Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy
Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington,...
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Published in | Journal of clinical anesthesia Vol. 18; no. 2; pp. 118 - 123 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.03.2006
Elsevier Science Elsevier Limited |
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Abstract | Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation.
Prospective, double-blind, crossover study.
University hospital.
Forty non-obese patients (BMI <28 kg·m
−2), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study.
After endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other.
Assessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Sp
o
2, ET
co
2, and peak inspiratory pressures were also recorded.
Postintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30° head-down. Chest auscultation detected bronchial intubation in two cases only (
P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ET
co
2, Sp
o
2, and peak inspiratory pressures did not change in patients who did experience bronchial intubation.
The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential. |
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AbstractList | Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation.
Prospective, double-blind, crossover study.
University hospital.
Forty non-obese patients (BMI <28 kg.m(-2)), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study.
After endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other.
Assessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Sp(O2), ET(CO2), and peak inspiratory pressures were also recorded.
Postintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30 degrees head-down. Chest auscultation detected bronchial intubation in two cases only (P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ET(CO2), Sp(O2), and peak inspiratory pressures did not change in patients who did experience bronchial intubation.
The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential. Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation. Prospective, double-blind, crossover study. University hospital. Forty non-obese patients (BMI <28 kg·m −2), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study. After endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other. Assessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Sp o 2, ET co 2, and peak inspiratory pressures were also recorded. Postintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30° head-down. Chest auscultation detected bronchial intubation in two cases only ( P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ET co 2, Sp o 2, and peak inspiratory pressures did not change in patients who did experience bronchial intubation. The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential. STUDY OBJECTIVEMain stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation.DESIGNProspective, double-blind, crossover study.SETTINGUniversity hospital.PATIENTSForty non-obese patients (BMI <28 kg.m(-2)), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study.INTERVENTIONSAfter endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other.MEASUREMENTSAssessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Sp(O2), ET(CO2), and peak inspiratory pressures were also recorded.MAIN RESULTSPostintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30 degrees head-down. Chest auscultation detected bronchial intubation in two cases only (P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ET(CO2), Sp(O2), and peak inspiratory pressures did not change in patients who did experience bronchial intubation.CONCLUSIONThe Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential. Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation. Prospective, double-blind, crossover study. University hospital. Forty non-obese patients (BMI <28 kg·m-2 ), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study. After endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other. Assessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Spo2, ETco2, and peak inspiratory pressures were also recorded. Postintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30° head-down. Chest auscultation detected bronchial intubation in two cases only ( P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ETco2, Spo2, and peak inspiratory pressures did not change in patients who did experience bronchial intubation. The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential. |
Author | Ezri, Tiberiu Khazin, Vadim Medalion, Benjamin Shechter, Pinhas Priel, Israel Loberboim, Mordechai Weinbroum, Avi A. Szmuk, Peter |
Author_xml | – sequence: 1 givenname: Tiberiu surname: Ezri fullname: Ezri, Tiberiu email: tezri@netvision.net.il organization: Department of Anesthesia, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 2 givenname: Vadim surname: Khazin fullname: Khazin, Vadim organization: Department of Anesthesia, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 3 givenname: Peter surname: Szmuk fullname: Szmuk, Peter organization: Post-Anesthesia Care Unit, University of Texas Medical School, Houston, TX, USA – sequence: 4 givenname: Benjamin surname: Medalion fullname: Medalion, Benjamin organization: Department of Cardiothoracic Surgery, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 5 givenname: Pinhas surname: Shechter fullname: Shechter, Pinhas organization: Department of Surgery A, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 6 givenname: Israel surname: Priel fullname: Priel, Israel organization: Department of Pulmonology, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 7 givenname: Mordechai surname: Loberboim fullname: Loberboim, Mordechai organization: Unit of Nuclear Medicine, Edith Wolfson Medical Center, Holon 58100, Israel 1 – sequence: 8 givenname: Avi A. surname: Weinbroum fullname: Weinbroum, Avi A. organization: Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 1 |
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CitedBy_id | crossref_primary_10_1016_j_bjan_2013_03_023 crossref_primary_10_1007_BF03017745 crossref_primary_10_1371_journal_pone_0217466 crossref_primary_10_4097_kjae_2010_59_S_S218 crossref_primary_10_1213_01_ane_0000237271_78867_1f crossref_primary_10_1007_s10877_014_9583_5 crossref_primary_10_23736_S0375_9393_18_12622_8 crossref_primary_10_5124_jkma_2012_55_7_641 crossref_primary_10_1097_ALN_0000000000001073 crossref_primary_10_1016_j_jclinane_2010_11_002 crossref_primary_10_1016_j_bjane_2013_03_023 crossref_primary_10_3390_children7110213 crossref_primary_10_1002_jum_15318 |
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Keywords | Bronchial intubation Chest auscultation Rapiscope Detection Cholecystectomy Human Obesity Auscultation Nutrition disorder Medical screening Anesthesia Intubation Nutritional status |
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Snippet | Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional... STUDY OBJECTIVEMain stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal... |
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SubjectTerms | Adolescent Adult Aged Aged, 80 and over Anesthesia Anesthesia, General Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Auscultation Biological and medical sciences Bronchi - injuries Bronchial intubation Bronchoscopes Bronchoscopy Carbon Dioxide - blood Chest auscultation Cholecystectomy, Laparoscopic Detection Double-Blind Method Female Humans Intubation Intubation, Intratracheal - adverse effects Male Medical Errors Medical sciences Middle Aged Obesity Oxygen - blood Prospective Studies Rapiscope Surgery Weight control |
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Title | Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy |
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