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This letter to the editor shows new technique of oral opening for insertion of supraglottic airway devices, mainly the Combitube.
Current Opinion in Anaesthesiology
Alternative management techniques for the difficult airway: esophageal-tracheal Combitube2004 •
Prehospital and Disaster Medicine
Success and Complication Rates with Prehospital Placement of an Esophageal-Tracheal Combitube as a Rescue Airway2006 •
Acta Anaesthesiologica Scandinavica
Less tongue engorgement with lateral placement of the Esophageal Tracheal Combitube2008 •
Journal of Clinical Anesthesia
Use of the video laryngoscopy for Combitube exchange in a difficult airway2009 •
Anesthesia and Analgesia
Effectiveness of the Self-Inflating Bulb for Verification of Proper Placement of the Esophageal Tracheal Combitube Registered Trademark1995 •
Seminars in Anesthesia Perioperative Medicine and Pain
Combitube: The all-in-one concept for securing the airway and adequate ventilation2001 •
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie
Improved esophageal patency when inserting the ProSeal™ laryngeal mask airway with an Eschmann™ tracheal tube introducer2009 •
Purpose We hypothesized that a more accurate alignment of the tip of the drain tube with the upper esophageal opening would be achieved in adult patients, as confirmed by fibreoptic bronchoscopy, by placing the ProSeal™ laryngeal mask airway (PLMA) by means of guiding it over an Eschmann™ tracheal tube introducer, commonly know as a gum elastic bougie (GEB), that was previously inserted into the esophagus, rather than by placing the PLMA with a curved metal introducer (IT). Methods Seventy-five adult elective surgery patients, whose airway management involved a PLMA, were randomly allocated to either the GEB- or IT-guided techniques. After inserting the PLMA, alignment of the tip of the drain tube relative to the esophageal opening was verified by a fibrescope introduced through the drain tube. Placing the fibrescope through the PLMA identified the glottic structures. The primary endpoint indicating the proper alignment of the tip of the drain tube of the PLMA with the upper esophageal opening was the ability to pass the fibrescope into the esophagus through the drain tube by a distance >35 cm without obstruction and the ability to simultaneously visualize the esophageal mucosa. Results The overall success rates of PLMA insertion were similar in the GEB and IT groups. However, the mean airway insertion times were longer with the GEB than with the IT-PLMA. The GEB group achieved proper alignment of the drain tube and the upper esophageal opening more frequently than the IT group (97% confidence interval (CI95) 91.5–100% vs 81% CI95 68.5–93.5% of subjects, respectively; P = 0.027). When the GEB was used to place the PLMA, the patients’ vocal cords were visualized more frequently than when the IT technique was used (100% vs 73% CI95 58.9–87.1% of subjects, respectively; P = 0.003). Conclusion Fibreoptic bronchoscopy confirmed that GEB is superior to the IT technique in ensuring precise alignment of the tip of the drain tube of the PLMA with the upper esophageal opening. Accurate positioning may better preserve gastroesophageal drainage function of the PLMA. Objectif Nous avons émis l’hypothèse qu’il serait possible de parvenir à un alignement plus précis entre la pointe du tube de drainage du masque laryngé et l’ouverture supérieure de l’œsophage chez les patients adultes, évalué par bronchoscopie par fibres optiques, en plaçant un masque laryngé ProSeal™ (PLMA) guidé par une bougie de Eschmann™, aussi connue sous le nom de bougie flexible (GEB), insérée précédemment dans l’œsophage, au lieu de placer le PLMA à l’aide d’un introducteur en métal courbé (IT). Méthode Soixante-quinze patients adultes devant subir une chirurgie non urgente et dont la prise en charge respiratoire impliquait un PLMA on été randomisés en deux groupes à recevoir soit la technique guidée par GEB soit la technique guidée par IT. Après l’insertion du PLMA, l’alignement entre la pointe du tube de drainage et l’ouverture de l’œsophage a été vérifié à l’aide d’un fibroscope introduit via le tube de drainage. Le fait de placer le fibroscope via le PLMA a permis d’identifier les structures glottiques. La capacité de faire passer le fibroscope dans l’œsophage via le tube de drainage sur une distance >35 cm sans obstruction et la capacité de visualiser simultanément la muqueuse oesophagienne ont constitué les critères principaux indiquant l’alignement correct entre la pointe du tube de drainage du PLMA et l’ouverture supérieure de l’œsophage. Résultats Les taux globaux de réussite de l’insertion du PLMA étaient comparables dans les groupes GEB et IT. Toutefois, les temps moyens d’insertion des dispositifs étaient plus longs dans le groupe GEB par rapport au groupe IT-PLMA. Un alignement adéquat du tube de drainage et de l’ouverture supérieure de l’œsophage a été réalisé dans le groupe GEB plus souvent que dans le groupe IT (intervalle de confiance 97 % (IC95) 91,5–100 % vs 81 % IC95 68,5–93,5 % des patients, respectivement; P = 0,027). Lors de l’utilisation de la GEB pour placer le PLMA, les cordes vocales des patients étaient plus souvent visualisées que lors de l’utilisation de la technique IT (100 % vs 73 % IC95 58,9–87,1 % des patients, respectivement; P = 0,003). Conclusion La bronchoscopie par fibres optiques a confirmé que la technique GEB est supérieure à la technique IT pour assurer un alignement précis entre la pointe du tube de drainage du PLMA et l’ouverture supérieure de l’œsophage. Un positionnement précis pourrait préserver la fonction de drainage gastro-oesophagien du PLMA de façon plus optimale.
2012 •
2013 •
BACKGROUND: Supraglottic airway devices such as Combitube and classic Laryngeal Mask Airway (cLMA) are used as an alternative to endotracheal tube for airway maintenance whenever needed. In our randomized prospective study we have compared Combitube with cLMA for effectiveness as airway devices in elective surgery . MATERIALS AND METHODS: Sixty adult patients of either sex and physical status ASA (American Society of Anaesthesiologists) I and II, undergoing planned orthopaedic and general surgical procedures were selected and were given conventional general anaesthesia. Patients were randomly allocated into two groups. In group C, Combitube was used as an airway device and in group L, cLMA was used. Parameters like ease of insertion, number of insertion attempts, effective airway time, haemodynamic changes, changes in oxygen saturation (SpO2) and end tidal carbon dioxide (EtCO2) , and complications were observed. RESULTS : Ease of insertion and first attempt success rate were compar...
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