Tracheal intubation with the aid of a 'dental mirror'

Autor: G. Barzoi, Rita Cataldo, Felice Eugenio Agrò, A. Mattei, S. Antonelli
Rok vydání: 2000
Předmět:
Zdroj: Resuscitation. 42(3)
ISSN: 0300-9572
Popis: Management of the difficult airway (assessed by the Cormack–Lehane grades [1]) is a significant cause of mortality and morbidity in anaesthesia, representing the most common cause of cerebral damage or death related to anaesthesia problems (34%). Pre-anaesthetic anaesthetic evaluation may predict up to 98% of difficult intubations [2]; in these cases fibreoptics and other special techniques may be helpful and can be prepared in advance. Greater difficulties occur when difficult conventional orotracheal intubation cannot be predicted (1–3.5%) [3] or in an emergency, when fibreoptics or other special equipment and expertise may be not available. Blood and secretions may obscure the view in such cases. The ‘dental mirror technique’, which may be used in such cases; was first described by Patil [4] as an aid to tracheal intubation in a 2.5-month-old full-term infant, instead of direct laryngoscopy. Recently, Gabhash et al. [5] describe the technique as an aid to see the tube between the vocal cords and so to confirm correct or incorrect tube placement. Oesophageal intubation occurs in 5% of children and 6% of adults. The ‘dental mirror’ reduces the morbidity due to tube misplacement which may occur in 27% of predicted difficult intubations [6]. Good manual dexterity is necessary to use this device in unpredicted difficult airway situations and in emergencies where tracheal intubation is imperative. Expertise may be firstly acquired in manikins and/or cadavers, and then in patients (ASA 1–2, Cormack–Lehane grade 1–2) undergoing elective surgery. In this regard, we are carrying out a prospective study. We have studied 10 patients, three males and seven females, with a mean age of 55.1 years (range 28–72, S.D. 14.42), a mean weight of 63.5 kg (range 48–74, S.D. 8.49) and a mean height of 166.9 cm (range 154–175, S.D. 6.77). During the preoperative anaesthetic examination, nine patients were Mallampati grade I, and one Mallampati grade II. The mean interincisor gap was found of 3.89 cm (range 3.5–4.5, S.D. 0.31). The procedure was carried out by a consultant anaesthesiologist with 5 years experience. After pre-oxygenation for 3 min with the patient breathing spontaneously, anaesthesia was induced with propofol (2.5–3.5 mg/kg), fentanyl (2–4 mcg/kg), midazolam (0.05 mg/kg) and vecuronium (0.2 mg/kg). Anaesthesia was maintained by a face mask (O2/N2O/Isoflurane) for a further 2 min. Simulating a Cormack–Lehane grade 3, the anaesthesiologist then carried out a direct laryngoscopy. A mirror, previously * Corresponding author. Tel.: +39-6-22541521; fax: +39-622541444. E-mail address: f.agro@unicampus.it (F. Agro)
Databáze: OpenAIRE
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