracheal intubation with McGrath videolaryngoscope

    PubMed Central

    Lee, Jiyoung; Kim, Jong Yeop; Kang, Se Yoon; Kwak, Hyun Jeong; Lee, Dongchul; Lee, Sook Young

    2017-01-01

    Abstract Background: The McGrath videolaryngoscope (VL) provides excellent laryngoscopic views, but directing an endotracheal tube can be difficult, and thus the routine use of a stylet is recommended. The goal of this study is to determine the appropriate angle (60° vs 90°) of the stylet when using the McGrath VL by comparing the time to intubation (TTI). Methods: One hundred and forty patients aged 19 to 70 years (American Society of Anesthesiologists classification I or II) who required tracheal intubation for elective surgery were randomly allocated to 1 of 2 groups, at the 60° angle (n = 70) or the 90° angle (n = 70). Anesthesia was induced with propofol, fentanyl, and rocuronium. The primary outcome was TTI assessed by a blind observer. Glottic grade, use of optimal external laryngeal manipulation, failed intubation at first attempt, ease of intubation, and severity of oropharyngeal bleeding were also recorded. Results: The mean TTI was significantly shorter in the 60° group than in the 90° group (29.3 ± 6.4 vs 32.5 ± 9.4 s, P = 0.022). The glottic grade and degree of intubation difficulty were not significantly different between the 2 groups. Conclusions: When intubating the patients with the McGrath videolaryngoscope, the 60° angled stylet allowed for faster orotracheal intubation than did the 90° angled stylet. PMID:28207549

  3. Surface modification of silicone tubes by functional carboxyl and amine, but not peroxide groups followed by collagen immobilization improves endothelial cell stability and functionality.

    PubMed

    Salehi-Nik, Nasim; Amoabediny, Ghassem; Shokrgozar, Mohammad Ali; Mottaghy, Khosrow; Klein-Nulend, Jenneke; Zandieh-Doulabi, Behrouz

    2015-03-02

    Surface modification by functional groups promotes endothelialization in biohybrid artificial lungs, but whether it affects endothelial cell stability under fluid shear stress, and the release of anti-thrombotic factors, e.g. nitric oxide (NO), is unknown. We aimed to test whether surface-modified silicone tubes containing different functional groups, but similar wettability, improve collagen immobilization, endothelialization, cell stability and cell-mediated NO-release. Peroxide, carboxyl, and amine-groups increased collagen immobilization (41-76%). Only amine-groups increased ultimate tensile strength (2-fold). Peroxide and amine enhanced (1.5-2.5 fold), but carboxyl-groups decreased (2.9-fold) endothelial cell number after 6 d. After collagen immobilization, cell numbers were enhanced by all group-modifications (2.8-3.8 fold). Cells were stable under 1 h-fluid shear stress on amine, but not carboxyl or peroxide-group-modified silicone (>50% cell detachment), while cells were also stable on carboxyl-group-modified silicone with immobilized collagen. NO-release was increased by peroxide and amine (1.1-1.7 fold), but decreased by carboxyl-group-modification (9.8-fold), while it increased by all group-modifications after collagen immobilization (1.8-2.8 fold). Only the amine-group-modification changed silicone stiffness and transparency. In conclusion, silicone-surface modification of blood-contacting parts of artificial lungs with carboxyl and amine, but not peroxide-groups followed by collagen immobilization allows the formation of a stable functional endothelial cell layer. Amine-group-modification seems undesirable since it affected silicone's physical properties.

  4. Retrograde nasal intubation via the cleft in Pierre-Robin Sequence neonates: a case series.

    PubMed

    Portnoy, Joel E; Tatum, Sherard

    2009-12-01

    Pierre-Robin Sequence, the triad of glossoptosis, micrognathia and cleft palate, provides a challenge in airway management both in and out of the operating room. Transnasal intubation is greatly preferred during its surgical intervention for maximum oral exposure in these very small patients without the added encumbrance of an oral endotracheal tube. From 2001 to 2009, three neonates with Pierre-Robin Sequence who underwent surgery to improve their airway had a novel method of securing a transnasal airway performed in the operating theater. After successful placement of a laryngeal mask airway (LMA) and subsequent endotracheal intubation via the LMA, this technique was used to convert from an oral to a nasal intubation. After the LMA is removed, a smaller endotracheal tube is placed into the nose and out of the mouth via the cleft in each of these patients. This smaller tube is then telescoped into the larger one and secured with suture. Both tubes are subsequently backed out of the nose in a retrograde fashion and disarticulated so that the now transnasal endotracheal tube can be re-connected to the anesthesia circuit. This case series highlights a rapid technique utilizing the patient's congenital defect for securing a transnasal airway alternative to that of transnasal fiberoptic intubation in Pierre-Robin Sequence neonates.

  5. Flow-through polymerase chain reaction inside a seamless 3D helical microreactor fabricated utilizing a silicone tube and a paraffin mold.

    PubMed

    Wu, Wenming; Trinh, Kieu The Loan; Lee, Nae Yoon

    2015-03-07

    We introduce a new strategy for fabricating a seamless three-dimensional (3D) helical microreactor utilizing a silicone tube and a paraffin mold. With this method, various shapes and sizes of 3D helical microreactors were fabricated, and a complicated and laborious photolithographic process, or 3D printing, was eliminated. With dramatically enhanced portability at a significantly reduced fabrication cost, such a device can be considered to be the simplest microreactor, developed to date, for performing the flow-through polymerase chain reaction (PCR).

  6. Pentax-airway scope for tracheal intubation breaks through the limitation of neck motion in an ankylosing spondylitis patient wearing halo vest--a case report.

    PubMed

    Cheng, Wei-Chun; Jimmy-Ong; Lee, Chia-Ling; Lan, Cing-Hong; Chen, Tsung-Ying; Lai, Hsien-Yong

    2010-12-01

    The Airway Scope (AWS) provides better glottic view than the conventional direct laryngoscopy in tracheal intubation. With it, the endotracheal tube can be more easily inserted into the tracheal lumen easily. We hereby presented a 24-year-old ankylosing spondylitis (AS) patient wearing a halo vest who was successfully intubated for undergoing cervical spine surgery involving C1 and C2 under general anesthesia. Pre-operative airway assessment revealed that he was a case of difficult intubation. An AWS was used for oral tracheal intubation which was achieved smoothly in the first attempt. AWS can be an alternative device for airway management in a patient wearing halo vest.

  7. [Temporary replacement of the common biliary duct by a silicone tube as an urgent repair of iatrogenic injury. Experimental study in pigs].

    PubMed

    Napolitano, Daniel A; Rodríguez Bertola, Xavier; Sambuelli, Gabriela M; Vial, Luis H; Torrecillas, Daniel A

    2015-03-01

    Surgery of the biliary tract is complex, and its volume has increased with iatrogenic injuries and living donor transplantation. The aim of this study was to analyze if the common duct can be temporarily replaced. We used nine 18-20 kg pigs. They were operated on, and their bile duct was replaced by a 100% silicone tube. All pigs underwent laboratory tests, magnetic resonance imaging, intraoperative ultrasound, cholangiography and biliar manometry with pathological biopsy examination within 60 days from the initial surgery. All pigs survived the first surgery over 60 days without laboratory evidence of evident cholestasis. Nine pigs were re-operated on at 60 days showing dilated common bile duct and hepatic ducts doubling its original size without dilating the intrahepatic bile ducts. There were no clinical, relevant laboratory or biopsy signs showing cholestasis. This experience represents the initial intention to find an optimal situation and prosthesis for replacement of the thin biliary tract, in surgical emergencies or palliative situations. The silicon tube, is a positive answer that remains permeable. A non-fibrotic reaction was found that allows a posterior definitive procedure, maintaining a good nutritional status.

  8. [A child with Klippel-Feil syndrome in whom GlideScope was effective for tracheal intubation].

    PubMed

    Arai, Takero; Hashimoto, Yuichi; Saito, Tomoyuki; Ogata, Tokiko; Chiba, Ayako; Sato, Hiromi; Enomoto, Sumie; Shimazaki, Mutsuhisa; Okuda, Yasuhisa

    2013-06-01

    GlideScope videolaryngoscope (GlideScope, herein-after referred to as "GS", Verathon Medical, Bothell, WA, USA), with a high-resolution camera positioned on a blade, enables operators to confirm the position of the larynx and a tube through clear view, thereby conducting intubation safely in a patient whose neck is difficult to be bent back. As the blade is slim, GS is indicated for use in children whose oral cavity is narrow. We herein report safe and smooth intubation with GS in a child with Klippel-Feil syndrome in whom difficult intubation was predicted.

  9. [Use of a gum elastic bougie for tracheal intubation with Pentax-AWS airway scope].

    PubMed

    Ueshima, Hironobu; Asai, Takashi; Shingu, Koh; Inoue, Hisashi; Hashimoto, Yuichi; Enomoto, Yoshiro; Okuda, Yasuhisa

    2008-01-01

    Pentax-AWS laryngoscope (Pentax, Tokyo, Japan) consists of a disposable anatomically shaped blade, a 12-cm cable with a charge-coupled device (CCD) camera and a 2.4-inch liquid crystal device (LCD) color monitor display. A tracheal tube can be attached to the right side of the blade. The device may be useful in patients with difficult airways. One limitation of the device is that intubation may be difficult if it is difficult to position the glottis to the target symbol on the monitor display. We experienced such a difficulty in four patients, and the use of a gum elastic bougie enabled intubation. In a 57-year-old woman with a difficult airway, tracheal intubation using either a Macintosh laryngoscope or a fiberscope had failed. By inserting the AWS laryngoscope, the glottis was easily seen on the monitor display. Nevertheless, it was difficult to position the glottis to the target symbol, and advancing a tracheal tube collided with the tissue around the glottis. A bougie was passed through the tracheal tube, and it became possible to insert the bougie into the trachea by adjusting the angle of its tip. The tracheal tube was then easily passed over the bougie into the trachea. We successfully used the same technique in other three patients. We believe that the gum elastic bougie can be useful for tracheal intubation using the Pentax-AWS laryngoscope.

  10. 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

  11. 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

  12. Is it safe to use frova airway intubating device during tracheal intubation in difficult airway patient with multiple and chest trauma?

    PubMed

    Hajjar, Waseem M; Alsubaie, Nourah; Nouh, Thamer A; Al-Nassar, Sami A

    2016-01-01

    Traumatic chest injury is one of the leading causes of death in motor vehicle accident (MVA). A complete tracheobronchial injury occurred in 1% of trauma cases and most of the cases died before arrival to the emergency department. We report a 37-year-old female involved in MVA presented to the emergency room (ER) with normal vital signs. Ten minutes later, her saturation dropped to 75%, which required ventilation; however, two attempts for endotracheal intubation failed. The third time frova airway intubating introducer used and succeeded. Immediately after tracheal intubation, the patient started to have extensive subcutaneous emphysema and severe hypoxia; chest X-ray showed right side tension pneumothorax which was not relieved by a chest tube insertion. Bronchoscopy confirmed total transection of the right main bronchus and lower tracheal laceration and injury. Emergency thoracotomy and repair of both trachea and the right main bronchus were successful.

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

    NASA Technical Reports Server (NTRS)

    Bever, R. S.

    1977-01-01

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

  14. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    PubMed

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  15. Airway management using submental intubation in head and neck surgery.

    PubMed

    Szantyr, Aleksandra; Szuta, Mariusz; Zapała, Jan

    2016-01-01

    In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform

  16. Comparison of two interferon-gamma release assays (QuantiFERON-TB Gold In-Tube and T-SPOT.TB) in testing for latent tuberculosis infection among HIV-infected adults.

    PubMed

    Sultan, B; Benn, P; Mahungu, T; Young, M; Mercey, D; Morris-Jones, S; Miller, R F

    2013-10-01

    There is currently no 'gold standard' for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with 'smear-positive' pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval = 0.27-0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.

  17. In situ silicone tube microextraction: a new method for undisturbed sampling of root-exuded thiophenes from marigold (Tagetes erecta L.) in soil.

    PubMed

    Mohney, Brian K; Matz, Tricia; Lamoreaux, Jessica; Wilcox, David S; Gimsing, Anne Louise; Mayer, Philipp; Weidenhamer, Jeffrey D

    2009-11-01

    The difficulties of monitoring allelochemical concentrations in soil and their dynamics over time have been a major barrier to testing hypotheses of allelopathic effects. Here, we evaluate three diffusive sampling strategies that employ polydimethylsiloxane (PDMS) sorbents to map the spatial distribution and temporal dynamics of root-exuded thiophenes from the African marigold, Tagetes erecta. Solid phase root zone extraction (SPRE) probes constructed by inserting stainless steel wire into PDMS tubing were used to monitor thiophene concentrations at various depths beneath marigolds growing in PVC pipes. PDMS sheets were used to map the distribution of thiophenes beneath marigolds grown in thin glass boxes. Concentrations of the two major marigold thiophenes measured by these two methods were extremely variable in both space and time. Dissection and analysis of roots indicated that distribution of thiophenes in marigold roots also was quite variable. A third approach used 1 m lengths of PDMS microtubing placed in marigold soil for repeated sampling of soil without disturbance of the roots. The two ends of the tubing remained out of the soil so that solvent could be washed through the tubing to collect samples for HPLC analysis. Unlike the other two methods, initial experiments with this approach show more uniformity of response, and suggest that soil concentrations of marigold thiophenes are affected greatly even by minimal disturbance of the soil. Silicone tube microextraction gave a linear response for alpha-terthienyl when maintained in soils spiked with 0-10 ppm of this thiophene. This method, which is experimentally simple and uses inexpensive materials, should be broadly applicable to the measurement of non-polar root exudates, and thus provides a means to test hypotheses about the role of root exudates in plant-plant and other interactions.

  18. Antimicrobial activity of silica coated silicon nano-tubes (SCSNT) and silica coated silicon nano-particles (SCSNP) synthesized by gas phase condensation.

    PubMed

    Tank, Chiti; Raman, Sujatha; Karan, Sujoy; Gosavi, Suresh; Lalla, Niranjan P; Sathe, Vasant; Berndt, Richard; Gade, W N; Bhoraskar, S V; Mathe, Vikas L

    2013-06-01

    Silica-coated, silicon nanotubes (SCSNTs) and silica-coated, silicon nanoparticles (SCSNPs) have been synthesized by catalyst-free single-step gas phase condensation using the arc plasma process. Transmission electron microscopy and scanning tunneling microscopy showed that SCSNTs exhibited a wall thickness of less than 1 nm, with an average diameter of 14 nm and a length of several 100 nm. Both nano-structures had a high specific surface area. The present study has demonstrated cheaper, resistance-free and effective antibacterial activity in silica-coated silicon nano-structures, each for two Gram-positive and Gram-negative bacteria. The minimum inhibitory concentration (MIC) was estimated, using the optical densitometric technique, and by determining colony-forming units. The MIC was found to range in the order of micrograms, which is comparable to the reported MIC of metal oxides for these bacteria. SCSNTs were found to be more effective in limiting the growth of multidrug-resistant Staphylococcus aureus over SCSNPs at 10 μg/ml (IC 50 = 100 μg/ml).

  19. Inadvertent Endobronchial Intubation in a Patient With a Short Neck Length.

    PubMed

    Cornelius, Bryant; Sakai, Tetsuro

    2015-01-01

    Inadvertent placement of the endotracheal tube into the right bronchus during intubation for general anesthesia is a fairly common occurrence. Many precautions should be taken by the anesthesia provider in order to minimize the incidence of endobronchial intubation, including bilateral auscultation of the lungs, use of the 21/23 rule, and palpation of the inflated endotracheal cuff at the sternal notch. These provisions, however, are not foolproof; anesthesia providers should realize that endobronchial intubation may occur from time to time because of variations in patient anatomy, changes in patient positioning, and cephalad pressures exerted during surgery. A 58-year-old man with chronic obstructive pulmonary disease received general endotracheal anesthesia for a laparoscopic cholecystectomy. His height was 165 cm (5 ft, 5 in) and the endotracheal tube was secured at his incisors at 21 cm after placement with a rigid laryngoscope. Bilateral breath sounds were confirmed with auscultation, although they were distant because of his chronic obstructive pulmonary disease. After radiographic examination in the postanesthesia care unit, a right main-stem intubation was revealed to have taken place, resulting in complete atelectasis of the left lung. After repositioning of the endotracheal tube, radiography confirmed that the patient had an anatomically short tracheal length.

  20. Foreign Body Obstruction Preventing Blind Nasal Intubation

    PubMed Central

    Prior, Simon

    2006-01-01

    A healthy young male patient was scheduled for dental care under nasotracheal intubated general anesthesia. The presence of a plastic calculator key complicated the intubation. This case report describes the event and reviews some possible techniques for coping with an airway that becomes obstructed by a foreign object. PMID:16863390

  1. 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.

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  3. Cervical Spinal Motion During Orotracheal Intubation.

    DTIC Science & Technology

    1998-01-01

    Sixteen fresh human cadavers were intubated while recording cervical motion using a cine fluoroscopic technique. Segmental cervical motion from the...intubation was performed using no external stabilization, Gardner-Wells traction and manual in-line cervical immobilization. The cadaveric spine motion...immobilization reduced motion at the destabilize C4-5 level. Four patients without significant cervical pathology and normal motion of flexion

  4. Assessment and confirmation of tracheal intubation when capnography fails: a novel use for an USB camera.

    PubMed

    Karippacheril, John George; Umesh, Goneppanavar; Nanda, Shetty

    2013-10-01

    A 62 year old male with a right pyriform fossa lesion extending to the right arytenoid and obscuring the glottic inlet was planned for laser assisted excision. Direct laryngoscopic assessment after topicalization of the airway, showed a Cormack Lehane grade 3 view. We report a case where, in the absence of a fiberscope, a novel inexpensive Universal Serial Bus camera was used to obtain an optimal laryngoscopic view. This provided direct visual confirmation of tracheal intubation with a Laser Flex tube, when capnography failed to show any trace. Capnography may not be reliable as a sole indicator of confirmation of correct endotracheal tube placement. Video laryngoscopy may provide additional confirmation of endotracheal intubation.

  5. Electron tube

    DOEpatents

    Suyama, Motohiro [Hamamatsu, JP; Fukasawa, Atsuhito [Hamamatsu, JP; Arisaka, Katsushi [Los Angeles, CA; Wang, Hanguo [North Hills, CA

    2011-12-20

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

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

    PubMed

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

    2016-04-21

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

  7. 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

  8. Heat Transfer from High-Temperature Surfaces to Fluids. III - Correlation of Heat-Transfer Data for Air Flowing in Silicon Carbide Tube with Rounded Entrance, Inside Diameter of 3/4 Inch, and Effective Length of 12 Inches. Part 3; Correlation of Heat-Transfer Data for Air Flowing in Silicon Carbide Tube with Rounded Entrance, Inside Diameter of 3/4 Inch, and Effective Length of 12 Inches

    NASA Technical Reports Server (NTRS)

    Sams, Eldon W.; Desmon, Leland G.

    1949-01-01

    A heat-transfer investigation was conducted with air flowing through an electrically heated silicon carbide tube with a rounded entrance, an inside diameter of 3/4 inch, and an effective heat-transfer length of 12 inches over a range of Reynolds numbers up to 300,000 and a range of average inside-tube-wall temperature up to 2500 R. The highest corresponding local outside-tube-wall temperature was 3010 R. Correlation of the heat-transfer data using the conventional Nueselt relation wherein physical properties of the fluid were evaluated at average bulk temperature resulted in a separation of data with tube-wall-temperature level. A satisfactory correlation of the heat-transfer data was obtained, however, by the use of modified correlation parameters wherein the mass velocity G (or product of average air density and velocity evaluated at bulk temperature P(sub b)V(sub b)) in the Reynolds number was replaced by the product of average air velocity evaluated at the bulk temperature and density evaluated at either the average inside-tube-wall temperature or the average film temperature; in addition, all the physical properties of air were correspondingly evaluated at either the average inside-tube-wall temperature or the average film temperature.

  9. Modeling water vapor and heat transfer in the normal and the intubated airways.

    PubMed

    Tawhai, Merryn H; Hunter, Peter J

    2004-04-01

    Intubation of the artificially ventilated patient with an endotracheal tube bypasses the usual conditioning regions of the nose and mouth. In this situation any deficit in heat or moisture in the air is compensated for by evaporation and thermal transfer from the pulmonary airway walls. To study the dynamics of heat and water transport in the intubated airway, a coupled system of nonlinear equations is solved in airway models with symmetric geometry and anatomically based geometry. Radial distribution of heat, water vapor, and velocity in the airway are described by power-law equations. Solution of the time-dependent system of equations yields dynamic airstream and mucosal temperatures and air humidity. Comparison of model results with two independent experimental studies in the normal and intubated airway shows a close correlation over a wide range of minute ventilation. Using the anatomically based model a range of spatially distributed temperature paths is demonstrated, which highlights the model's ability to predict thermal behavior in airway regions currently inaccessible to measurement. Accurate representation of conducting airway geometry is shown to be necessary for simulating mouth-breathing at rates between 15 and 100 l x min(-1), but symmetric geometry is adequate for the low minute ventilation and warm inspired air conditions that are generally supplied to the intubated patient.

  10. [Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

    PubMed

    Meyer, P; Guérin, J M; Habib, Y; Lévy, C

    1988-01-01

    Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

  11. Microbiology of endotracheal aspirates in intubated pediatric intensive care unit patients: correlations with radiographic findings.

    PubMed

    Golden, S E; Shehab, Z M; Bjelland, J C; Ryan, K J; Ray, C G

    1987-07-01

    We studied the utility of Gram-stained smears and semiquantitative cultures of endotracheal aspirates (ETAs) in diagnosing pneumonia in intubated patients in a pediatric intensive care unit. The chest radiographs of 35 intubated patients were independently reviewed by a pediatric radiologist and classified into probable, possible and unlikely pneumonias. Concomitant bacteriologic and radiographic information was available in 15 episodes of probable and 13 of possible pneumonia. These findings were compared with the ETAs obtained during the study from patients with no radiographic evidence of pneumonia (N = 21). There was a good correlation between ETA findings and radiographic evidence of pneumonia when ETAs were obtained within 60 minutes of initial intubation. Only a growth of greater than or equal to 3+ of a pathogen was associated with probable pneumonia when ETAs were obtained more than 60 minutes from initial intubation. There was a poor correlation between the microbiologic findings from ETAs and the results of blood cultures and postmortem examinations. Moreover 5 of 10 pairs of ETAs obtained within 18 hours of each other demonstrated discordant results. The ETAs from patients with indwelling endotracheal tubes correlated poorly with radiographic findings and are of questionable value in diagnosing the presence of pneumonia or its etiology in this group. They must be cautiously interpreted in critically ill patients.

  12. Ketorolac Tromethamine Spray Prevents Postendotracheal-Intubation-Induced Sore Throat after General Anesthesia

    PubMed Central

    Yang, H. L.; Tsai, S. C.; Tsay, P. K.; Lin, H. T.

    2016-01-01

    Background. Postoperative sore throat is one of the major complaints of general anesthesia in the postanesthesia care unit. This prospective study investigated the preventive effect of ketorolac tromethamine spray in postendotracheal-intubation-induced sore throat after general anesthesia. Methods. Surgical patients undergoing general anesthesia with endotracheal intubation were recruited from a medical center. Patients were randomly assigned to group K (treated with 5% ketorolac tromethamine spray) or group D (treated with distilled water spray). Before intubation, each endotracheal tube was sprayed with the appropriate solution by physicians over the 20 cm length of the cuff. Each group comprised 95 patients fitting the inclusion and exclusion criteria for whom complete data sets were collected. The intensity of the sore throat was measured at 1, 3, 6, and 24 h after surgery, and data were compared. Results. The two groups had similar characteristics. Postoperative sore throat was significantly less frequent in group K than in group D (p < 0.001) and the pain intensity was significantly lower in group K than in group D at each time point (all p < 0.001). Conclusions. This study demonstrated that preanesthesia 5% ketorolac tromethamine spray could effectively decrease postendotracheal-intubation-induced sore throat in patients undergoing general anesthesia. PMID:28025646

  13. Hybrid endotracheal tubes

    NASA Astrophysics Data System (ADS)

    Sakezles, Christopher Thomas

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

  14. Delayed sequence intubation: is it ready for prime time?

    PubMed

    Taylor, John A; Hohl, Corinne Michele

    2017-01-01

    Clinical question Does delayed sequence intubation (DSI) improve preoxygenation and safety when intubating otherwise uncooperative patients? Article chosen Weingart SD, Trueger S, Wong N, et al. Delayed sequence intubation: a prospective observational study. Ann Emerg Med 2015;65(4):349-55. doi:10.1016/j.annemergmed.2014.09.025 OBJECTIVE: To investigate whether the administration of ketamine 3 minutes prior to the administration of a muscle relaxant allows for optimal preoxygenation in uncooperative patients undergoing intubation.

  15. A comparison of tape-tying versus a tube-holding device for securing endotracheal tubes in adults.

    PubMed

    Murdoch, E; Holdgate, A

    2007-10-01

    During the transfer of intubated patients, endotracheal tube security is paramount. This study aims to compare two methods of securing an endotracheal tube in adults: tying with a cloth tape versus the Thomas Endotracheal Tube Holder (Laerdal). A manikin-based study was performed using paramedics and critical care doctors (consultants and senior trainees) as participants. Each participant was asked to secure an endotracheal tube that had been placed within the trachea of a manikin a total of six times, the first three times using tied cloth tape and the last three times using a Thomas Endotracheal Tube Holder. Following each 'fixation' and after the participant had left the room, the security of the tube was tested by applying a fixed force laterally and to the right by dropping a 1.25 kg weight a distance of 50 cm. The amount of movement of the tube with respect to the teeth was measured and recorded in millimetres. Two-hundred-and-seventy tube fixations (135 tied vs. 135 tube holder) were performed by 45 participants. The degree of tube movement was significantly higher when the tube was secured with a tie compared with when the tube holder was used (median movement 22 mm vs. 4 mm, P < 0.0001). We have demonstrated that the tube holder device minimised tube movement in a manikin model when compared with conventional tape tying. The use of this device when transporting intubated patients may reduce the risk of tube displacement though further clinical studies are warranted.

  16. Tube support

    DOEpatents

    Mullinax, Jerry L.

    1988-01-01

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

  17. Intubating condition, hemodynamic parameters and upper airway morbidity: A comparison of intubating laryngeal mask airway with standard direct laryngoscopy

    PubMed Central

    Kavitha, J.; Tripathy, Debendra Kumar; Mishra, Sandeep Kumar; Mishra, Gayatri; Chandrasekhar, L. J.; Ezhilarasu, P.

    2011-01-01

    Background: Intubating Laryngeal Mask Airway (ILMA) is a relatively new device designed to have better intubating characteristics than the standard Laryngeal Mask Airway. This study was designed to compare Intubating Laryngeal Mask with standard Direct Laryngoscopy (DLS), taking into account ease of intubation, time taken for intubation, success rate of intubation, hemodynamic responses and upper airway morbidity. Materials and Methods: Sixty patients, ASA I or II, of age between 20 and 60 years, were enrolled in this prospective and randomized study. They were randomly allocated to one of the two groups: group ILMA, Intubating Laryngeal Mask Airway; group DLS, Direct Laryngoscopy. The patients were intubated orally using either equipment after induction of general anesthesia. Results and Conclusions: DLS is comparatively a faster method to secure tracheal intubation than Intubating Laryngeal Mask. ILMA offers no advantage in attenuating the hemodynamic responses compared to direct laryngoscope. The success rate of intubation through Intubating Laryngeal Mask is comparable with that of DLS. The upper airway morbidity and mean oxygen saturation are comparable in both the groups. PMID:25885300

  18. Etomidate: to use or not to use for endotracheal intubation in the critically ill?

    PubMed

    Smischney, Nathan J; Kashyap, Rahul; Gajic, Ognjen

    2015-09-01

    Endotracheal intubation is frequently performed in the intensive care unit (ICU). It can be life-saving for many patients who present with acute respiratory distress. However, it is equally associated with complications that may lead to unwanted effects in this patient population. According to the literature, the rate of complications associated with endotracheal intubation is much higher in an environment such as the ICU as compared to other, more controlled environments (i.e., operating room). Thus, the conduct of performing such a procedure needs to be accomplished with the utmost care. To facilitate establishment of the breathing tube, sedation is routinely administered. Given the tenuous hemodynamic status of the critically ill, etomidate was frequently chosen to blunt further decreases in blood pressure and/or heart rate. Recently however, reports have demonstrated a possible association with the use of etomidate for endotracheal intubation and mortality in the critically ill. In addition, this association seems to be predominantly in patients diagnosed with sepsis. As a result, some have advocated against the use of this medication in septic patients. Due to the negative associations identified with etomidate and mortality, several investigators have evaluated potential alternatives to this solution (e.g., ketamine and ketamine-propofol admixture). These studies have shown promise. However, despite the evidence against using etomidate for endotracheal intubation, other studies have demonstrated no such association. This leaves the critical care clinician with uncertainty regarding the best sedative to administer in this patient population. The following editorial discusses current evidence regarding etomidate use for endotracheal intubation and mortality. In particular, we highlight a recent article with the largest population to date that found no association between etomidate and mortality in the critically ill and illustrate important findings that the

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

    PubMed Central

    Schoettker, Patrick; Corniche, Jocelyn

    2015-01-01

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

  20. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy.

    PubMed

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis.

  1. Interleukin-6 as a marker of inflammation secondary to endotracheal intubation in pediatric patients.

    PubMed

    Vasileiou, Panagiotis V S; Chalkias, Athanasios; Brozou, Vasiliki; Papageorgiou-Brousta, Mary; Kaparos, George; Koutsovasilis, Anastasios; Xanthos, Theodoros; Iacovidou, Nicoletta

    2013-12-01

    Ιnterleukin-6 (IL-6) has been identified as an early biochemical marker of inflammation both in animal and human studies. With this study, we sought to examine the development of local inflammation of the glottic tissues in correlation with the duration of intubation in anesthetized pediatric patients. We measured IL-6 levels in the organic material isolated from the tip of the tube post-extubation in 48 children aged 7 months to 14 years old who were submitted to a total of 72 surgical procedures. A statistically significant positive correlation (ρ = 0.28, p = 0.05) was detected among duration of anesthesia and IL-6 concentration. The odds of having detectable IL-6 levels rose by 36.7 % for every 10 min of anesthetic duration (p = 0.045). In conclusion, the increase of IL-6 in relation to the duration of the intubation indicates an increased risk of inflammation.

  2. [Cuff damage during naso-tracheal intubation for general anesthesia in oral surgery].

    PubMed

    Nakamura, S; Watanabe, T; Hiroi, E; Sasaki, T; Matsumoto, N; Hori, T

    1997-11-01

    In our hospital, twenty-one cases of endotracheal tube cuff rupture during naso-tracheal intubation were noted in cases using 725 polyvinyl chloride (PVC) tracheal tubes. We analysed the causes of cuff troubles in these 21 samples of tubes. When the cuffs were inflated, they were not capable of containing the air in most cases. Some cuffs had small holes (described as pinholes), and the others had longer slits on scrape marks and burst. These scrape marks may have been caused by the object with sharp edges such as spina or crista of the nasal septum, or otherwise by the tip of intubation forceps. The cuff material appeared to be slightly hardened in some samples which may be due to the lubrication. We usually lubricated the tube with lidocaine spray or gel formulation and then sometimes placed it in hot water to soften it for avoiding naso-mucosal injury. It is not generally recommended to place tubes in hot water, as this procedure may soften the cuff and make it more suspectible to damage. The clarification is also needed on the use of lidocaine. Although the gel formulation is acceptable, but the spray formulation is known to react with cuff material and make it more susceptible to inducing blistering, pinholes and sudden rupture of PVC cuffs. We conclude that these cuff damages might have occurred from various causes. A main cause must be passing the tube through the narrow nasal turbinate with spina or crista. Other causes could not only be the use of Magill forceps but also lubrication of the tube with lidocaine spray and placing it in hot water.

  3. Ear Tubes

    MedlinePlus

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

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

    PubMed

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

    2012-01-01

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

  5. Silicones in medical electronics.

    PubMed

    Bruner, Stephen

    2008-01-01

    The use of silicones, although already extensive, is set to grow in medical electronics. Silicones used in medical device applications as tubing or moulded parts should also be considered for electronic applications in the same device. This article outlines the potential reduction in complexity that this solution offers. Benefits include eliminating negative materials interactions and avoiding bonding problems.

