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Evaluation of the Efficacy of the Flexiblade Laryngoscope in Endotracheal Intubation
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Sun Young Jang, Sang Kyi Lee
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Korean J Crit Care Med. 2001;16(1):42-47.
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 Abstract
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- BACKGROUND
A new laryngoscope, Flexiblade has flexible adjustable rigid blade. The Flexiblade is composed of a handle and a blade with an adjunct trigger. Squeezing the trigger changes the blade curvature from nearly a straight Miller blade into a curved Macintosh blade. This study was designed to evaluate the clinical application of the Flexiblade laryngoscope in endotracheal intubation for adult patients.
METHODS
Following the induction of general anesthesia and muscle paralysis, the laryngoscopic views of 50 patients were measured while five different blade positions in the oral cavity were performed. The laryngoscopic view which was described by Cormack and Lehane was classified from grade 1 to grade 4 except one blade position. Adjusting maneuvers such as laryngeal lift and/or a styletted intubation were used to facilitate a tracheal intubation. Complications which were directly related to the Flexiblade laryngoscope were also evaluated.
RESULTS
In use of the Flexiblade laryngoscope just like straight Miller blade, the vocal cord (< or =grade 2) were exposured in 82% of the patients. The 96% of patients showed a good vocal cord exposure (< or =grade 2) with a partial depression of the triggers of the laryngoscope. Overall rate of a successful intubation was 98%. In partial depression of trigger of the Flexiblade laryngoscope compared with neutral position, 22 patients of 26 patients with laryngoscopic view of grade 2 were improved by one grade, and 15 patients of the 17 patients with laryngoscopic view of grade 3 were improved by more than one grade.
CONCLUSIONS
The Flexiblade laryngoscope is useful for endotracheal intubation for adult patients.
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Assessment of Positive Pressure Controlled Ventilation with the Laryngeal Mask Airway
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Young Soon Lim, Sang Kyi Lee
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Korean J Crit Care Med. 1999;14(2):148-153.
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Abstract
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- BACKGOUND: Cuff overinflation may cause premature rejection of the laryngeal mask airway (LMA) or provocation of incomplete and ineffective reflex responses. Therefore a previous report recommends that the cuff is inflated to a pressure of 60 cmH2O to minimize side effects. The objective of this study was to assess the possibility of controlled positive pressure ventilation in adults when intra-cuff pressure of LMA was set to 60 cmH2O.
METHODS
We studied 20 adult patients who received general inhalational anesthesia with LMA and mechanical positive pressure ventilation for gynecological operations. The following variables was determined during anesthesia at two time points 3 min after endotracheal intubation and 5 min before neuromuscular blockade: pop-off pressure, tidal volume, peak-air way pressure, plateau pressure, compliance, SpO2, and ETCO2.
RESULTS
Mean compliances measured were normal. Mean airway pressures (peak, plateau) were 13.6 and 15.1 cmH2O at two time points respectively while setting the tidal volume with 10 ml/kg. However, pop-off pressure were 18.3 and 20.1 cmH2O, respectively. Mean tidal volumes without gas leak around the LMA cuff were 14.5 and 14.5 ml/kg, respectively.
Mean SpO2 and mean ETCO2 were measured 99.0 and 99.2%, 31.3 and 30.3 mmHg in two time points, respectively.
CONCLUSIONS
The study suggested that controlled mechanical positive pressure ventilation using the laryngeal mask airway with 60 cmH2O intra-cuff pressure were be adequate when pulmonary compliance and airway resistance were normal.
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Evaluation of the Technique of Central Venous Catheterization via the External Jugular Vein
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Seong Hoon Ko, Dong Chan Kim, Sang Kyi Lee, He Sun Song
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Korean J Crit Care Med. 1999;14(2):143-147.
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Abstract
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- BACKGOUND: This study was designed to evaluate the effectiveness and feasibility of central venous catheterization via the external jugular vein (EJV). We compared the success rate of left and right EJV catheterization. The influence of the course of left and right external jugular vein on success rate was investigated also.
METHODS
Eighty anesthetized adult surgical patients were studied consecutively. Patients were allocated to left or right EJV catheterization and measured the angles between EJV and clavicle and transverse shoulder line.
Catheterization was performed under sterile conditions by Seldinger technique after angiography of EJV and subclavian vein. We analyzed the relationship between the angles and success rate and time for catheterization. We compared the success rate of left and right EJV catheterization.
RESULTS
The overall rate of intrathoracic placement was 74 from 80 catheterization (92.5%). Analysis of success in left and right EJV catheterization did not reveal statistically significant differences. The success rates did not show any correlation with course of EJV. Complications were few and not serious.
