Hyerim Kim

A comparison of direct laryngoscopic views in different head and neck positions in edentulous patients

OBJECTIVE Proper head and neck positioning is an important factor for successful direct laryngoscopy, and the optimum position in edentulous patients is unclear. We compared direct laryngoscopic views in simple head extension, sniffing, and elevated sniffing positions in edentulous patients. METHODS Eighteen adult edentulous patients scheduled for elective surgery were included in the study. After induction of anesthesia, the laryngeal view was assessed under direct laryngoscopy using the percentage of glottic opening (POGO) score in 3 different head and neck positions in a randomized order: simple head extension without a pillow, sniffing position with a pillow of 7 cm, and elevated sniffing position with a pillow of 10 cm. After assessment of the laryngeal views, tracheal intubation was performed. RESULTS A significant difference was observed in the laryngeal views assessed at the 3 head positions (P= .001). The POGO scores (mean [SD]) in the sniffing position (78.9% [19.7%]) and elevated sniffing position (72.6% [20.8%]) were significantly improved compared to that with simple head extension (53.8% [25.9%]) (P= .001, respectively). The sniffing position provided the best laryngeal view. The mean POGO scores were higher in the sniffing position than the elevated sniffing position, but no significant difference was observed between these 2 positions (P= .268). CONCLUSIONS The sniffing and elevated sniffing positions provide better laryngeal views during direct laryngoscopy compared to simple head extension in edentulous patients.

Effect of the Macintosh curved blade size on direct laryngoscopic view in edentulous patients

Objective: In the present study, we compared the laryngoscopic view depending on the size of the Macintosh curved blade in edentulous patients. Methods: Thirty‐five edentulous adult patients scheduled for elective surgery were included in the study. After induction of anesthesia, two direct laryngoscopies were performed alternately using a standard‐sized Macintosh curved blade (No. 4 for men and No. 3 for women) and smaller‐sized Macintosh curved blade (No. 3 for men and No. 2 for women). During direct laryngoscopy with each blade, two digital photographs of the lateral view were taken when the blade tip was placed in the valleculae; the laryngoscope was lifted to achieve the best laryngeal view. Then, the best laryngeal views were assessed using the percentage of glottic opening (POGO) score. On the photographs of the lateral view of direct laryngoscopy, the angles between the line extending along the laryngoscopic handle and the horizontal line were measured. Results: The POGO score was improved with the smaller‐sized blade compared with the standard‐sized blade (87.3% [11.8%] vs. 71.3% [20.0%], P < 0.001, respectively). The angles between the laryngoscopic handle and the horizontal line were greater with the smaller‐sized blade compared to the standard‐sized blade when the blade tip was placed on the valleculae and when the laryngoscope was lifted to achieve the best laryngeal view (both P < 0.001). Conclusions: Compared to a standard‐sized Macintosh blade, a smaller‐sized Macintosh curved blade improved the laryngeal exposure in edentulous patients.

A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and GlideScope for Double-Lumen Endobronchial Intubation

OBJECTIVE To compare GlideScope and lighted stylet for double-lumen endobronchial tube (DLT) intubation in terms of intubation time, success rate of first attempt at intubation, difficulty in DLT advancement toward the glottis, and postoperative sore throat and hoarseness. DESIGN A prospective, randomized study. SETTING Medical center governed by a university hostpial. PARTICIPANTS Sixty-two adult patients undergoing thoracic surgery using DLT intubation. INTERVENTION After the induction of anesthesia, DLT intubation was performed using GlideScope (n = 32) or lighted stylet (n = 32). MEASUREMENTS AND MAIN RESULTS Number of intubation attempts, difficulty of DLT advancement toward the glottis, time taken for DLT intubation, and the incidence and severity of postoperative sore throat and hoarseness at 1 and 24 hours after surgery were evaluated. Time taken for DLT intubation was shorter in the lighted stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53] s, median [interquartile range], respectively; p < 0.001). DLT advancement toward the glottis was easier in the lighted stylet group than in the GlideScope group (p = 0.016). The success rate of DLT intubation in the first attempt (96.9% v 90.6% for lighted stylet and GlideScope, respectively), and the incidence and severity of postoperative sore throat and hoarseness were not different between the two groups. CONCLUSIONS The use of lighted stylet allowed easier advancement of the DLT toward the glottis in the oropharyngeal space and reduced time for achieving DLT intubation compared with GlideScope.

Higher Operating Table for Optimal Needle-Entry Angle and Less Discomfort During Spinal Anesthesia

The aim of this study was to find the optimal table height to facilitate insertion of the spinal needle at a 90° angle and to reduce the anesthesiologist’s discomfort. Sixty patients were randomly allocated according to landmarks on the anesthesiologist’s body: umbilicus (group U), lowest rib margin (R), xiphoid process (X), and nipple (N). The coronal insertion angle between the patient’s skin and the spinal needle was obtuse in groups U and R, and 90° in group X. We demonstrated that high operating tables at the xiphoid and nipple level facilitate more optimal needle entry angles while reducing the discomfort and joint flexion of anesthesiologists during spinal anesthesia.