  6. 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

  7. An innovative approach to orotracheal intubations: the Alexandrou Angle of Intubation position.

    PubMed

    Alexandrou, Nikolaos A; Yeh, Benson; Barbara, Paul; Leber, Mark; Marshall, Lewis W

    2011-01-01

    Visualization of the vocal cords is paramount during orotracheal intubations. We employed a novel patient position in this derivation study. The Alexandrou Angle of Intubation (AAI) position is defined as a 20°-30° incline where the supine patient's head is elevated in relation to the body and legs. Our study participants were blinded to the goals of the research as well as our novel technique. Using intubation manikins, our participants ranked their preference for visualizing the vocal cords between the Flat, Trendelenburg, and AAI positions. A majority (58.8%) of our study participants preferred the AAI for visualizing the vocal cords over the other two positions. Future studies will reveal whether AAI will play a significant role in emergent airway management.

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

    SciTech Connect

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

    1999-08-01

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

  9. Risk Factors for Hypotension in Urgently Intubated Burn Patients

    DTIC Science & Technology

    2012-01-01

    fold increase in the odds of death. The use of propofol for the induction of anesthesia for endotracheal intubation in critically ill burned patients...did not increase the odds of hypotension or death. In burn patients requiring emergent endotracheal intubation in the BICU, the care team should...01 DEC 2012 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Risk factors for hypotension in urgently intubated burn patients 5a

  10. Confirmation of correct tracheal tube placement in newborn infants.

    PubMed

    Schmölzer, Georg M; O'Reilly, Megan; Davis, Peter G; Cheung, Po-Yin; Roehr, Charles Christoph

    2013-06-01

    Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms "Infant, Newborn", "Endotracheal intubation", "Resuscitation", "Clinical signs", "Radiography", "Respiratory Function Tests", "Laryngoscopy", "Ultrasonography", and "Bronchoscopy". Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.

  11. Work practices relating to intubation and associated procedures in intensive care units in Sweden.

    PubMed

    Mehta, S; Mickiewicz, M

    1986-11-01

    A survey into the current usage of tracheal tubes and associated procedures, such as various sedation regimes and antacid therapy, in intensive care units was carried out in Sweden by sending a questionnaire to physicians in charge of intensive care units in 70 acute hospitals which included seven main teaching hospitals. The purpose of the survey was to see how far the recent advances in tube and cuff design and awareness of the problems caused by prolonged therapeutic paralysis in intensive care units have influenced the attitudes and work practices of physicians in Sweden. Forty-nine replies were received (a 70% response rate). All hospitals used polyvinyl chloride tubes of Magill design, with high residual volume, low pressure cuffs. Intensive care units in 85.7% of teaching hospitals and 47.6% of non-teaching hospitals preferred the nasal route for intubation. Most non-teaching hospitals used a size 7 tube in both adult male and female patients for nasal intubation. The majority of units changed from tracheal tubes to tracheostomy after a period of 1-2 weeks. 85% of all hospitals monitored intracuff pressure as a routine, and in most intensive care units the cuff was inflated to no-leak ventilation. The majority of units rarely used muscle relaxants. Phenoperidine and diazepam were the most popular drugs used for the sedation technique. 71.4% of teaching hospitals and 40.9% of non-teaching hospitals used antacids routinely in patients on intermittent positive pressure respiration. The results are discussed.

  12. Circular Scan Streak Tube Development

    NASA Technical Reports Server (NTRS)

    Nevin, S.

    1980-01-01

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

  13. TUBE TESTER

    DOEpatents

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

    1958-01-14

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

  14. Aspiration pneumonia caused by inadvertent insertion of gastric tube in an obtunded patient postoperatively

    PubMed Central

    Xu, Zhang; Li, Wenxian

    2011-01-01

    A nasogastric feeding tube is commonly inserted to facilitate patient meeting nutritional needs after oral surgery. But sometimes incorrect position may cause a severe iatrogenic damage. The authors present a case of an aspiration pneumonia complication with the result of malposition of nasogastric tube while the patient was intubated postoperatively. He recovered 3 weeks later with antibody therapy. PMID:22674097

  15. 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

  16. Interarytenoid osseous bridge after prolonged endotracheal intubation.

    PubMed

    Boemo, Rafael Luis; Navarrete, María Luisa; Genestar, Elisabet Ingrid; González, Mireia; Fuentes, Juan Fernando; Fortuny, Pedro

    2012-01-01

    Posterior glottic stenosis or interarytenoid fibrous adhesion is uncommon and has sometimes been misdiagnosed as cord paralysis. Laryngoscopy and laryngeal electromyography studies are the two main diagnostic aids. We present the case of a 63-year-old man under endotracheal intubation during 10 days after a cardiac procedure who was evaluated in our department for persistent dysphonia. The laryngoscopy showed a granuloma-like lesion in the posterior glottic space. During the microlaryngoscopy procedure, the osseous consistence of the interarytenoid lesion was observed. Laser surgery excision of the lesion was performed with good results. According to our review of the literature, this corresponds to the second case reported.

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

    PubMed Central

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

    2016-01-01

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

  18. Sinusitis associated with nasogastric intubation in 3 horses

    PubMed Central

    Nieto, Jorge E.; Yamout, Sawsan; Dechant, Julie E.

    2014-01-01

    Sinusitis has not been reported as a complication of long-term nasogastric intubation in horses. We describe 3 horses that developed nosocomial sinusitis following abdominal surgery with associated perioperative nasogastric intubation. Sinusitis was suspected by the presence of malodorous discharge and confirmed by percussion, upper airway endoscopy, radiographs (n = 3), and bacterial culture (n = 1). PMID:24891638

  19. Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

    PubMed Central

    Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

    2016-01-01

    Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

  20. Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients

    PubMed Central

    Rajan, Sunil; Surendran, Jayasankar; Paul, Jerry; Kumar, Lakshmi

    2017-01-01

    Background and Aims: Obese individuals are predisposed to difficult airway and intubation. They usually yield confusing or misleading auscultatory findings. We aimed to assess the rapidity and efficacy of ultrasonographic (USG) sliding lung sign for confirming endotracheal intubation in normal as well as overweight and obese surgical patients. Methods: This prospective, observational study was performed in forty surgical patients. Twenty patients with body mass index (BMI) <25 were recruited to Group A, whereas twenty patients with BMI ≥25 constituted Group B. Following induction and intubation, appearance of end-tidal carbon dioxide waveform was used to confirm endotracheal intubation. Presence of breath sounds bilaterally was sought by auscultation, and time taken for auscultatory confirmation was noted. The USG confirmation of air entry to the lung field as indicated by lung sliding was sought, and the time taken was noted. Chi-square test, independent t-test and paired t-test were used as applicable. Results: Auscultatory confirmation was more rapid in Group A as compared to Group B (9.34 ± 2.43 s vs. 14.35 ± 5.53 s, P = 0.001). However, there was no significant difference in USG confirmation time in both the groups (8.57 ± 2.05 s vs. 8.61 ± 1.66 s). Four patients in Group B had doubtful breath sounds against none in Group A. There was no doubtful lung slide with USG in both groups. One case of endobronchial intubation in Group B was diagnosed with USG which was doubtful by auscultation. Conclusion: Ultrasound directed confirmation of endotracheal tube placement in overweight and obese patients is superior in speed and accuracy in comparison to the standard auscultatory method.

  1. Body posture during simulated tracheal intubation.

    PubMed

    Matthews, A J; Johnson, C J; Goodman, N W

    1998-04-01

    Seventeen experienced anaesthetists and 15 novices were filmed intubating the trachea of a training manikin. Measurements were made of the distance from manikin's chin to subject's nose and of the angles at the elbow, the shoulder and of the forearm with the horizontal. Trained subjects stood further back (trained: median 43 cm, interquartile range 41-56 cm; novices 35 cm, 26-38 cm; Mann-Whitney U, p < 0.01), with a straighter arm (trained elbow angle: 108 degrees, 99-121 degrees; novices': 92 degrees, 88-102 degrees; Mann-Whitney U, p < 0.01). Trained subjects tended to hold the laryngoscope closer to the hinge, with a pincer grip; novices were more likely to use a full grip of the handle. Trainers should consider giving novices explicit instructions on how to stand and how to hold the laryngoscope.

  2. 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

  3. Feeding Tubes

    MedlinePlus

    ... Feeding Tubes Health Information Sheet Q & A with Experts Patient Stories Social Security Disability Application Process For Kids ... Feeding Tubes Health Information Sheet Q & A with Experts Patient Stories Social Security Disability Application Process For Kids ...

  4. Sorption of parabens by flexible tubings.

    PubMed

    Bahal, S M; Romansky, J M

    2001-08-01

    Flexible tubings are extensively used in pharmaceuticals, food industry, and in hospitals. This study was undertaken to compare various flexible tubings to determine their sorption characteristics, using methyl and propyl parabens. After 24 h, some tubings showed 100% sorption of propylparaben and over 40% for methylparaben. Significant losses were observed within a few hours using several tubings. For methylparaben, the losses were in the following decreasing order of sorption: Tygon, Clearflo, silicone, Nylotube, and Newtex. For propylparaben, the losses were in the following order: Tygon, Clearflo, silicone, Newtex, and Nylotube. Teflon, Zelite, and Vitube showed little to no losses of methyl and propylparaben over 120 h of study. The silicone tubing, refilled after 120 h with fresh methylparaben or propylparaben solutions, again showed significant losses within a few hours. The tubings show slow desorption when filled with the buffer vehicle. For Silastic tubing, increase in temperature from 25 to 40 degrees C, increase in pH from 3.5 to 6.5, tubing lot to lot variation, or curing with peroxide or platinum had little or no effect on paraben sorption. As expected, the sorption of parabens increased with increasing surface area of Silastic tubing. Results provided can be used to select the best tubings and to minimize paraben losses during production and filling of liquid pharmaceuticals andfood products containing these antimicrobial preservatives.

  5. 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

  6. Tracheostomy tubes.

    PubMed

    Hess, Dean R; Altobelli, Neila P

    2014-06-01

    Tracheostomy tubes are used to administer positive-pressure ventilation, to provide a patent airway, and to provide access to the lower respiratory tract for airway clearance. They are available in a variety of sizes and styles from several manufacturers. The dimensions of tracheostomy tubes are given by their inner diameter, outer diameter, length, and curvature. Differences in dimensions between tubes with the same inner diameter from different manufacturers are not commonly appreciated but may have important clinical implications. Tracheostomy tubes can be cuffed or uncuffed and may be fenestrated. Some tracheostomy tubes are designed with an inner cannula. It is important for clinicians caring for patients with a tracheostomy tube to appreciate the nuances of various tracheostomy tube designs and to select a tube that appropriately fits the patient. The optimal frequency of changing a chronic tracheostomy tube is controversial. Specialized teams may be useful in managing patients with a tracheostomy. Speech can be facilitated with a speaking valve in patients with a tracheostomy tube who are breathing spontaneously. In mechanically ventilated patients with a tracheostomy, a talking tracheostomy tube, a deflated cuff technique with a speaking valve, or a deflated cuff technique without a speaking valve can be used to facilitate speech.

  7. Process for making silicon

    NASA Technical Reports Server (NTRS)

    Levin, Harry (Inventor)

    1987-01-01

    A reactor apparatus (10) adapted for continuously producing molten, solar grade purity elemental silicon by thermal reaction of a suitable precursor gas, such as silane (SiH.sub.4), is disclosed. The reactor apparatus (10) includes an elongated reactor body (32) having graphite or carbon walls which are heated to a temperature exceeding the melting temperature of silicon. The precursor gas enters the reactor body (32) through an efficiently cooled inlet tube assembly (22) and a relatively thin carbon or graphite septum (44). The septum (44), being in contact on one side with the cooled inlet (22) and the heated interior of the reactor (32) on the other side, provides a sharp temperature gradient for the precursor gas entering the reactor (32) and renders the operation of the inlet tube assembly (22) substantially free of clogging. The precursor gas flows in the reactor (32) in a substantially smooth, substantially axial manner. Liquid silicon formed in the initial stages of the thermal reaction reacts with the graphite or carbon walls to provide a silicon carbide coating on the walls. The silicon carbide coated reactor is highly adapted for prolonged use for production of highly pure solar grade silicon. Liquid silicon (20) produced in the reactor apparatus (10) may be used directly in a Czochralski or other crystal shaping equipment.

  8. 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

  9. Preauricular skin tags and difficult tracheal intubation: a case report.

    PubMed

    Moschini, V; Collini, R

    2009-10-01

    Despite the large variety of equipment available for pediatric intubations, difficult tracheal intubation is still a main factor in deaths associated with anesthesia, especially in children with congenital anomalies of the airways or with rare diseases and syndromes. The aim of this study was to focus attention on the possibility of difficult intubation in children with preauricular tags. This condition is reported as both isolated and associated with more complex syndromes, including nephrourological anomalies and multiple craniofacial dysmorphysms. We retrospectively analyzed the anesthesia procedures for seven children (aged between 3 and 18 months) who underwent surgical ablation of preauricular tags between October 2006 and April 2008 at the Fondazione Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena of Milan. Two of these children, both native residents of Sri Lanka, presented with a problematic airway and difficult tracheal intubation, which was suspected in one case but totally unexpected in the other. Considering the International Guidelines for difficult intubation in pediatrics and the data of other authors, our conclusions for how to approach a child with preauricular tags are: 1) to verify whether the defect is isolated or associated with other malformations; 2) to analyze the medical history and to perform an accurate physical examination to identify a possibly difficult airway; and 3) to not exceed three attempts to intubate and, if possible, to choose an alternative strategy.

  10. Is roller pump induced tubing rupture a clinical possibility?

    PubMed

    Kim, Won Gon; Chung, Chan Il; Cho, Sang Rock

    2002-06-01

    We analyzed the effects of variations in the diameter of silicone rubber and polyvinyl chloride (PVC) tubings on the likelihood of tubing rupture during modeling of accidental arterial line clamping in cardiopulmonary bypass (CPB) with a roller pump. A closed CPB circuit constructed with a roller pump was tested with both PVC and silicone rubber tubings of 1/2, 3/8, and 1/4 inch internal diameter. Arterial line pressure was monitored, and an occlusive clamp was placed across the tubing distal to the pressure monitor site to model an accidental arterial line occlusion. A charge coupled device camera with 512 (horizontal) x 492 (vertical) pixels was installed above the roller pump to measure tubing diameters at pump outlet where the maximum deformations (distension) of the tubings occurred. Quantitative measurement of the changes of tubing diameters with the change of arterial line pressure was performed using computerized image processing techniques. A visible change of tubing diameter was generally noticeable by around 250 psi of arterial line pressure, which was already very high. By 1,500 psi, the PVC tubings showed an increase of diameter between 5% to 10% while the silicone rubber tubings showed an increase between 20% to 25%. Silicone rubber tubings of all sizes showed greater distensibility than PVC tubings of equivalent size. In conclusion, although roller pump induced tubing rupture remains a theoretical problem during CPB in terms of the inherent mechanism of the pump, in reality such an occurrence is impossible in real clinical conditions.

  11. [Training of endotracheal intubation for an emergency medical technician and three cases of endotracheal intubation during emergency situation].

    PubMed

    Kaneda, Toru; Suzuki, Toshiyasu

    2007-05-01

    It is said that airway management is an important part of lifesaving at the prehospital care for a seriously ill emergency patient. We performed the training of endotracheal intubation for an emergency medical technician, and in this report we discussed the results of trainings and examined 3 cases of endotracheal intubation in the emergency situation after training. Various kinds of problem arose through this training, for example, difficulty to get the consent from patients, overlap of a case for clinical resident and emergency medical technician, large responsibility of the anesthesiologist as a teaching staff. In addition, there may be no useful case for lifesaving at the emergency situation in 3 cases of endotracheal intubation. We consider that it may be difficult, but possibility cannot deny if endotracheal intubation by emergency medical technicians contribute to lifesaving rate improvement from viewpoint of prehospital care.

  12. Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

    PubMed

    Tsoucalas, Gregory; Sgantzos, Markos

    2016-12-01

    Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations.

  13. Compounding with Silicones.

    PubMed

    Allen, Loyd V

    2015-01-01

    Since the 1940s, methylchlorosilanes have been used to treat glassware to prevent blood from clotting. The use of silicones in pharmaceutical and medical applications has grown to where today they are used in many life-saving devices (pacemakers, hydrocephalic shunts) and pharmaceutical applications from tubing, to excipients in topical formulations, to adhesives to affix transdermal drug delivery systems, and are also being used in products as active pharmaceutical ingredients, such as antiflatulents. About 60% of today's skin-care products now contain some type of silicone where they are considered safe and are known to provide a pleasant "silky-touch," non-greasy, and non-staining feel. Silicones exhibit many useful characteristics, and the safety of these agents supports their numerous applications; their biocompatibility is partially due to their low-chemical reactivity displayed by silicones, low-surface energy, and their hydrophobicity. Silicones are used both as active ingredients and as excipients. In addition is their use for "siliconization," or surface treatment, of many parenteral packaging components. Dimethicone and silicone oil are used as lubricants on stoppers to aid machineability, in syringes to aid piston movement, or on syringe needles to reduce pain upon injection. Silicones are also useful in pharmaceutical compounding as is discussed in this artiele included with this article are in developing formulations with silicones.

  14. Tracheal rupture related to endotracheal intubation after thyroid surgery: a case report and systematic review.

    PubMed

    Xu, Xiaohan; Xing, Na; Chang, Yanzi; Du, Yingying; Li, Zhisong; Wang, Zhongyu; Yan, Jie; Zhang, Wei

    2016-04-01

    Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. The most likely cause of tracheal injury is massive overinflation of the endotracheal tube cuff and pre-existing tracheal wall weakness. We review the relevant literature and predisposing factors contributing to this complication. Only articles that reported at least the demographic data (age and sex), the treatment performed and the outcome were included. Papers that did not detail these variables were excluded. We also focus on a case of tracheal laceration after tracheal intubation in a patient with severe thyroid carcinoma. This patient received surgical repair and recovered uneventfully. Two hundred and eight studies that reported cases or case series were selected for analysis. Most of the reported cases (57·2%) showed an uneventful recovery after surgical therapy. The overall mortality was 19·2% (40 patients). Our patient too recovered without any serious complication. Careful prevention, early detection and proper treatment of the problem are necessary when tracheal rupture occurs. The morbidity and mortality associated with tracheal injury mandate a high level of suspicion and expedient management.

  15. Nasal septum giant pyogenic granuloma after a long lasting nasal intubation: case report.

    PubMed

    Neves-Pinto, Roberto M; Carvalho, Adolpho; Araujo, Elizabeth; Alberto, Carlos; Basilio-De-Oliveira; De Carvalho, Gustavo Adolpho

    2005-03-01

    The authors present a case of Pyogenic Granuloma (PG) arising from the nasal septum in the posterior nasal cavity of a patient male sex, caucasian, 32 years old, with a previous history of cranioencephalic trauma, several neurosurgeries for different subsequent neurological problems and the use of a nasogastric tube for feeding (nasal intubation) during 30 days. He underwent surgery in St. Vincent de Paul Hospital (Rio de Janeiro) on May 18, 1993, for the tumor removal and straightening of the nasal septum. Under endoscopic guidance the complete excision of the tumor mass was perfectly done thanks to the excellent exposure of the lesion, provided by the enlarged telescopic view, and the wide access afforded by the septum straighttening plus the cartilaginous septum mobilization through the maxilla-premaxilla approach of Cottle, allied to the lateralization and volume reduction of the right inferior nasal concha, simultaneously performed, thus making lateral rhinotomy or "degloving" unnecessary. The patient is until now (2004) completely free of the lesion operated on. This is the first report in the literature of such a lesion associated to nasal intubation as the triggering agent.

  16. [Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

    PubMed

    Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

    2015-01-01

    Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.

  17. Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation

    PubMed Central

    Lee, Sanghyun; Kim, Wonhee; Kang, Hyunggoo; Oh, Jaehoon; Lim, Tae Ho; Lee, Yoonjae; Kim, Changsun; Cho, Jun Hwi

    2015-01-01

    Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt. Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation. Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (all P < 0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt, P = 1; in 30° tilt, P = 0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (all P < 0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes. Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate. PMID:26161426

  18. Selective fiberoptic left main-stem intubation for severe unilateral barotrauma in a 24-week premature infant.

    PubMed

    Meyer, Michael T; Rice, Tom B; Glaspey, John C

    2002-03-01

    A 24-week premature infant developed severe right-sided pulmonary barotrauma secondary to mechanical ventilation for respiratory distress syndrome (RDS). High-frequency oscillatory ventilation and permissive hypercapnia were initiated. A chest tube was placed to relieve a pneumothorax, and a catheter was inserted into an air-filled cyst for drainage. These maneuvers failed to improve the child's respiratory status. The child's left main-stem bronchus was then successfully fiberoptically intubated for single-lung ventilation in order to reduce the unilateral barotrauma. Single-lung ventilation was effectively and safely continued for 5 days, with complete resolution of the pulmonary barotrauma.

  19. Comparison of different intubation techniques performed inside a moving ambulance: a manikin study.

    PubMed

    Wong, K B; Lui, C T; Chan, William Y W; Lau, T L; Tang, Simon Y H; Tsui, K L

    2014-08-01

    OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS

  20. 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

  1. 500 C SILICON CARBIDE RECTIFIER PROGRAM.

    DTIC Science & Technology

    Efforts were continued on the development of 500 degree C silicon carbide rectifiers. The growth rate of silicon carbide crystals prepared by the...as obtained from a simple model. All values agree within a factor of five. The use of molten borax as an etchant for silicon carbide was studies...is possible. Details are given on the life and storage tests which were successfully passed by two silicon carbide rectifiers. An open tube-flowing

  2. Recombinant ciliary neurotrophic factor promotes nerve regeneration and induces gene expression in silicon tube-bridged transected sciatic nerves in adult rats.

    PubMed

    Xu, Jia-jun; Chen, Er-yu; Lu, Chang-lin; He, Cheng

    2009-06-01

    Sciatic nerves in adult male rats were transected and reunited via a silicone chamber. This was followed by a focal injection of recombinant ciliary neurotrophic factor (CNTF). To evaluate the effect of this therapeutic approach and to explore its possible mechanisms, nerve regeneration was traced by horseradish peroxidase retrograde labeling. Functional recovery was evaluated by functional assessment of the hind feet and the expression of a number of proteins was detected using immunohistochemistry. The results showed that a single administration of CNTF could promote regeneration of motor axons, with improved functional recovery in adult rats. Growth associated protein (GAP)-43, S100, CD68 and major histocompatibility complex class II immunoreactivity in the regenerative and distal nerves suggested that CNTF could promote axon regeneration, Schwann cell migration, monocyte infiltration and activation. CNTF might also indirectly promote axonal regeneration by further activating the JAK-STAT3 pathway and subsequently upregulating phosphotyrosine, GAP-43 and S100 expression to enhance proliferation, growth and migration of Schwann cells. CNTF has suggested important targets for pharmacological intervention in peripheral nerve disease and injury.

  3. Feeding tube insertion - gastrostomy

    MedlinePlus

    ... tube insertion; G-tube insertion; PEG tube insertion; Stomach tube insertion; Percutaneous endoscopic gastrostomy tube insertion ... and down the esophagus, which leads to the stomach. After the endoscopy tube is inserted, the skin ...

  4. First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation.

    PubMed

    Cavus, Erol; Neumann, Tobias; Doerges, Volker; Moeller, Thora; Scharf, Edwin; Wagner, Klaus; Bein, Berthold; Serocki, Goetz

    2011-02-01

    In the present preliminary study we evaluated the C-MAC® D-Blade (Karl Storz, Tuttlingen, Germany), a new videolaryngoscopic C-MAC blade for difficult intubation, during both routine and difficult intubations. First, both the conventional direct laryngoscopy and the D-Blade were used in 15 consecutive patients with normal airways during routine induction of anesthesia. Second, the D-Blade was used as a rescue device in 20 of 300 (6.7%) consecutive patients, when conventional direct laryngoscopy failed. In the 15 patients during routine induction of anesthesia, with direct laryngoscopy, a Cormack-Lehane (C/L) grade 1 and grade 2a view was seen in 7 and 8 patients, respectively. It was possible to insert the D-Blade and to get a video view of the glottis on the first attempt in all patients; with the D-Blade, all 15 patients had a C/L 1 view. The time to successful intubation with the D-Blade was 15 (8-26) seconds (median (range)). In the 20 patients, in whom unexpected difficulty with direct laryngoscopy was observed, C/L grades 3 and 4 were present in 15 and 5 patients, respectively. With the use of the D-Blade, indirect C/L video view improved to C/L class 1 in 15 patients, and to 2a in 5 patients, respectively. The time from touching the laryngoscope to optimal laryngoscopic view was 11 (5-45) seconds and for successful intubation 17 (3-80) seconds. In all 35 patients, with the D-Blade no direct view of the glottis was possible and subsequently a semiflexible tube guide was required.

  5. Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation.

    PubMed

    Rodrigues, Estela T; Suazo, Iván C; Guimarães, Antonio S

    2009-01-01

    The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.

  6. Preparation of the patient and the airway for awake intubation

    PubMed Central

    Ramkumar, Venkateswaran

    2011-01-01

    Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned. PMID:22174458

  7. Reconstruction of soft plate necrosis after endotracheal intubation.

    PubMed

    Lee, Hyuck Jae; Lim, So Young; Pyon, Jai-Kyong; Mun, Goo Hyun; Bang, Sa Ik; Oh, Kap Sung

    2014-01-01

    Uvular necrosis after long-term endotracheal intubation has been previously reported, but there have been no reports regarding soft palate necrosis after endotracheal intubation. Recently, we encountered 2 patients who had a high degree of soft palate necrosis following endotracheal intubation during long-term care in the intensive care unit. This study reports noncongenital soft palate cleft caused by endotracheal intubation. Two patients, aged 30 and 38 years, with noncongenital cleft palate were treated with pharyngeal flap and/or palatoplasty at our institution from March 2011 to May 2013. Initially, the patients complained of acquired speech disorder and severe oronasal regurgitation caused by a palatal defect. Speech ability was evaluated preoperatively and postoperatively by a perceptual language test and nasopharyngoscopy. The cleft soft palates of both patients were completely repaired, and the aforementioned symptoms improved after surgery. Postoperative courses were uneventful in both of the cases, and neither patient experienced a recurrence. Although rare, long-term intensive care unit care with endotracheal intubation can cause noncongenital soft palate cleft. In cases with iatrogenic cleft palate that does not heal with conservative treatment, surgical procedures such as pharyngeal flap and palatoplasty can be helpful.

  8. Endotracheal Administration of Sufentanil and Tetracaine During Awake Fiberoptic Intubation.

    PubMed

    Ji, Meng; Tao, Jun; Cheng, Min; Wang, Qingli

    2016-01-01

    Combined use of local anesthetics and low-dose opioids enhances the effects of local anesthetics. This study aimed to evaluate the efficacy of combined administration of sufentanil and tetracaine through the cricothyroid membrane during awake nasal intubation using fiberoptic bronchoscopy in patients with difficult airways. Forty patients were divided into 2 groups: group A received endotracheal administration of 25 μg of sufentanil and 2 mL of 1% tetracaine mixture; group B received endotracheal administration of 2 mL 1% tetracaine and routine local anesthetic sprays followed by slow intravenous injection of 25 μg of sufentanil. The results showed that endotracheal intubation was safely completed in all patients and vital signs including blood pressure, heart rate, and pulse oxygen saturation were not significantly different between groups A and B. However, time required for local anesthesia to take effect, time required to complete intubation, cough reflex, patient tolerance during intubation, and hemodynamic indices were significantly better in group A than in group B. In conclusion, our results suggest that endotracheal administration of sufentanil combined with tetracaine is safe, effective, and feasible in the context of awake nasal intubation using fiberoptic bronchoscopy.

  9. 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.

  10. [Tracheal rupture after orotracheal intubation in intensive care].

    PubMed

    Hayi-Slayman, D; Page, M; Ben Cheikh, A; Christin, F; Ber, C-E; Rimmelé, T

    2007-06-01

    We report a case of an iatrogenic tracheal rupture following an endotracheal intubation. The 78-year-old patient was admitted to the intensive care unit because of an acute respiratory failure related to a severe nosocomial pneumonia occurring 21 days after an abdominal aorta surgery. His main antecedent was a cigarette smoke-induced chronic obstructive pulmonary disease. Immediately after being intubated, a traumatic tracheobronchial rupture was suspected because of the sudden appearance of cervicothoracic subcutaneous emphysema. A thoracic computed tomography with multiplanar reformations confirmed the diagnosis and the evolution was unfortunately rapidly unfavourable. Risk factors, clinical and radiological aspects, and management of this rare but serious complication of endotracheal intubation will be discussed.

  11. Gastrostomy Tube (G-Tube)

    MedlinePlus

    ... warmth at the tube site; discharge that's yellow, green, or foul-smelling; fever) excessive bleeding or drainage from the tube site severe abdominal pain persistent vomiting or diarrhea trouble passing gas or having a bowel movement pink-red tissue (called granulation tissue) coming out ...

  12. 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

  13. Extended anaesthesia and nasotracheal intubation of a red kangaroo (Macropus rufus).

    PubMed

    Bauquier, S H; Golder, F J

    2010-11-01

    Anaesthesia requires maintenance of a patent airway. Nasotracheal intubation of a red kangaroo (Macropus rufus) was performed when the inability to open the animal’s mouth prevented orotracheal intubation. Nasotracheal intubation was easy to perform, secured the airway and permitted delivery of supplemental oxygen, isoflurane and intermittent positive pressure ventilation.

  14. Protective tubes for sodium heated water tubes

    DOEpatents

    Essebaggers, Jan

    1979-01-01

    A heat exchanger in which water tubes are heated by liquid sodium which minimizes the results of accidental contact between the water and the sodium caused by failure of one or more of the water tubes. A cylindrical protective tube envelopes each water tube and the sodium flows axially in the annular spaces between the protective tubes and the water tubes.

  15. Silicone metalization

    SciTech Connect

    Maghribi, Mariam N.; Krulevitch, Peter; Hamilton, Julie

    2008-12-09

    A system for providing metal features on silicone comprising providing a silicone layer on a matrix and providing a metal layer on the silicone layer. An electronic apparatus can be produced by the system. The electronic apparatus comprises a silicone body and metal features on the silicone body that provide an electronic device.

  16. Silicone metalization

    SciTech Connect

    Maghribi, Mariam N.; Krulevitch, Peter; Hamilton, Julie

    2006-12-05

    A system for providing metal features on silicone comprising providing a silicone layer on a matrix and providing a metal layer on the silicone layer. An electronic apparatus can be produced by the system. The electronic apparatus comprises a silicone body and metal features on the silicone body that provide an electronic device.

  17. Multiple tube premixing device

    DOEpatents

    Uhm, Jong Ho; Varatharajan, Balachandar; Ziminsky, Willy Steve; Kraemer, Gilbert Otto; Yilmaz, Ertan; Lacy, Benjamin; Stevenson, Christian; Felling, David

    2012-12-11

    The present application provides a premixer for a combustor. The premixer may include a fuel plenum with a number of fuel tubes and a burner tube with a number of air tubes. The fuel tubes extend about the air tubes.

  18. Multiple tube premixing device

    DOEpatents

    Uhm, Jong Ho; Naidu, Balachandar; Ziminksy, Willy Steve; Kraemer, Gilbert Otto; Yilmaz, Ertan; Lacy, Benjamin; Stevenson, Christian; Felling, David

    2013-08-13

    The present application provides a premixer for a combustor. The premixer may include a fuel plenum with a number of fuel tubes and a burner tube with a number of air tubes. The fuel tubes extend about the air tubes.

  19. The Bullard laryngoscope. Reports of two cases of difficult intubation.

    PubMed

    Midttun, M; Laerkholm Hansen, C; Jensen, K; Pedersen, T

    1994-04-01

    The Bullard laryngoscope is a new combination of a fibreoptic light source and an anatomically shaped rigid blade, to aid visualization of the larynx. We present two patients with expected severe difficult endotracheal intubation and describe their anaesthetic management. Our experience confirms previous observations which showed that the Bullard laryngoscope provides an excellent view of the vocal cords in patients with severe difficult airways.

