Abstract
Purpose
To introduce an improved method of styletted oral laryngoscopic tracheal intubation.
Description of the technique
The oral tracheal stylet unit (OTSU) is constructed using a commonly available intubating stylet combined with an ordinary endotracheal tube (ETT). The ETT/stylet is created by a series of specific steps to form an OTSU, each with a standard shape and design that allows the tracheal tube to separate freely from the stylet. After construction, every unit is tested to confirm that the frictional resistance created by the tracheal tube, as it slides along the stationary stylet, is at an absolute minimum.
Successful tracheal intubation is based on the following concepts: (a) The j-shaped OTSU, when correctly directed through the airway, passes freely from the mouth to the larynx, the laryngoscopic channel; (b) The tip of the ETT must first be placed between the vocal cords with every intubation. The trachéal tube is then launched and advanced into the trachea by sliding along and off a stationary stylette; (c) Only minimal force is required to propel the ETT during intubation; (d) Resistance to placement, launch or advancement means the tip of the OTSU has come into physical contact with the patient’s airway; (e) When the epiglottis obscures the larynx, the tip of the OTSU is used to explore the hypopharynx and identify the glottis. The ability to differentiate where the ETT tip is located depends primarily on interpreting the sensations of touch and pressure transmitted from the bevel of the OTSU to the hand. Successful tracheal intubation is accomplished when all criteria for placement, launch, and advancement are met.
Conclusion
Styletted oral tracheal intubation is well known. However, we describe an improvement of the technique, based on solid physical principles and years of experience, that should prove useful both for routine intubations and unexpected difficult airways.
Résumé
Objectif
Présenter une méthode améliorée d’intubation laryngoscopique oro-trachéale avec stylet.
Description de la, technique
Le stylet d’intubation oro-trachéal (SIOT) est le résultat de la combinaison d’un stylet d’intubation habituellement disponible et d’un tube endotrachéal (TET) ordinaire. Le TET/stylet est créé à la suite d’opérations spécifiques visant à produire un SIOT, chaque opération suivant un modèle et une forme réglementaires qui permettent au tube trachéal de se séparer librement du stylet. Après la construction, chaque unité est testée pour confirmer que la résistance frictionnelle créée par le tube trachéal qui glisse le long du stylet fixe est réduite au strict minimum.
L’intubation trachéale réussie se fonde sur les concepts suivants : (a) Le SIOT en forme de J, lorsqu’il est correctement poussé dans les voies aériennes, passe librement de la bouche au larynx, le canal laryngoscopique; (b) La pointe du TET doit d’abord être placée entre les cordes vocales pour chaque intubation. Le TET est alors introduit et avancé en glissant dans la trachée à distance du stylet fixe; (c) Seule une force minimale est nécessaire pour pousser le TET pendant l’intubation; (d) La résistance à la mise en place, à l’introduction ou à l’avancée signifie que la pointe du SIOT est entrée en contact avec les voies aériennes du patient; (e) Lorsque l’épiglotte masque le larynx, le bout du SIOT est utilisé pour explorer l’hypopharynx et repérer la glotte. La possibilité de savoir où se situe la pointe du TET dépend principalement de l’interprétation des sensations tactiles et de la pression transmises du biseau du SIOT à la main. L’intubation trachéale réussie est celle qui répond à tous les critères de mise en place, d’introduction et de poussée du tube.
Conclusion
L’intubation avec un stylet oro-trachéale est bien connue. Toutefois, nous décrivons une amélioration de la technique, fondée sur de solides principes physiques et des années d’expérience, ce qui devrait se révéler utile autant pour les intubations normales que pour les cas d’intubation difficile inattendue.
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References
Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828–33.
Cheney FW. The American Society of Anesthesiologists closed claims project. What have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology 1999; 91: 552–6.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesth 1987; 42: 487–90.
Frerk CM. Predicting difficult intubation. Anaesthesia 1991; 46: 1005–8.
Rocke DA, Murray WB, Rout CC, Gouws E. Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology 1992; 77: 67–73.
Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41: 372–83.
Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesth Analg 1995; 81: 254–8.
Naguib M, Malabarey T, AlSatli RA, Al Damegh S, Samarkandi AH. Predictive models for difficult laryngoscopy and intubation. A clinical, radiologic and three-dimensional computer imaging study. Can J Anesth 1999; 46: 748–59.
Karkouti K, Rose DK, Wigglesworth D, Cohen MM. Predicting difficult intubation: a multivariable analysis. Can J Anesth 2000; 47: 730–9.
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the diffcult airway. Anesthesiology 1993; 78: 597–602.
Benumof JL. ASA difficult airway algorithm: new thoughts and considerations. In: Hagberg CA (Ed.). Handbook of Difficult Airway Management, 1st ed., Philadelphia: Churchill Livingstone, 2000: 31–48.
Kitamura T, Yamada Y, Du H-L, Hanaoka K. Efficiency of a new fiberoptic stylet scope in tracheal intubation. Anesthesiology 1999; 91: 1628–32.
Cooper SD, Benumof JL, Ozaki GT. Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy. Anesth Analg 1994; 79: 965–70.
Weiss M, Schwarz U, Gerber AC. Difficult airway management: comparison of the Bullard laryngoscope with the video-optical intubation stylet. Can J Anesth 2000; 47: 280–4.
Weiss M. Video-intuboscopy: a new aid to routine and difficult tracheal intubation. Br J Anaesth 1998; 80: 525–7.
Gravenstein D, Melker RJ, Lampotang S. Clinical assessment of a plastic optical fiber stylet for human tracheal intubation. Anesthesiology 1999; 91: 648–53.
MacQuarrie K, Hung OR, Law JA. Tracheal intubation using a Bullard laryngoscope for patients with a simulated difficult airway. Can J Anesth 1999; 46: 760–5.
Kannan S, Chestnutt N, McBride G. Intubating LMA guided awake fibreoptic intubation in severe maxillofacial injury. Can J Anesth 2000; 47: 989–91.
Eisenburger P, Laczika K, List M, et al. Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians. Anesthesiology 2000; 92: 687–90.
Gaitini LA, Vaida SJ, Mostafa S, et al. The combitube in elective surgery. A report of 200 cases. Anesthesiology 2001; 94: 79–82.
Aoyama, K, Takenaka I, Nagaoka E, Kadoya T, Sata T, Shigematsu A. Potential damage to the larynx associated with light-guided intubation: a case and series of fiberoptic examinations. Anesthesiology 2001; 94: 165–7.
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Stasiuk, R.B.P. Improving styletted oral tracheal intubation: rational use of the OTSU. Can J Anesth 48, 911–918 (2001). https://doi.org/10.1007/BF03017359
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DOI: https://doi.org/10.1007/BF03017359