MyMedR

Periasamy, Chentilnathan, Irfan Mohamad, Khairul Bariah Johan, Nik Fariza Husna Nik Hassan

Archives of Orofacial Sciences, 2013;8(1):41-43.

MyJurnal

Tracheostomy is a life saving surgical procedure performed to maintain upper airway ventilation. The
indications include providing relief of upper airway obstruction, to replace endotracheal intubation in patients needing prolonged assisted ventilation, protection of tracheobronchial tree and facilitates tracheobronchial toilet.More importantly, post operative tracheostomy care is very crucial for the success of the treatment and avoiding complications. We report a rare case of an obligate parasite which had infested the tracheal stoma due to poorhygiene.

Matched MeSH terms: Intubation, Intratracheal

Fulltext A Comparative Study of Different Induction Techniques (Propofol-Placebo, Propofol-Ephedrine and Propofol-Placebo-Crystalloid) on Intubating Conditions after Rocuronium Administration

Muhd Helmi Azmi, Karis Misiran

Medicine & Health, 2007;2(2):103-109.

MyJurnal

This was a prospective randomized double blind controlled study to compare intubating conditions at 60 seconds with rocuronium 0.6 mg/kg by using three different induction techniques: propofol-placebo (PP), propofol-ephedrine (PE) and propofol-placebo-crystalloid (PC). Ninety patients were included and randomly allocated to receive one of the three combinations. The patients were induced using fentanyl 2 µg/kg, followed by propofol 2.5 mg/kg with normal saline as placebo (Group PP and Group PC) or ephedrine 70 µg/kg (Group PE) given over 30 seconds. Subsequently, rocuronium 0.6 mg/kg was given over five seconds and endotracheal intubations were performed 60 seconds later. Intubating conditions were clinically acceptable in all patients except in four patients in PP group, who had poor intubating conditions. The proportion of excellent intubating conditions was significantly highest in Group PE (94%) followed by Group PC (81%) and lowest in Group PP (50%). In conclusion, induction with propofol-ephedrine and propofol-placebo-crystalloid combinations rovided significantly better intubating conditions than propofol alone, when rocuronium 0.6 mg/kg was used for intubation at 60 seconds.

Matched MeSH terms: Intubation, Intratracheal

Fulltext Novel usage of dexmedetomidine in a paediatric patient with giant tongue haemangioma

Mohd Zulfakar Mazlan, Shamsul Kamalrujan Hassan, Laila Abd Mukmin, Mohd Hasyizan Hassan, Huda Zainal Abiddin, Irfan Mohamad, et al.

Malaysian Journal of Medicine and Health Sciences, 2016;12(2):46-48.

MyJurnal

Giant haemangioma of the tongue is a disease which can
obstruct the oropharyngeal airway and is presented with
obstructive symptoms. Due to its vascularity, inserting
laryngoscope for intubation can cause high risks, such as
inducing bleeding. Hypoxia and excessive bleeding must be
anticipated while securing the airway. We present a case of
novel usage of dexmedetomidine as a conscious sedation agent
for awake fibre optic intubation in a 9-year-old child with
obstructive symptoms secondary to a huge tongue
haemangioma, who was presented for interventional
sclerotherapy of the lesion.

Matched MeSH terms: Intubation, Intratracheal

Fulltext Paediatric one lung anaesthesia by selective bronchial intubation

Lew YS

Singapore Med J, 2000 Aug;41(8):398-400.

PMID: 11256348

One lung anaesthesia in paediatric patients may not always be achievable by bronchial blockade or double lumen tube intubation due to inadequate experiences or facilities. We attempted to isolate right lung by selectively intubating the left bronchus with single lumen tube on a 10 kg child. Optimal surgical condition and satisfactory oxygenation achieved but complicated with severe respiratory acidosis. The possible causes for hypercapnea in this child were discussed.

Matched MeSH terms: Intubation, Intratracheal/adverse effects*; Intubation, Intratracheal/instrumentation; Intubation, Intratracheal/methods*

Fulltext Comparison of the Air-Q intubating laryngeal mask airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic assisted endotracheal intubation for simulated cervical spine injury

Che Omar S, Hardy Mohamad Zaini R, Fui Wong T, Nazaruddin W Hassan WM

Anaesthesiol Intensive Ther, 2021;53(3):241-245.

PMID: 34006053 DOI: 10.5114/ait.2021.105759

INTRODUCTION: Airway management in patients with a cervical spine injury is a difficult and challenging task. The aim of this study was to compare the effectiveness of the Air-Q intubating laryngeal airway and the Ambu AuraGain laryngeal mask airway as a conduit for fibreoptic (FO) assisted endotracheal intubation in adult patients with a simulated cervical spine injury.

