Yozo Manabe

The Parker Flex-Tip® tube prevents subglottic impingement on the tracheal wall during nasotracheal intubation.

patient safety: (1) the subclavian anatomical area has complex anatomy and routine ultrasound use for needle insertion can detect variations, (2) understanding available ultrasound features helps to properly identify anatomy, and (3) the subclavian artery and vein can be transposed. If transposition is identified in future patients, major morbidity can be avoided by altering the needle approach for subclavian venous access or infraclavicular block.

The success rate of nasotracheal intubation using lightwand does not depend on the laryngoscopic view.

PurposeThe purpose of this study was to evaluate the usefulness of Trachlight (TL) for nasotracheal intubation and to determine the relationship between the grade of laryngeal view and the subsequent ease of nasotracheal intubation using TL.MethodsPatients requiring nasotracheal intubation were enrolled in this study. Laryngoscopy was performed in all patients under topical anesthesia, with 8% lidocaine spray applied to the supraglottic region and the vocal cords. Glottic visualization during laryngoscopy was assessed using the Cormack and Lehane classification. Patients were allocated to four groups according to this classification. If the TL intubation was unsuccessful after three attempts, intubation was carried out using direct laryngoscopy. Intubation difficulty was assessed by the original 6-point scale and the total intubation time was also recorded.ResultsTrachlight intubation was successful in 89.1% of the 110 patients enrolled in the study. There was no observed correlation between the original 6-point scale and glottic visualization. The total intubation time and the ratio of “unsuccessful” cases were not significantly different among the four groups.ConclusionNo relationship was found between the ease of nasotracheal intubation using TL and glottic visualization.

Unrecognized bronchial intubation associated with the uncuffed pediatric tracheal tube with bilateral Murphy eyes.

Unreliability of breath sounds auscultation after intubation is reportedly mainly related to the presence of the Murphy eye. This study was performed to ascertain whether an uncuffed pediatric tracheal tube with bilateral Murphy eyes increases the risk of unrecognized bronchial intubation, compared to an uncuffed tube without eyes.

Mallampati classification without tongue protrusion can predict difficult tracheal intubation more accurately than the traditional Mallampati classification

a b s t r a c t Introduction: The modified Mallampati classification (m-MMT) is the most popular technique for predict- ing difficult tracheal intubation. However, tongue protrusion may sometimes hide the oropharynx when the distance of the mouth opening is short, and this may lead to false-positive (FP) estimations of difficulty. The purpose of this study is to determine whether the Mallampati classification with no tongue protru- sion (NT-MMT) can predict difficult tracheal intubation more accurately than the traditional m-MMT method. Methods: A total of 748 patients requiring endotracheal intubation were enrolled in this study. They were evaluated by m-MMT and by NT-MMT prior to surgery. After induction of general anesthesia with muscle relaxation, all patients underwent direct laryngoscopy, and the best glottic view was recorded as defined by the grading system of Cormack and Lehane. The preoperative assessment data and the intubation findings were used to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the aforementioned tests in predicting difficult intubation. Results: NT-MMT classification scored higher in all parameters than m-MMT. Similarly, the coefficient of reliability of Spearmanstest was higher with NT-MMT than with m-MMT. Conclusion: NT-MMT is easy to perform and was more accurate in predicting difficult tracheal intubation than m-MMT.

Appropriate Head Position for Nasotracheal Intubation by Using Lightwand Device

Background: The purpose of this study was to determine the relationship between the head position and the subsequent ease of nasotracheal intubation by using lightwand device TrachlightTM (TL). Methods: Patients requiring nasotracheal intubation were subdivided into three groups according to the intubated head position (Group S: sniffing position, Group E: extension position, Group N: neutral position). The number of attempts, the total intubation time, and the failures of the TL intubation were recorded. Intubation difficulty by means of TL was assessed by the original 6-point scale. Results: Of total 300 patients enrolled in the study, TL intubation was successful in the patients of 91.3%. No correlation between the original scale and the head position was observed. Conclusion: TL is an effective alternative for patients who require nasotracheal intubation. We could not find the favorable head position for nasotracheal intubation with TL, so we recommend that the nasotracheal intubation with TL should be started with neutral position and have to find the appropriate head position individually.

Syndrome of inappropriate secretion of antidiuretic hormone found by preoperative electrolyte analysis.

1. Kumar B, Bhagat H. A Comparison of 3% saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery. Anesth Analg 2011;112:485 2. Bedford RF, Morris L, Jane JA. Intracranial hypertension during surgery for supratentorial tumor: correlation with preoperative computed tomography scans. Anesth Analg 1982;61:430–3 3. Rasmussen M, Bundgaard H, Cold GE. Craniotomy for supratentorial brain tumors: risk factors for brain swelling after opening the dura mater. J Neurosurg 2004;101:621–6 4. Wu CT, Chen LC, Kuo CP, Ju DT, Borel CO, Cherng CH, Wong CS. A comparison of 3% hypertonic saline and mannitol for brain relaxation during elective supratentorial brain tumor surgery. Anesth Analg 2010;110:903–7 DOI: 10.1213/ANE.0b013e318200a8fc