  20. New method of preoxygenation for orotracheal intubation in patients with hypoxaemic acute respiratory failure in the intensive care unit, non-invasive ventilation combined with apnoeic oxygenation by high flow nasal oxygen: the randomised OPTINIV study protocol

    PubMed Central

    Jaber, Samir; Molinari, Nicolas; De Jong, Audrey

    2016-01-01

    Introduction Tracheal intubation in the intensive care unit (ICU) is associated with severe life-threatening complications including severe hypoxaemia. Preoxygenation before intubation has been recommended in order to decrease such complications. Non-invasive ventilation (NIV)-assisted preoxygenation allows increased oxygen saturation during the intubation procedure, by applying a positive end-expiratory pressure (PEEP) to prevent alveolar derecruitment. However, the NIV mask has to be taken off after preoxygenation to allow the passage of the tube through the mouth. The patient with hypoxaemia does not receive oxygen during this period, at risk of major hypoxaemia. High-flow nasal cannula oxygen therapy (HFNC) has a potential for apnoeic oxygenation during the apnoea period following the preoxygenation with NIV. Whether application of HFNC combined with NIV is more effective at reducing oxygen desaturation during the intubation procedure compared with NIV alone for preoxygenation in patients with hypoxaemia in the ICU with acute respiratory failure remains to be established. Methods and analysis The HFNC combined to NIV for decreasing oxygen desaturation during the intubation procedure in patients with hypoxaemia in the ICU (OPTINIV) trial is an investigator-initiated monocentre randomised controlled two-arm trial with assessor-blinded outcome assessment. The OPTINIV trial randomises 50 patients with hypoxaemia requiring orotracheal intubation for acute respiratory failure to receive NIV (pressure support=10, PEEP=5, fractional inspired oxygen (FiO2)=100%) combined with HFNC (flow=60 L/min, FiO2=100%, interventional group) or NIV alone (reference group) for preoxygenation. The primary outcome is lowest oxygen saturation during the intubation procedure. Secondary outcomes are intubation-related complications, quality of preoxygenation and ICU mortality. Ethics and dissemination The study project has been approved by the appropriate ethics committee (CPP Sud

  1. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation in Cadavers—Cadavers vs. Patients, the Effect of Repeated Intubations, and the Effect of Type II Odontoid Fracture on C1-C2 Motion

    PubMed Central

    Hindman, Bradley J.; From, Robert P.; Fontes, Ricardo B.; Traynelis, Vincent C.; Todd, Michael M.; Zimmerman, M. Bridget; Puttlitz, Christian M.; Santoni, Brandon G.

    2015-01-01

    Introduction The aims of this study were to characterize: 1) cadaver intubation biomechanics, including the effect of repeated intubations; and 2) the relationship between intubation force and the motion of an injured cervical segment. Methods Fourteen cadavers were serially intubated using force-sensing Macintosh and Airtraq laryngoscopes in random order, with simultaneous cervical spine motion recorded with lateral fluoroscopy. Motion of the C1-C2 segment was measured in the intact and injured state (Type II odontoid fracture). Injured C1-C2 motion was proportionately corrected for changes in intubation forces that occurred with repeated intubations. Results Cadaver intubation biomechanics were comparable to those of patients in all parameters other than C2-C5 extension. In cadavers, intubation force (Set 2/Set1 force ratio = 0.61 [95% CI: 0.46, 0.81]; P=0.002) and Oc-C5 extension (Set 2 –Set 1 difference = −6.1 degrees [95% CI: −11.4, −0.9]; P=0.025) decreased with repeated intubations. In cadavers, C1-C2 extension did not differ: 1) between intact and injured states; or 2) in the injured state, between laryngoscopes (with and without force correction). With force correction, in the injured state, C1-C2 subluxation was greater with the Airtraq (mean difference 2.8 mm [95% CI: 0.7, 4.9 mm]; P=0.004). Discussion With limitations, cadavers may be clinically relevant models of intubation biomechanics and cervical spine motion. In the setting of a Type II odontoid fracture, C1-C2 motion during intubation with either the Macintosh or Airtraq does not appear to greatly exceed physiologic values or to have a high likelihood of hyperextension or direct cord compression. PMID:26288267

  2. Fiberoptic Guided Retrograde Intubation in an Anticipated Difficult Airway: Revival of an Antiquated Technique

    PubMed Central

    Ninu, Marie; Yunus, Md.; Syiemiong, Newstar

    2016-01-01

    Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation. This fiber optic guided retrograde intubation is a first reported case of its kind in a predicted difficult airway which can be beneficial in different difficult airway situations. PMID:27891428

  3. Comparative study of heart rate responses to laryngoscopic endotracheal intubation and to endotracheal intubation using intubating laryngeal mask airway under general anaesthesia in patients with pure mitral stenosis for closed mitral commissurotomy.

    PubMed

    Das, Soumi; Gupta, Sampa Dutta; Goswampi, Anupam; Kundu, Kanak Kanti

    2013-04-01

    The various drugs and methods studied in an attempt to curb the haemodynamic stress response associated with conventional laryngoscopic endotracheal intubation have not been found to be ompletely satisfactory. The rise in heart rate can be detrimental to patients with mitral stenosis. This study was aimed to compare the heart rate responses to endotracheal intubation using conventional laryngoscope and with the help of intubating laryngeal mask airway (ILMA) in patients with isolated mitral stenosis. Thirty-four adult patients of either sex, aged between 18 and 40 years with isolated mitral stenosis to undergo closed mitral commissurotomy were randomly allocated into two groups : Group A (n=17)- To be intubated using laryngoscopy. Group B (n=17)- To be intubated with the help of ILMA. The heart rate was recorded immediately preinduction, just prior to introducing the intubating device and postintubation every minute up to first 5 minutes. On applying statistical tests, it was found that the median heart rate values in group A at 2, 3, 4 and 5 minutes postintubation were significantly higher than in group B (p<0.05). Although use of both laryngosope and ILMA for endotracheal intubation was associated with rise in heart rate, the rise was less with ILMA compared to laryngoscope. Hence, it can be concluded that use of ILMA may be a preferable device for endotracheal intubation laryngoscopy in patients with isolated mitral stenosis.

  4. Tube Feedings.

    ERIC Educational Resources Information Center

    Plummer, Nancy

    This module on tube feedings is intended for use in inservice or continuing education programs for persons who work in long-term care. Instructor information, including teaching suggestions and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are then provided. A brief discussion follows…

  5. Jejunostomy feeding tube

    MedlinePlus

    ... DJ, Martin BC, Gonzalez L, Aebersold M. Nutritional management and enteral intubation. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills . 9th ed. New York, ...

  6. Sampling trace-level organic solutes with polymeric tubing. Part 1: Static studies

    SciTech Connect

    Parker, L.V.; Ranney, T.A.

    1997-12-31

    Twenty polymeric tubings were filled with a test solution containing eight organic solutes. The test solutions were monitored for losses, indicating that sorption had occurred, and for signs that leaching of organic constituents had occurred. The tubings tested included seven flexible products and eight fluoropolymers. Among the rigid tubings tested, three fluoropolymers (fluorinated ethylene propylene (FEP), FEP-lined polyethylene, polyvinylidene fluoride) were the least sorptive tubings. However, even these tubings readily sorbed some of the analytes. Among the flexible tubings tested, a fluoroelastomer tubing and a tubing made of a copolymer of vinylidene fluoride and hexafluoropropylene were the least sorptive. Several of the tubings tested leached constituents into the test solution. The polyurethane, polyamide, flexible polyvinyl chloride (PVC), polyester-lined PVC, and silicone-modified thermoplastic elastomer tubings were found to leach the most constituents. The authors were unable to detect any constituents leaching from the polyethylene tubings, the rigid fluoropolymer tubings, and one of the plasticized polypropylene tubings.

  7. Comparison between different tests and their combination for prediction of difficult intubation: An analytical study

    PubMed Central

    Basunia, Sandip Roy; Ghosh, Sarmila; Bhattacharya, Susmita; Saha, Indranil; Biswas, Atanu; Prasad, Anu

    2013-01-01

    Context: There is an impelling need for accurate tests to predict difficult intubation, as failure to achieve endotracheal intubation causes significant morbidity and mortality in anesthetic practice. Aim: To calculate the validity of the different tests along with their combination and agreement when compared with endotracheal intubation in predicting difficult intubation. Settings and Design: Operation theaters, analytical study. Materials and Methods: Three hundred patients aged between 16 and 60 years of American society of anesthesiologist (ASA) physical status I and II, scheduled for elective surgical procedures requiring endotracheal intubation were studied during January-July 2012. Mallampati grade (MP), sternomental distance (SMD), thyromental distance (TMD), and Delilkan and Calder test were recorded for every patient. Endotracheal intubation was performed by an experienced anesthesiologist blinded to the measurements and recorded grading of intubation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR), odds ratio (OR), and kappa coefficient of tests individually and in combination were calculated. Statistical Analysis Used: IBM SPSS software (version 16.0) and Epi-info software (version 3.2). Results: Difficult and failed intubation was 13.3% and 0.6%, respectively. Difficult intubation increased with age. TMD and Calder test showed highest sensitivity individually and Dellilkan's test showed least sensitivity. Among the combination of tests, MP with SMD and MP with Calder test had the highest sensitivity. Conclusion: Among individual test TMD and Calder are better predictive tests in terms of sensitivity. Combination of tests increases the chance of prediction of difficult intubation. PMID:25885730

  8. Airway Management in Maxillofacial Trauma: Do We Really Need Tracheostomy/Submental Intubation

    PubMed Central

    Mittal, Geeta; Mittal, Rajinder K.; Katyal, Sunil; Uppal, Sanjeev; Mittal, Varun

    2014-01-01

    Background: There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. Aim: To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. Materials and Methods: In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Results: Young patients with male predominance is the most common affected population. Panfacial fracture is the most common type of injury (39.83%) among facial fractures. Airway was managed with intraoperative change of nasotracheal to orotracheal intubation in 33.05% of the patients whereas submental intubation or tracheostomy was done in 8.62% of the patients. Conclusion: Nasal route for endotracheal intubation is not a contraindication in the presence of nasal fractures, base of skull fractures and CSF leak. By changing the nasotracheal intubation to orotracheal intubation intraoperatively in cases panfacial fractures, most of the tracheostomies and submental intubations can be avoided. PMID:24783087

  9. Sublingual glyceryl trinitrate during colonoscopy and terminal ileal intubation: a randomized controlled trial.

    PubMed

    Hill, Patsy-Anne; Panteleimonitis, Sofoklis; McKay, Graham; Watson, Carol; Prach, Andre; Macdonald, Angus

    2017-02-01

    Background and aims Sublingual glyceryl trinitrate has been used as an aid to cannulate the Sphincter of Oddi during endoscopic retrograde cholangiopancreatography. Its role in terminal ileal intubation during colonoscopy is unknown. This study examines the role of sublingual glyceryl trinitrate in terminal ileal intubation during colonoscopy. Methods A triple-blind randomized controlled trial comparing sublingual glyceryl trinitrate (800 µg) vs. placebo (saline) in relation to terminal ileal intubation during colonoscopy was performed. Following caecal intubation, participants received sublingual glyceryl trinitrate/placebo followed by a 2-min observation period before intubation was attempted. Data on time to intubate the terminal ileum and intubation rate were collected. Results A total of 110 patients (age: 58 years (18-75)) were recruited and randomised as per protocol: 54 received sublingual glyceryl trinitrate. Terminal ileal intubation was successful in all patients receiving sublingual glyceryl trinitrate and in 53 (94.6%) of those receiving saline ( p = 0.243: Fischer's exact). The median time taken for ileal intubation after application of spray was 72.5 (7-900) s in the glyceryl trinitrate group compared with 125 (5-900) s in the placebo group ( p = 0.150: Mann-Whitney). There were no major adverse events reported in either group. Conclusions Terminal ileal intubation rates and timing were very good in both groups. Routine sublingual glyceryl trinitrate was not proven to be beneficial in improving terminal ileal intubation or intubation success rates in the hands of experienced colonoscopists. However, trends in this small study might suggest that glyceryl trinitrate could be useful in the hands of less experienced colonoscopists or in difficult terminal ileal intubation cases.

  10. Within-Subject Interlaboratory Variability of QuantiFERON-TB Gold In-Tube Tests

    DTIC Science & Technology

    2012-09-06

    administrative support; and to Eva Bozeman for assisting with blood collection. Author Contributions Conceived and designed the experiments: GHM DJG LRH...Performed the experiments: WCW ATJ GHM DJG CB. Analyzed the data: WCW GHM BHC WD. Wrote the paper: WCW GHM DJG LRH CB KBW LR LJD SOC BHC JB ATJ WD DM

  11. Superhydrophobic, nanotextured polyvinyl chloride films for delaying Pseudomonas aeruginosa attachment to intubation tubes and medical plastics.

    PubMed

    Loo, Ching-Yee; Young, Paul M; Lee, Wing-Hin; Cavaliere, Rosalia; Whitchurch, Cynthia B; Rohanizadeh, Ramin

    2012-05-01

    Bacterial attachment onto the surface of polymers in medical devices such as polyvinyl chloride (PVC) is influenced by the physicochemical properties of the polymer, including its surface hydrophobicity and roughness. In this study, to prevent biofilm formation onto PVC devices, the PVC surface was modified using a combination of solvent (tetrahydrofuran) and non-solvents (i.e. ethanol and methanol). The surface of unmodified PVC was smooth and relatively hydrophobic (water contact angle (CA)=80°). Ethanol-treated PVCs revealed the presence of micron-sized particulates and porous structures as the concentration of ethanol was increased. Surface hydrophobicity (measured in terms of CA) increased from 73° to 150° as the ethanol concentration increased from 15% to 35% (v/v). In general, methanol-treated PVCs were more hydrophilic compared to those treated with ethanol. The colonization of Pseudomonas aeruginosa PAO1 onto unmodified PVC surface was rapid, and individual bacterial cells could be seen after 6h incubation. On the surface of treated PVC, the secretion of extracellular matrix layers was evident at 18 h and P. aeruginosa PAO1 start to form microcolonies at 24h of incubation. The initial attachment of P. aeruginosa PAO1 was delayed to 18 and 24h, respectively in the PVCs treated with 25% (v/v) and 35% (v/v) ethanol. It can be concluded that the treatment used in this study to prepare superhydrophobic PVC surface prevented the colonization of bacteria up to 24h after culture.

  12. Endotracheal tube fixation methods for optimal stability: a comparison of adhesive tape, suture, and tape-suture fixation.

    PubMed

    Farbod, Frank; Tuli, Puneet; Robertson, Bernard F; Jackson, Ian T

    2010-07-01

    Accidental extubation of an intubated patient is a serious consideration in the surgical patient. Adequate fixation in the intubated patient is essential to prevent potentially life-threatening complications. Several methods of endotracheal tube fixation have been described in the literature. In this study, we examine 3 common methods of fixation: adhesive tape alone, suture, and tape-suture. Testing occurred in a laboratory setting with 2 fresh cadavers. Endotracheal tubes were inserted, using the methods of fixation in question. We subjected each fixation technique to progressively increasing weight to determine which technique is most resistant to accidental removal. We found that fixation of the tube by combining tape around the tube with a suture through the tape is the best noninvasive technique of the 3 methods evaluated in cases where movement of the head is anticipated.

  13. The non-intubated anesthesia for airway surgery

    PubMed Central

    Nakanishi, Ryoichi

    2016-01-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed. PMID:28066621

  14. The non-intubated anesthesia for airway surgery.

    PubMed

    Okuda, Katsuhiro; Nakanishi, Ryoichi

    2016-11-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.

  15. Neutron tubes

    DOEpatents

    Leung, Ka-Ngo; Lou, Tak Pui; Reijonen, Jani

    2008-03-11

    A neutron tube or generator is based on a RF driven plasma ion source having a quartz or other chamber surrounded by an external RF antenna. A deuterium or mixed deuterium/tritium (or even just a tritium) plasma is generated in the chamber and D or D/T (or T) ions are extracted from the plasma. A neutron generating target is positioned so that the ion beam is incident thereon and loads the target. Incident ions cause D-D or D-T (or T-T) reactions which generate neutrons. Various embodiments differ primarily in size of the chamber and position and shape of the neutron generating target. Some neutron generators are small enough for implantation in the body. The target may be at the end of a catheter-like drift tube. The target may have a tapered or conical surface to increase target surface area.

  16. QUANTIZING TUBE

    DOEpatents

    Jensen, A.S.; Gray, G.W.

    1958-07-01

    Beam deflection tubes are described for use in switching or pulse amplitude analysis. The salient features of the invention reside in the target arrangement whereby outputs are obtained from a plurality of collector electrodes each correspondlng with a non-overlapping range of amplitudes of the input sigmal. The tube is provded with mcans for deflecting the electron beam a1ong a line in accordance with the amplitude of an input signal. The target structure consists of a first dymode positioned in the path of the beam wlth slots spaced a1ong thc deflection line, and a second dymode posltioned behind the first dainode. When the beam strikes the solid portions along the length of the first dymode the excited electrons are multiplied and collected in separate collector electrodes spaced along the beam line. Similarly, the electrons excited when the beam strikes the second dynode are multiplied and collected in separate electrodes spaced along the length of the second dyode.

  17. Chest tube insertion

    MedlinePlus

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head. Sometimes, ...

  18. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  19. [Endotracheal tube for laryngeal CO2 laser microsurgery. 208 cases].

    PubMed

    Brille, P; Milhaud, A; Starobinsky, E; Postel, J P; Buffet, J P; Vaquette, C; Boudin, G; Daelman, F; Lemoine, E

    1985-07-06

    To suppress the risk inherent in laryngeal microsurgery performed with a CO2 laser beam, the authors suggest to use a reinforced silicone endotracheal tube, the cuff of which is protected by a silicone plus aluminium powder shield. The resistance of silicone to fire is augmented during laser shots by a nitrogen flow on the upper side of the shield at the rates of 2 l/min in patients breathing air and 30 l/min in patients give oxygen.

  20. Comparison of Successful Intubation Between Video Laryngoscopy View Before Attempted Intubation and Direct Laryngoscopic Intubation by Student Registered Nurse Anesthetists: A Pilot Study.

    PubMed

    Wands, Brenda; Minzola, Debra

    2015-12-01

    Airway management is a primary focus when student registered nurse anesthetists (SRNAs) begin clinical rotations in their nurse anesthesia program. Successful endotracheal intubation requires both knowledge of and experience with the airway and its structures. Lack of clinical maturity and unfamiliarity with the patient airway intensifies student anxiety in the clinical arena. The purpose of this pilot study was to examine the success rate of direct laryngoscopy by 9 SRNAs who were just entering clinical practice rotations. This study required group 1 to perform direct laryngoscopy in their first clinical opportunity in the operating room; group 2 was required to observe a minimum of 3 video laryngoscopic (GlideScope, Verathon Inc) intubations performed by the clinical preceptor before the students' first attempt using direct laryngoscopy. Other modalities used to secure the airway in this study included the GlideScope and a laryngeal mask airway. Results of the data analysis revealed there was no significant difference between groups for success of direct laryngoscopy (group 1, 54%; group 2, 58%; P = .45).

  1. Prehospital endotracheal tube airway or esophageal gastric tube airway: a critical comparison.

    PubMed

    Shea, S R; MacDonald, J R; Gruzinski, G

    1985-02-01

    This study compares two similar groups of patients in cardiopulmonary arrest with ventricular fibrillation (VF). In the survival study group of 296 patients, 148 patients received an endotracheal tube airway (ETA) and 148 patients received an esophageal gastric tube airway (EGTA), the improved version of the esophageal obturator airway (EOA). Survival rates, both short term (ETA = 35.8%, EGTA = 39.1%) and long term (ETA = 11.5%, EGTA = 16.2%), and neurological sequelae of survivors showed no statistically significant difference between the two groups (P greater than .05). In addition, we found that success and complication rates of intubation were similar. Training time was longer for the ETA. We conclude that both airways have a place in the prehospital setting.

  2. Nasogastric feeding tube

    MedlinePlus

    Feeding - nasogastric tube; NG tube; Bolus feeding; Continuous pump feeding; Gavage tube ... If your child has an NG tube, try to keep your child from touching or pulling on the tube. After your nurse teaches you how to flush the tube ...

  3. Airtraq® versus Macintosh laryngoscope: A comparative study in tracheal intubation

    PubMed Central

    Bhandari, Geeta; Shahi, K. S.; Asad, Mohammad; Bhakuni, Rajani

    2013-01-01

    Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Materials and Methods: Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups. Results: We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001. Conclusion: Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant. PMID:25885839

  4. [A device to facilitate training of intubation by emergency medical technician].

    PubMed

    Fujita, Yasuaki; Takahashi, Ayako; Yamada, Aya; Kobayashi, Kazuhiko; Nakata, Jun; Teramoto, Yuzo

    2012-06-01

    In our hospital, the average duration of training in intubation by the emergency medical technician training intubation was 17.9 days. Compared to other reports, our training period is shorter. Short training period has reduced burden of hospital and fire station. One of the important contributions to the society for anesthesiologists is to increase the number of emergency medical technicians who can intubate. But long training period has been increasing the burden of anesthesiologists and emergency medical technicians. We report a practical method of intubation by emergency medical technician in our hospital.

  5. Silicon entering through silicon utilizing organisms has biological effects in human beings

    NASA Astrophysics Data System (ADS)

    Shraddhamayananda, S.

    2012-12-01

    Except in the lungs, there is no evidence that silicon can do any harm in our body and Silicon is as essential as magnesium and calcium for us. It helps in proper activities of the bone tissues and all of the components in the human skeletal system. It can prevent osteoporosis in bones and also helps in lowering of blood pressure. Silicon can also inhibit fungal disease by physically inhibiting fungal germ tube penetration of the epidermis. Many of our foods which are associated with silicon utilizing organisms like rice, vegetables, wheat etc, contain plenty silicon, however, during processing most silicon get lost. In alternative medicine silicon is used to promote expulsion of foreign bodies from tissue, in formation of suppuration and finally expulsion of pus from abscesses. Silicon is also used to remove fibrotic lesions and scar tissue and in this way it can prevent formation of keloids. Sometimes it is also used to treat chronic otitis media, and chronic fistula,

  6. Tube furnace

    DOEpatents

    Foster, Kenneth G.; Frohwein, Eugene J.; Taylor, Robert W.; Bowen, David W.

    1991-01-01

    A vermiculite insulated tube furnace is heated by a helically-wound resistance wire positioned within a helical groove on the surface of a ceramic cylinder, that in turn is surroundingly disposed about a doubly slotted stainless steel cylindrical liner. For uniform heating, the pitch of the helix is of shorter length over the two end portions of the ceramic cylinder. The furnace is of large volume, provides uniform temperature, offers an extremely precise programmed heating capability, features very rapid cool-down, and has a modest electrical power requirement.

  7. Tube furnace

    SciTech Connect

    Foster, K.G.; Frohwein, E.J.; Taylor, R.W.; Bowen, D.W.

    1990-12-31

    A vermiculite insulated tube furnace is heated by a helically-wound resistance wire positioned within a helical groove on the surface of a ceramic cylinder, that in turn is surroundingly disposed about a doubly slotted stainless steel cylindrical liner. For uniform heating, the pitch of the helix is of shorter length over the two end portions of the ceramic cylinder. The furnace is of large volume, provides uniform temperature, offers an extremely precise programmed heating capability, features very rapid cool-down, and has a modest electrical power requirement.

  8. Tube furnace

    SciTech Connect

    Foster, K.G.; Frohwein, E.J.; Taylor, R.W.; Bowen, D.W.

    1990-01-01

    A vermiculite insulated tube furnace is heated by a helically-wound resistance wire positioned within a helical groove on the surface of a ceramic cylinder, that in turn is surroundingly disposed about a doubly slotted stainless steel cylindrical liner. For uniform heating, the pitch of the helix is of shorter length over the two end portions of the ceramic cylinder. The furnace is of large volume, provides uniform temperature, offers an extremely precise programmed heating capability, features very rapid cool-down, and has a modest electrical power requirement.

  9. The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation.

    PubMed

    Low, D; Healy, D; Rasburn, N

    2008-02-01

    Traditional teaching of laryngoscopy is difficult due to the trainer and trainee lacking a shared view. The Karl Storz BERCI DCI Video Laryngoscope provides a video image for the trainer and a direct view identical to that of a standard laryngoscope for the trainee. Forty-nine novice subjects were randomly assigned to a control group (n = 24) taught using a standard Macintosh laryngoscope or a study group (n = 25) taught using the Video Laryngoscope. Following training all subjects were assessed using a standard laryngoscope. Under simulated difficult airway conditions the study group performed better in terms of number of attempts (p = 0.02), number of repositioning manoeuvres required (p = 0.046) and teeth trauma (p = 0.034). The study group were more confident of the success of their tube placement (p = 0.035), found it easier than the control group (p = 0.042) and had improved knowledge of airway anatomy (p = 0.011). We conclude that video laryngoscopy confers benefits in the teaching of tracheal intubation.

  10. Conservative management of post-intubation tracheal tears—report of three cases

    PubMed Central

    Just, Tino; Dommerich, Steffen; Hingst, Volker; Böttcher, Arne; Schuldt, Tobias; Guder, Ellen; Mencke, Thomas; Pau, Hans-Wilhelm

    2014-01-01

    Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure. PMID:24977034

  11. Tapered pulse tube for pulse tube refrigerators

    DOEpatents

    Swift, Gregory W.; Olson, Jeffrey R.

    1999-01-01

    Thermal insulation of the pulse tube in a pulse-tube refrigerator is maintained by optimally varying the radius of the pulse tube to suppress convective heat loss from mass flux streaming in the pulse tube. A simple cone with an optimum taper angle will often provide sufficient improvement. Alternatively, the pulse tube radius r as a function of axial position x can be shaped with r(x) such that streaming is optimally suppressed at each x.

  12. [Pressure-volume analysis of wound suction drainage containers and suction capacity of drainage tubes].

    PubMed

    Mohadjer, C; Siegert, R; Jäger, H; Weidauer, H

    1994-01-01

    Four low-vacuum systems and eight high-vacuum systems were examined with special reference to the pressure-volume relations. The maximum filling volume for adequate transport of wound secretion was determined for each type. The use of a synthetic wound fluid instead of water resulted in a smaller aspiration volume. Enlargement of the tube diameter resulted in a reduced initial vacuum for the low-vacuum systems, whereas the high-vacuum systems were not affected. Normal drain tubes were compared with "Ulm drains" and silicon tubes for suction capacity. The suction maximum of normal tubes and silicon tubes was located at the proximal holes of the perforated tubes. The "Ulm drain," with perforation diameter increasing continuously to the distal end of the tube, was found to exert suction even at the more distal part of the tube. It is estimated that this tube allows locally more balanced vacuum in the wound.

  13. A Comparison of the Haider Tube-Guard® Endotracheal Tube Holder Versus Adhesive Tape to Determine if This Novel Device Can Reduce Endotracheal Tube Movement and Prevent Unplanned Extubation

    PubMed Central

    Buckley, Jack C.; Brown, Adam P.; Shin, John S.; Rogers, Kirsten M.

    2016-01-01

    BACKGROUND: Endotracheal tube security is a critical safety issue. We compared the mobility of an in situ endotracheal tube secured with adhesive tape to the one secured with a new commercially available purpose-designed endotracheal tube-holder device (Haider Tube-Guard®). We also observed for the incidence of oropharyngeal or facial trauma associated with the 2 tube fixation methods. METHODS: Thirty adult patients undergoing general anesthesia with neuromuscular blockade were prospectively enrolled. Immediately after intubation, a single study author positioned the endotracheal tube tip in the distal trachea using a bronchoscope. Anesthesiologists caring for patients secured the tube in their normal fashion (always with adhesive tape). A force transducer was used to apply linear force, increasing to 15 N or until the principal investigator deemed that the force be aborted for safety reasons. The displacement of the endotracheal tube was measured with the bronchoscope. Any tape was then removed and the endotracheal tube secured with the Haider Tube-Guard device. The linear force was reapplied and the displacement of the endotracheal tube measured. The Haider Tube-Guard device was left in place for the duration of the case. The patient’s face and oropharynx were examined for any evidence of trauma during surgery and in the recovery room. On discharge from the postanesthesia care unit, the patient answered a brief survey assessing for any subjective evidence of minor facial or oropharyngeal trauma. RESULTS: Under standardized tension, the endotracheal tube withdrew a mean distance of 3.4 cm when secured with adhesive tape versus 0.3 cm when secured with the Haider Tube-Guard (P <0.001). Ninety-seven percent of patients (29/30) experienced clinically significant endotracheal tube movement (>1 cm) when adhesive tape was used to secure the tube versus 3% (1/30) when the Haider Tube-Guard was used (P <0.001). Thirty percent of patients (9/30) were potentially deemed

  14. 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

  15. 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

  16. Post-Intubation Sore Throat and Menstruation Cycles

    PubMed Central

    Orandi, Amirali; Orandi, Amirhossein; Najafi, Atabak; Hajimohammadi, Fatemeh; Soleimani, Sara; Zahabi, Somayeh

    2013-01-01

    Background Postoperative sore throat is one of the most common complications of general anesthesia and intubation with prevalence of 18%-65% in different studies. Several risk factors including female gender, postoperative nausea and vomiting and so on have been mentioned. Objectives The aim of this study was to evaluate the incidence of postoperative sore throat in females and its association with menstrual cycles. Patients and Methods One hundred females between 18-45 years old with ASA class I or II without predicted difficult airway that were candidate for operation in supine position were enrolled in study. Patients who had pulmonary disease, smoking, common cold within two weeks prior to the operation, previous traumatic intubation history, removable dentures, any congenital or acquired deformity in face, neck, mouth and airway, any known pathology in mouth like aphthous and mouth ulcer,pregnant women, and patients with irregular cycles, and those taking oral contraceptive pills were excluded. By the same protocol general anesthesia was provided and the patients were asked to fill out a three-point scale questionnaire (Low, High, None) 1,6 and 24 hours following intubation to study and record the incidence and severity of sore throat, dysphagia and hoarseness. The date of last menstrual period had been recorded as well. Results Of 100 patients, in the first six hours, 51 patients had sore throat and 49 had no pain. During the first 6 hours, 33 patients (33%) had dysphagia and 13 patients had hoarseness at 6th postoperative hour. Age, weight, LMP, intubation time, operation and extubation time and coughing were compared to sore throat, dysphagia and hoarseness. The association between the incidence of coughing and bucking and sore throat was significant (P = 0.03). None of the parameters had a statistically meaningful association with dysphagia. Conclusions According to our results, by omitting probable risk factors of incidence of sore throat and evaluation

  17. [Successful surgical treatment of tracheal rupture caused by endotracheal intubation].

    PubMed

    Baranyai, Zsolt; Kocsis, Akos; Jósa, Valéria

    2010-06-06

    Rupture of the trachea is a rare complication of endotracheal intubation. The most common cause of the injury is the overinflation of the cuff. The authors present the case of a 45-year-old male in whom a 6 cm long trachea lesion was perceived during the operation due to a meso-hypopharyngeal tumor. Primary intervention resulted in successful reconstruction and full recovery. The case demonstrates the importance of prompt diagnosis and adequate therapy that helped in preventing an assumingly life-long complication or even death.

  18. Tube-in-tube thermophotovoltaic generator

    DOEpatents

    Ashcroft, J.; Campbell, B.; DePoy, D.

    1998-06-30

    A thermophotovoltaic device includes at least one thermal radiator tube, a cooling tube concentrically disposed within each thermal radiator tube and an array of thermophotovoltaic cells disposed on the exterior surface of the cooling tube. A shell having a first end and a second end surrounds the thermal radiator tube. Inner and outer tubesheets, each having an aperture corresponding to each cooling tube, are located at each end of the shell. The thermal radiator tube extends within the shell between the inner tubesheets. The cooling tube extends within the shell through the corresponding apertures of the two inner tubesheets to the corresponding apertures of the two outer tubesheets. A plurality of the thermal radiator tubes can be arranged in a staggered or an in-line configuration within the shell. 8 figs.

  19. Tube-in-tube thermophotovoltaic generator

    SciTech Connect

    Ashcroft, John; Campbell, Brian; DePoy, David

    1998-01-01

    A thermophotovoltaic device includes at least one thermal radiator tube, a cooling tube concentrically disposed within each thermal radiator tube and an array of thermophotovoltaic cells disposed on the exterior surface of the cooling tube. A shell having a first end and a second end surrounds the thermal radiator tube. Inner and outer tubesheets, each having an aperture corresponding to each cooling tube, are located at each end of the shell. The thermal radiator tube extends within the shell between the inner tubesheets. The cooling tube extends within the shell through the corresponding apertures of the two inner tubesheets to the corresponding apertures of the two outer tubesheets. A plurality of the thermal radiator tubes can be arranged in a staggered or an in-line configuration within the shell.

  20. Gastrostomy feeding tube - bolus

    MedlinePlus

    Feeding - gastrostomy tube - bolus; G-tube - bolus; Gastrostomy button - bolus; Bard Button - bolus; MIC-KEY - bolus ... Your child's gastrostomy tube (G-tube) is a special tube in your child's stomach that will help deliver food and medicines until your ...