MATERIAL AND METHODS: A total of 66 adult patients underwent elective surgery under general anaes-thesia, and they were randomized to two groups: the Air-Q (AQ) group (n = 33) and the Ambu AuraGain (AA) group (n = 33). A simulated cervical spine injury was created using a cervical collar, which was applied after the induction of general anaesthesia. Ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, oropharyngeal leak pressure (OLP), Brimacombe score for FO laryngeal view, post-intubation complications and haemodynamic changes were recorded for both groups.

RESULTS: The OLP was significantly higher in the AA group than in the AQ group (34.9 ± 6.4 vs. 28.6 ± 7.8 cm H 2 O; P = 0.001). Otherwise, there were no significant differences in the ease of insertion, time taken for successful insertion, time taken for successful FO guided endotracheal intubation, Brimacombe score for FO laryngeal view, haemodynamic parameters or complication rate between the two groups.

CONCLUSIONS: Air-Q was comparably effective as Ambu AuraGain as a conduit for FO endotracheal intubation in patients with a simulated cervical spine injury; however, Ambu AuraGain has a better seal with significant OLP.

Matched MeSH terms: Intubation, Intratracheal

Fulltext Nitrous oxide pollution in the operating room. A comparison of two modes of ventilation

Noorddin Y, Raha AR, Jaafar MZ, Rozaidi SH, Muraly S, Marlizan MY

Med J Malaysia, 2007 Jun;62(2):127-9.

PMID: 18705444 MyJurnal

The use of laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) is becoming more popular in the practice of anesthesia. It is undeniable that this device has numerous advantages over endotracheal tube, however it does not provide an airtight seal between the airway and atmospheric gases. This may lead to pollution of the operating room environment with nitrous oxide. One hundreds adult patients undergoing general anaesthesia were divided into two groups. The airway in Group I was maintained with LMA with spontaneous ventilation and ETT with intermittent positive pressure ventilation (IPPV) was used for Group II. The result demonstrated that the ETT group recorded concentrations of nitrous oxide that were well above the NIOSH recommended eight hour time weighted average of 25ppm throughout the duration of surgery when compared to patients using LMA.

Matched MeSH terms: Intubation, Intratracheal*

Fulltext Fracture synthetic tracheostomy tube: an ENT emergency

Shashinder S, Tang IP, Kuljit S, Muthu K, Gopala KG, Jalaludin MA

Med J Malaysia, 2008 Aug;63(3):254-5.

PMID: 19248703 MyJurnal

A synthetic tracheostomy tube [non-metallic type] fracturing within three days of insertion is very rare but it could lead to serious complications such as acute asphyxia or sudden death. We report three such cases at our centre. Recommendations are made to closely observe patients on tracheostomy tube in the first seven days post-insertion of the tube.

Matched MeSH terms: Intubation, Intratracheal/instrumentation*

Fulltext Comparison of the ease of insertion of the laryngeal tube VBM and laryngeal mask airway during manual in-line neck stabilization

Noor Zairul M, Khairul Faizi A, Norzalina E

Med J Malaysia, 2006 Jun;61(2):157-61.

PMID: 16898305

The purpose of this study is to assess whether the newly developed laryngeal tube (LT) VBM is easy, simple to use and able to provide adequate ventilation and oxygenation to a patient with an unstable neck who required airway management. We compared the LT to the laryngeal mask airway (LMA) as alternative airway management tool in adult patient with unstable neck who underwent intubation with manual in-line neck stabilization. A randomized single-blinded prospective study was conducted involving a total of 40 ASA I and II premedicated patients who were divided into two groups with 20 patients for each group; either LT or LMA group for airway management during elective surgery. After preoxygenation, anaesthesia was induced and neuromuscular blockade was produced with intravenous drugs. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (TOF 1). A size 3, 4 or 5 LT OR a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilized by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilization). If it was not possible to ventilate the lungs, or if endotrachial carbon dioxide (ETCO2) and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. There was a statistically significant difference for both groups in the time required for successful insertion (time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1+/-17.3 seconds) (p= 0.01). There was no statistical differences (p>0.05) in number of attempts needed to achieve a patent airway although we were able to achieve a clear airway in all patients in LT group at the first attempt compared with 85% in LMA group. successful insertion rate was 100% for both groups. We conclude that the LT is easier to insert and is a suitable alternative to the LMA for airway management when the patient's head and neck are stabilized by manual in-line method.