CONCLUSIONS
This study indicated that left and right EJVs were good routes for central venous catheterizationan with acceptably high success rate. However, we could not find the predictor of success for central venous catheterization via EJV.
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Reliable Verification of Endotracheal Tube Location by Pilot Balloon Compression Technique of Tracheal Tube
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Sang Kyi Lee
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Korean J Crit Care Med. 1998;13(2):218-223.
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Abstract
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- BACKGOUND: Correct placement of an endotacheal tube (ETT) is crucial, and an ideal test for confirmation of proper ETT placement should be simple and quick to perform, reliable, safe, inexpensive, and repeatable. Palpation of the ETT cuff at the suprasternal notch has been used by clinicians for many years, however the effectiveness of the technique has never been documented. So the author evaluated an efficacy of the pilot balloon compression technique to verify the correct location of an ETT.
METHODS
After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repeated pressure is applied with the fingers at the pilot balloon. Simultaneously, the suprasternal notch is palpated in the other hand. When the cuff maximally distends from the pressure applied at the pilot balloon, the ETT is secured. After securing the ETT, the distances from its tip to the upper incisor and the carina were measured by means of fiberoptic laryngoscopy.
RESULTS
Endobroncheal intubation was noted in three patients (3%). Average distance from the tip of the ETT to upper incisor in men was 23.9 cm (range, 21.7~26.9) and in women 22.5 cm (range, 20.0~26.0). Average distance to the carina in men was 2.6 cm (range, -0.5~5.0) and in women 1.8 cm (range, -0.6~4.4).
CONCLUSIONS
In this study, location of the ETT was not reliably confirmed by the technique. So the technique should need some modification. When maximal sensation of the ETT cuff is palpated 2.4~3.3 cm in men and 3.2~3.7 cm in women above the suprastenal notch, the location of the ETT tip is theoretically reliable. However, the technique should not be used to verify endotracheal intubation itself.
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Anesthetic Experience of Hemorrhagic Shock Patient with Rh-, AB Blood Type without Blood Transfusion
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Sang Kyi Lee, Woo Sun Kim
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Korean J Crit Care Med. 1997;12(2):173-176.
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Abstract
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- Blood loss is usually replaced with crystalloid or colloid solutions until a predetermined minimal hematocrit is reached. But in severe blood loss, blood transfusion is indicated for maintenance of oxygen-carrying capacity, coagulation factors and intravascular volume. Jehovah's witness patients refuse blood transfusion, but some patients with rare blood type may even not have the chance of blood transfusion. Commonly utilized and effective alternatives to blood transfusion are acute hemodilution, autotransfusion and other blood salvage techniques. We report a case of successful anesthetic management in patient of hemorrhagic shock with rare blood type (Rh-, AB type) without blood trasfusion.
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An Anthropometric Measurements of the Upper Airway Using Fiberoptic Laryngoscope in Korean Adults
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Sang Kyi Lee, Chun Won Yoo
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Korean J Crit Care Med. 1997;12(2):143-150.
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Abstract
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- Introduction: An anthropometric distance is crucial for an easy endotracheal intubation and correct placement of endotracheal tube in the trachea. There may be a racial difference of the anthropometric measurement. So we measured the anthropometric distances of the upper airway in Korean adult patients.
METHODS
A standard anesthetic induction and maintenance was performed in 100 adult patients following endotracheal intubation. Various anthropometric measurements were determined while the patients head were in a neutral position. Thyromental and sternomental distance were measured. A distance from upper central incisor to carina or cricoid cartilage was directly measured using fiberoptic laryngoscope. However, the length from upper central incisor to midtrachea & the cricoid cartilage-carina distance were indirectly calculated from the above measured distances.
Correlation analyses were also performed between age, height, or weight and the above measured anthropometric distances.
RESULTS
The mean distances from upper central incisor to carina, cricoid cartilage or midtrachea were 25.5+/-1.8, 13.9+/-1.9, or 19.8+/-1.8cm respectively. The mean distance from cricoid cartilage to carina was 11.6+/-1.4cm.
Thyromental and thyrosternal distance were 6.6+/-0.9 and 15.7+/-1.5cm respectively. All mean anthropometric distances of male were longer than those of female patients.
Thirty-eight patients (38%) had the thyromental distance < or = 6cm while one patient (1%) had thyrosternal distance < or = 12.5cm. A good correlation (r< or =0.6) was observed between height and upper central incisor-carina distance.
CONCLUSIONS
This study suggests that these measured anthropometric data are useful for an easy endotracheal intubation and accurate endotracheal placement in the trachea.
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