  1. Oral versus intubated feeding and the effect on glycaemic and insulinaemic responses, gastric emptying and satiety.

    PubMed

    Morey, S; Shafat, A; Clegg, M E

    2016-01-01

    Cephalic phase responses (CPR) are important in early initiation of digestion and maximal absorption of nutrients prior to ingestion. Bypassing CPR has been shown to have consequences on metabolic responses that may influence satiety. The aim of this study was to investigate if using gastric intubation to bypass oro-pharyngeal and oesophageal exposure would reduce CPR including insulin and blood glucose and whether these impact on gastric emptying and satiety. Ten male subjects were tested on 2 occasions, 3-7 days apart after an overnight fast, in randomized order. Subjects were cannulated and intubated with a gastric tube for both tests. For test one, subjects ate 400 ml soup with a spoon and for test two the soup was infused into the stomach at an equivalent rate. Subsequently measurements of glycaemic (GR) and insulinaemic responses (IR) from cannula samples, breath samples for measurement of gastric emptying using the [(13)C] sodium acetate breath test and visual analogue scales (VAS) for satiety were taken over 180 min. There were differences in IR over the first 15 min (Oral: 169.0 ± 22.1; Gastric 124.1 ± 18.8; t(9) = 2.67; p = 0.028) but no difference in GR. There were differences in gastric emptying half time (Oral: 85.0 ± 2.7; Gastric 79.4 ± 3.3; t(9) = 2.40; p = 0.04) and ascension time (Oral: 68.2 ± 2.2; Gastric 64.0 ± 2.2; t(9) = 2.57; p = 0.03) with food taking longer to empty from the stomach on the Oral test day than on the Gastric test day. There was no significant difference in the satiety ratings. This study demonstrated that bypassing oro-pharyngeal and oesophageal exposure decreases the normal physiological CPR with detriment to IR and gastric emptying.

  2. Gated SIT Vidicon Streak Tube

    NASA Astrophysics Data System (ADS)

    Dunbar, D. L.; Yates, G. J.; Black, J. P.

    1986-01-01

    A recently developed prototype streak tube designed to produce high gain and resolution by incorporating the streak and readout functions in one envelope thereby minimizing photon-to-charge transformations and eliminating external coupling losses is presented. The tube is based upon a grid-gated Silicon-Intensified-Target Vidicon (SITV) with integral Focus Projection Scan (FPS) TV readout. Demagnifying electron optics (m=0.63) in the image section map the 40-mm-diameter photocathode image unto a 25-mm-diameter silicon target where gains >= 103 are achieved with only 10 KV accelerating voltage. This is compared with much lower gains (~ 50) at much higher voltages (~ 30 KV) reported for streak tubes using phosphor screens. Because SIT technology is well established means for electron imaging in vacuum, such fundamental problems as "backside thinning" required for electron imaging unto CCDs do not exist. The high spatial resolution (~ 30 1p/mm), variable scan formats, and high speed electrostatic deflection (250 mm2 areas are routinely rastered with 256 scan lines in 1.6 ms) available from FPS readout add versatility not available in CCD devices. Theoretical gain and spatial resolution for this design (developed jointly by Los Alamos National Laboratory and General Electric Co.) are compared with similar calculations and measured data obtained for RCA 73435 streaks fiber optically coupled to (1) 25-mm-diameter SIT FPS vidicons and (2) 40-mm-diameter MCPTs (proximity-focused microchannel plate image intensifier tubes) fiber optically coupled to 18-mm-diameter Sb2S3 FPS vidicons. Sweep sensitivity, shutter ratio, and record lengths for nanosecond duration (20 to 200 ns) streak applications are discussed.

  3. 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

  4. 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.

  5. [Difficult fiberoptic tracheal intubation in 1 month-old infant with Treacher Collins Syndrome].

    PubMed

    Fuentes, Ricardo; De la Cuadra, Juan Carlos; Lacassie, Hector; González, Alejandro

    2016-09-27

    Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al.

  6. Analysis of the incidence of postintubation injuries in patients intubated in the prehospital or early hospital conditions of the hospital emergency department and the intensive care unit

    PubMed Central

    Cierniak, Marcin; Timler, Dariusz; Sobczak, Renata; Wieczorek, Andrzej; Sekalski, Przemyslaw; Borkowska, Natalia; Gaszynski, Tomasz

    2015-01-01

    Background Intubation is still one of the best methods to secure the airway. In the case of prehospital or early hospital conditions when factors such as urgency, stress, or inaccuracy of the undertaken activities are involved, the risk of causing complications, for instance, edema or postintubation injuries, increases, especially while dealing with a difficult intubation. The risk of improper inflation of the endotracheal tube cuff also increases, which is considered in this study. Objective The aim of this study was to evaluate the prevalence of postintubation complications, such as postintubation injuries or edema, in a research sample, and to examine whether such complications occur more often, for example, while using a guidewire. In this study, we also evaluated the injuries associated with the inflation of the endotracheal tube cuff. Materials and methods This study was performed on a group of 153 patients intubated in prehospital conditions. The tests were carried out in three clinical sites that received patients from prehospital care. Postintubation injuries were revealed and photographed using videolar-yngoscope, such as the C-MAC and the McGrath series 5. The endotracheal tube cuff pressure was measured using a pressure gage manual (VBM Medizintechnik GmbH). The quantitative analyses of differences between incidence of variables were assessed using χ2 test for P<0.05. Analyses have been carried out using the Statistica software. Results In the group of 153 patients, postintubation injuries occurred in 17% of cases. The dependency between using the guidewire and the occurrence of the hematomas and loss of mucosa was statistically significant (P<0.01). In nearly half (42%) of the patients the endotracheal tube cuff pressure was excessively inflated over 30 cm H2O, and in two cases, endotracheal tube displacement was observed on account of poor cuff inflation (<20 cm H2O). Conclusion The highest percentage of overfilled cuffs were observed in the

  7. Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation-Based Study

    PubMed Central

    Thomas, Eric J; Katakam, Lakshmi

    2017-01-01

    Background Neonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught. Objective To determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting. Methods A randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013–8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate. Results One hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03–9.28). Conclusions In a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance. PMID:28168139

  8. 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.

  9. 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

  10. Design for a three-dimensional printed laryngoscope blade for the intubation of rats.

    PubMed

    Vongerichten, Anna; Aristovich, Kirill; dos Santos, Gustavo Sato; McEvoy, Andrew W; Holder, David S

    2014-04-01

    Endotracheal intubation of rats is a common technique that is best carried out with a laryngoscope blade. The blade allows direct visualization of the trachea during intubation, reducing the risk of accidental intubation of the esophagus. Laryngoscope blades for use in rats are not commercially available, however. Three-dimensional (3D) printers have recently become available and can be used to produce small plastic items simply and reliably based on an established design. The authors created a design for a laryngoscope blade to be printed with a 3D printer and polylactide filament material. Using the printed laryngoscope blade, the authors successfully intubated 35 rats. The presented design may be used by any experimenter with access to a 3D printer to fabricate the same laryngoscope blade for their intubation procedures.

  11. Feeding tube - infants

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007235.htm Feeding tube - infants To use the sharing features on this page, please enable JavaScript. A feeding tube is a small, soft, plastic tube placed ...

  12. Tracheostomy tube - eating

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000464.htm Tracheostomy tube - eating To use the sharing features on this ... you swallow foods or liquids. Eating and Tracheostomy Tubes When you get your tracheostomy tube, or trach, ...

  13. Eustachian tube patency

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/001630.htm Eustachian tube patency To use the sharing features on this page, please enable JavaScript. Eustachian tube patency refers to how much the eustachian tube ...

  14. Synthesis of silicon nanocones using rf microplasma at atmospheric pressure

    NASA Astrophysics Data System (ADS)

    Shirai, H.; Kobayashi, T.; Hasegawa, Y.

    2005-10-01

    We report the synthesis of silicon nanocones using the rf microplasma discharge at atmospheric pressure. The products formed underneath the tube electrode on Fe-coated crystalline silicon were constituted mainly of silicon and silicon oxide despite the use of a methane-argon mixture. Carbon nanotubes and silicon nanowires were also formed around the silicon nanocones. The number density and average size of silicon nanocones increased with the plasma exposure time accompanied by the enlargement of their surface distribution. The growth mechanism of silicon nanocones is discussed in terms of the catalytic growth via diffusion of silicon with nanocrystalline Si particle through FeSix nanoclusters, and enhanced Si oxidation by the plasma heating.

  15. 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

  16. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study

    PubMed Central

    Naziri, Freshteh; Amiri, Hakimeh Alereza; Rabiee, Mozaffar; Banihashem, Nadia; Nejad, Farhad Mohammad; Shirkhani, Ziba; Solimanian, Sedigheh

    2015-01-01

    Introduction: Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant. Materials and Methods: In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation. Results: There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia. Conclusions: In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R. PMID:26543458

  17. Heat exchanger tube mounts

    DOEpatents

    Wolowodiuk, W.; Anelli, J.; Dawson, B.E.

    1974-01-01

    A heat exchanger in which tubes are secured to a tube sheet by internal bore welding is described. The tubes may be moved into place in preparation for welding with comparatively little trouble. A number of segmented tube support plates are provided which allow a considerable portion of each of the tubes to be moved laterally after the end thereof has been positioned in preparation for internal bore welding to the tube sheet. (auth)

  18. Finite element determination of the forces exerted by endotracheal tubes on the upper airways.

    PubMed

    Gustin, B; G'Sell, C; Cochelin, B; Wourms, P; Potier-Ferry, M

    1996-06-01

    Accidents occurring during intubations often originate in the mechanical interaction between the tube and the upper airways. A review of these accidents, including their possible complications, shows that they are mainly due to the forces exerted by the tube on the anatomical structures during the long intubation periods. The structural design of currently available tubes is presented, and the viscoelastic properties of the constituent PVC materials are analysed. It is shown how the long-term viscoelastic behaviour of the polymer can be assessed from accelerated relaxation tests in uniaxial tension at temperatures higher than the body temperature and how the variation in the relaxation modulus can be modelled through a simple constitutive equation with a minimum number of parameters. From these data, the mechanical interaction of the tubes with the trachea are computed by means of the finite element method. The relative efficiency of different types of endotracheal tubes is thus discussed and operational criteria are eventually defined for the choice of tubes in clinical situations.

  19. How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients.

    PubMed

    Blot, Stijn I; Poelaert, Jan; Kollef, Marin

    2014-11-28

    Microaspiration of subglottic secretions through channels formed by folds in high volume-low pressure poly-vinyl chloride cuffs of endotracheal tubes is considered a significant pathogenic mechanism of ventilator-associated pneumonia (VAP). Therefore a series of prevention measures target the avoidance of microaspiration. However, although some of these can minimize microaspiration, benefits in terms of VAP prevention are not always obvious. Polyurethane-cuffed endotracheal tubes successfully reduce microaspiration but high quality data demonstrating VAP rate reduction are lacking. An analogous conclusion can be made regarding taper-shaped cuffs compared with classic barrel-shaped cuffs. More clinical data regarding these endotracheal tube designs are needed to demonstrate clinical value in addition to in vitro-based evidence. The clinical usefulness of endotracheal tubes developed for subglottic secretions drainage is established in multiple studies and confirmed by meta-analysis. Any change in cuff design will fail to prevent microaspiration if the cuff is insufficiently inflated. At least one well-designed trial demonstrated that continuous cuff pressure monitoring and control decrease the risk of VAP. Gel lubrication of the cuff prior to intubation temporarily hampers microaspiration through sludging the channels formed by folds in high volume-low pressure cuffs. As the beneficial effect of gel lubrication is temporarily, its potential to reduce VAP risk is probably nonsignificant. A minimum positive end-expiratory pressure of at least 5 cmH2O can be recommended as it reduces the risk of microaspiration in vitro and in vivo. One randomized controlled study demonstrated a reduced risk of VAP in patients ventilated with PEEP (5-8 cmH2O). Regarding head-of-bed elevation, it can be recommended to avoid supine positioning. Whether a 45° head-of-bed elevation is to be preferred above 25-30° head-of-bed elevation remains unproven. Finally, the routine monitoring of

  20. Videolaryngoscopes for placement of double lumen tubes: Is it time to say goodbye to direct view?

    PubMed Central

    El-Tahan, MR

    2016-01-01

    The advances in thoracic procedures require optimum lung separation to provide adequate room for surgical access. This can be achieved using either a double-lumen tube (DLT) or a bronchial blocker (BB). Most thoracic anesthesiologists prefer the use of DLT. However, lung separation in patients with potential difficult airway can be achieved using either BB through a single lumen tube or placement of a DLT over a tube exchanger or a fiberoptic bronchoscope. Numerous videolaryngoscopes (VL) have been introduced offering both optical and video options to visualize the glottis. Many studies reported improved glottis visualization and easier DLT intubation in patients with normal and potential difficult airway. However, these studies have a wide diversity of outcomes, which may be attributed to the differences in their designs and the prior experience of the operators in using the different devices. In the present review, we present the main outcomes of the available publications, which have addressed the use of VL-guided DLT intubation. Currently, there is enough evidence supporting using VL for DLT intubation in patients with predicted and unanticipated difficult airway. In conclusion, the use of VL could offer an effective method of DLT placement for lung separation in patients with the potential difficult airway. PMID:27051377

  1. Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving.

    PubMed

    Levitan, Richard M

    2003-07-01

    Concern about patient safety and failed rapid sequence intubation has led to an increased awareness of potentially difficult laryngoscopy situations and algorithms promoting techniques in awake patients. Given the low overall incidence of failed laryngoscopy, however, prediction of difficult laryngoscopy has poor positive predictive value and uncertain clinical utility, especially in emergency settings. Non-rapid sequence intubation approaches have comparatively lower chances of intubation success, require more time, and are associated with more complications. As a specialty, emergency medicine has adopted rapid sequence intubation as the mainstay of emergency airway treatment for many appropriate reasons; the problem that must be addressed is how patient safety can be ensured while what is an inherently dangerous procedure is performed. A novel way to conceptualize patient risk and safety issues in rapid sequence intubation is to examine how inherent risk is managed in skydiving. Metaphorical lessons from skydiving that are applicable to rapid sequence intubation include (1) a redundancy of safety; (2) a methodic approach to primary chute deployment; (3) use of backup chutes that are fast, simple, and easy to deploy; (4) attention to monitoring; and (5) equipment vigilance. This article reviews how each of these lessons apply metaphorically to rapid sequence intubation, wherein the primary chute is laryngoscopy, the backup chute is rescue ventilation, and monitoring involves pulse oximetry.

  2. Complications from submental endotracheal intubation: a prospective study and literature review.

    PubMed

    de Toledo, Guilherme Lacerda; Bueno, Sebastião Cristian; Mesquita, Ricardo Alves; Amaral, Márcio Bruno Figueiredo

    2013-06-01

    Submental endotracheal intubation, as compared to the use of tracheotomy, is an alternative for the surgical management of maxillofacial trauma, as described by Altemir FH (The submental route for endotracheal intubation: a new technique. J Maxillofac Surg 1986; 14: 64). Although the submental endotracheal intubation is a useful technique, a wide range of complications have been reported in the literature. The core aim of this article is to present additional data from 17 patients who have undergone submental endotracheal intubation and who have received at least 6 months of postoperative follow up. A prospective study was carried out on patients who suffered maxillofacial trauma between 2008 and 2011. Age, gender, etiology of trauma, fracture type, complications, and follow up were evaluated. Case series, as well as retrospective and prospective studies regarding submental endotracheal intubation in maxillofacial trauma, were also reviewed. This study demonstrated a low rate of complications in submental endotracheal intubation and no increase in operative time within the evaluated sample. The submental endotracheal intubation may be considered a simple, secure, and effective technique for operative airway control in major maxillofacial traumas.

  3. Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

    PubMed Central

    Ferrando, Carlos; Aguilar, Gerardo; Belda, F. Javier

    2011-01-01

    Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score. Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq) anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared. Results. The Airtraq significantly decreased the Cormack-Lehane score (P = 0.04). On the other hand, there were no differences in times of laryngoscopy (P = 0.645; IC 95% 3.1, +4.8) and intubation (P = 0.62; C95%  −6.1, +10.0) between the two devices. No relevant complications were found during the maneuvers of intubation using both devices. Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation. PMID:22162683

  4. Bender/Coiler for Tubing

    NASA Technical Reports Server (NTRS)

    Stoltzfus, J. M.

    1983-01-01

    Easy-to-use tool makes coils of tubing. Tubing to be bend clamped with stop post. Die positioned snugly against tubing. Operator turns handle to slide die along tubing, pushing tubing into spiral groove on mandrel.

  5. A persistent 'can't intubate, can't oxygenate' crisis despite rocuronium reversal with sugammadex.

    PubMed

    Kyle, B C; Gaylard, D; Riley, R H

    2012-03-01

    A 'can't intubate, can't oxygenate' airway crisis is a rare event which most anaesthetists will never experience during their career(1,2). This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in 'can't intubate, can't oxygenate' crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the 'can't intubate, can't oxygenate' situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.

  6. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-effect of severe distractive-flexion injury on C3-4 motion.

    PubMed

    Hindman, Bradley J; Fontes, Ricardo B; From, Robert P; Traynelis, Vincent C; Todd, Michael M; Puttlitz, Christian M; Santoni, Brandon G

    2016-11-01

    OBJECTIVE With application of the forces of intubation, injured (unstable) cervical segments may move more than they normally do, which can result in spinal cord injury. The authors tested whether, during endotracheal intubation, intervertebral motion of an injured C3-4 cervical segment 1) is greater than that in the intact (stable) state and 2) differs when a high- or low-force laryngoscope is used. METHODS Fourteen cadavers underwent 3 intubations using force-sensing laryngoscopes while simultaneous cervical spine motion was recorded with lateral fluoroscopy. The first intubation was performed with an intact cervical spine and a conventional high-force line-of-sight Macintosh laryngoscope. After creation of a severe C3-4 distractive-flexion injury, 2 additional intubations were performed, one with the Macintosh laryngoscope and the other with a low-force indirect video laryngoscope (Airtraq), used in random order. RESULTS During Macintosh intubations, between the intact and the injured conditions, C3-4 extension (0.3° ± 3.0° vs 0.4° ± 2.7°, respectively; p = 0.9515) and anterior-posterior subluxation (-0.1 ± 0.4 mm vs -0.3 ± 0.6 mm, respectively; p = 0.2754) did not differ. During Macintosh and Airtraq intubations with an injured C3-4 segment, despite a large difference in applied force between the 2 laryngoscopes, segmental extension (0.4° ± 2.7° vs 0.3° ± 3.3°, respectively; p = 0.8077) and anterior-posterior subluxation (0.3 ± 0.6 mm vs 0.0 ± 0.7 mm, respectively; p = 0.3203) did not differ. CONCLUSIONS The authors' hypotheses regarding the relationship between laryngoscope force and the motion of an injured cervical segment were not confirmed. Motion-force relationships (biomechanics) of injured cervical intervertebral segments during endotracheal intubation in cadavers are not predicted by the in vitro biomechanical behavior of isolated cervical segments. With the limitations inherent to cadaveric studies, the results of this study suggest

  7. Comparison of the air-Q intubating laryngeal airway and the cobra perilaryngeal airway as conduits for fiber optic-guided intubation in pediatric patients

    PubMed Central

    Girgis, Karim K.; Youssef, Maha M. I.; ElZayyat, Nashwa S.

    2014-01-01

    Background: One of the methods proposed in cases of difficult airway management in children is using a supraglottic airway device as a conduit for tracheal intubation. The aim of this study was to compare the efficacy of the Air-Q Intubating Laryngeal Airway (Air-Q) and the Cobra Perilaryngeal Airway (CobraPLA) to function as a conduit for fiber optic-guided tracheal intubation in pediatric patients. Materials and Methods: A total of 60 children with ages ranging from 1 to 6 years, undergoing elective surgery, were randomized to have their airway managed with either an Air-Q or CobraPLA. Outcomes recorded were the success rate, time and number of attempts required for fiber optic-guided intubation and the time required for device removal after intubation. We also recorded airway leak pressure (ALP), fiber optic grade of glottic view and occurrence of complications. Results: Both devices were successfully inserted in all patients. The intubation success rate was comparable with the Air-Q and the CobraPLA (96.7% vs. 90%), as was the first attempt success rate (90% vs. 80%). The intubation time was significantly longer with the CobraPLA (29.5 ± 10.9 s vs. 23.2 ± 9.8 s; P < 0.05), but the device removal time was comparable in the two groups. The CobraPLA showed a significantly higher ALP (20.8 ± 5.2 cmH2O vs. 16.3 ± 4.5 cmH2O; P < 0.001), but the fiber optic grade of glottic view was comparable with the two devices. The CobraPLA was associated with a significantly higher incidence of blood staining of the device on removal and post-operative sore throat. Conclusion: Both the Air-Q and CobraPLA can be used effectively as a conduit for fiber optic-guided tracheal intubation in children. However, the Air-Q proved to be superior due to a shorter intubation time and less airway morbidity compared with the CobraPLA. PMID:25422603

  8. Prediction of endotracheal tube size for pediatric patients from the epiphysis diameter of radius

    PubMed Central

    Cheon, Ji Hyun; Baek, Seung Hoon; Kim, Kyung Hoon

    2017-01-01

    Background Using a too big or a too small size of an endotracheal tube in pediatric patients would result in tracheal injury or insufficient ventilation. Determining the appropriate endotracheal tube size is important because using an inappropriate size can cause complications. This study was performed to predict the appropriate endotracheal tube size by measuring the transverse diameter of the epiphysis of the distal radius under the assumption that the growth rates of cartilages in the entire body are close to each other. Methods Fifty-eight children aged 3 to 10 years who required general anesthesia were intubated with an uncuffed endotracheal tube. The tube size was considered to be appropriate when leaks occurred at inspiratory peak pressures between 10 to 25 mmHg. The transverse diameters of the epiphysis were measured with an ultra-sonogram at the distal radius and the proximal phalanx of the third finger and the fifth finger. Correlations and prediction probabilities of measurements were evaluated. The number needed to harm (NNH), which indicates the number of patients who need to be intubated for one patient who needs tube exchange, was investigated. Results The Spearman's correlation coefficient between the endotracheal tube size and the epiphysis of the distal radius was 0.814, which was the biggest coefficient. For epiphysis of the proximal phalanx of the third finger and the fifth finger, the correlation coefficient was 0.704 and 0.701, respectively. If the Cole's formula was applied for selection of the tube size, the NNH would be 7. Conclusions The appropriate endotracheal tube size could be predicted by means of the epiphyseal transverse diameter of the distal radius rather than the circumference measurements of the phalanx. PMID:28184267

  9. Predicting endotracheal tube size by length in newborns.

    PubMed

    Luten, Robert; Kahn, Nagma; Wears, Robert; Kissoon, Niranjan

    2007-05-01

    The objective of this study was to determine the relationship of length to endotracheal tube (ETT) size in newborns and to use this relationship to develop a tool for predicting ETT size. The study, a prospective derivation, and validation of a predictive model, took place in the neonatal intensive care units (NICUs) in two urban teaching hospitals. Subjects included: ETT derivation set - 39 intubated neonates admitted to the NICU; Validation set - 69 intubated newborns from the same NICU. Leak percentages were measured in intubated neonates where the actual ETT size did not correlate with the tape-determined ETT size. Interventions were length, weight, and leak measurements. A prototype tape was developed using the derivation set and published anthropometric studies. The accuracy of the tape was validated on a separate set of newborns. The average relative difference between tape-predicted weight and actual weight was 9.5% (confidence interval [CI] = 8.3-10.6%) and was evenly distributed throughout all the weight groups. The tape predicted actual ETT size in 96% of cases (CI 86.3-99.5%) and was correct within 1 tube size (1/2 mm) in 100% (CI 94.8-100%). The only error in prediction of ETT size was in underestimation. Length-based weight estimations were tested on 100 subjects and predicted actual weight within 20% in 94% of cases. We concluded that length is an accurate predictor of ETT size and weight in term and preterm newborns and may be useful in situations in which weights are unobtainable, such as emergency resuscitation.

  10. Silicon spintronics.

    PubMed

    Jansen, Ron

    2012-04-23

    Worldwide efforts are underway to integrate semiconductors and magnetic materials, aiming to create a revolutionary and energy-efficient information technology in which digital data are encoded in the spin of electrons. Implementing spin functionality in silicon, the mainstream semiconductor, is vital to establish a spin-based electronics with potential to change information technology beyond imagination. Can silicon spintronics live up to the expectation? Remarkable advances in the creation and control of spin polarization in silicon suggest so. Here, I review the key developments and achievements, and describe the building blocks of silicon spintronics. Unexpected and puzzling results are discussed, and open issues and challenges identified. More surprises lie ahead as silicon spintronics comes of age.

  11. Knotting of a nasogastric feeding tube in a child with head injury: A case report and review of literature.

    PubMed

    Ismail, Nasiru J; Bot, Gyang Markus; Hassan, Ismail; Shilong, Danaan J; Obande, Joseph O; Aliu, Salamat Ahuoiza; Dung, Ezekiel D; Shehu, Bello B

    2014-01-01

    Nasogastric intubation is one of the most common routine nonoperative procedures available for the hospital care of patients. The insertion and removal of this tube is associated with many complications. The complications include trauma, nasal septal abscess and inadvertent entry into the cranial cavity and trachea, ulceration, bleeding from varices and perforation. Knotting of the nasogastric tube is one of the very rare complications of nasogastric intubation particularly in children. To the best of our knowledge there are very few reported cases in children. The technique used in the patient was the application of a steady tug which allows the lower oesophageal sphincter to open, therefore enabling the removal of the nasogastric tube. The possible predispositions to knotting of a nasogastric tube include small bore tubes, excess tube length and gastric surgery. We postulate that reduced gastric tone is another possible predisposing factor with head injury being the most likely reason in the index patient. We also challenge the fact that the small sized stomach is a risk factor for knotting of a feeding tube if the functional status and tone are normal, because of the rarity in children.

  12. Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis

    PubMed Central

    Puma, Francesco; Santoprete, Stefano; Urbani, Moira; Cagini, Lucio; Andolfi, Marco; Potenza, Rossella; Daddi, Niccolò

    2017-01-01

    Background Post-intubation tracheoesophageal fistula (PITEF) is an often mistreated, severe condition. This case series reviewed for both the choice and timing of surgical technique and outcome PITEF patients. Methods This case series reviewed ten consecutive patients who had undergone esophageal defect repair and airway resection/reconstruction between 2000 and 2014. All cases were examined for patients: general condition, medical history, preparation to surgery, diagnostic work-up, timing of surgery and procedure, fistula size and site, ventilation type, nutrition, post-operative course and complications. Results All patients were treated according to Grillo’s technique. Overall, 6/10 patients had undergone a preliminary period of medical preparation. Additionally, 3 patients had already had a tracheostomy, one had had a gastrostomy and 4 had both. One patient had a Dumon stent with enlargement of the fistula. Concomitant tracheal stenosis had been found in 7 patients. The mean length of the fistulas was 20.5 mm (median 17.5 mm; range, 8–45 mm), at a median distance from the glottis of 43 mm (range, 20–68 mm). Tracheal resection was performed in all ten cases. The fistula was included in the resection in 6 patients, while it was excluded in the remaining 4 due to their distance. Post-repair tracheotomy was performed in 3 patients. The procedure was performed in 2 ventilated patients. Morbidity related to fistula and anastomosis was recorded in 3 patients (30%), with one postoperative death (10%); T-Tube placement was necessary in 3 patients, with 2/3 decannulations after long-stenting. Definitive PITEF closure was obtained for all patients. At 5-year follow-up, the 9 surviving patients had no fistula-related morbidity. Conclusions Primary esophageal closure with tracheal resection/reconstruction seemed to be effective treatment both short and long-term. Systemic conditions, mechanical ventilation, detailed preoperative assessment and appropriate preparation

  13. 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

  14. Retrograde intubation in a case of ankylosing spondylitis posted for correction of deformity of spine

    PubMed Central

    Raval, Chetankumar; Patel, Heena; Patel, Pranoti; Kharod, Utpala

    2010-01-01

    Ankylosing spondylitis (AS) patients are most challenging. These patient present the most serious array of intubation and difficult airway imaginable, secondary to decrease or no cervical spine mobility, fixed flexion deformity of thoracolumbar spine and possible temporomandibular joint disease. Sound clinical judgment is critical for timing and selecting the method for airway intervention. The retrograde intubation technique is an important option when fiberoptic bronchoscope is not available, and other method is not applicable for gaining airway access for surgery in prone position. We report a case of AS with fixed flexion deformity of thoracic and thoracolumbar spine, fusion of posterior elements of cervical spine posted for lumbar spinal osteotomy with anticipated difficult intubation. An awake retrograde oral intubation with light sedation and local block is performed. PMID:20668567

  15. Role of melatonin in attenuation of haemodynamic responses to laryngoscopy and intubation

    PubMed Central

    Gupta, Priyamvada; Jethava, Durga; Choudhary, Ruchika; Jethava, Dharam Das

    2016-01-01

    Background and Aims: Laryngoscopy and endotracheal intubation are considered as potent stimuli which lead to an increase in heart rate and blood pressure. Melatonin (N-acetyl-5-methoxytryptamine) has been studied for pre-operative anxiolysis and sedation in Intensive Care Unit. We made a hypothesis that melatonin can provide haemodynamic stability during laryngoscopy and intubation when given 120 min before the procedure. Methods: Sixty American Society of Anesthesiologists physical status Grade I and II patients of either gender, 20–45 years old, 40–65 kg body weight, scheduled to undergo elective surgical procedures under general anaesthesia were assigned into two equal groups - Group C (control) and Group M (melatonin). They received oral placebo or melatonin tablets 6 mg, respectively, 120 min before surgery. The haemodynamic parameters were recorded preoperatively, during laryngoscopy and endotracheal intubation and thereafter at 1, 3, 5 and 10 min. Unpaired t-test was used for between-group comparison of ratio and interval scale data. For within-group comparison of ratio and interval scale data, repeated-measures ANOVA and post hoc Bonferroni t-tests were used. Results: It was observed that in the control group, there was a significant increase in heart rate and blood pressure at laryngoscopy and intubation and persisted till 10 min post-intubation. In melatonin group, there was an insignificant increase in heart rate at the time of laryngoscopy and intubation which however settled within 1 min post-intubation. Conclusion: Melatonin is an effective drug for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation. PMID:27761033

  16. Awake nasotracheal intubation using fiberoptic bronchoscope in a pediatric patient with Freeman-Sheldon syndrome.

    PubMed

    Kim, J S; Park, S Y; Min, S K; Kim, J H; Lee, S Y; Moon, B K

    2005-09-01

    The Freeman-Sheldon syndrome is a congenital disease primarily affecting the facial, limb and respiratory muscles that give rise to classical clinical features including typical whistling face and short webbed neck associated with difficult intubation. We present successful awake nasotracheal intubation in a 6-year-old patient with typical clinical features of Freeman-Sheldon syndrome by using fiberoptic bronchoscope on two separate occasions.

  17. 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. PMID:27621903

  18. Uniportal video-assisted thoracic surgery colorectal lung metastasectomy in non-intubated anesthesia

    PubMed Central

    Sellitri, Francesco; Perroni, Gianluca; Schillaci, Orazio; Mineo, Tommaso Claudio

    2017-01-01

    Background More than ten years ago we started a program of video-assisted thoracic surgery (VATS) lung metastasectomy in non-intubated local anesthesia. In this study we investigated the effectiveness and long term results of this combined surgical-anesthesiological technique. Methods Between 2005 and 2014, 48 patients (25 men and 23 women) with pulmonary oligometastases from colorectal cancer, at the first episode, underwent VATS metastasectomy under non-intubated local anesthesia. Three patients required intubation for intolerance. In the same period 13 patients scheduled for non-intubated metastasectomy refused awake surgery and were used as a control group. Results The two groups were homogeneous for both demographic and pathological features. Mean number of lesions resected per patient were 1.51 (non-intubated) vs. 1.77 (control), respectively (P=0.1). The oxygenation was significantly lower in the non-intubated group especially at the end of the procedure, but the values inverted from the first postoperative hour. There was no mortality in any groups. The non-intubated group demonstrated a significant shorter overall operating time (P=0.04), better quality of recovery after both 24 (P=0.04) and 48 hours (P=0.04), shorter median hospital stay (P=0.03) and lower estimated costs (P=0.03), even excluding the hospital stay. Major morbidity rate was lower (6% vs. 23%) yet not significant (P=0.1). Both disease free survival and overall survival were similar between groups. Conclusions VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Morbidity rate was lower yet not significant. Long term results were similar. PMID:28275472

  19. 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

  20. [Vecuronium: onset of effect and intubation conditions in comparison to pancuronium and suxamethonium].

