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2 results

  • Chapter 20 - The airway in obstetrics

  • from Section 3 - Specialties
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 189-192

  • Summary

    Tracheal intubation is an essential skill but can be difficult and may result in complications, the most serious being hypoxaemic brain damage and death. A significant lifting force, causing considerable tissue distortion but not damage, may be required in direct laryngoscopy. The Macintosh technique of laryngoscopy depends on indirect elevation of the epiglottis and is the most frequently used direct laryngoscopy technique in most centres. Direct laryngoscopy with the straight laryngoscope was the first technique to allow tracheal intubation under vision. The straight laryngoscope offers unique advantages and there is good evidence of its value. The laryngoscope is inserted to the right of the midline and passed along the paraglossal gutter to the right side of the tongue. Many alternative techniques can facilitate tracheal intubation under vision in patients in whom this is not possible with direct laryngoscopy. Nasotracheal intubation is necessary when the oral route is not available.

  • Factors Influencing Successful Intubation in the Prehospital Setting

  • James V. Doran, Bartholomew J. Tortella, Walter J. Drivet, Robert F. Lavery
  • Journal:
    Prehospital and Disaster Medicine / Volume 10 / Issue 4 / December 1995
    Published online by Cambridge University Press:
    28 June 2012, pp. 259-264
    Print publication:
    December 1995
  • Objective:

    To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.

    Design, Setting, and Participants:

    Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.

    Results:

    Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).

    Conclusions:

    Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.