Matched MeSH terms: Intubation, Intratracheal/instrumentation*

Use of capnography delaying the diagnosis of tracheal intubation

Chan YK, Zuraidah S, Tan PS

Anaesthesia, 1998 Dec;53(12):1207-8.

PMID: 10193227

There was a delay in making the correct diagnosis of tracheal intubation in a parturient who developed severe bronchospasm after intubation because we relied on the capnogram.

Matched MeSH terms: Intubation, Intratracheal/adverse effects*

Fulltext Comparison of two bolus doses of esmolol for attenuation of haemodynamic response to tracheal intubation

Sharma S, Ghani AA, Win N, Ahmad M

Med J Malaysia, 1995 Dec;50(4):372-6.

PMID: 8668059

This prospective study was designed to compare the effectiveness of esmolol (either 100 mg or 200 mg) with a placebo in blunting the haemodynamic response to laryngoscopy and intubation. Seventy-five patients of ASA I or II scheduled for routine-surgery were selected and entered into a placebo-controlled study. Patients were randomly allocated to receive placebo, 100 mg or 200 mg of esmolol IV as part of an anaesthetic induction technique. There were no significant differences in the demographic distribution of the patients in the study. There was no statistical difference in the baseline heart rate (HR) and systolic blood pressure (SBP) between the three groups. One minute after the administration of the drug (prior to intubation) the differences in HR between the placebo group and both the 100 mg and 200 mg groups were significant (p < 0.05), and also at 1 min and 2 min following intubation for the 200 mg group (p < 0.05). In the 200 mg group there was a significant decrease, compared with placebo, in SBP at 1 min (p < 0.05) and at 2 min (p < 0.05) after intubation. In this study, adequate haemodynamic control following was obtained with the administration of 200 mg of esmolol.

Matched MeSH terms: Intubation, Intratracheal*

Acquired tracheo-oesophageal fistula following tracheal intubation in a burned patient

Tan KK, Lee JK, Tan I, Sarvesvaran R

Burns, 1993 Aug;19(4):360-1.

PMID: 8357487

A 27-year old male sustained a 60 per cent TBSA burn with inhalation injury following a road traffic accident. He developed respiratory distress on day 3 postburn, and was intubated and ventilated. He was noted to have greenish aspirate from his trachea on day 17 of ventilation. He succumbed from sepsis and died on day 21 post injury. At post-mortem, a large tracheo-oesophageal fistula (TOF) was found at the level of the cuff of the nasotracheal tube.

Matched MeSH terms: Intubation, Intratracheal/adverse effects*

Fulltext Comparison of fazadinium and suxamethonium for endotracheal intubation in Malaysian patients

Namazie M, Das S

Med J Malaysia, 1980 Jun;34(4):391-4.

PMID: 6111740

Matched MeSH terms: Intubation, Intratracheal*

Rapid intravenous induction followed by self-applied cricoid pressure and rapid intubation

Liew RP

Med J Malaysia, 1973 Dec;28(2):94-8.

PMID: 4276224

Matched MeSH terms: Intubation, Intratracheal*

Fulltext Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients

Wan Ibadullah WH, Yahya N, Ghazali SS, Kamaruzaman E, Yong LC, Dan A, et al.

Braz J Anesthesiol, 2016 Jul-Aug;66(4):363-8.

PMID: 27343785 DOI: 10.1016/j.bjane.2014.11.013

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients.

METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded.

RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking.

CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Matched MeSH terms: Intubation, Intratracheal*

Fulltext Repair of tracheal tear during oesophagectomy using the mobilised stomach

Krishnan MM, Khanijow VK, Ong G, Delilkan AE

Singapore Med J, 1991 Apr;32(2):174-6.

PMID: 2042084

Tracheal tears are not as uncommon as initially thought. The resultant insufficiency and hypoxia can be life-threatening. The keystone in management is early recognition and diagnosis. Immediate surgical repair is essential.

Matched MeSH terms: Intubation, Intratracheal/adverse effects*

Fulltext COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study

Noor Azhar M, Bustam A, Poh K, Ahmad Zahedi AZ, Mohd Nazri MZA, Azizah Ariffin MA, et al.

Emerg Med J, 2021 Feb;38(2):111-117.

PMID: 33219133 DOI: 10.1136/emermed-2020-210514

BACKGROUND: Concerns over high transmission risk of SARS-CoV-2 have led to innovation and usage of an aerosol box to protect healthcare workers during airway intubation in patients with COVID-19. Its efficacy as a barrier protection in addition to the use of a standard personal protective equipment (PPE) is not fully known. We performed a simulated study to investigate the relationship between aerosol box usage during intubation and contaminations on healthcare workers pre-doffing and post-doffing of PPE.