    PubMed

    Engel, B; Schuh, F T

    1985-12-01

    The onset of neuromuscular blockade following the i.v. injection of vecuronium and pancuronium 0.05, 0.08 or 0.1 mg/kg and suxamethonium 0.5 or 1.0 mg/kg was studied in 304 patients during induction of anaesthesia by means of the compound action potential derived from the adductor pollicis muscle, which was indirectly stimulated via the ulnar nerve. The intubation conditions 1-5 min after injection were assessed using a scoring system related to ease of laryngoscopy, movement of vocal cords and coughing, and reflex movements of extremities. Development of motor blockade was time- and dose-dependent. After administration of 0.1 mg/kg vecuronium, the actual maximum effect (more than 90% block) was established within 4 min; after 0.1 mg/kg pancuronium within 6 min and after 1.0 mg/kg suxamethonium within 2 min. Intubation conditions improved with time. After 0.1 mg/kg vecuronium atraumatic intubation was possible within 2 min and after 0.1 mg/kg pancuronium within 4 min. Following 1.0 mg/kg suxamethonium, optimum intubation conditions were achieved within 1 min. Although suxamethonium acts the fastest and tracheal intubation can be achieved within 0.5-1.0 min, its use involves certain side effects and disadvantages. Vecuronium acts considerably faster than pancuronium and good or excellent intubation conditions are present within 2 min. Suxamethonium is no longer the muscle relaxant of choice for intubation except for crash intubation, e.g., in patients with a full stomach.

  1. 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

  2. Zero dead volume tube to surface seal

    DOEpatents

    Benett, William J.; Folta, James A.

    2000-01-01

    A method and apparatus for connecting a tube to a surface that creates a dead volume seal. The apparatus is composed of three components, a body, a ferrule, and a threaded fitting. The ferrule is compressed onto a tube and a seal is formed between the tube and a device retained in the body by threading the fitting into the body which provides pressure that seals the face of the ferrule to a mating surface on the device. This seal can be used at elevated temperatures depending on the materials used. While the invention has been developed for use with micro-machined silicon wafers used in Capillary Gas Chromatograph (GC), it can be utilized anywhere for making a gas or fluid face seal to the surface of a device that has near zero dead volume.

  3. 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

  4. 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.

  5. The intubation scoop (i-scoop) - a new type of laryngoscope for difficult and normal airways.

    PubMed

    Raymondos, K; Seidel, T; Sander, B; Gerdes, A; Goetz, F; Helmstädter, V; Panning, B; Dieck, T

    2014-09-01

    The i-scoop is an intubation device with a curved guiding bar with laterally located lenses at its tip, rather than a blade. Twenty-five anaesthesiologists intubated a manikin that simulated first a normal and then a difficult airway. All participants were able to intubate the difficult airway with a good view of the glottis using the i-scoop. None was able to intubate using seven other laryngoscopes (Macintosh laryngoscope, GlideScope(®) GVL and AVL, McGrath(®) (Series 5/MAC), C-MAC(®) , A.P. Advance(™) ). Intubation was successful only with the Airtraq(®) (n = 10), the Airway Scope (n = 5), the C-MAC D-Blade (n = 2), the A.P. Advance DAB (n = 1) and the GlideScope DL Trainer (n = 1) (p < 0.001, success rate of i-scoop vs all 12 laryngoscopes combined). In contrast to all other videolaryngoscopes, intubation of the normal airway with the i-scoop was achieved even faster than with the Macintosh laryngoscope (p < 0.02). The i-scoop outperformed all other laryngoscopes in both difficult and normal airways, and therefore has potential as an easier and safer alternative to present devices.

  6. 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.

  7. Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit

    PubMed Central

    Clark, Matthew T.; Vergales, Brooke D.; Paget-Brown, Alix O.; Smoot, Terri J.; Lake, Douglas E.; Hudson, John L.; Delos, John B.; Kattwinkel, John; Moorman, J. Randall

    2013-01-01

    Background Infants admitted to the neonatal intensive care unit (NICU), and especially those born with very low birth weight (VLBW; <1500 grams), are at risk for respiratory decompensation requiring endotracheal intubation and mechanical ventilation. Intubation and mechanical ventilation are associated with increased morbidity, particularly in urgent unplanned cases. Methods We tested the hypothesis that the systemic response associated with respiratory decompensation can be detected from physiological monitoring, and that statistical models of bedside monitoring data can identify infants at increased risk of urgent, unplanned intubation. We studied 287 VLBW infants consecutively admitted to our NICU and found 96 events in 51 patients, excluding intubations occurring within 12 hours of a previous extubation. Results In order of importance in a multivariable statistical model, we found the characteristics of reduced O2 saturation, especially as heart rate was falling, increased heart rate correlation with respiratory rate, and the amount of apnea all were significant independent predictors. The predictive model, validated internally by bootstrap, had receiver-operating characteristic area of 0.84 ± 0.04. Conclusions We propose that predictive monitoring in the NICU for urgent unplanned intubation may improve outcomes by allowing clinicians to intervene non-invasively before intubation is required. PMID:23138402

  8. PEG tube insertion -- discharge

    MedlinePlus

    ... shower or bathe. Keeping the PEG-tube in Place If the feeding tube comes out, the stoma ... eds. Pfenninger and Fowler's Procedures for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 100. ...

  9. Glass tube splitting tool

    NASA Technical Reports Server (NTRS)

    Klein, J. A.; Murray, C. D.; Stein, J. A.

    1971-01-01

    Tool accurately splits glass tubing so cuts are aligned 180 deg apart and reassembled tube forms low pressure, gastight enclosure. Device should interest industries using cylindrical closed glass containers.

  10. Eustachian tube (image)

    MedlinePlus

    ... are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in ... become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped ...

  11. Neural Tube Defects

    MedlinePlus

    Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month ... she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina ...

  12. Silicon nitride/silicon carbide composite powders

    DOEpatents

    Dunmead, Stephen D.; Weimer, Alan W.; Carroll, Daniel F.; Eisman, Glenn A.; Cochran, Gene A.; Susnitzky, David W.; Beaman, Donald R.; Nilsen, Kevin J.

    1996-06-11

    Prepare silicon nitride-silicon carbide composite powders by carbothermal reduction of crystalline silica powder, carbon powder and, optionally, crystalline silicon nitride powder. The crystalline silicon carbide portion of the composite powders has a mean number diameter less than about 700 nanometers and contains nitrogen. The composite powders may be used to prepare sintered ceramic bodies and self-reinforced silicon nitride ceramic bodies.

  13. Unusual Displacement of a Mobilised Dental Bridge during Orotracheal Intubation.

    PubMed

    Feltracco, Paolo; Barbieri, Stefania; Salvaterra, Francesca; Tiano, Letizia; Gaudio, Rosa Maria; Galligioni, Helmut; Ori, Carlo; Avato, Francesco Maria

    2011-01-01

    Dental trauma during tracheal intubation mostly happens in case of poor dentition, restricted mouth opening, and/or difficult laryngoscopy. 57-year-old man undergoing laparoscopic radiofrequency ablation of unresectable hepatocellular carcinoma had his dental work detached at induction of anesthesia. Oropharyngeal direct view, manual inspection, fibreoptic nosendoscopy, tracheobronchoscopy, and fiberoptic inspection of the esophagus and stomach were unsuccessful in locating the dislodged bridge. While other possible exams were considered, such as lateral and AP x-ray of head and neck, further meticulous manual "sweepings" of the mouth were performed, and by moving the first and second fingers below the soft palate deep towards the posterolateral wall of the pharynx, feeling consistent with a dental prosthesis was detected in the right pharyngeal recess. Only after pulling the palatopharyngeal arch upward was it possible to grasp it and extract it out with the aid of a Magill Catheter Forceps. Even though the preexisting root and bridge deficits were well reported by the consultant dentist, the patient was fully reimbursed. The lack of appropriate documentation of the advanced periodontal disease in the anesthesia records, no mention of potential risks on anesthesia consent, and insufficient protective measures during airway instrumentation reinforced the reimbursement claim.

  14. Guide tube flow diffuser

    SciTech Connect

    Berringer, R.T.; Myron, D.L.

    1980-11-04

    A nuclear reactor upper internal guide tube has a flow diffuser integral with its bottom end. The guide tube provides guidance for control rods during their ascent or descent from the reactor core. The flow diffuser serves to divert the upward flow of reactor coolant around the outside of the guide tube thereby limiting the amount of coolant flow and turbulence within the guide tube, thus enhancing the ease of movement of the control rods.

  15. Microhole Tubing Bending Report

    DOE Data Explorer

    Oglesby, Ken

    2012-01-01

    A downhole tubing bending study was made and is reported herein. IT contains a report and 2 excel spreadsheets to calculate tubing bending and to estimate contact points of the tubing to the drilled hole wall (creating a new support point).

  16. 1992 tubing tables

    SciTech Connect

    Not Available

    1992-01-01

    This paper is helpful to those designing oil well completions or purchasing tubing with proprietary or premium connections. Tables contain specifications and application data for over 100 different tubing joints, including those used with fiberglass pipe. The tables this year contain dimensional and performance data for coiled tubing.

  17. Prevention and treatment of amputation neuroma by an atelocollagen tube in rat sciatic nerves.

    PubMed

    Sakai, Yasuo; Ochi, Mitsuo; Uchio, Yuji; Ryoke, Koji; Yamamoto, Soichiro

    2005-05-01

    To evaluate the potential of the atelocollagen tube as a cap for amputation neuromas, the histological and histochemical characteristics of the neuroma and spinal cord were compared with those following silicone capping. Four weeks after the transection of 18 rat sciatic nerves, the amputated neuroma was resected, and the nerve stump inserted into an atelocollagen or silicone tube. The histological changes in the nerve ends and c-fos expression in the dorsal horn of the fourth lumbar spinal cord were evaluated at 4 weeks postoperatively. The regenerated nerve structure in the atelocollagen or silicone tube was very thin. In contrast, a typical bulbous neuroma was observed in the control group (the nerve stump was left in place). The atelocollagen and silicone tube groups demonstrated fewer c-fos-expressed cells in the spinal cord than the controls. These results suggest that capping by an atelocollagen tube, like that by a silicone tube, might successfully prevent an amputated neuroma from forming, and suppress induced pain. The atelocollagen tube may be a promising biomaterial for the prevention or treatment of a painful amputation neuroma.

  18. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

    PubMed Central

    2012-01-01

    Introduction Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy. Methods In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®). Results A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001). Conclusion Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur. PMID:22695007

  19. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into...

  20. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into...

  1. 21 CFR 868.5800 - Tracheostomy tube and tube cuff.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into...

  2. Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation.

    PubMed

    Grgurich, Erin; Arnemann, Cynthia; Amon, Kim; Horton, Rose; Carlson, Jestin N

    As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

  3. 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.

  4. Pollen tube development.

    PubMed

    Johnson, Mark A; Kost, Benedikt

    2010-01-01

    Pollen tubes grow rapidly in a strictly polarized manner as they transport male reproductive cells through female flower tissues to bring about fertilization. Vegetative pollen tube cells are an excellent model system to investigate processes underlying directional cell expansion. In this chapter, we describe materials and methods required for (1) the identification of novel factors essential for polarized cell growth through the isolation and analysis of Arabidopsis mutants with defects in pollen tube growth and (2) the detailed functional characterization of pollen tube proteins based on transient transformation and microscopic analysis of cultured tobacco pollen tubes.

  5. REACTOR COOLANT TUBE SEAL

    DOEpatents

    Morris, W.J.

    1958-12-01

    A plle-flattenlng control element and a fluid seal therefore to permit movement of the element into a liquld contnining region of a neutronlc reactor are described. The device consists of flattened, thin-walled aluminum tubing contalnlng a uniform mixture of thermal neutron absorbing material, and a number of soft rubber closures for the process tubes, having silts capable of passing the flattened elements therethrough, but effectively sealing the process tubes against fluld leaknge by compression of the rubber. The flattened tubing is sufficiently flexible to enable it to conform to the configuratlon of the annular spacing surrounding the fuel elements ln the process tubes.

  6. 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.

  7. Comparative trial of succinylcholine vs low dose atracurium-lidocaine combination for intubation in short outpatient procedures.

    PubMed Central

    Luyk, N. H.; Weaver, J. M.; Quinn, C.; Wilson, S.; Beck, F. M.

    1990-01-01

    Despite its many disadvantages, succinylcholine is the most commonly used drug for intubation of patients for short out-patient procedure. This double blind trial compared a low dose atracurium/lidocaine combination to succinylcholine for intubation in 40 ASA1 adult patients. Low dose atracurium/lidocaine provided clinical intubating conditions at two minutes and cardiovascular stability equivalent to succinylcholine with significantly less myalgia. Spontaneous respiration was slower after low dose atracurium/lidocaine relative to succinylcholine. Low dose atracurium/lidocaine may provide an acceptable alternative to succinylcholine for intubation in short outpatient procedures. PMID:2096747

  8. Heat tube device

    NASA Technical Reports Server (NTRS)

    Khattar, Mukesh K. (Inventor)

    1990-01-01

    The present invention discloses a heat tube device through which a working fluid can be circulated to transfer heat to air in a conventional air conditioning system. The heat tube device is disposable about a conventional cooling coil of the air conditioning system and includes a plurality of substantially U-shaped tubes connected to a support structure. The support structure includes members for allowing the heat tube device to be readily positioned about the cooling coil. An actuatable adjustment device is connected to the U-shaped tubes for allowing, upon actuation thereof, for the heat tubes to be simultaneously rotated relative to the cooling coil for allowing the heat transfer from the heat tube device to air in the air conditioning system to be selectively varied.

  9. [Endoscopic diagnosis, treatment and prevention of intubation related injuries of the larynx and trachea in neurosurgical patients].

    PubMed

    Gasanov, A L; Levitskaia, N N; Pinchuk, T P; Danielian, Sh N; Petrikov, S S; Efremenko, S V

    2013-01-01

    The goal of the study was to assess of efficacy of endoscopic diagnosis, prevention and treatment of intubation related larynx and tracheal injuries in patients with acute neurosurgical pathology and prolonged mechanical ventilation. 199 patients with different neurosurgical pathology were enrolled in the study group. Mean age was 50 +/- 14. Control group consisted of 399 patient. Mean age was 43 +/- 12. Clinical state of patient from both group were similar. Endoscopic method in the study group included revision of airways via nasal route with tracheostomy tube inserted. Larynx and tracheal injuries by endoscopy were identified in 42 patients (33.6%) in the study group and in 12 patients (7.6) in the control group. Such injuries weren't mentioned in 83 patients in study group and in 146 patients of the control group. Tracheal stenosis was developed in the study group in 0,8% of patients, which is by 7,9 times lower than in the control group (6.3%). We consider that this result was achieved due to our approach to treatment and prevention of tracheal stenosis.

  10. Intercostal drainage tube or intracardiac drainage tube?

    PubMed Central

    Anitha, N.; Kamath, S. Ganesh; Khymdeit, Edison; Prabhu, Manjunath

    2016-01-01

    Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near-exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure. PMID:27397467

  11. Preparing Anesthetists to Manage Cannot Intubate/Cannot Ventilate Situations.

    PubMed

    Wofford, Kenneth A

    2017-01-01

    Cannot intubate/cannot ventilate (CICV) situations during anesthesia are rare, potentially catastrophic to the patient, and difficult to predict. Widely adopted practice guidelines advocate an algorithmic approach to CICV situations in which the anesthetist: (a) recognizes the CICV situation, (b) calls for help, (c) steadily progresses through a variety of methods to ventilate the patient and secure the airway, (d) restores ventilation via an infraglottic airway if the patient cannot be safely awakened prior to becoming moribund. Despite widespread consensus that rapid progression to placement of an infraglottic airway is critical to the survival of the patient in a CICV situation, the rarity of CICV is a substantial barrier for anesthetists attempting to gain and maintain skill at placing infraglottic airways. Peer-reviewed literature reveals a number of themes relevant to training anesthetists in infraglottic airway placement. Specific training in infraglottic airway access consistently decreased the time required for anesthetists to decide to place an infraglottic airway. No one approach or method for placing an infraglottic airway was consistently faster or more successful. Model fidelity (i.e., the use of low-fidelity task trainers vs. high-fidelity simulated patients) during teaching did not affect the performance of anesthetists at placing infraglottic airways, and performance rapidly plateaued after five repetitions during teaching. Finally, skill at placing an infraglottic airway was sustained for 6 to 12 months after training. These findings have implications for how nurse anesthetists should learn and sustain the skill of infraglottic airway placement. Nurse anesthetists should undergo initial training that requires the repetitive placement of infraglottic airways, and receive sustainment training every 6 to 12 months thereafter. Although rarely used, the skill of an anesthetist in infraglottic airway placement can mean the difference between life and

  12. 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

  13. TPV Tube Generators for Apartment Building and Industrial Furnace Applications

    NASA Astrophysics Data System (ADS)

    Fraas, Lewis M.; Avery, James E.; Daniels, Wilbert E.; Huang, Huang X.; Malfa, Enrico; Venturino, Matteo; Testi, Giandomenico; Mascalzi, Gianni; Wuenning, Joachim G.

    2003-01-01

    Major changes in the regulation of electric and natural gas industries during recent years have forced energy companies to explore opportunities in small-size Combined Heat and Power systems. These differ fundamentally from the traditional model of central generation and delivery since small, modular electric generators can be located very close to end-users inside a building or a single house within an industrial area, combined with the production of heat and cold. In particular, interest is growing in the new technologies for sub-100kWe units, including systems based on thermophotovoltaic (TPV) technology. TPV generator tubes can be inserted into hot furnaces to generate electricity and low-grade heat. In this generator tube, a water-cooled GaSb photovoltaic converter array inside the tube faces outward toward an infrared emitter liner mounted on the inside surface of the closed-end tube. Each tube can be sized to generate several kW and a given furnace can heat several tubes. We have conducted pilot experiments on key components in order to develop the concept just described. This includes a pilot scale array tested in an electrical furnace that heat a 3″ diameter alumina tube with an infrared emitting liner. Also, a silicon carbide tube with a water-cooling system was tested in a ceramic fiber lined furnace equipped with a commercial 200 kW flameless regenerative burner, simulating a TPV generator tube in such a system.

  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. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section

    PubMed Central

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m2 who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m2. The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively. PMID:28246593

  16. New visible endotracheal intubation method using the endoscope system for mice inhalational anesthesia.

    PubMed

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

    2014-06-01

    Appropriate and effective anesthesia is critical, because it has a strong influence on laboratory animals, and its affect greatly impacts the experimental data. Inhalational anesthesia by endotracheal intubation is currently prevailing in general anesthesia and is prefered over injection anesthesia, especially for large laboratory animals, because it is a safe and easy control agent. However, it is not common for small laboratory animals, because of the high degree of technical skills required. We assessed the capability of use for mice of the endotracheal intubation by using the endoscope system "TESALA AE-C1" and inhalational anesthesia using a ventilator. Endotracheal intubation was successfully performed on all 10 C57BL/6 mice injected with M/M/B: 0.3/4/5 comprised of medetomidine, midazoram and butorphanol, at a dose of 0.3 mg/kg + 4.0 mg/kg + 5.0 mg/kg body weight/mouse, respectively. After the intubated mice were connected with the inhalational anesthesia circuit and the ventilator, vital signs were measured until 15 min after the connection. The data with M/M/B: 0.3/4/5 showed stable and normal values, which indicated that this new endotracheal intubation method was simple, reliable and safe, which mean that this anesthesia is favorable in regard to the animal's welfare.

  17. [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.

  18. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section.

    PubMed

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon; Limpawattana, Panita; Siriussawakul, Arunotai

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m(2) who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m(2). The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively.

  19. The etiological factors of recurrence after tracheal resection and reconstruction in post-intubation stenosis.

    PubMed

    Abbasidezfouli, Azizollah; Akbarian, Ehsan; Shadmehr, Mohammad Behgam; Arab, Mehrdad; Javaherzadeh, Mojtaba; Pejhan, Saviz; Abbasi-Dezfouli, Golbahar; Farzanegan, Roya

    2009-09-01

    We assessed several factors which might be responsible for the recurrence of post-intubation airway stenosis in a large group of patients who underwent resection and reconstruction surgery by one surgical team. Four hundred and ninety-four patients underwent reconstruction of post-intubation airway stenosis during 1995-2006. The case group comprised patients who had developed recurrence, while controls had no recurrence. The diagnosis of the recurrence was made based on the presence of clinical signs or symptoms and bronchoscopic evaluation. The following variables were compared in both groups: age, sex, duration of intubation, reason for intubation, period of time between intubation and surgery, history of previous tracheotomy, previous therapeutic interventions, subglottic involvement, length of resection, presence of unusual tension at the site of anastomosis and anastomotic infection. Fifty-two patients (10.5%) developed recurrence. Lengthy resection, presence of tension at the site of anastomosis, anastomotic infection and subglottic involvement were significantly higher in the case group. Logistic regression model showed that the three main predictors are anastomotic infection (OR=3.44), subglottic involvement (OR=2.43), and presence of tension (OR=1.97), respectively. It is concluded that the surgeon can play an important role in avoiding recurrence by decreasing tension, preventing infection, and preserving subglottic structure.

  20. [Joseph O'Dwyer--a pioneer in endotracheal intubation and pressure respiration].

    PubMed

    Goerig, M; Filos, K; Renz, D

    1988-10-01

    The oro- and nasotracheal intubation has been developed into one of the most important techniques in anaesthesiology. Originally, intubations were carried out for overcoming acute diphteric airway obstruction in children. As late as the end of the 19 century, the only life saving chance was to perform tracheotomy. Although the technique for this operation at that time was well developed, it was very often impossible to save the life of those moribund patients. The famous American paediatrician Joseph O'Dwyer re-initiated the technique of intubation and his excellent results became great success and promoted world-wide use, although it was a well-known procedure at that time. His intubation method - also called the O'Dwyer-Method-was first published in the N. Y. Medical Journal as "Intubation of the Larynx" 100 years ago. Working together with the surgeon George Fell, O'Dwyer designed an apparatus, for artificial respiration. As Fell-O'Dwyer Apparatus it was widely used in cases of asphyxia, - even in those caused by overdosage of anaesthetics. Further developments of the apparatus permitted positive pressure ventilation and the combination with a funnel for narcotics increased the repertory of anaesthesiological possibilities.

  1. Pulse Tube Refrigerator

    NASA Astrophysics Data System (ADS)

    Matsubara, Yoichi

    The pulse tube refrigerator is one of the regenerative cycle refrigerators such as Stirling cycle or Gifford-McMahon cycle which gives the cooling temperature below 150 K down to liquid helium temperature. In 1963, W. E. Gifford invented a simple refrigeration cycle which is composed of compressor, regenerator and simple tube named as pulse tube which gives a similar function of the expander in Stirling or Gifford-McMahon cycle. The thermodynamically performance of this pulse tube refrigerator is inferior to that of other regenerative cycles. In 1984, however, Mikulin and coworkers made a significant advance in pulse tube configuration called as orifice pulse tube. After this, several modifications of the pulse tube hot end configuration have been developed. With those modifications, the thermodynamic performance of the pulse tube refrigerator became the same order to that of Stirling and Gifford-McMahon refrigerator. This article reviews the brief history of the pulse tube refrigerator development in the view point of its thermodynamically efficiency. Simplified theories of the energy flow in the pulse tube have also been described.

  2. Lunar Lava Tube Sensing

    NASA Technical Reports Server (NTRS)

    York, Cheryl Lynn; Walden, Bryce; Billings, Thomas L.; Reeder, P. Douglas

    1992-01-01

    Large (greater than 300 m diameter) lava tube caverns appear to exist on the Moon and could provide substantial safety and cost benefits for lunar bases. Over 40 m of basalt and regolith constitute the lava tube roof and would protect both construction and operations. Constant temperatures of -20 C reduce thermal stress on structures and machines. Base designs need not incorporate heavy shielding, so lightweight materials can be used and construction can be expedited. Identification and characterization of lava tube caverns can be incorporated into current precursor lunar mission plans. Some searches can even be done from Earth. Specific recommendations for lunar lava tube search and exploration are (1) an Earth-based radar interferometer, (2) an Earth-penetrating radar (EPR) orbiter, (3) kinetic penetrators for lunar lava tube confirmation, (4) a 'Moon Bat' hovering rocket vehicle, and (5) the use of other proposed landers and orbiters to help find lunar lava tubes.

  3. Silicon microdosimetry.

    PubMed

    Agosteo, Stefano; Pola, Andrea

    2011-02-01

    Silicon detectors are being studied as microdosemeters since they can provide sensitive volumes of micrometric dimensions. They can be applied for assessing single-event effects in electronic instrumentation exposed to complex fields around high-energy accelerators or in space missions. When coupled to tissue-equivalent converters, they can be used for measuring the quality of radiation therapy beams or for dosimetry. The use of micrometric volumes avoids the contribution of wall effects to the measured spectra. Further advantages of such detectors are their compactness, cheapness, transportability and a low sensitivity to vibrations. The following problems need to be solved when silicon devices are used for microdosimetry: (i) the sensitive volume has to be confined in a region of well-known dimensions; (ii) the electric noise limits the minimum detectable energy; (iii) corrections for tissue-equivalency should be made; (iv) corrections for shape equivalency should be made when referring to a spherical simulated site of tissue; (v) the angular response should be evaluated carefully; (vi) the efficiency of a single detector of micrometric dimensions is very poor and detector arrays should be considered. Several devices have been proposed as silicon microdosemeters, based on different technologies (telescope detectors, silicon on insulator detectors and arrays of cylindrical p-n junctions with internal amplification), in order to satisfy the issues mentioned above.

  4. Novel biopsy forceps anchoring technique for completion of direct cholangioscopy after freehand intubation.

    PubMed

    Zimmer, V

    2017-03-16

    The widespread dissemination of direct cholangioscopy (DC) has been hindered by the need for special equipment and the perceived high procedure-related technical complexity. DC with freehand intubation has been reported to have high technical success rates in a single report, albeit the pervasive expert opinion question its clinical applicability, thus most centers resort to anchoring techniques for intubation and/or scope advancement.[1] However, although newer anchoring balloons are being developed, first-generation balloons have been withdrawn from the market.[2] Of interest, in a recent study a next-generation double bending cholangioscope has been reported to yield high rates of intubation success without endoscopic accessories. This article is protected by copyright. All rights reserved.

  5. [Preliminary study of transcutaneous oxygen partial pressure in adults after discontinuing normobaric hyperoxia during intubation].

    PubMed

    Brille, P; Milhaud, A; Delloue, M; Starobinsky, E; Kadri, N; Dembele, L; Tinturier, F; Cristin, J

    1989-01-01

    When tracheal intubation is conducted with traditional laryngoscope PtcO2 fall during the first minute after intubation; when continuous O2 supplied laryngoscope (Laryng O2) is used PtcO2 rise; the difference is statistically significant (p less than 0.001) either the subjects are in curarisation apnea or in spontaneous ventilation. With traditional laryngoscope, the fall is faster with spontaneous ventilation conditions than during curarisation apnea. Likewise in normal conscient subject the same fall is faster (p less than 0.001) during first minute of posthyperoxic spontaneous quiet ventilation than the first minute of voluntary hypocapnic apnea induced by hyperventilation during the same hyperoxia. Such results have to be taken into account for the indications of tracheal intubation technical means if hypoxic conditions are to be suspected, particularly for infants and subjects with cardio-respiratory failure.

  6. Methemoglobinemia after fiberoptic intubation in a patient with an unstable cervical fracture: a case report.

    PubMed

    Basra, Sushil K; Vives, Michael J; Reilly, Mark C; Reiter, Mitchell F; Kushins, Lawrence G

    2006-06-01

    Methemoglobinemia, a condition associated with cyanosis and diminished pulse oximetry values, has been reported after use of local anesthetics to facilitate fiberoptic intubation. The majority of reports in the literature detail this development during diagnostic procedures such as endoscopy and bronchoscopy. A case of methemoglobinemia in a multiple-injury patient with an unstable compressive-flexion injury of the cervical spine undergoing fiberoptic intubation is presented. A literature review of this entity is also presented. The patient underwent fiberoptic intubation using topical pharyngeal anesthetics before planned cervical corpectomy, strut grafting and instrumentation. He became acutely cyanotic with abruptly diminished pulse oximetry readings. Subsequent blood gas analysis demonstrated methemoglobinemia. Intravenous methylene blue administration led to an uncomplicated resolution of the condition. Surgeons and anesthesiologists who manage such patients should be aware of methemoglobinemia, a rare but potentially fatal complication related to topical airway anesthetics.

  7. [Regional anesthesia of the airways in difficult tracheal intubation in a conscious patient with spontaneous respiration].

    PubMed

    Dziadz'ko, A M

    2002-01-01

    Clinical pattern of anesthesia, hemodynamic and gas exchange states were evaluated in 64 patients with congenital or acquired damage of maxillary-facial region due to tumor or trauma. 51 patients were intubated under locoregional anesthesia of the upper respiratory tract (superior laryngeal nerves, glossopharyngeal nerves, intratracheal anesthesia) by means of blind nasal or oral fiberoptic retrograde and by using laryngeal mask technique. In 12 cases fiberoptic device was used for intubation under local anesthesia by lidocaine solution. There was no airways obstruction in any case. Satisfactory anesthesia in oropharynx, larynx and trachea was reached in all cases, the most profound blockage of airways and lack of pharyngeal and laryngeal reflexes being in patients under locoregional anesthesia. So locoregional anesthesia can be used for awake intubation.

  8. The rigid nasendoscope as a tool for difficult tracheal intubation: a manikin study.

    PubMed

    Goodwin, N; Latto, I P; Hodzovic, I; Williams, G; Hall, J E

    2003-07-01

    We examined the use of the 30 degrees rigid nasendoscope in aiding difficult tracheal intubations. A Cormack and Lehane grade 4 difficult intubation (no view of glottis or epiglottis) was set up on a manikin. After 10 s of tuition, 40 anaesthetists attempted to pass a standard gum elastic bougie between the cords, with and without the nasendoscope, in randomised order. A bougie curved to an 'optimal curve' was also tested. Using the standard bougie 13/40 (33%) passed the bougie between the cords without the nasendoscope, compared with 31/40 (78%) when using the nasendoscope (p < 0.001). The 'optimal curve' bougie resulted in 29/40 (73%) and 39/40 (98%) success rates without and with the nasendoscope, respectively (p = 0.004). The nasendoscope is a simple and easy to use tool in grade 4 intubation, and results are improved further by the use of an 'optimal curve' bougie.

  9. Experimental and numerical study on unsteady natural convection heat transfer in helically coiled tube heat exchangers

    NASA Astrophysics Data System (ADS)

    Neshat, E.; Hossainpour, S.; Bahiraee, F.

    2014-06-01

    Both of experimental and numerical investigations were performed to understand unsteady natural convection from outer surface of helical coils. Four helical coils with two different curvature ratios were used. Each coil was mounted in the shell both vertically and horizontally. The cold water was entered the coil and the hot water in the shell was cooling by unsteady natural convection. A CFD code was developed to simulate natural convection heat transfer. Equations of tube and shell are solved simultaneously. Statistical analyses have been done on data points of temperature and natural convection Nusselt number. It was revealed that shell-side fluid temperature and the Nusselt number of the outer surface of coils are functions of in-tube fluid mass flow rate, specific heat of fluids and geometrical parameters including length, inner diameter of the tube and the volume of the shell, and time.

  10. Conduction cooled tube supports

    DOEpatents

    Worley, Arthur C.; Becht, IV, Charles

    1984-01-01

    In boilers, process tubes are suspended by means of support studs that are in thermal contact with and attached to the metal roof casing of the boiler and the upper bend portions of the process tubes. The support studs are sufficiently short that when the boiler is in use, the support studs are cooled by conduction of heat to the process tubes and the roof casing thereby maintaining the temperature of the stud so that it does not exceed 1400.degree. F.

  11. Programming DNA tube circumferences.

    PubMed

    Yin, Peng; Hariadi, Rizal F; Sahu, Sudheer; Choi, Harry M T; Park, Sung Ha; Labean, Thomas H; Reif, John H

    2008-08-08

    Synthesizing molecular tubes with monodisperse, programmable circumferences is an important goal shared by nanotechnology, materials science, and supermolecular chemistry. We program molecular tube circumferences by specifying the complementarity relationships between modular domains in a 42-base single-stranded DNA motif. Single-step annealing results in the self-assembly of long tubes displaying monodisperse circumferences of 4, 5, 6, 7, 8, 10, or 20 DNA helices.

  12. Ruggedized electronographic tube development

    NASA Technical Reports Server (NTRS)

    Nevin, S.

    1981-01-01

    Because of their glass components and lack of far ultraviolet sensitivity, currently available Spectracons are not suited for rocket launch. Technology developed for second generation image tubes and for magnetically focused image tubes can be applied to improve the optical and mechanical properties of these magnetically focused electronographic tubes whose 40 kilovolt signal electrons exit a 4-micrometer thick mica window and penetrate a photographic recording emulsion.

