Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy

Tiberiu Ezri, Vadim Khazin, Peter Szmuk, Benjamin Medalion, Pinhas Shechter, Israel Priel, Mordechai Loberboim, Avi A. Weinbroum

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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, Spo2, ETco2, 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° 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. 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.

Original languageEnglish (US)
Pages (from-to)118-123
Number of pages6
JournalJournal of Clinical Anesthesia
Volume18
Issue number2
DOIs
StatePublished - Mar 2006

Fingerprint

Auscultation
Laparoscopic Cholecystectomy
Intubation
Thorax
Insufflation
Head
Double-Blind Method
Pressure
Intratracheal Intubation
Critical Care
Cross-Over Studies
Prospective Studies
Anesthesiologists

Keywords

  • Bronchial intubation
  • Chest auscultation
  • Detection
  • Rapiscope

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy. / Ezri, Tiberiu; Khazin, Vadim; Szmuk, Peter; Medalion, Benjamin; Shechter, Pinhas; Priel, Israel; Loberboim, Mordechai; Weinbroum, Avi A.

In: Journal of Clinical Anesthesia, Vol. 18, No. 2, 03.2006, p. 118-123.

Research output: Contribution to journalArticle

Ezri, Tiberiu ; Khazin, Vadim ; Szmuk, Peter ; Medalion, Benjamin ; Shechter, Pinhas ; Priel, Israel ; Loberboim, Mordechai ; Weinbroum, Avi A. / Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy. In: Journal of Clinical Anesthesia. 2006 ; Vol. 18, No. 2. pp. 118-123.
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AU - Khazin, Vadim

AU - Szmuk, Peter

AU - Medalion, Benjamin

AU - Shechter, Pinhas

AU - Priel, Israel

AU - Loberboim, Mordechai

AU - Weinbroum, Avi A.

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N2 - 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, Spo2, ETco2, 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° 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. 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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KW - Chest auscultation

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