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Anaesth Rep 2021 Jan-Jun;9(1):114-117. Epub 2021 Jun 1.

Department of Anaesthesiology Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.

Flexible bronchoscopic tracheal intubation is a fundamental technique in the management of the difficult airway but requires specific skills which may be both difficult to achieve and maintain. Therefore, techniques to improve its success should be developed. We present two cases, one where the ear, nose and throat surgeon could not view the glottis due to laryngeal pathology, and one where pathology in the oropharynx obscured access to the trachea during attempts at flexible bronchoscopic and videolaryngoscopic tracheal intubation. Read More

Intensive Care Med 2021 Jun 25;47(6):653-664. Epub 2021 May 25.

Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France.

Purpose: The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.

Methods: In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i. Read More

Best Pract Res Clin Anaesthesiol 2021 Jul 18;35(2):207-220. Epub 2020 Sep 18.

Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. Electronic address:

Neuropatients often require invasive mechanical ventilation (MV). Ideal ventilator settings and respiratory targets in neuro patients are unclear. Current knowledge suggests maintaining protective tidal volumes of 6-8 ml/kg of predicted body weight in neuropatients. Read More

J Int Med Res 2021 May;49(5):3000605211016740

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea.

Objective: Tracheal intubation using a direct laryngoscope is difficult to teach. The McGrath videolaryngoscope, a Macintosh-like device with a camera, can be used as a direct laryngoscope to educate novices under supervision using the screen. We compared the effect on Macintosh laryngoscopy skills following training with a McGrath videolaryngoscope as a direct versus indirect laryngoscope. Read More

Am J Transl Res 2021 15;13(4):2738-2744. Epub 2021 Apr 15.

Department of Anesthesiology, Shibei Hospital Jing'an District, Shanghai 200435, China.

Objective: To investigate the effect of tracheal intubation and ProSeal laryngeal mask airway (PLMA) on hemodynamics, oxygen saturation, peak airway pressure and adverse events during anesthesia for thyroid surgery.

Methods: 65 patients who underwent luminal thyroid surgery under general anesthesia were enrolled as the study subjects, and were divided into control group (30 patients, tracheal intubation) and experimental group (35 patients, PLMA) using random number table. The time to establishment of artificial airway and success rate, hemodynamics, oxygen saturation, peak airway pressure and adverse effects were observed in the two groups. Read More

Paediatr Anaesth 2021 May 16. Epub 2021 May 16.

Anaesthesia and Pain Research Institute, Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Background: Although a neuromuscular blocking agent during induction of anesthesia is the standard of care in adults, some pediatric anesthesiologists remain concerned about their use for several reasons. Therefore, propofol and short-acting opioids with a moderate concentration of sevoflurane have been used as alternatives to a neuromuscular blocking agent.

Aims: This study compared propofol, alfentanil, and rocuronium to determine the optimal anesthetic agent for intubation conditions as well as emergence in a short pediatric procedure. Read More

N Engl J Med 2021 05;384(19):1836-1847

From the Department of Anesthesia, Spital Grabs, Grabs, and the Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern - both in Switzerland; and the Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.

J Comp Eff Res 2021 Apr 27. Epub 2021 Apr 27.

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA.

Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Read More

Beijing Da Xue Xue Bao Yi Xue Ban 2020 Sep;53(2):337-340

Department of Anesthesiology, First Hospital, Peking University, Beijing 100034, China.

Objective: To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.

Methods: We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. Read More

Ann Surg 2021 Apr 7. Epub 2021 Apr 7.

Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University.

Objective: We aim to report a novel surgical technique that robotic-assisted thoracoscopic surgery combined with non-intubated spontaneous ventilation to perform tracheal/airway surgery.