METHODS: This was a randomised cross-over study conducted between 9 April to 5 May 2020 in the ED of University Malaya Medical Centre. Postgraduate Emergency Medicine trainees performed video laryngoscope-assisted intubation on an airway manikin with and without an aerosol box in a random order. Contamination was simulated by nebulised Glo Germ. Primary outcome was number of contaminated front and back body regions pre-doffing and post-doffing of PPE of the intubator and assistant. Secondary outcomes were intubation time, Cormack-Lehane score, number of intubation attempts and participants' feedback.

RESULTS: Thirty-six trainees completed the study interventions. The number of contaminated front and back body regions pre-doffing of PPE was significantly higher without the aerosol box (all p values<0.001). However, there was no significant difference in the number of contaminations post-doffing of PPE between using and not using the aerosol box, with a median contamination of zero. Intubation time was longer with the aerosol box (42.5 s vs 35.5 s, p<0.001). Cormack-Lehane scores were similar with and without the aerosol box. First-pass intubation success rate was 94.4% and 100% with and without the aerosol box, respectively. More participants reported reduced mobility and visibility when intubating with the aerosol box.

CONCLUSIONS: An aerosol box may significantly reduce exposure to contaminations but with increased intubation time and reduced operator's mobility and visibility. Furthermore, the difference in degree of contamination between using and not using an aerosol box could be offset by proper doffing of PPE.

Matched MeSH terms: Intubation, Intratracheal/instrumentation*

Intubation without muscle relaxant: an alternative technique for rapid tracheal intubation

Wong AK, Teoh GS

Anaesth Intensive Care, 1996 Apr;24(2):224-30.

PMID: 9133197

The quality of laryngoscopy and tracheal intubation with propofol augmented by alfentanil was investigated as an alternative technique for rapid tracheal intubation. 119 patients aged between 18 and 60 years (ASA 1 and 2) undergoing elective surgery were prospectively studied in a randomized double-blind controlled fashion. Tracheal intubation facilitated by suxamethonium 1.0 mg/kg alfentanil 15 mu g/kg alfentanil 30 mu g/kg or saline control was compared after propofol induction. The quality of laryngoscopy and intubation were graded according to jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. Failure to intubate occurred in 4% and 17% with alfentanil 15 mu g/kg and saline control respectively Tracheal intubation was successful in all patients with alfentanil 30 mu g/kg and suxamethonium 1.0 mg/kg. Alfentanil 15 mu g/kg was not statistically significantly different from saline (P = 0.112). Alfentanil 30 mu g/kg provided similar overall intubating conditions (P = 0.5) to suxamethonium 1.0 mg/kg. Alfentanil in both dosages effectively attenuated the haemodynamic responses to laryngoscopy and tracheal intubation.

Matched MeSH terms: Intubation, Intratracheal/instrumentation; Intubation, Intratracheal/methods*

Fulltext Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear

Mohd Esa NY, Faisal M, Vengadesa Pilla S, Abdul Rahaman JA

BMJ Case Rep, 2020 Dec 22;13(12).

PMID: 33370965 DOI: 10.1136/bcr-2020-236414

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.

Matched MeSH terms: Intubation, Intratracheal/adverse effects*; Intubation, Intratracheal/instrumentation

Fulltext Transient unilateral parotid gland swelling following upper endoscopy

Chieng Jin Yu, Then Ru Fah, Sharifah Intan Safura Shahabudin, Pan Yan

Journal of Clinical and Health Sciences, 2021;6(1):50-52.

MyJurnal

Transient parotid gland swelling could happen as complication after per oral endoscopy or
intubation. We reported a 53-year-old man who developed transient unilateral parotid gland
swelling following esophagogastroduodenoscopy (OGDS) with dilatation of achalasia cardia.
The swelling of the parotid gland was transient and resolved completely without any
intervention.

Matched MeSH terms: Intubation, Intratracheal

Fulltext Management of palatal fracture and airway challenge in a child —a red flag

Lim, Min Jim, Tengku Aszraf Tengku Shaeran, Soon, Eu Chong

Malaysian Journal of Paediatrics and Child Health, 2019;25(1):19-22.

MyJurnal

Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted in failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ventilated in the intensive care unit and was extubated two days later. He was discharged well from hospital after one week of admission. Airway management is a rush against time, particularly in a pediatric patient suffering from a palatal fracture. The need for helping hands for suction and child control must be emphasized to ensure the patient’s survival.

Matched MeSH terms: Intubation, Intratracheal

Displaying publications 41 - 60 of 94 in total