| Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy. | |
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MedLine Citation:
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PMID: 16563329 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: 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. DESIGN: Prospective, double-blind, crossover study. SETTING: University hospital. PATIENTS: 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. INTERVENTIONS: 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. MEASUREMENTS: 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. MAIN RESULTS: 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. CONCLUSION: 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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Authors:
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Tiberiu Ezri; Vadim Khazin; Peter Szmuk; Benjamin Medalion; Pinhas Shechter; Israel Priel; Mordechai Loberboim; Avi A Weinbroum |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of clinical anesthesia Volume: 18 ISSN: 0952-8180 ISO Abbreviation: J Clin Anesth Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-03-27 Completed Date: 2006-09-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8812166 Medline TA: J Clin Anesth Country: United States |
Other Details:
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Languages: eng Pagination: 118-23 Citation Subset: IM |
Affiliation:
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Department of Anesthesia, Edith Wolfson Medical Center, Holon 58100, Israel. tezri@netvision.net.il |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Anesthesia, General Auscultation Bronchi / injuries* Bronchoscopes* Bronchoscopy* Carbon Dioxide / blood Cholecystectomy, Laparoscopic* Double-Blind Method Female Humans Intubation, Intratracheal / adverse effects* Male Medical Errors Middle Aged Oxygen / blood Prospective Studies |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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