Summary Background Data: Our team has demonstrated video-assisted transthoracic surgery (VATS) can be used for thoracic tracheal diseases with satisfactory outcomes. Our team has also demonstrated that tracheal/ airway resection and reconstruction under spontaneous ventilation can improve the anastomosis and operating time. Read More

Ann Palliat Med 2021 Mar;10(3):3354-3363

Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Background: Anesthesia airway management is challenging during tracheal resection and reconstruction as these surgical procedures involve the airway. This case series describes four approaches to airway management in patients undergoing tracheal resection and reconstruction and discusses their advantages and disadvantages.

Methods: Thirteen patients underwent 1 of the following 4 kinds of airway management techniques during tracheal resection and reconstruction between 2013 and 2019: intubation, intubation with high frequency jet ventilation (HFJV), non-intubation, and venovenous extracorporeal membrane oxygenation (VV-ECMO). Read More

Anesthesiology 2021 Apr 13. Epub 2021 Apr 13.

Background: Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors. Read More

Rev Esp Anestesiol Reanim (Engl Ed) 2021 Jun-Jul;68(6):369-371. Epub 2020 Sep 7.

Sección de Anestesia Cardiaca, Vascular y Torácica de Sociedad Española de Anestesiología y Reanimación (SEDAR), España; Hospital Universitario Politécnico La FE, València, España.

J Pak Med Assoc 2021 02;71(2(A)):434-439

Department of Anesthesiology and Reanimation, Bulent Ecevit University, Turkey.

Objective: To determine the predictive tests for difficulty in laryngeal mask airway insertion, and to observe the success rate of insertion in the first attempt.

Methods: The prospective, observational study was conducted at Bülent Ecevit University Hospital, Turkey, from September 2013 to 2014, and comprised patients of American Society of Anaesthesiologists grade I to IV adult patients who underwent elective surgery under general anaesthesia. The supraglottic airway device was randomly selected for each patient, and the laryngeal mask airway was used as per the decision of an anaesthesiologist who was not part of the study. Read More

Br J Anaesth 2021 Jun 1;126(6):1173-1181. Epub 2021 Apr 1.

Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.

Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. Read More

Anaesthesia 2021 05;76(5):705-709

Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Indian J Anaesth 2021 Mar 13;65(3):210-215. Epub 2021 Mar 13.

Department of Anaesthesiology, JIPMER, Puducherry, India.

Background And Aims: This study assesses the extubation practices of anaesthesiologists and whether these practices differ from existing guidelines.

Methods: The literature related to tracheal extubation was searched and a validated questionnaire was designed to assess practices of tracheal extubation. The questionnaire included techniques, manoeuvres, preparation, timing and plan of extubation. Read More

J Int Med Res 2021 Mar;49(3):300060521999768

Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Objective: To assess safety and efficacy of a novel intubation laryngeal mask airway (ILMA) during the recovery period following supratentorial tumour surgery.

Methods: Patients who underwent supratentorial tumour surgery at our centre from January 2012 to December 2016 were eligible for this prospective randomised, parallel group study. We developed a novel ILMA using closely fitting laryngeal masks (No. Read More

Anesth Analg 2021 Mar 10. Epub 2021 Mar 10.

Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

Background: Obstructive sleep apnea (OSA) has been found to be associated with difficult airway, although there is a paucity of prospective studies investigating thresholds of OSA severity with difficult airway outcomes. The aim of this study was to examine the association between OSA and difficult intubation or difficult mask ventilation. We also explored the utility of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) score for difficult airway prediction. Read More

Vestn Otorinolaringol 2021 ;86(1):36-40

Morozovskaya Children's City Clinical Hospital, Moscow, Russia.

The purpose of work is to analyze the causes of tracheostomy in children hospitalized in a large multidisciplinary pediatric hospital.

Material And Methods: Retrospective analysis of case of children treated in a multidisciplinary urgent hospital - GBUZ «Morozovskaya CCCH of MDH», which in the period from 01.01. Read More

J Vis Exp 2021 02 26(168). Epub 2021 Feb 26.