  13. Retrograde gastrojejunostomy tube migration.

    PubMed

    Adesina, Adeleke; Rammohan, Guhan; Jeanmonod, Rebecca

    2014-01-01

    Percutaneous enteral feeding tubes are placed about 250,000 times each year in the United States. Although they are relatively safe, their placement may be complicated by perforation, infection, bleeding, vomiting, dislodgment, and obstruction. There have been numerous reports of antegrade migration of gastrojejunostomy (G-J) tubes. We report a case of G-J tube regurgitation following protracted vomiting and discuss the management of this very rare entity.

  14. COAXIAL TUBE COUPLING

    DOEpatents

    Niemoth, H.R.

    1963-02-26

    BS>This patent shows a device for quickly coupling coaxial tubes in metal-to-metal fashion, so as to be suitable for use in a nuclear reactor. A threaded coliar urges a tapered metal extension on the outer coaxial tube into a tapered seat in the device and simultaneously exerts pressure through a coaxial helical spring so that a similar extension on the inner tube seats in a similar seat near the other end. (AEC)

  15. TUBE SPLITTING APPARATUS

    DOEpatents

    Frantz, C.E.; Cawley, W.E.

    1961-05-01

    A tool is described for cutting a coolant tube adapted to contain fuel elements to enable the tube to be removed from a graphite moderator mass. The tool splits the tube longitudinally into halves and curls the longitudinal edges of the halves inwardly so that they occupy less space and can be moved radially inwardly away from the walls of the hole in the graphite for easy removal from the graphite.

  16. Conditions of endotracheal intubation with and without muscle relaxant in children.

    PubMed

    Rizvanović, Nermina; Čaušević, Senada; Šabanović, Adisa

    2017-02-01

    Aim To compare intubation conditions and hemodynamic response of two induction regimens, with or without muscle relaxant using a combination of either fentanyl and propofol or propofol and suxamethonium. Methods A total of 80 children aged 4-12 years were enrolled in a prospective randomized double-blinded study. Children were randomly allocated in two equal groups. In group F induction was done with fentanyl and propofol, while propofol and suxamethonium were used in group S. Intubation conditions were assessed using Copenhagen Consensus Score (CCS), based on ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation and limb movements. Systolic blood pressure (SBP),diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were observed at preinduction, postinduction and postintubation at 1, 3 and 5 minute. Results Clinically acceptable CCS was found in 95% of patients in group F versus 100% in group S. Intubation conditions wereexcellent in 85%, good in 10% and poor in 5% of patients in group F. In the group F, signifficantly lower SBP and MAP postinduction and postintubation at 1 and 3 minute, and lower DBP postinduction and postintubation at 1 minute (p<0.05) was found comparing to group S. In group S, significantly higher postinduction and postintubation HR at 1 minute was found comparing to group F (p<0.05). Conclusion Induction combination fentanyl-propofol provide acceptable intubation conditions comparable with suxamethonium in children. This induction regimen ensures better hemodynamic stability associated with endotracheal intubation. It could be recommended for intubation when muscle relaxants are not indicated.

  17. 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

  18. Effect of varied training techniques on field endotracheal intubation success rates.

    PubMed

    Stewart, R D; Paris, P M; Pelton, G H; Garretson, D

    1984-11-01

    A pool of 146 mobile intensive care unit paramedics was divided into four equal groups and trained in the technique of direct laryngoscopic endotracheal intubation of cardiac arrest or deeply comatose patients. Group 1 was selected from supervisors and crew chiefs and trained as preceptors. The remaining paramedics were assigned to three other study groups. Groups 1 and 2 were trained with a didactic presentation followed by manikin practice, an animal laboratory exercise, and operating room experience. Group 3 had no OR experience; Group 4 had only didactic/manikin training. Intubations were observed by preceptors on scene. During the study period of 27 months, 689 of 763 patients (90.3%) were successfully intubated by 122 paramedics. While results suggest variation in skill levels according to training group (Group 1, 92.4%; Group 2, 87.6%, Group 3, 83.3%; Group 4, 76.9%), statistical analysis allowing for the variables of seniority and number of intubations performed by personnel failed to reveal differences in groups attributable to training programs. Complication rates were relatively low for all groups, the most common being prolonged intubation attempts. A significant improvement in the skill was seen as the study progressed when groups are pooled and compared. The findings suggest that endotracheal intubation of deeply comatose or cardiac arrest patients is a field procedure that can be performed safely and skillfully by well-monitored paramedical personnel. Operating room or animal laboratory experience may increase initial success levels, but these factors do not appear to greatly influence eventual performance or incidence of complications of the procedure.

  19. The optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

    PubMed Central

    Ezzat, Alaa; Fathi, Essam; Zarour, Ahmad; Singh, Rajvir; Abusaeda, M. Osama; Hussien, M. Magdy

    2011-01-01

    Background Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose (ED95) of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. Objectives To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. Methods This retrospective comparative study was carried into three groups of ASA III & IV (American Society of Anesthesiologist's Physical Status III and IV) non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board (IRB) approval was obtained. This study was limited to 88 patients who received fentanyl 1µg/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Results Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly (P<.001). Tracheal intubation was 100% successful in the three groups of patients. Conclusion Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III & IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes. PMID:21772925

  20. Sapphire tube pressure vessel

    SciTech Connect

    Outwater, J.O.

    2000-05-23

    A pressure vessel is provided for observing corrosive fluids at high temperatures and pressures. A transparent Teflon bag contains the corrosive fluid and provides an inert barrier. The Teflon bag is placed within a sapphire tube, which forms a pressure boundary. The tube is received within a pipe including a viewing window. The combination of the Teflon bag, sapphire tube and pipe provides a strong and inert pressure vessel. In an alternative embodiment, tie rods connect together compression fittings at opposite ends of the sapphire tube.

  1. Composite Pulse Tube

    NASA Technical Reports Server (NTRS)

    Martin, Jerry L.; Cloyd, Jason H.

    2007-01-01

    A modification of the design of the pulse tube in a pulse-tube cryocooler reduces axial thermal conductance while preserving radial thermal conductance. It is desirable to minimize axial thermal conductance in the pulse-tube wall to minimize leakage of heat between the warm and cold ends of the pulse tube. At the same time, it is desirable to maximize radial thermal conductance at the cold end of the pulse tube to ensure adequate thermal contact between (1) a heat exchanger in the form of a stack of copper screens inside the pulse tube at the cold end and (2) the remainder of the cold tip, which is the object to which the heat load is applied and from which heat must be removed. The modified design yields a low-heat-leak pulse tube that can be easily integrated with a cold tip. A typical pulse tube of prior design is either a thin-walled metal tube or a metal tube with a nonmetallic lining. It is desirable that the outer surface of a pulse tube be cylindrical (in contradistinction to tapered) to simplify the design of a regenerator that is also part of the cryocooler. Under some conditions, it is desirable to taper the inner surface of the pulse tube to reduce acoustic streaming. The combination of a cylindrical outer surface and a tapered inner surface can lead to unacceptably large axial conduction if the pulse tube is made entirely of metal. Making the pulse-tube wall of a nonmetallic, lowthermal- conductivity material would not solve the problem because the wall would not afford the needed thermal contact for the stack of screens in the cold end. The modified design calls for fabricating the pulse tube in two parts: a longer, nonmetallic part that is tapered on the inside and cylindrical on the outside and a shorter, metallic part that is cylindrical on both the inside and the outside. The nonmetallic part can be made from G-10 fiberglass-reinforced epoxy or other low-thermal-conductivity, cryogenically compatible material. The metallic part must have high

  2. Wound tube heat exchanger

    DOEpatents

    Ecker, Amir L.

    1983-01-01

    What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

  3. Sapphire tube pressure vessel

    DOEpatents

    Outwater, John O.

    2000-01-01

    A pressure vessel is provided for observing corrosive fluids at high temperatures and pressures. A transparent Teflon bag contains the corrosive fluid and provides an inert barrier. The Teflon bag is placed within a sapphire tube, which forms a pressure boundary. The tube is received within a pipe including a viewing window. The combination of the Teflon bag, sapphire tube and pipe provides a strong and inert pressure vessel. In an alternative embodiment, tie rods connect together compression fittings at opposite ends of the sapphire tube.

  4. Fuel nozzle tube retention

    DOEpatents

    Cihlar, David William; Melton, Patrick Benedict

    2017-02-28

    A system for retaining a fuel nozzle premix tube includes a retention plate and a premix tube which extends downstream from an outlet of a premix passage defined along an aft side of a fuel plenum body. The premix tube includes an inlet end and a spring support feature which is disposed proximate to the inlet end. The premix tube extends through the retention plate. The spring retention feature is disposed between an aft side of the fuel plenum and the retention plate. The system further includes a spring which extends between the spring retention feature and the retention plate.

  5. 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

  6. Measurement of respiratory impedance by impulse oscillometry--effects of endotracheal tubes.

    PubMed

    Kuhnle, G E; Brandt, T; Roth, U; Goetz, A E; Smith, H J; Peter, K

    2000-12-01

    Impulse Oscillometry is a new, noninvasive method to measure respiratory impedance, i.e. airway resistance and reactance at different oscillation frequencies. These parameters are potentially useful for the monitoring of respiratory mechanics in the critically ill patent with respiratory dysfunction. The endotracheal tube, used to mechanically ventilate these patients, however, represents an additional nonlinear impedance that introduces artifacts into the measurements. The objective of this work was therefore to investigate the effects of clinically available endotracheal tubes on resistance and reactance of an in vitro analogue of the respiratory system. Additionally, the effects of decreasing the compressible gas volume in this experimental model, as a simulation of decreased lung capacity and compliance, was investigated. Impulse oscillometric measurements of the test analogue gave highly reproducible results with and without an endotracheal tube. The tubes had significant influence on the measurement of the test object at all frequencies investigated. Changes of low frequent reactance were negligible - at least if repetitive measurements of the same system are performed - for realistic measurement of airway resistance, a correction of the tube impedance or measurement of the pressure distal of the tube is required. Resistance increased and low frequent reactance decreased significantly with decreasing gas volume. These changes were of magnitudes higher than the variations due to the introduction of the endotracheal tubes. Our results suggest that changes of respiratory reactance measured with impulse oscillometry may be used as a monitoring parameter in intubated patients.

  7. [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.

  8. 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.

  9. Novel Metal Encapsulated Silicon Cage Clusters

    NASA Astrophysics Data System (ADS)

    Kawazoe, Yoshiyuki

    2002-03-01

    The discovery of novel nano-forms of carbon such as fullerenes and nanotubes created much interest in the search for similar novel structures of silicon for applications in nano-devices. However, these cage structures are not stable for silicon. Small silicon clusters having upto about 20 atoms are found to have prolate structures in which a 10-atom unit plays an important role. Here we report results of new findings(Vijay Kumar and Yoshiyuki Kawazoe, ``Metal-Encapsulated Fullerenelike and Cubic Caged Clusters of Silicon", Phys. Rev. Lett., 87[4] (2001), 045503-1-045503-4.) on a rich variety of caged silicon clusters that are realized by encapsulating a metal atom. The shape and size of these new clusters depend upon the metal atom which also determines their properties. As silicon is the most important material for devices, these findings offer new opportunities to design novel nano-silicon based devices. The results have been obtained by performing computer experiments using ab initio calculations in an effort to stabilize a silicon cage of 20 atoms. We have tried several metal atoms and used a cage shrinking approach. These led to the findings of fullerene and cubic type stable symmetric clusters in the range of 14 to 16 silicon atoms, depending on the encapsulated metal atom. A Frank-Kasper polyhedron, M@Si16 is found to be of lowest energy for M = Ti and Hf with exceptionally large gaps of about 2.35 eV that lie in the optical region. Further studies have been done to stabilize the smallest fullerene shape of 20 silicon atoms and to develop assemblies of clusters to form more interesting nano-scale structures like wires, which might be useful industrially to realize conducting atomic lines covered by semiconductor tubes.

  10. Steam generator tube failures

    SciTech Connect

    MacDonald, P.E.; Shah, V.N.; Ward, L.W.; Ellison, P.G.

    1996-04-01

    A review and summary of the available information on steam generator tubing failures and the impact of these failures on plant safety is presented. The following topics are covered: pressurized water reactor (PWR), Canadian deuterium uranium (CANDU) reactor, and Russian water moderated, water cooled energy reactor (VVER) steam generator degradation, PWR steam generator tube ruptures, the thermal-hydraulic response of a PWR plant with a faulted steam generator, the risk significance of steam generator tube rupture accidents, tubing inspection requirements and fitness-for-service criteria in various countries, and defect detection reliability and sizing accuracy. A significant number of steam generator tubes are defective and are removed from service or repaired each year. This wide spread damage has been caused by many diverse degradation mechanisms, some of which are difficult to detect and predict. In addition, spontaneous tube ruptures have occurred at the rate of about one every 2 years over the last 20 years, and incipient tube ruptures (tube failures usually identified with leak detection monitors just before rupture) have been occurring at the rate of about one per year. These ruptures have caused complex plant transients which have not always been easy for the reactor operators to control. Our analysis shows that if more than 15 tubes rupture during a main steam line break, the system response could lead to core melting. Although spontaneous and induced steam generator tube ruptures are small contributors to the total core damage frequency calculated in probabilistic risk assessments, they are risk significant because the radionuclides are likely to bypass the reactor containment building. The frequency of steam generator tube ruptures can be significantly reduced through appropriate and timely inspections and repairs or removal from service.

  11. [A Patient with Klippel-Feil Syndrome Having Difficulties in Inserting and Placing an Endotracheal Tube under General Anesthesia].

    PubMed

    Hashidume, Yusuke; Tachibana, Shunsuke; Takada, Yukimasa; Edanaga, Mitsutaka; Yamakage, Michiaki

    2016-04-01

    A patient with Klippel-Feil syndrome had difficulties in inserting and placing an endotracheal tube under general anesthesia. Klippel-Feil syndrome, characterized by cervical vertebral fusion, scoliosis and endocardiosis, is a rare disease. Anesthesiologists should pay attention to management of anesthesia in airway troubles. A 53-year-old woman diagnosed with Klippel-Feil syndrome was scheduled for general anesthesia with intubation. We tried to insert an endotracheal tube using McGRATH MAC, but it was difficult to insert and place the tube. Finally, we managed to insert a 5.5 mm endotracheal tube. The three-dimensional computed tomography (3D-CT) images after the operation, showed tracheal stenosis at the level of the fourth and fifth cervical vertebrae. In cases where airway difficulties are expected, evaluating 3D-CT images might be useful in airway management.

  12. An experimental study of pulsatile flow through compliant tubes

    NASA Astrophysics Data System (ADS)

    Sturgeon, Victoria; Savas, Omer; Saloner, David

    2006-11-01

    An experimental investigation is made into transitional behaviors and instability of oscillatory input flows through elastic tubes, a problem with applications to hemodynamics and flows in the pulmonary system. Sinusoidal input flow is driven through a compliant silicone model in a series of experiments to investigate the effects of wall motion. A novel mechanism allows active control and feedback over the pressure on the tube exterior. By comparing the pressure within and outside of the tube and modifying the exterior pressure accordingly, the tube is inflated in a controlled manner without altering the input flow. In these experiments, the tube wall is deformed sinusoidally with an amplitude of approximately ten percent of its radius. Experiments are conducted using varying values of the parameters α= a √φν and β= δx √φν where a is the tube radius, φ the angular velocity of the input flow, ν the kinematic viscosity, and δx the cross-stream averaged periodic displacement of a fluid particle undergoing pulsatile motion. For a given α, it is found that indications of conditional turbulence appear in this flow through elastic tubes at far lower values of β - and thus at lower amplitudes of oscillation - than are reported in the literature for flows through rigid tubing.

  13. Method for shaping polyethylene tubing

    NASA Technical Reports Server (NTRS)

    Kramer, R. C.

    1981-01-01

    Method forms polyethylene plastic tubing into configurations previously only possible with metal tubing. By using polyethylene in place of copper or stain less steel tubing inlow pressure systems, fabrication costs are significantly reduced. Polyethylene tubing can be used whenever low pressure tubing is needed in oil operations, aircraft and space applications, powerplants, and testing laboratories.

  14. Pyrotechnic Tubing Connector

    NASA Technical Reports Server (NTRS)

    Graves, Thomas J.; Yang, Robert A.

    1988-01-01

    Tool forms mechanical seal at joint without levers or hydraulic apparatus. Proposed tool intended for use in outer space used on Earth by heavily garbed workers to join tubing in difficult environments. Called Pyrotool, used with Lokring (or equivalent) fittings. Piston slides in cylinder when pushed by gas from detonating pyrotechnic charge. Impulse of piston compresses fittings, sealing around butting ends of tubes.

  15. Ultrasonography for endotracheal tube position in infants and children.

    PubMed

    Jaeel, Pooja; Sheth, Mansi; Nguyen, Jimmy

    2017-03-01

    Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults but has been less studied in infants and children. We review the literature regarding US for ETT positioning in the pediatric population. A literature search was conducted using the Ovid and MEDLINE databases with search terms regarding US relating to ETT intubation and positioning in infants and children. Most studies in neonates and infants used the midsagittal suprasternal view. Studies reported >80% visualization of the ETT tip by US, and US interpretation of the ETT position correlated with the XR position in 73-100% of cases. Studies of older children used the suprasternal views, substernal views, and mid-axillary intercostal views. US appears comparable to XR and capnography in determining ETT position in this population.

  16. Fallopian Tube Catheterization

    PubMed Central

    Thurmond, Amy Suzanne

    2013-01-01

    Fallopian tube catheterization is used for treatment of infertility caused by proximal tubal occlusion, and has replaced surgical treatment for this condition. More recently, fallopian tube catheterization has been used for tubal sterilization. Interventional radiologists tested numerous methods for tubal occlusion using the rabbit as an animal model. As a result, a tubal device has recently been Food and Drug Administration approved for permanent sterilization using hysteroscopic guidance; it can also be placed fluoroscopically by fallopian tube catheterization as an “off-label” procedure. This is a 5-year continuation and update on a procedure that has been done by interventional radiologists for 25 years; history of the development of fallopian tube catheterization in women has been published in detail in this journal. Highlighted in this article will be description of the basic components needed for fallopian tube catheterization. PMID:24436565

  17. LSA Large Area Silicon Sheet Task Continuous Czochralski Process Development

    NASA Technical Reports Server (NTRS)

    Rea, S. N.

    1979-01-01

    A commercial Czochralski crystal growing furnace was converted to a continuous growth facility by installation of a small, in-situ premelter with attendant silicon storage and transport mechanisms. Using a vertical, cylindrical graphite heater containing a small fused quartz test tube linear from which the molten silicon flowed out the bottom, approximately 83 cm of nominal 5 cm diamter crystal was grown with continuous melt addition furnished by the test tube premelter. High perfection crystal was not obtained, however, due primarily to particulate contamination of the melt. A major contributor to the particulate problem was severe silicon oxide buildup on the premelter which would ultimately drop into the primary melt. Elimination of this oxide buildup will require extensive study and experimentation and the ultimate success of continuous Czochralski depends on a successful solution to this problem. Economically, the continuous Czochralski meets near-term cost goals for silicon sheet material.

  18. Complete subglottic tracheal stenosis managed with rigid bronchoscopy and T-tube placement

    PubMed Central

    Prasad, Kuruswamy Thurai; Dhooria, Sahajal; Sehgal, Inderpaul Singh; Aggarwal, Ashutosh Nath; Agarwal, Ritesh

    2016-01-01

    Surgery is the preferred treatment modality for benign tracheal stenosis. Interventional bronchoscopy is used as a bridge to surgery or in instances when surgery is not feasible or has failed. Stenosis in the subglottic trachea is particularly a treatment challenge, in view of its proximity to the vocal cords. Herein, we describe a patient with complete tracheal stenosis in the subglottic region, which developed after prolonged intubation and mechanical ventilation. The patient developed recurrent stenosis despite multiple surgical and endoscopic procedures. We were able to manage the patient successfully with rigid bronchoscopy and Montgomery T-tube placement. PMID:27890997

  19. [Contact allergy-induced tracheal stenosis caused by vulcanization accelerators in the endotracheal tube?].

    PubMed

    Niehaus, H H; Enzmann, H

    1995-07-01

    Tracheal stenoses occur mainly under iatrogenic conditions: they develop specially after long-term intubation, but also after tracheotomy. Etiological-pathogenic relevant factors include the mechanical irritation of mucosa, perichondrium and cartilage in addition to infected tracheal secretions. An allergic cell-mediated reaction in the respiratory tract has been already described. It is seldom recognized. The possibility of such a hyperergic, allergic, delayed reaction (Type IV Coombs-Gell response) with subsequent tracheal stenosis caused by rubber chemicals (accelerators) found in endotracheal tubes is presented in the following case report.

  20. Measuring contact angles inside of capillary tubes with a tensiometer.

    PubMed

    Extrand, C W; Moon, Sung In

    2014-10-01

    We describe a new tensiometry method that allows for determination of wetting inside small diameter tubes or hollow fibers, where the maximum force from the ultimate rise height of liquid is used to estimate advancing contact angles. The technique was first validated with transparent tubes of glass, poly(carbonate) (PC) and poly(tetrafluoroethylene) (PTFE) using four liquids: isopropanol, silicone oil, ethylene glycol and water. Advancing contact angles measured with the tensiometer agreed well with those estimated from final rise height. As this tensiometry technique does not require a view of the liquid, it can be used to measure the wettability inside opaque tubes. We demonstrated this with poly(ether ether ketone) (PEEK) tubes.

  1. Limitation of long term ventilation tube: in view of complications and hearing restoration.

    PubMed

    Yanagihara, N; Yagi, T

    1985-01-01

    The silicon-rubber T-tube was applied to 181 ears in 116 patients with chronic otitis media with effusion within last 5 years. Among the 181 ears, 81 (46%) accepted the T-tube without problems. In the remaining 97 ears, complications such as otorrhea, occlusion of the tube, extrusion of the tube, enlarged perforation and cholesteatoma occurred. However, in 161 ears (89%), the tube could be stabilized in the middle ear and functioned as ventilating tube beyond 3 months. Based on the incidence and prognosis of the ears with the complications and the results of hearing, we conclude that insertion of the T-tube is valuable and reliable method of treatment in the ears with retractions or atelectasis but in the ears with adhesion or granulation, this method of treatment has only limited value.

  2. The Effects of Intravenous Dexmedetomidine Injections on IOP in General Anesthesia Intubation: A Meta-Analysis

    PubMed Central

    Zhu, Yu; Liu, Zhen

    2017-01-01

    Objective. The aim of this meta-analysis is to evaluate the effects of dexmedetomidine on intraocular pressure (IOP) in patients with general anesthesia administered via intubation. Methods. We searched randomized controlled trials (RCT) on the effects of intravenous injection of dexmedetomidine on IOP in patients with general anesthesia administered via intubation. Results. The meta-analysis study showed that (1) a statistically significant difference [WMD = −3.40 mmHg, 95% CI (−4.76, −2.04), P < 0.00001] was found between IOP of the two groups. (2) The IOP of the dexmedetomidine group that was administrated succinylcholine was lower than that of placebo group which was administrated succinylcholine [WMD = −4.13 mmHg, 95% CI (−6.01, −2.25), P < 0.0001]. (3) Compared with the IOP of patients in the placebo group, patients with intubation in the dexmedetomidine group maintained a lower IOP [WMD = −3.10 mmHg, 95% CI (−5.12, −1.07), P = 0.003]. However, for incidences of bradycardia, the use of dexmedetomidine was higher than that of the placebo [RR = 0.23, 95% CI (0.07, 0.76), P = 0.02]. Conclusion. This meta-analysis showed that, in many cases, dexmedetomidine can lower the IOP of patients with general anesthesia administered by intubation. PMID:28261613

  3. 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).

  4. Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

    PubMed Central

    Myatra, Sheila Nainan; Ahmed, Syed Moied; Kundra, Pankaj; Garg, Rakesh; Ramkumar, Venkateswaran; Patwa, Apeksh; Shah, Amit; Raveendra, Ubaradka S.; Shetty, Sumalatha Radhakrishna; Doctor, Jeson Rajan; Pawar, Dilip K.; Ramesh, Singaravelu; Das, Sabyasachi; Divatia, Jigeeshu Vasishtha

    2017-01-01

    Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  5. The role of magnesium sulfate in tracheal intubation without muscle relaxation in patients undergoing ophthalmic surgery

    PubMed Central

    Soltani, Hassan-Ali; Hashemi, Seyed Jalal; Montazeri, Kamran; Dehghani, Alireza; Nematbakhsh, Mehdi

    2016-01-01

    Background: Muscle relaxant agents usually use to facilitate tracheal intubation; however, sometimes limitations exist. Magnesium (Mg) sulfate is a candidate for muscle relaxant substitute. This study was designed to determine the effect of Mg sulfate accompanied with propofol and fentanyl in patients undergoing ophthalmic surgery. Materials and Methods: In a double-blind randomized protocol and before tracheal intubation, Mg sulfate 40, 45, or 50 mg/kg in 100 ml of saline (Groups 1–3, respectively) or saline alone (Group 4) were administrated intravenously in 100 patients (n = 25 in each group) with the American Society of Anesthesiologist (ASA) physical Status I, II, or III. The patients' intubation condition in all subjects were determined and described. Results: The patients' demographic data including age, ASA, systolic and diastolic blood pressures, intraocular pressure, and body mass index were not significantly different between the groups. A better mask ventilation feasibility in Mg sulfate 45 group (Group 2) was observed when compared with Mg sulfate 50 (Group 3) (P = 0.022) and saline group (Group 4) (P = 0.021). In addition, the vocal cord movement and muscle relaxant requirement in saline group were significantly different from others groups (P < 0.05). The laryngoscopic time in saline group was greater than other groups significantly (P < 0.0001). Conclusion: Intravenous administration of Mg sulfate accompanied with propofol and fentanyl facilitates the tracheal intubation without neuromuscular blocking agents. To avoid Mg level increasing in plasma; however, the low dose of Mg sulfate is suggested. PMID:28163742

  6. 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

  7. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

    PubMed Central

    Zarogoulidis, Paul; Kontakiotis, Theodoros; Tsakiridis, Kosmas; Karanikas, Michael; Simoglou, Christos; Porpodis, Konstantinos; Mitrakas, Alexandros; Esebidis, Agisilaos; Konoglou, Maria; Katsikogiannis, Nikolaos; Zervas, Vasilis; Aggelopoulou, Christina; Mikroulis, Dimitrios; Zarogoulidis, Konstantinos

    2012-01-01

    Management of a “difficult airway” remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a “difficult airway” and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality. PMID:22802693

  8. The current role of U tubes for benign and malignant biliary obstruction.

    PubMed Central

    Millikan, K W; Gleason, T G; Deziel, D J; Doolas, A

    1993-01-01

    OBJECTIVE. The recent experience with U tubes at Rush-Presbyterian-St. Lukes Medical Center was reviewed in order to assess their current role in hepatobiliary surgery. SUMMARY BACKGROUND DATA. Transhepatic intubation by a variety of methods has been used routinely for biliary decompression and inhibition of anastomotic stricture since the 1960s. U tubes were popularized in the early 1970s. However, little has been written about their use and efficacy in recent years. Because of the apparent benefits associated with the use of U tubes versus other stenting techniques, the authors performed this study. METHODS. The hospital and office charts of all patients who had U tubes placed between 1980 and 1992 were reviewed retrospectively. Between 1980 and 1992, U tubes were placed intraoperatively in 54 patients for biliary decompression and/or stenting. Twelve patients were operated on for benign causes of obstruction. Forty-two patients with malignant tumors underwent surgery for U tube placement in conjunction with or without tumor resection and anastomotic bypass. RESULTS. There was a 0% operative mortality rate in the benign group. In six patients, the U tube played a major role in the long-term management of their disease processes. None of these patients has had restricture since removal of the tube. In the malignant group, the 30-day operative mortality rate was 12%. After 3 months, marked clinical improvement and complete biliary decompression were achieved, with mean bilirubin levels dropping from 14.0 mg/dL to 1.3 mg/dL. No patients in the malignant group required reoperation for recurrent biliary obstruction after U tube placement. CONCLUSIONS. The use of U tubes is advocated for biliary decompression and/or anastomotic stenting in patients with benign stricture or resectable malignancy and in patients with nonresectable, malignant biliary obstruction for adequate palliation of intractable jaundice. PMID:8239776

  9. Facilitation of fiberoptic nasotracheal intubation with magnesium sulfate: A double-blind randomized study

    PubMed Central

    Elgebaly, Ahmed Said; Eldabaa, Ahmed Ali

    2014-01-01

    Background: A double-blinded, prospective, and randomized study was designed to determine the efficacy and tolerability of intravenous (IV) magnesium sulfate (MgSO4) to facilitate fiberoptic bronchoscopic (FOB) nasotracheal intubations. Patients and Methods: A total of 120 patients scheduled to undergo elective awake fiberoptic nasotracheal intubation, while they were anesthetized for elective surgery were randomly allocated to one of three groups: The control Group S (n = 40) received 100 ml (50 ml 0.9% saline + 50 ml paracetamol) was infused in 10 min and direct IV 5 ml 0.9% normal saline, Group MD (n = 40): Received midazolam IV in a dose of 0.07 mg/kg in 5 ml 0.9% normal saline and 100 ml 0.9% was infused in 10 min and Group MS (n = 40): IV 45 mg/kg MgSO4 10 min in 100 ml of 0.9% normal saline through 10 min and direct IV 5 ml 0.9% normal saline. Results: Time required for nasotracheal intubation was significantly less in group Groups MD and MS, as compared with the control group, but not significant between the two groups. (Group MD: 9.05 + 1.95 min, Group MS 3.75 + 0.75 min and Group S 16.85 + 1.7 min). However, the number of fiberoptic intubation was significantly more in the MD and MS groups, as compared with the control group. Easy intubation (control group: 0, Group MD: 25 and Group MS: 35), moderate difficulty (control group: 5, Group MD: 12 and Group MS: 4) and difficult (control group: 35, Group MD: 3 and Group MS: 1). Procedure adverse events were significantly lower in Group MS. None of the patients in Group MS had procedure hypoxia, but it occurred in 10 patients of Group MD and 20 patients in Group S. Six patients in Group S and two in Group MD had procedure apnea whereas, none of the patients in the MS group experienced this. After medication and just before intubation heart rate and mean arterial pressure were significantly less in Groups MD and MS, as compared to the control group (Group MD: 77 + 7.7 beat/min, Group MS: 70 + 5.6 beat/min and

  10. [Enteral tube feeding].

    PubMed

    Haller, Alois

    2014-03-01

    Tube feeding is an integral part of medical therapies, and can be easily managed also in the outpatient setting. Tube feeding by the stomach or small intestine with nasogastral or nasojejunal tubes is common in clinical practice. Long-term nutrition is usually provided through a permanent tube, i. e. a percutaneous endoscopic gastrostomy (PEG). Modern portable nutrition pumps are used to cover the patient's nutritional needs. Enteral nutrition is always indicated if patients can not or should not eat or if nutritional requirements cannot be covered within 3 days after an intervention, e. g. after abdominal surgery. Industrially produced tube feedings with defined substrate concentrations are being used; different compositions of nutrients, such as glutamine fish oil etc., are used dependent on the the condition of the patient. Enteral nutrition may be associated with complications of the tube, e. g. dislocation, malposition or obstruction, as well as the feeding itself, e. g.hyperglycaemia, electrolyte disturbances, refeeding syndrome diarrhea or aspiration). However, the benefit of tube feeding usually exceeds the potential harm substantially.