Department of Pediatric Cardiology, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu; Department of Critical Care Medicine, University of Pittsburgh;

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical characteristics, which is further complicated in the case of the newborn. Of the different methods of advanced airway management, endotracheal intubation is less aggressive than tracheostomy, and is more feasible than supraglottic management given the lack of supraglottic devices of such a small size. Read More

Respir Care 2021 May 9;66(5):785-792. Epub 2021 Mar 9.

Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil. Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts.

Background: In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Read More

Zhonghua Yi Xue Za Zhi 2021 Mar;101(9):630-635

Department of Anesthesiology, the Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China.

To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,=60),single-lumen endotracheal intubation group (group D,=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,=60). The arterial blood samples were collected immediately after endotracheal intubation (T), 30 min after artificial pneumothorax (single lung ventilation) (T), 30 min after artificial pneumothorax (double lung ventilation) (T), and 30 min after extubation (T) to detect arterial blood gas. Read More

Medicine (Baltimore) 2021 Feb;100(8):e24842

Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.

Abstract: An association between animals and volatile anaesthetic requirements has been shown; however, evidence related to the postoperative outcome of human patients is lacking. Our aim was to investigate whether there is a difference in the requirement for sevoflurane among people undergoing gastrointestinal surgery.We observed 390 adult patients who underwent gastrointestinal surgery with an American Society of Anesthesiologists physical status of I or II with an expected surgery duration of > 2 hours. Read More

Ann Emerg Med 2021 03;77(3):305-314

Brown Emergency Medicine Residency, Providence, RI.

Br J Anaesth 2021 May 17;126(5):1055-1066. Epub 2021 Feb 17.

Centre for Trauma Sciences, Queen Mary University of London, London, UK.

Background: Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. Read More

Medicine (Baltimore) 2021 Feb;100(7):e24676

Department of Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.

Abstract: New generation supraglottic airway devices are suitable for airway management in many laparoscopic surgeries. In this study, we evaluated and compared the ventilation parameters of the laryngeal mask airway-supreme (LM-S) and endotracheal tube (ETT) when a neuromuscular blocker (NMB) agent was not used during laparoscopic gynecological surgery. The second outcome was based on the evaluation of the surgical view because it may affect the surgical procedure. Read More

Ann Otol Rhinol Laryngol 2021 Feb 15:3489421995285. Epub 2021 Feb 15.

Department of Otolaryngology, University of Maryland School of Medicine, Baltimore, MD, USA.

Objectives: To identify the incidence and risk factors for intubation-related laryngeal lesions that preclude tracheostomy decannulation in a large population.

Methods: A 3-year retrospective case-control study was performed of tracheotomized adults in acute rehabilitation facilities who underwent routine endoscopic evaluation of the airway as part of the facilities' decannulation protocol. Patients with known upper airway pathology, external laryngeal trauma, cricothyrotomy or emergent tracheostomy, prior head and neck radiation, isolated tracheal lesions, and patients with incomplete reports were excluded. Read More

Int J Nurs Stud 2021 May 16;117:103881. Epub 2021 Jan 16.

School of Medicine. University of Electronic Science and Technology of China, No.4, Section 2, North Jianshe Road, Chengdu, Sichuan, PR China. Electronic address:

Background: More and more countries utilize nurse anesthetists as an anesthetic care provider to make up for the insufficiency of anesthesiologists.

Objective: To examine whether introducing nurse anesthetists with expanded scope of practice to anesthetic care would jeopardize the safety of patients and quality of anesthetic care.

Design: This observational study used an interrupted time series design. Read More

J Anesth 2021 04 8;35(2):232-238. Epub 2021 Feb 8.

Department of Anesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.

Purpose: Education in airway management is a fundamental component of anesthesiology training programs. There has been a shift towards the use of simulation models of higher fidelity for education in airway management. The goal of this study was to create a novel cadaveric model of a simulated parapharyngeal abscess with features of a difficult airway such as distorted anatomy and narrow airway passages presenting as stridor. Read More