  11. A simple blind placement of the left-sided double-lumen tubes

    PubMed Central

    Zong, Zhi Jun; Shen, Qi Ying; Lu, Yao; Li, Yuan Hai

    2016-01-01

    Abstract One-lung ventilation (OLV) has been commonly provided by using a double-lumen tube (DLT). Previous reports have indicated the high incidence of inappropriate DLT positioning in conventional maneuvers. After obtaining approval from the medical ethics committee of First Affiliated Hospital of Anhui Medical University and written consent from patients, 88 adult patients belonging to American society of anesthesiologists (ASA) physical status grade I or II, and undergoing elective thoracic surgery requiring a left-side DLT for OLV were enrolled in this prospective, single-blind, randomized controlled study. Patients were randomly allocated to 1 of 2 groups: simple maneuver group or conventional maneuver group. The simple maneuver is a method that relies on partially inflating the bronchial balloon and recreating the effect of a carinal hook on the DLTs to give an idea of orientation and depth. After the induction of anesthesia the patients were intubated with a left-sided Robertshaw DLT using one of the 2 intubation techniques. After intubation of each DLT, an anesthesiologist used flexible bronchoscopy to evaluate the patient while the patient lay in a supine position. The number of optimal position and the time required to place DLT in correct position were recorded. Time for the intubation of DLT took 100 ± 16.2 seconds (mean ± SD) in simple maneuver group and 95.1 ± 20.8 seconds in conventional maneuver group. The difference was not statistically significant (P = 0.221). Time for fiberoptic bronchoscope (FOB) took 22 ± 4.8 seconds in simple maneuver group and was statistically faster than that in conventional maneuver group (43.6 ± 23.7 seconds, P < 0.001). Nearly 98% of the 44 intubations in simple maneuver group were considered as in optimal position while only 52% of the 44 intubations in conventional maneuver group were in optimal position, and the difference was statistically significant (P < 0.001). This

  12. The Effects of Glucose Therapy Agents-Apple Juice, Orange Juice, and Cola-on Enteral Tube Flow and Patency.

    PubMed

    Steinberg, Daphna J; Montreuil, Jasmine; Santoro, Andrea L; Zettas, Antonia; Lowe, Julia

    2016-06-01

    To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal. Each tube was irrigated with 1 glucose therapy agent, providing approximately 20 g of carbohydrate every 4 h. Flow-rate measurements were collected at 2 h intervals. The results showed that the glucose therapy agent choice affected flow rates: apple juice and cola had higher average flow rates than orange juice (P = 0.01). A significant difference was found between tube type and enteral formula: polyethylene tubes had higher average flow rates than silicone tubes (P < 0.0001), and Isosource HN with fibre had higher flow rates than Novasource Renal (P = 0.01). We concluded that apple juice and cola have less tube clogging potential than orange juice, and thus may be considered as primary treatment options for hypoglycemia in enterally fed patients. Polyethylene tubes and Isosource HN with fibre were less likely to clog than silicone tubes and Novasource Renal.

  13. Non-intubated video-assisted thoracic surgery in patients aged 80 years and older

    PubMed Central

    Facktor, Matthew A.

    2015-01-01

    Background Video-assisted thoracic surgery (VATS) is routinely performed with general anesthesia and double-lumen endotracheal intubation, but this technique may stress an elderly patient’s functional reserve. We chose to study the safety and efficacy of non-intubated VATS, utilizing local anesthesia, sedation, and spontaneous ventilation in the elderly. Methods The medical records of all patients aged 80 years and older who underwent VATS under local anesthesia and sedation during the time period 6/1/2002 to 6/1/2010 at Geisinger Health System (Pennsylvania, USA) and 10/1/2011 to 12/31/2014 at Sinai Hospital (Maryland, USA) were retrospectively reviewed. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on comorbidity. Results A total of 96 patients ranging in age from 80 to 104 years underwent 102 non-intubated VATS procedures: pleural biopsy/effusion drainage with or without talc 73, drainage of empyema 17, evacuate hemothorax 4, pericardial window 3, lung biopsy 2, treat chylothorax 2, treat pneumothorax 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent procedure or biopsy. Complications occurred in three patients (3.1% morbidity): cerebrovascular accident, pulmonary embolism, prolonged air leak. One 94-year-old patient died from overanticoagulation and two 84-year-old patients died of their advanced lung cancers (3.1% morbidity). Conclusions Non-intubated VATS utilizing local anesthesia and sedation in the elderly is well tolerated and safe for a number of indications. PMID:26046042

  14. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    PubMed

    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.

  15. Endotracheal intubation with flexible fiberoptic bronchoscopy in patients with abnormal anatomic conditions of the head and neck.

    PubMed

    Elizondo, Eduardo; Navarro, Francisco; Pérez-Romo, Alfredo; Ortega, Concepción; Muñoz, Heberto; Cicero, Raúl

    2007-11-01

    We performed a retrospective chart review to evaluate the indications for endotracheal intubation via flexible fiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our 1100-bed, tertiary care university hospital. We reviewed 9201 clinical records of anesthetic procedures during which endotracheal intubation had been performed from January to December 2002. We identified 66 patients who had been intubated with flexible fiberoptic bronchoscopy. On preanesthetic examination, 61 of these patients had been found to be poor candidates for conventional laryngoscopic intubation-51 because of abnormal head and neck anatomy and 10 because of reduced visual access to the airway (Mallampati class IV). The remaining 5 patients were intubated via flexible fiberoptic bronchoscopy after conventional intubation had failed during emergency surgery. Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units.

  16. Screening Characteristics of Bedside Ultrasonography in Confirming Endotracheal Tube Placement; a Diagnostic Accuracy Study

    PubMed Central

    Zamani Moghadam, Hamid; Sharifi, Mohamad Davood; Rajabi, Hasan; Mousavi Bazaz, Mojtaba; Alamdaran, Ali; Jafari, Niazmohammad; Hashemian, Seyed Amir Masoud; Talebi Deloei, Morteza

    2017-01-01

    Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard. Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test). Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively. Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement. PMID:28286826

  17. Use of the GlideScope video laryngoscope for intubation during ex utero intrapartum treatment in a fetus with a giant cyst of the 4th branchial cleft

    PubMed Central

    Byun, Sung Hye; Lee, So Young; Hong, Seong Yeon; Ryu, Taeha; Kim, Baek Jin; Jung, Jin Yong

    2016-01-01

    Abstract Introduction: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure. Symptoms and clinical findings: A 28-year-old woman presented with a fetus having a cystic neck mass diagnosed on prenatal ultrasound at 25 weeks of gestation. We planned the EXIT procedure in conjunction with cesarean delivery at 38 weeks of gestation, as the mass enlarged to 4.9 cm × 3.2 cm, protruded externally at the neck, and subsequently resulted in polyhydramnios. Therapeutic intervention and outcomes: After induction of anesthesia using intravenous thiopental (300 mg), adequate uterine relaxation was achieved with sevoflurane (2.0–3.0 vol%) combined with continuous intravenous infusion of nitroglycerin (0.5–1.0 μg/kg/min) for maintaining uteroplacental circulation. After hysterotomy, the head and right upper limb of the fetus were partially delivered, and fetal heart tones were monitored with a sterile Doppler probe. After oropharyngeal suctioning to improve the visual field, the fetus was intubated successfully using a sterile GVL by an anesthesiologist, and the passage of the endotracheal tube beyond the vocal cords was confirmed on the screen of the GVL system. Immediately after the fetal airway was definitely secured, the fetus was fully delivered with umbilical cord clamping. After delivery, nitroglycerine administration was ceased and sevoflurane administration was reduced to 0.5 minimum alveolar concentration. Additionally, oxytocin (10

  18. Ketamine in the field: the use of ketamine for induction of anaesthesia before intubation in injured patients in the field.

    PubMed

    Gofrit, O N; Leibovici, D; Shemer, J; Henig, A; Shapira, S C

    1997-01-01

    Intubating the subconscious, struggling patient in a pre-hospital setting can be a difficult task even in experienced hands. We performed a clinical prospective study to evaluate the applicability of ketamine for induction of anaesthesia before intubation in the field. Ketamine was distributed to all air medical rescue teams--trained reserve army volunteers from various medical specialties. Lectures and literature concerning the use of ketamine for anaesthesia induction before intubation were given. The physicians were instructed to administer ketamine, in a dose of 2 mg/kg intravenously, if a single intubation attempt failed. Following the administration of ketamine, a questionnaire was filled in by the physician. Analysis of the data was performed after 24 months. During the study period, intubation was indicated in 161 injured patients evacuated by air in Israel. In 29 patients (18 per cent) the first intubation attempt had failed and they were given ketamine. The reasons for failure of the first intubation attempt were restlessness or trismus in 23 patients and traumatic distortion of the upper airway anatomical landmarks in six. Following ketamine administration, intubation was successful in 19 patients (65.5 per cent) in all of whom the indication for ketamine administration was restlessness or trismus. All patients with upper airway anatomy distortion were given a cricothyroidotomy. There were no complications attributed to ketamine. All patients reached hospital alive. This preliminary study suggests that the use of ketamine in this pre-hospital setting is safe. The drug is effective in cases where the primary reason for failure to intubate is restlessness or trismus. The drug is not effective in cases of anatomical damage to the upper airway. In these cases, cricothyroidotomy should probably be performed as early as possible.

  19. A randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade for insertion of double-lumen tubes.

    PubMed

    Lin, W; Li, H; Liu, W; Cao, L; Tan, H; Zhong, Z

    2012-07-01

    We performed a randomised trial comparing the CEL-100 videolaryngoscope(TM) with the Macintosh laryngoscope blade in 170 patients undergoing double-lumen tube placement for thoracic surgery. Compared with the Macintosh laryngoscope blade, use of the CEL-100 resulted in significantly more patients with a Cormack and Lehane Grade-1 laryngeal view (90.4% vs 61.0%, p < 0.001), a higher rate of successful intubation on the first attempt (92.8% vs 79.3%, p = 0.012), a lower median (IQR [range]) intubation difficulty score (0 (0-0 [0-60]) vs 15 (0-30 [0-80]), p < 0.001), a higher incidence of correct positioning of the tube (90.3% vs 79.2%, p = 0.041) and significantly fewer patients requiring external laryngeal pressure (19.3% vs 32.9%, p = 0.046). Median (IQR [range]) time to successful intubation was 45 (38-55 [22-132]) s with the CEL-100 compared with 51 (40-61 [30-160] s using the Macintosh laryngoscope blade. We conclude that the CEL-100 videolaryngoscope is superior to the Macintosh laryngoscope blade for double-lumen tube insertion.

  20. Silicon Detectors

    NASA Astrophysics Data System (ADS)

    Sadrozinski, Hartmut

    2014-03-01

    The use of silicon detectors has experienced an exponential growth in accelerator and space based experiments, similar to trends in the semiconductor industry as a whole, usually paraphrased as ``Moore's Law.'' Some of the essentials for this phenomenon will be presented, together with examples of the exciting science results which it enabled. With the establishment of a ``semiconductor culture'' in universities and laboratories around the world, an increased understanding of the sensors results in thinner, faster, more radiation-resistant detectors, spawning an amazing wealth of new technologies and applications, which will be the main subject of the presentation.

  1. Use of a venting PEG tube in the management of recurrent acute gastric dilatation associated with Prader-Willi syndrome.

    PubMed

    Mohammed, Ahmed M A; Dennis, Robert J

    2016-01-12

    A patient with Prader-Willi Syndrome was admitted to the ICU with features of recurrent acute gastric dilatation, aspiration pneumonia and a massive pulmonary embolus. He was initially managed with intubation, assisted ventilation, intravenous fluids and anticoagulation. Decompression of the stomach was achieved with a nasogastric tube. After ventilator weaning, he did not tolerate the nasogastric intubation that led to a further episode of aspiration pneumonia as a result of non-resolving gastric dilatation. He required readmission to intensive care for a further period of ventilatory support. While the patient was sedated and ventilated, a venting percutaneous endoscopic gastrostomy (PEG) with a jejunal feeding extension was placed, permitting both continued decompression of the stomach and enteral feeding. The patient tolerated the PEG-J well and his nutritional needs were successfully addressed. Oral intake was slowly re-established with ongoing decompression of the stomach with the PEG. He was discharged from hospital with the PEG in place.

  2. Use of a venting PEG tube in the management of recurrent acute gastric dilatation associated with Prader-Willi syndrome

    PubMed Central

    Mohammed, Ahmed M.A.; Dennis, Robert J.

    2016-01-01

    A patient with Prader-Willi Syndrome was admitted to the ICU with features of recurrent acute gastric dilatation, aspiration pneumonia and a massive pulmonary embolus. He was initially managed with intubation, assisted ventilation, intravenous fluids and anticoagulation. Decompression of the stomach was achieved with a nasogastric tube. After ventilator weaning, he did not tolerate the nasogastric intubation that led to a further episode of aspiration pneumonia as a result of non-resolving gastric dilatation. He required readmission to intensive care for a further period of ventilatory support. While the patient was sedated and ventilated, a venting percutaneous endoscopic gastrostomy (PEG) with a jejunal feeding extension was placed, permitting both continued decompression of the stomach and enteral feeding. The patient tolerated the PEG-J well and his nutritional needs were successfully addressed. Oral intake was slowly re-established with ongoing decompression of the stomach with the PEG. He was discharged from hospital with the PEG in place. PMID:26763981

  3. Use of Functionalized Carbon Nanotubes for Covalent Attachment of Nanotubes to Silicon

    NASA Technical Reports Server (NTRS)

    Tour, James M.; Dyke, Christopher A.; Maya, Francisco; Stewart, Michael P.; Chen, Bo; Flatt, Austen K.

    2012-01-01

    The purpose of the invention is to covalently attach functionalized carbon nanotubes to silicon. This step allows for the introduction of carbon nanotubes onto all manner of silicon surfaces, and thereby introduction of carbon nano - tubes covalently into silicon-based devices, onto silicon particles, and onto silicon surfaces. Single-walled carbon nanotubes (SWNTs) dispersed as individuals in surfactant were functionalized. The nano - tube was first treated with 4-t-butylbenzenediazonium tetrafluoroborate to give increased solubility to the carbon nanotube; the second group attached to the sidewall of the nanotube has a silyl-protected terminal alkyne that is de-protected in situ. This gives a soluble carbon nanotube that has functional groups appended to the sidewall that can be attached covalently to silicon. This reaction was monitored by UV/vis/NJR to assure direct covalent functionalization.

  4. Silicon Carbide Nanotube Synthesized

    NASA Technical Reports Server (NTRS)

    Lienhard, Michael A.; Larkin, David J.

    2003-01-01

    Carbon nanotubes (CNTs) have generated a great deal of scientific and commercial interest because of the countless envisioned applications that stem from their extraordinary materials properties. Included among these properties are high mechanical strength (tensile and modulus), high thermal conductivity, and electrical properties that make different forms of single-walled CNTs either conducting or semiconducting, and therefore, suitable for making ultraminiature, high-performance CNT-based electronics, sensors, and actuators. Among the limitations for CNTs is their inability to survive in high-temperature, harsh-environment applications. Silicon carbon nanotubes (SiCNTs) are being developed for their superior material properties under such conditions. For example, SiC is stable in regards to oxidation in air to temperatures exceeding 1000 C, whereas carbon-based materials are limited to 600 C. The high-temperature stability of SiCNTs is envisioned to enable high-temperature, harsh-environment nanofiber- and nanotube-reinforced ceramics. In addition, single-crystal SiC-based semiconductors are being developed for hightemperature, high-power electronics, and by analogy to CNTs with silicon semiconductors, SiCNTs with single-crystal SiC-based semiconductors may allow high-temperature harsh-environment nanoelectronics, nanosensors, and nanoactuators to be realized. Another challenge in CNT development is the difficulty of chemically modifying the tube walls, which are composed of chemically stable graphene sheets. The chemical substitution of the CNTs walls will be necessary for nanotube self-assembly and biological- and chemical-sensing applications. SiCNTs are expected to have a different multiple-bilayer wall structure, allowing the surface Si atoms to be functionalized readily with molecules that will allow SiCNTs to undergo self-assembly and be compatible with a variety of materials (for biotechnology applications and high-performance fiber-reinforced ceramics).

  5. Comparison of rocuronium at two different doses and succinylcholine for endotracheal intubation in adult patients for elective surgeries

    PubMed Central

    Chavan, SG; Gangadharan, S; Gopakumar, AK

    2016-01-01

    Background: The effects of rocuronium at two different doses, that is, 0.6 mg/kg (2 × ED95) and 0.9 mg/kg (3 × ED95), were compared with succinylcholine (2 mg/kg) when used for endotracheal intubation in adult patients for elective surgeries under general anesthesia. Materials and Methods: Ninety patients were divided into three groups of 30 each. Groups A, B received injection rocuronium at 0.6 mg/kg, 0.9 mg/kg respectively and Group C received succinylcholine at 2 mg/kg. Onset of action of relaxant, intubation conditions, time taken to intubate and duration of action were compared. Statistical Analysis Used: To compare the statistical difference in the age, weight, height of the study subjects, onset of action of relaxant, intubation conditions, time taken to intubate, and duration of action analysis of variance and unpaired t-test were used. Results: The onset time was considerably shorter with rocuronium 0.9 mg/kg than 0.6 mg/kg. The onset time of rocuronium 0.9 mg/kg was found to be significantly longer than succinylcholine 2 mg/kg. Time taken to intubate was shortest with succinylcholine 2 mg/kg. The time taken to intubate with the rocuronium 0.9 mg/kg was found to be comparable to that of rocuronium 0.6 mg/kg. Intubation score of rocuronium 0.9 mg/kg was the best (17.75), which was comparable with succinylcholine. However, the intubation score obtained with rocuronium 0.6 mg/kg was inferior. Duration of action was shortest with succinylcholine. The duration of action is prolonged when the dose of rocuronium is increased from 0.6 to 0.9 mg/kg. Conclusion: Rapid sequence induction of anesthesia with propofol and fentanyl, succinylcholine allowed a more rapid endotracheal intubation sequence and created superior intubation conditions than rocuronium. However, the technique of using a large dose of rocuronium to achieve perfect conditions for tracheal intubation may have application whenever succinylcholine is relatively contraindicated. PMID:27833478

  6. Snorkeling and Jones tubes.

    PubMed

    Lam, Lewis Y W; Weatherhead, Robert G

    2015-01-01

    We report a case of tympanic membrane rupture during snorkeling in a 17-year-old young man who had previously undergone bilateral Jones tubes placed for epiphora. To our knowledge, this phenomenon has not been previously reported.

  7. Enteral nutrition by tube.

    PubMed

    Armstrong, P J; Hand, M S; Frederick, G S

    1990-01-01

    When oral intake is unsatisfactory or contraindicated, maintenance of nutrition by tube feeding is an alternative to the parenteral route. A large volume of research data supports the decision to use the enteral route whenever possible. Entry of food into the alimentary tract is a stimulus to structural and functional maintenance of that tract. Enteral nutrition can be given via indwelling nasoesophageal, pharyngostomy, esophagostomy, percutaneous or surgical gastrostomy, or enterostomy tube. Use of an appropriate catheter, familiarity with the technique used, and careful patient selection and monitoring are important factors in successful tube feeding. Blenderized pet food diets should be fed whenever possible; commercially available liquid diets provide an alternative when tube caliber or patient factors preclude the use of blenderized foods.

  8. Integrated structure vacuum tube

    NASA Technical Reports Server (NTRS)

    Dimeff, J.; Kerwin, W. J. (Inventor)

    1976-01-01

    High efficiency, multi-dimensional thin film vacuum tubes suitable for use in high temperature, high radiation environments are described. The tubes are fabricated by placing thin film electrode members in selected arrays on facing interior wall surfaces of an alumina substrate envelope. Cathode members are formed using thin films of triple carbonate. The photoresist used in photolithography aids in activation of the cathodes by carbonizing and reacting with the reduced carbonates when heated in vacuum during forming. The finely powdered triple carbonate is mixed with the photoresist used to delineate the cathode locations in the conventional solid state photolithographic manner. Anode and grid members are formed using thin films of refractory metal. Electron flow in the tubes is between grid elements from cathode to anode as in a conventional three-dimensional tube.

  9. Tube-Forming Assays.

    PubMed

    Brown, Ryan M; Meah, Christopher J; Heath, Victoria L; Styles, Iain B; Bicknell, Roy

    2016-01-01

    Angiogenesis involves the generation of new blood vessels from the existing vasculature and is dependent on many growth factors and signaling events. In vivo angiogenesis is dynamic and complex, meaning assays are commonly utilized to explore specific targets for research into this area. Tube-forming assays offer an excellent overview of the molecular processes in angiogenesis. The Matrigel tube forming assay is a simple-to-implement but powerful tool for identifying biomolecules involved in angiogenesis. A detailed experimental protocol on the implementation of the assay is described in conjunction with an in-depth review of methods that can be applied to the analysis of the tube formation. In addition, an ImageJ plug-in is presented which allows automatic quantification of tube images reducing analysis times while removing user bias and subjectivity.

  10. Kinking of medical tubes.

    PubMed

    Ingles, David

    2004-05-01

    The phenomenon of kinking in medical tubing remains a problem for some applications, particularly critical ones such as transporting gasses or fluids. Design features are described to prevent its occurrence.

  11. Ear tube insertion

    MedlinePlus

    ... Ear tube surgery - what to ask your doctor Review Date 8/5/2015 Updated by: Sumana Jothi ... Otolaryngology, NCHCS VA, SFVA, San Francisco, CA. Internal review and update on 09/01/2016 by David ...

  12. Ear tube insertion - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100045.htm Ear tube insertion - series—Normal anatomy To use the ... 4 Overview The eardrum (tympanic membrane) separates the ear canal from the middle ear. Review Date 8/ ...

  13. Tracheostomy tube - speaking

    MedlinePlus

    Air passing through vocal cords (larynx) causes them to vibrate, creating sounds and speech. A tracheostomy tube blocks most of the air from passing through your vocal cords. Instead, your breath (air) goes out ...

  14. Gastrostomy tube placement - slideshow

    MedlinePlus

    ... presentations/100125.htm Gastrostomy tube placement - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  15. Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections.

    PubMed

    Gonzalez-Rivas, Diego

    2016-03-01

    The development of thoracoscopy has more than one hundred years of history since Jacobaeus described the first procedure in 1910. He used the thoracoscope to lyse adhesions in tuberculosis patients. This technique was adopted throughout Europe in the early decades of the 20(th) century for minor and diagnostic procedures. It is only in the last two decades that interest in minimally invasive thoracic surgery was reintroduced by two key technological improvements: the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers. From these advances the first video-assisted thoracic surgery (VATS) major pulmonary resection was performed in 1992. In the following years, the progress of VATS was slow until studies showing clear benefits of VATS over open surgery started to be published. From that point on, the technique spread throughout the world and variations of the technique started to emerge. The information available on internet, live surgery events and experimental courses has contributed to the rapid learning of minimally invasive surgery during the last decade. While initially slow to catch on, the traditional multi-port approach has evolved into a uniportal approach that mimics open surgical vantage points while utilizing a non-rib-spreading single small incision. The early period of uniportal VATS development was focused on minor procedures until 2010 with the adoption of the technique for major pulmonary resections. Currently, experts in the technique are able to use uniportal VATS to encompass the most complex procedures such as bronchial sleeve, vascular reconstructions or carinal resections. In contrast, non-intubated and awake thoracic surgery techniques, described since the early history of thoracic surgery, peaked in the decades before the invention of the double lumen endotracheal tube and have failed to gain widespread acceptance following their re-emergence over a decade ago thanks to the improvements in

  16. The feasibility of laryngoscope-guided tracheal intubation in microgravity during parabolic flight: a comparison of two techniques.

    PubMed

    Groemer, Gernot E; Brimacombe, Joseph; Haas, Thorsten; de Negueruela, Cristina; Soucek, Alexander; Thomsen, Michael; Keller, Christian

    2005-11-01

    We determined the feasibility of laryngoscope-guided tracheal intubation (LG-TI) in microgravity obtained during parabolic flight and tested the hypothesis that LG-TI is similarly successful in the free-floating condition, with the patient's head gripped between the anesthesiologist's knees, as in the restrained condition, with the torso strapped to the surface. Three personnel with no experience in airway management or microgravity participated in the study. LG-TI of a sophisticated full-size manikin was attempted on seven occasions in each condition by each investigator after ground-based training. The parabolic flights, which took place in an Airbus 300 over the Atlantic Ocean, provided 23 s of microgravity. During this time, the investigator opened a box with airway equipment, performed LG-TI, and attached and held onto a self-inflating bag. The efficacy of ventilation was assessed during level flight by squeezing the bag and noting whether the manikin sensors indicated a tidal volume > or =300 mL. There were no differences in ventilation success (41% versus 33%) or time to successful insertion (both 18 s) between the free-floating and the restrained conditions. More than 90% of failures were caused by the inability to insert the tracheal tube within 23 s. There were no differences in performance among investigators. We conclude that LG-TI is feasible in microgravity obtained during parabolic flight, but the success rate is infrequent because of severe time restrictions. There were no differences in success rate between the free-floating condition, with the head gripped between the knees, and the restrained condition, with the torso strapped to the surface.

  17. Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

    PubMed Central

    2016-01-01

    The development of thoracoscopy has more than one hundred years of history since Jacobaeus described the first procedure in 1910. He used the thoracoscope to lyse adhesions in tuberculosis patients. This technique was adopted throughout Europe in the early decades of the 20th century for minor and diagnostic procedures. It is only in the last two decades that interest in minimally invasive thoracic surgery was reintroduced by two key technological improvements: the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers. From these advances the first video-assisted thoracic surgery (VATS) major pulmonary resection was performed in 1992. In the following years, the progress of VATS was slow until studies showing clear benefits of VATS over open surgery started to be published. From that point on, the technique spread throughout the world and variations of the technique started to emerge. The information available on internet, live surgery events and experimental courses has contributed to the rapid learning of minimally invasive surgery during the last decade. While initially slow to catch on, the traditional multi-port approach has evolved into a uniportal approach that mimics open surgical vantage points while utilizing a non-rib-spreading single small incision. The early period of uniportal VATS development was focused on minor procedures until 2010 with the adoption of the technique for major pulmonary resections. Currently, experts in the technique are able to use uniportal VATS to encompass the most complex procedures such as bronchial sleeve, vascular reconstructions or carinal resections. In contrast, non-intubated and awake thoracic surgery techniques, described since the early history of thoracic surgery, peaked in the decades before the invention of the double lumen endotracheal tube and have failed to gain widespread acceptance following their re-emergence over a decade ago thanks to the improvements in

  18. Clearing obstructed feeding tubes.

    PubMed

    Marcuard, S P; Stegall, K L; Trogdon, S

    1989-01-01

    This is a report of an in vitro study evaluating the ability of six solutions to dissolve clotted enteral feeding, which can cause feeding tube occlusion. The following clotted enteral feeding products were tested: Ensure Plus, Ensure Plus with added protein (Promod 20 g/liter), Osmolite, Enrich, and Pulmocare. Clot dissolution was then tested by adding Adolf's Meat Tenderizer, Viokase, Sprite, Pepsi, Coke, or Mountain Dew. Distilled water served as control. Dissolution score for each mixture was assessed blindly. Best dissolution was observed with Viokase in pH 7.9 solution (p less than 0.01). Similar results were obtained when feeding tube patency was restored in eight in vitro occluded feeding tubes (Dobbhoff, French size 8) by using first Pepsi (two/eight successful) and then Viokase in pH 7.9 (six/six successful). We also report our experience in the first 10 patients with occluded feeding tubes using this Viokase solution injected through a Drum catheter into the feeding tube. In seven patients, this method proved to be successful, and the reasons for failure in three patients include a knotted tube, impacted tablet powder, and a formula clot fo 24 hr duration and 45 cm in length.

  19. Design and fabrication of an IPMC-embedded tube for minimally invasive surgery applications

    NASA Astrophysics Data System (ADS)

    Liu, Jiayu; Wang, Yanjie; Zhao, Dongxu; Zhang, Chi; Chen, Hualing; Li, Dichen

    2014-03-01

    Minimally Invasive Surgery (MIS) is receiving much attention for a number of reasons, including less trauma, faster recovery and enhanced precision. The traditional robotic actuators do not have the capabilities required to fulfill the demand for new applications in MIS. Ionic Polymer-Metal Composite (IPMC), one of the most promising smart materials, has extensive desirable characteristics such as low actuation voltage, large bending deformation and high functionality. Compared with traditional actuators, IPMCs can mimic biological muscle and are highly promising for actuation in robotic surgery. In this paper, a new approach which involves molding and integrating IPMC actuators into a soft silicone tube to create an active actuating tube capable of multi-degree-of-freedom motion is presented. First, according to the structure and performance requirements of the actuating tube, the biaxial bending IPMC actuators fabricated by using solution casting method have been implemented. The silicone was cured at a suitable temperature to form a flexible tube using molds fabricated by 3D Printing technology. Then an assembly based fabrication process was used to mold or integrate biaxial bending IPMC actuators into the soft silicone material to create an active control tube. The IPMC-embedded tube can generate multi-degree-of-freedom motions by controlling each IPMC actuator. Furthermore, the basic performance of the actuators was analyzed, including the displacement and the response speed. Experimental results indicate that IPMC-embedded tubes are promising for applications in MIS.

  20. Particle shedding from peristaltic pump tubing in biopharmaceutical drug product manufacturing.

    PubMed

    Saller, Verena; Matilainen, Julia; Grauschopf, Ulla; Bechtold-Peters, Karoline; Mahler, Hanns-Christian; Friess, Wolfgang

    2015-04-01

    In a typical manufacturing setup for biopharmaceutical drug products, the fill and dosing pump is placed after the final sterile filtration unit in order to ensure adequate dispensing accuracy and avoid backpressure peaks. Given the sensitivity of protein molecules, peristaltic pumps are often preferred over piston pumps. However, particles may be shed from the silicone tubing employed. In this study, particle shedding and a potential turbidity increase during peristaltic pumping of water and buffer were investigated using three types of commercially available silicone tubing. In the recirculates, mainly particles of around 200 nm next to a very small fraction of particles in the lower micrometer range were found. Using 3D laser scanning microscopy, surface roughness of the inner tubing surface was found to be a determining factor for particle shedding from silicone tubing. As the propensity toward particle shedding varied between tubing types and also cannot be concluded from manufacturer's specifications, individual testing with the presented methods is recommended during tubing qualification. Choosing low abrasive tubing can help to further minimize the very low particle counts to be expected in pharmaceutical drug products.

  1. Silicon halide-alkali metal flames as a source of solar grade silicon

    NASA Technical Reports Server (NTRS)

    Olson, D. B.; Miller, W. J.; Gould, R. K.

    1980-01-01

    The feasibility of using continuous high-temperature reactions of alkali metals and silicon halides to produce silicon in large quantities and of suitable purity for use in the production of photovoltaic solar cells was demonstrated. Low pressure experiments were performed demonstrating the production of free silicon and providing experience with the construction of reactant vapor generators. Further experiments at higher reagent flow rates were performed in a low temperature flow tube configuration with co-axial injection of reagents and relatively pure silicon was produced. A high temperature graphite flow tube was built and continuous separation of Si from NaCl was demonstrated. A larger scaled well stirred reactor was built. Experiments were performed to investigate the compatability of graphite based reactor materials of construction with sodium. At 1100 to 1200 K none of these materials were found to be suitable. At 1700 K the graphites performed well with little damage except to coatings of pyrolytic graphite and silicon carbide which were damaged.

  2. Coiled tubing operations and services

    SciTech Connect

    Jaworsky, A.S. II )

    1991-11-01

    Coiled tubing offers many advantages over conventional jointed tubing used for drilling in oil fields, including time savings, pumping flexibility, fluid placement, reduced formation damage and safety. The article gives an overview of coiled tubing history and development. Operating concepts are explained, along with descriptions of the major equipment and components associated with coiled tubing use in the oil field today.

  3. Effect of rocuronium on the bispectral index under anesthesia and tracheal intubation

    PubMed Central

    Yue, Hui; Han, Jinyu; Liu, Ling; Wang, Kaiyuan; Li, Jincheng

    2016-01-01

    The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I–II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40–60, and a deep sedation group (group 2), with a BIS value <20 or with burst suppression. Each group was randomly divided into 4 subgroups A-D (n=9) according to the various doses of rocuronium (0.3, 0.6, 0.9 and 1.2 mg/kg). Tracheal intubation was performed after 2 min of rocuronium administration. BIS, electromyography (EMG), heart rate (HR) and mean arterial pressure (MAP) were recorded continuously and averaged over 1 min during baseline (T1), steady state (T2), 2 min after rocuronium infusion (T3), and 0, 2 and 5 min after tracheal intubation. The results demonstrated that HR and MAP decreased significantly at T2 and T3 compared with T1. Following tracheal intubation (L0), HR and MAP significantly increased compared with T2 and T3, and returned to levels similar to those prior to intubation after 5 min. In group 1C and 1D, BIS was significantly decreased at T3 compared with T2; BIS was significantly increased at L0 compared with T3 in group 1A and 1B. EMG at earlier stages of anesthesia was significantly higher compared with other points, and was significantly increased at L0 compared with T3 in group 1A and 1B. These results demonstrated that BIS response may be associated with the dosage of rocuronium in the normal sedation group, although no association was observed with the deep sedation group. Tracheal intubation resulted in marked hemodynamic

  4. 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

  5. Process for making silicon from halosilanes and halosilicons

    NASA Technical Reports Server (NTRS)

    Levin, Harry (Inventor)

    1988-01-01

    A reactor apparatus (10) adapted for continuously producing molten, solar grade purity elemental silicon by thermal reaction of a suitable precursor gas, such as silane (SiH.sub.4), is disclosed. The reactor apparatus (10) includes an elongated reactor body (32) having graphite or carbon walls which are heated to a temperature exceeding the melting temperature of silicon. The precursor gas enters the reactor body (32) through an efficiently cooled inlet tube assembly (22) and a relatively thin carbon or graphite septum (44). The septum (44), being in contact on one side with the cooled inlet (22) and the heated interior of the reactor (32) on the other side, provides a sharp temperature gradient for the precursor gas entering the reactor (32) and renders the operation of the inlet tube assembly (22) substantially free of clogging. The precursor gas flows in the reactor (32) in a substantially smooth, substantially axial manner. Liquid silicon formed in the initial stages of the thermal reaction reacts with the graphite or carbon walls to provide a silicon carbide coating on the walls. The silicon carbide coated reactor is highly adapted for prolonged use for production of highly pure solar grade silicon. Liquid silicon (20) produced in the reactor apparatus (10) may be used directly in a Czochralski or other crystal shaping equipment.

  6. Bias-assisted KOH etching of macroporous silicon membranes

    NASA Astrophysics Data System (ADS)

    Mathwig, K.; Geilhufe, M.; Müller, F.; Gösele, U.

    2011-03-01

    This paper presents an improved technique to fabricate porous membranes from macroporous silicon as a starting material. A crucial step in the fabrication process is the dissolution of silicon from the backside of the porous wafer by aqueous potassium hydroxide to open up the pores. We improved this step by biasing the silicon wafer electrically against the KOH. By monitoring the current-time characteristics a good control of the process is achieved and the yield is improved. Also, the etching can be stopped instantaneously and automatically by short-circuiting Si and KOH. Moreover, the bias-assisted etching allows for the controlled fabrication of silicon dioxide tube arrays when the silicon pore walls are oxidized and inverted pores are released.

  7. Comparison of the Levitan FPS Scope and the single-use bougie for simulated difficult intubation in anaesthetised patients.

    PubMed

    Greenland, K B; Liu, G; Tan, H; Edwards, M; Irwin, M G

    2007-05-01

    A randomised cross-over study was performed in 34 patients with no evidence of airway difficulties, following induction of general anaesthesia, to compare the efficacy of the Levitan FPS scope (LFPS) and the single-use bougie for tracheal intubation during simulated grade IIIa laryngoscopy. Success rates for intratracheal placement of the device, and the time required for insertion and tracheal intubation were recorded. Both devices were equally successful (31/34 for the LFPS vs 29/34 for the bougie) for insertion into the glottis. The mean insertion time for the LFPS was statistically longer than that for the bougie (4.4-12.5 s) but this difference was not clinically relevant. Intubation times were similar between the two devices. Major problems hindering successful intubation using the LFPS were the presence of a narrow epiglottic-pharyngeal wall space and copious secretions. An inability to maintain the desired shape was the principal cause of failure with the bougie.

  8. Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: an old procedure revisited.

    PubMed

    Chalak, Lina F; Kaiser, Jeffrey R; Arrington, Robert W

    2007-02-01

    Pulmonary interstitial emphysema (PIE) contributes to worsening respiratory status in already compromised premature infants. Various treatments for PIE include high-frequency ventilation, postural therapy, pneumonectomy or lobectomy and selective bronchial intubation. While right main stem bronchus intubation is easy to perform at the bedside for treatment of PIE in the left lung, left main stem bronchus intubation for the treatment of right-sided PIE remains challenging and the technique was rarely reported and poorly described. In this case report, we revisit this procedure and describe successful treatment of right lung PIE with hyperinflation by selective left main stem intubation at 2 weeks of life in a 24-week-old premature infant who had respiratory distress syndrome and pulmonary hemorrhage. A detailed description is given to allow clinical bedside replication following specific anatomic landmarks.

  9. 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

  10. Silicon carbide

    SciTech Connect

    Ault, N.N.; Crowe, J.T. )

    1991-05-01

    This paper reports that, since silicon carbide (SiC) does not occur in nature, it must be synthesized by a high-temperature chemical reaction. The first commercial production began at the end of the 19th century when Acheson developed a process of reacting sand and coke in a resistance furnace. This process is still the basic SiC manufacturing process used today. High-quality silica sand (99.5% SiO{sub 2}), low-sulfur petroleum coke, and electricity (23.8 MJ/kg) are the major ingredients in the production of SiC. The reaction takes place in a trough-like furnace with a removable refractory side (or some similar configuration) and with permanent refractory ends holding carbon electrodes. When the furnace is started, the carbon electrodes are joined by the graphite core laid the length of the furnace near the center of the mixture which fills the furnace.

  11. Silicon Photomultiplier charaterization

    NASA Astrophysics Data System (ADS)

    Munoz, Leonel; Osornio, Leo; Para, Adam

    2014-03-01

    Silicon Photo Multiples (SiPM's) are relatively new photon detectors. They offer many advantages compared to photo multiplier tubes (PMT's) such as insensitivity to magnetic field, robustness at varying lighting levels, and low cost. The SiPM output wave forms are poorly understood. The experiment conducted collected waveforms of responses of Hamamatsu SiPM to incident laser pulse at varying temperatures and bias voltages. Ambient noise was characterized at all temperatures and bias voltages by averaging the waveforms. Pulse shape of the SiPM response was determined under different operating conditions: the pulse shape is nearly independent of the bias voltage but exhibits strong variation with temperature, consistent with the temperature variation of the quenching resistor. Amplitude of responses of the SiPM to low intensity laser light shows many peaks corresponding to the detection of 1,2,3 etc. photons. Amplitude of these pulses depends linearly on the bias voltage, enabling determination of the breakdown voltage at each temperature. Poisson statistics has been used to determine the average number of detected photons at each operating conditions. Department of Education Grant No. P0315090007 and the Department of Energy/ Fermi National Accelerator Laboratory.

  12. Thin silicon solar cells

    SciTech Connect

    Hall, R.B.; Bacon, C.; DiReda, V.; Ford, D.H.; Ingram, A.E.; Cotter, J.; Hughes-Lampros, T.; Rand, J.A.; Ruffins, T.R.; Barnett, A.M.

    1992-12-01

    The silicon-film design achieves high performance by using a dun silicon layer and incorporating light trapping. Optimally designed thin crystalline solar cells (<50 microns thick) have performance advantages over conventional thick devices. The high-performance silicon-film design employs a metallurgical barrier between the low-cost substrate and the thin silicon layer. Light trapping properties of silicon-film on ceramic solar cells are presented and analyzed. Recent advances in process development are described here.

  13. Circle nephrostomy tube revisited

    PubMed Central

    Noureldin, Yasser A.; Diab, Christian; Valenti, David; Andonian, Sero

    2016-01-01

    Introduction: There are few options for patients requiring chronic urinary drainage using nephrostomy tubes. Although circle nephrostomy tube (CNT) was invented in 1954, it is rarely used. Its advantages include longer indwelling time such that it is changed semi-annually when compared with the standard nephrostomy tube (SNT), which is changed monthly. However, there are no studies comparing indwelling times and costs with these two tubes. The aim of the present study was to compare CNT with SNT in terms of frequency of tube changes, reasons for earlier tube changes, and associated costs. Methods: Patients who had CNT inserted between 2009 and 2015 were reviewed. The indications for chronic indwelling nephrostomy tubes were tabulated. The frequency of tube changes was compared between CNT and SNT in the same patients. Furthermore, costs associated with insertion and exchange of CNT and SNT were analyzed. Results: Seven patients with mean age of 71.9 ± 7.6 years (range 43–96) had a total of 36 CNT changes. The mean number of CNT changes was four (range 2–5) at a mean interval of 168.3 ± 15.6 days (range 120–231). All patients had SNT prior to converting to CNT. When compared with the mean interval for SNT changes, the mean interval for CNT changes was significantly longer (44.8 ± 19.4 vs. 168.3 ± 41.3 days; p=0.028). Tube blockage and urinary leakage were the most common reasons for earlier than scheduled CNT changes. In our centre, CNT insertion and exchange cost $1965.48 and $923.96 compared with $1450.43 and $803.81 for SNT, respectively. There was an estimated cost savings of $46 861.10 (range $87 414.30 –$40 553.20) for the whole cohort by switching from SNTs to CNTs. Conclusions: Despite the small sample size as the main limitation, this study confirms that CNTs are associated with significantly fewer changes and lower cost when compared with SNTs for poor-surgical-risk patients requiring chronic NTs.

  14. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

    PubMed Central

    Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha

    2014-01-01

    Overview: Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate. PMID:25538514

  15. 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

  16. Exhaled breath condensate analysis from intubated newborns by nano-HPLC coupled to high resolution MS.

    PubMed

    Kononikhin, A S; Starodubtseva, N L; Chagovets, V V; Ryndin, A Y; Burov, A A; Popov, I A; Bugrova, A E; Dautov, R A; Tokareva, A O; Podurovskaya, Y L; Ionov, O V; Frankevich, V E; Nikolaev, E N; Sukhikh, G T

    2017-03-15

    Invasiveness of examination and therapy methods is a serious problem for intensive care and nursing of premature infants. Exhaled breath condensate (EBC) is the most attractive biofluid for non-invasive methods development in neonatology for monitoring the status of intubated infants. The aim of the study was to propose an approach for EBC sampling and analysis from mechanically ventilated neonates. EBC collection system with good reproducibility of sampling was demonstrated. Discovery-based proteomic and metabolomic studies were performed using nano-HPLC coupled to high resolution MS. Label-free semi-quantitative data were compared for intubated neonates with congenital pneumonia (12 infants) and left-sided congenital diaphragmatic hernia (12 infants) in order to define disease-specific features. Totally 119 proteins and 164 metabolites were found. A number of proteins and metabolites that can act as potential biomarkers of respiratory diseases were proposed and require further validation.

  17. A simple technique for intubating the mouth during OGD in patients with previous neck radiation

    PubMed Central

    Buckley, Christina E; Achakzai, Akbar Amin; O'Hanlon, Deirdre

    2014-01-01

    Trismus and microstomia are commonly associated complications of neck irradiation. In recent years we are seeing an increase in the number of patients with various head and neck cancers being treated with radiotherapy. This can pose a significant challenge in performing oesophagogastroduodenoscopy (OGD) in this cohort of patients. We describe a novel technique for intubating the mouth during OGD in patients with previous neck radiation. Instead of placing a standard mouthpiece, we place the barrel of a 5 mm syringe, which is cut in half, into the patient's mouth. This method allows easy passage of the gastroscope, where the mouth opening is limited by trismus from prior radiation. It also serves to protect the patient's teeth during OGD. Successful intubation with a gastroscope is possible in patients with severe trismus using our novel technique. PMID:24849645

  18. Survey of factors effective on re-intubation among children admitted to pediatric intensive care unit.

    PubMed

    Bilan, N; Ghaffari, S H

    2009-03-01

    This study was aimed to recognize the risk factors of re intubation among children who were admitted to pediatric intensive care unit. in an analytical cross-sectional study, the risk factors of reintubation in two groups of patients compared, both groups consist of 55 children, one with successful extubation and another with extubation failure. The study showed that neuromuscular disorders are the main underlying disease in extubation-failure group (p = 0.004). Besides, in comparison between two group of patients who had successful versus failed extubation, hypercapnia (PaCO2 > 50 mmHg) was shown to be the most common cause of both the first intubation (p = 0.003) and reintubation (p = 0.002) in patients who failed extubation. This study shows that neuromuscular disorders as a background, are the most common causes which defeat weaning from ventilator or result in reintubation by induction of hypercapnia.

  19. Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus.

    PubMed

    Schiermeyer, R P; Finkelstein, J A

    1994-03-01

    Rapid infusion of intravenous magnesium sulfate (MgSO4) was given to two young adults with impending respiratory failure caused by status asthmaticus. The infusion of 2 g of MgSO4 during a 2-minute period was associated with an immediate, dramatic reversal of their severe bronchospasm. This treatment obviated the need for intubation. Continuous beta 2-agonist therapy was performed simultaneously, taking advantage of the MgSO4-induced bronchodilation to deliver the beta 2-agonist to the target tissues. Rapid infusion of intravenous MgSO4 has been documented as safe in standard obstetric literature. Previous reports of MgSO4 therapy for acute asthma have used slow infusion. This is the first report of rapid infusion of MgSO4 for the emergency department management of asthma. In both cases, this therapy obviated the need for endotracheal intubation and mechanical ventilation.

  20. Inflation with air via a facepiece for facilitating insertion of a nasogastric tube: a prospective, randomised, double-blind study.

    PubMed

    Gupta, D; Agarwal, A; Nath, S S; Goswami, D; Saraswat, V; Singh, P K

    2007-02-01

    Insertion of a nasogastric tube is a routine procedure but during anaesthesia it is often difficult and time consuming. One hundred and sixty adults undergoing elective surgery under general anaesthesia were randomly divided into two groups. After induction of anaesthesia, neuromuscular blockade and tracheal intubation, a nasogastric tube was inserted through the nose with the head of the patient in the neutral position, either with or without prior inflation with air via a facepiece attached to a self-inflating bag applied firmly with the face. Insertion of the nasogastric tube was successful in 75/78 (96%) following inflation compared with 54/80 (68%) without inflation (p<0.001). In four patients receiving inflation, a fibreoptic endoscope was passed as far as the upper oesophageal sphincter; this revealed opening of the upper oesophageal sphincter during inflation.

  1. Radiation sensitivity of silicon imaging sensors on missions to the outer planets.

    NASA Technical Reports Server (NTRS)

    Brucker, G. J.; Cope, A. D.

    1972-01-01

    Review of the results of an investigation of the magnitude of the degradation effects of radiation on the operating characteristics of camera tubes using silicon diode arrays in the space environment, and discussion of the radiation damage mechanisms concerned. The effects produced by bombardment of bare-silicon-diode arrays or vidicon tubes with 85-kV X rays, Cobalt 60 gamma rays, 1 MeV and 11 MeV electrons, 3 MeV and 142 MeV protons, and reactor neutrons are presented. Interference effects produced by radiation bombardment during operation of television tubes are investigated, and limiting fluxes of electrons and protons are given.

  2. [Heat and moisture exchangers for conditioning of inspired air of intubated patients in intensive care. The humidification properties of passive air exchangers under clinical conditions].

    PubMed

    Rathgeber, J; Züchner, K; Kietzmann, D; Weyland, W

    1995-04-01

    Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent tracheo-bronchial or pulmonary damage resulting from dry and cold inspired gases. HME are mounted directly on the tracheal tube, where they collect a large fraction of the heat and moisture of the expired air, adding this to the subsequent inspired breath. The effective performance depends on the water-retention capacity of the HME: the amount of water added to the inspired gas cannot exceed the stored water uptake of the previous breath. This study evaluates the efficiency of four different HME under laboratory and clinical conditions using a new moisture-measuring device. METHODS. In a first step, the absolute efficiency of four different HME (DAR Hygrobac, Gibeck Humid-Vent 2P, Pall BB 22-15 T, and Pall BB 100) was evaluated using a lung model simulating physiological heat and humidity conditions of the upper airways. The model was ventilated with tidal volumes of 500, 1,000, and 1,500 ml and different flow rates. The water content of the ventilated air was determined between tracheal tube and HME using a new high-resolution humidity meter and compared with the absolute water loss of the exhaled air at the gas outlet of a Siemens Servo C ventilator measured with a dew-point hygrometer. Secondly, the moisturizing efficiency was evaluated under clinical conditions in an intensive care unit with 25 intubated patients. Maintaining the ventilatory conditions for each patient, the HME were randomly changed. The humidity data were determined as described above and compared with the laboratory findings. RESULTS AND DISCUSSION. The water content at the respirator outlet is inversely equivalent to the humidity of the inspired gases and represents the water loss from the respiratory tract if the patient is ventilated with dry gases. Moisture retention and heating capacity decreased with higher volumes and higher flow rates. These data are simple to obtain without affecting the

  3. Buried oxide layer in silicon

    DOEpatents

    Sadana, Devendra Kumar; Holland, Orin Wayne

    2001-01-01

    A process for forming Silicon-On-Insulator is described incorporating the steps of ion implantation of oxygen into a silicon substrate at elevated temperature, ion implanting oxygen at a temperature below 200.degree. C. at a lower dose to form an amorphous silicon layer, and annealing steps to form a mixture of defective single crystal silicon and polycrystalline silicon or polycrystalline silicon alone and then silicon oxide from the amorphous silicon layer to form a continuous silicon oxide layer below the surface of the silicon substrate to provide an isolated superficial layer of silicon. The invention overcomes the problem of buried isolated islands of silicon oxide forming a discontinuous buried oxide layer.

  4. Addition of a video camera system improves the ease of Airtraq(®) tracheal intubation during chest compression.

    PubMed

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

    2012-04-01

    Recent resuscitation guidelines for cardiopulmonary resuscitation emphasize that rescuers should perform tracheal intubation with minimal interruption of chest compressions. We evaluated the use of video guidance to facilitate tracheal intubation with the Airtraq (ATQ) laryngoscope during chest compression. Eighteen novice physicians in our anesthesia department performed tracheal intubation on a manikin using the ATQ with a video camera system (ATQ-V) or with no video guidance (ATQ-N) during chest compression. All participants were able to intubate the manikin using the ATQ-N without chest compression, but five failed during chest compression (P < 0.05). In contrast, all participants successfully secured the airway with the ATQ-V, with or without chest compression. Concurrent chest compression increased the time required for intubation with the ATQ-N (without chest compression 14.8 ± 4.5 s; with chest compression, 28.2 ± 10.6 s; P < 0.05), but not with the ATQ-V (without chest compression, 15.9 ± 5.8 s; with chest compression, 17.3 ± 5.3 s; P > 0.05). The ATQ video camera system improves the ease of tracheal intubation during chest compressions.

  5. Choice of Intravenous Agents and Intubation Neuromuscular Blockers by Anesthesia Providers

    DTIC Science & Technology

    1996-09-01

    of this study to determine if experience of the provider made a difference in the agent chosen. Both quantitative and qualitative methods were...comparison of quantitative and qualitative data of induction and intubation agents collected from CRNAs and MDAs according to experience of both types of...providers was analyzed to provide meaningful data. The difference in choice of agents by experience was found not to be significant. IV CHOICE OF

  6. Awake Tracheal Intubation in an 8-Year-Old Girl with McCune-Albright Syndrome.

    PubMed

    Bohman, J Kyle; Segura, Leal

    2013-10-01

    An 8-year-old girl with McCune-Albright syndrome presented for resection of a very large fibrous dysplasia mass of the face with significant distortion of the airway anatomy. She had significant obstructive sleep apnea with daytime somnolence and hemoglobin oxygen desaturations while breathing room air preoperatively. We were able to successfully manage her airway by providing IV sedation, topical anesthesia of the airway, and oral fiberoptic intubation in close collaboration with our otorhinolaryngology colleagues.

  7. [Delayed iatrogenic tracheal post-intubation rupture. A short review of the aetiopathology and treatment].

    PubMed

    Pinegger, S; Gómez-Ríos, M A; Vizcaíno, L; Carillo, M

    2013-05-01

    Iatrogenic tracheal rupture is a rare complication with a high morbidity and mortality. Tracheal intubation is the main cause and its origin is multifactorial. The diagnosis is based on non-specific but highly suggestive signs and symptoms, such as subcutaneous emphysema, pneumothorax, respiratory distress, or haemoptysis. Confirmation of the diagnosis requires an examination by bronchoscopy. Surgical repair has traditionally been the treatment of choice although the current trend is conservative management.

  8. Neural tube defects.

    PubMed

    Greene, Nicholas D E; Copp, Andrew J

    2014-01-01

    Neural tube defects (NTDs), including spina bifida and anencephaly, are severe birth defects of the central nervous system that originate during embryonic development when the neural tube fails to close completely. Human NTDs are multifactorial, with contributions from both genetic and environmental factors. The genetic basis is not yet well understood, but several nongenetic risk factors have been identified as have possibilities for prevention by maternal folic acid supplementation. Mechanisms underlying neural tube closure and NTDs may be informed by experimental models, which have revealed numerous genes whose abnormal function causes NTDs and have provided details of critical cellular and morphological events whose regulation is essential for closure. Such models also provide an opportunity to investigate potential risk factors and to develop novel preventive therapies.

  9. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    PubMed Central

    Badheka, Jigisha Prahladrai; Jadliwala, Rashida Mohammedi; Chhaya, Vrajeshchandra Amrishbhi; Parmar, Vandana Surendrabhai; Vasani, Amit; Rajyaguru, Ajay Maganlal

    2015-01-01

    BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. MATERIALS AND METHODS: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. RESULTS: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. CONCLUSION: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries. PMID:26622115

  10. Effectiveness of Synchronized Noninvasive Ventilation to Prevent Intubation in Preterm Infants

    PubMed Central

    Ramos-Navarro, Cristina; Sanchez-Luna, Manuel; Sanz-López, Ester; Maderuelo-Rodriguez, Elena; Zamora-Flores, Elena

    2016-01-01

    Background Noninvasive ventilation is being increasingly used on preterm infants to reduce ventilator lung injury and bronchopulmonary dysplasia. The aim of this study was to evaluate the effectiveness of synchronized nasal intermittent positive pressure ventilation (SNIPPV) to prevent intubation in premature infants. Methods Prospective observational study of SNIPPV use on preterm infants of less than 32 weeks' gestation. All patients were managed using a prospective protocol intended to reduce invasive mechanical ventilation (iMV) use. Previous respiratory status, as well as respiratory outcomes and possible secondary side effects were analyzed. Results SNIPPV was used on 78 patients: electively to support extubation on 25 ventilator-dependent patients and as a rescue therapy after nasal continuous positive airway pressure failure on 53 patients. For 92% of patients in the elective group and 66% in the rescue group, iMV was avoided over the following 72 hours. No adverse effects were detected, and all patients were in a stable condition even if intubation was eventually needed. Conclusions The application of SNIPPV in place of or to remove mechanical ventilation avoids intubation in 74.4% of preterm infants with respiratory failure. No adverse effects were detected. PMID:27500013

  11. A new curved laryngoscope blade for routine and difficult tracheal intubation.

    PubMed

    Nishikawa, Koji; Yamada, Koki; Sakamoto, Atsuhiro

    2008-10-01

    We have designed a new curved laryngoscope blade based on a new concept of reversing the peardrop phenomenon to facilitate a view of the larynx sufficient for intubation in a greater variety of patients than the current Macintosh blade affords. The new design has a bifid tip and S-shaped spatula to exert more effective pressure in the vallecula area, elevate the epiglottis and change directions of the forces on the tongue to prevent posteroinferior displacement of the compressed tongue in the submandibular space during laryngoscopy. A radiograph laryngoscopy technique was used to guide the new blade curvature design and compare the performance of the new blade with the Macintosh blade in patients with or without a difficult airway. Our results confirm that the new blade provides a laryngeal view sufficient to accomplish intubation by compressing the root of the tongue in an anterocephalad direction in the submandibular space and elevating the epiglottis effectively in patients with or without unanticipated difficult airway. The new curved blade can also effectively move the U-shaped epiglottis out of the laryngeal view to facilitate intubation in pediatric patients aged 2 mo-13 yr.

  12. [The EXIT procedure: Indications, limitations, risks and progress to the fetal endoscopical tracheal intubation].

    PubMed

    Cruz-Martínez, Rogelio; Méndez, Antonio; Pineda-Alemán, Hugo; Rebolledo-Fernández, Carlos

    2015-01-01

    Congenital oral and neck masses are associated with a 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. In 1997, the Ex Utero Intrapartum Treatment (EXIT) technique was designed to establish a secure neonatal airway. This procedure allows neonatal tracheal intubation while the uteroplacental circulation maintains fetal oxygenation in a partial fetal delivery during cesarean section. However, it must be emphasized that this technique requires a multidisciplinary team, maternal general anesthesia, high surgery times and potential maternal risks such as placental abruption and increased maternal blood loss due to uterine atony. In addition, the clinical algorithm to obtain a neonatal airway can be quite challenging and neonatal mortality has been reported due to the inability in obtaining an airway at birth. Recently, our Mexican group described a novel minimally invasive fetoscopical technique before cesarean delivery that allows prenatal airway control by means of a fetal endoscopic tracheal intubation (FETI) under maternal peridural anesthesia. This procedure attempted to avoid the need for an EXIT procedure and its potential risks. In this review we described the indications, risks and potential benefits of the EXIT technique and its possible replacement by the fetal endoscopic tracheal intubation technique.

  13. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation?

    PubMed

    Bindra, Ashish; Prabhakar, Hemanshu; Singh, Gyaninder Pal; Ali, Zulfiqar; Singhal, Vasudha

    2010-06-01

    Management of the airway is central to the practice of anesthesia. Several bedside airway assessment methods have been proposed for preoperative identification of patients who are difficult to intubate. The modified Mallampati test (MMT) remains a time-tested technique to date for recognizing an anticipated difficult tracheal intubation as assessed by Cormack-Lehane grade. Both Mallampati and its further modification by Samsoon and Young evaluate patients in the seated position. Recently a study mentioned a change in MMT score from sitting to supine position toward the higher side. However, there is a lack of data regarding the relationship of positional change in MMT with Cormack-Lehane grade. The aim of this prospective study was to assess if MMT score observed in sitting or supine position is a better predictor of difficult tracheal intubation. One hundred and twenty-three patients of ASA physical status I and II, aged 18-60 years, who were scheduled to undergo various neurosurgical procedures were enrolled for the study. We found that the MMT in supine position has a higher positive predictive value and is associated with more true positives as compared to MMT in the sitting position.

  14. Retrospective analysis of the clinical course for intubation vs. unspecified laryngeal granulomas.

    PubMed

    Kumai, Yoshihiko; Yumoto, Eiji; Nishimoto, Kohei; Minoda, Ryosei

    2014-05-01

    Intubation laryngeal granulomas (ILGs) are a well-known complication of endotracheal intubation. Cases other than ILGs can be categorized as unspecified laryngeal granulomas (ULGs) since their etiologies are often difficult to confirm. We intended to clarify clinical features of both ILGs and ULGs and that anticoagulant medication could cause the formation and delayed healing of ILGs in terms of wound-healing delay. We compared the results of our treatment of ILGs (n = 16) and ULGs (n = 47) treated between 1998 and 2009 to characterize these patients. The clinical course, treatment (medical vs. surgical), indications for surgical resection, treatment outcome, and use of anticoagulants for preexisting disease were reviewed and compared between these two groups. The resolution rate was significantly better in ILGs (p < .05). Five ILGs and seven ULGs were surgically resected. The main reason for resection was airway obstruction and the need for histological assessment, respectively. The use of anticoagulants was significantly higher in ILGs than ULGs (8/16 vs. 4/47, p < .01). The resolution period was significantly longer in the ILGs patients with anticoagulant medication compared to that in the ILGs patients without anticoagulant medication (152 ± 101 days vs. 76 ± 44 days, p < .05). ILGs may have different clinical course from ULGs, especially in terms of the resolution period. Moreover, administration of anticoagulants may deter healing of small injury due to intubation. Patients taking anticoagulants should be managed carefully during the perioperative period to prevent the occurrence of ILGs.

  15. Antifungal Susceptibility Patterns of Candida Species Recovered from Endotracheal Tube in an Intensive Care Unit

    PubMed Central

    Baghdadi, Elham; Rezaie, Sassan; Abolghasem, Sara; Kiasat, Neda; Salehi, Zahra; Sharifynia, Somayeh

    2016-01-01

    Aims. Biofilms formed by Candida species which associated with drastically enhanced resistance against most antimicrobial agents. The aim of this study was to identify and determine the antifungal susceptibility pattern of Candida species isolated from endotracheal tubes from ICU patients. Methods. One hundred forty ICU patients with tracheal tubes who were intubated and mechanically ventilated were surveyed for endotracheal tube biofilms. Samples were processed for quantitative microbial culture. Yeast isolates were identified to the species level based on morphological characteristics and their identity was confirmed by PCR-RFLP. Antifungal susceptibility testing was determined according to CLSI document (M27-A3). Results. Ninety-five strains of Candida were obtained from endotracheal tubes of which C. albicans (n = 34; 35.7%) was the most frequently isolated species followed by other species which included C. glabrata (n = 24; 25.2%), C. parapsilosis (n = 16; 16.8%), C. tropicalis (n = 12; 12.6%), and C. krusei (n = 9; 9.4%). The resulting MIC90 for all Candida species were in increasing order as follows: caspofungin (0.5 μg/mL); amphotericin B (2 μg/mL); voriconazole (8.8 μg/mL); itraconazole (16 μg/mL); and fluconazole (64 μg/mL). Conclusion. Candida species recovered from endotracheal tube are the most susceptible to caspofungin. PMID:27642628

  16. Comparison of the Ambu Aura-i with the Air-Q Intubating Laryngeal Airway as A Conduit for Fiberoptic-guided Tracheal Intubation in Children with Ear Deformity.

    PubMed

    Zhi, Juan; Deng, Xiao-Ming; Yang, Dong; Wen, Chao; Xu, Wen-Li; Wang, Lei; Xu, Jin

    2016-12-20

    Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmH2O in the Air-Q group and (22.2±5.0) cmH2O in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmH2O in the Air-Q group and (33.9±15.9) cmH2O in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.

  17. The electrostatic storage tube

    NASA Technical Reports Server (NTRS)

    Rutherford, R. E., Jr.

    1973-01-01

    An electrostatic camera system is discussed which is based on the electrostatic storage tube. The development of the system was begun following a series of experiments which indicated that the device offers signficantly improved performance over currently available devices. The approach used in developing the high performance camera involves: converting the input image to an electron image at low loss, applying a low noise gain process, and storing the resulting charge pattern in a low-loss target. The basic processes and elements of the electrostatic storage tube are illustrated and discussed. Graphs that depict the camera performance characteristics are included.

  18. PRODUCTION OF URANIUM TUBING

    DOEpatents

    Creutz, E.C.

    1958-04-15

    The manufacture of thin-walled uranium tubing by the hot-piercing techique is described. Uranium billets are preheated to a temperature above 780 d C. The heated billet is fed to a station where it is engaged on its external surface by three convex-surfaced rotating rollers which are set at an angle to the axis of the billet to produce a surface friction force in one direction to force the billet over a piercing mandrel. While being formed around the mandrel and before losing the desired shape, the tube thus formed is cooled by a water spray.

  19. UVC fluencies for preventative treatment of Pseudomonas aeruginosa contaminated polymer tubes.

    PubMed

    Bak, Jimmy; Ladefoged, Søren D; Begovic, Tanja; Winding, Anne

    2010-10-01

    Exposing Pseudomonas aeruginosa biofilm grown on the inner surface of Teflon and silicone tubes to UVC light (265 nm) from light emitting diodes (LED) has previously been shown to substantially reduce biofilm growth. Smaller UVC fluencies were required to disinfect Teflon tubes compared to silicone tubes. Light propagation enhancement in tubes can be obtained if the refractive index of the intra-luminal saline solution is higher than that of the polymer. This condition is achieved by using Teflon tubes with a low refractive index (1.34) instead of the polymers with a high refractive index (1.40-1.50) normally used for tubing in catheter production. Determining whether or not UVC light exposure can disinfect and maintain the intra-luminal number of colony forming units (CFUs) at an exceedingly low level and thus avoid the growth and establishment of biofilm is of interest. The use of UVC diodes is demonstrated to be a preventative disinfection treatment on tubes made of Teflon, which enhances the UVC light propagation, and on tubes made of a softer material, ethylene vinyl acetate (EVA), which is suitable for catheters but much less suitable for UVC light propagation. Simulating an aseptic breach (∼10(3)-10(4) CFU ml(-1)), the UVC disinfection set-up was demonstrated using tubes contaminated with planktonic P. aeruginosa. After the tubes (10-20 cm) were inoculated with the bacterial solution for 3 h, they were emptied and filled with saline solutions (0.9-20%). Next UVC fluencies (0-21 mJ cm(-2)) were applied to the tubes 3 h after inoculation. Colony counts were carried out on liquid samples drawn from the tubes the first day after UVC treatment and liquid and surface samples were collected and analyzed 3-4 days later. A fluence of approximately 1.0 mJ cm(-2) was noted as being sufficient for no growth for a period of 3-4 days for the Teflon tubes. Determining the fluence threshold for the EVA tubes was not possible. Almost all of the UVC-treated EVA tubes

  20. Purified silicon production system

    DOEpatents

    Wang, Tihu; Ciszek, Theodore F.

    2004-03-30

    Method and apparatus for producing purified bulk silicon from highly impure metallurgical-grade silicon source material at atmospheric pressure. Method involves: (1) initially reacting iodine and metallurgical-grade silicon to create silicon tetraiodide and impurity iodide byproducts in a cold-wall reactor chamber; (2) isolating silicon tetraiodide from the impurity iodide byproducts and purifying it by distillation in a distillation chamber; and (3) transferring the purified silicon tetraiodide back to the cold-wall reactor chamber, reacting it with additional iodine and metallurgical-grade silicon to produce silicon diiodide and depositing the silicon diiodide onto a substrate within the cold-wall reactor chamber. The two chambers are at atmospheric pressure and the system is open to allow the introduction of additional source material and to remove and replace finished substrates.