TY - JOUR
T1 - Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy
AU - Ezri, Tiberiu
AU - Khazin, Vadim
AU - Szmuk, Peter
AU - Medalion, Benjamin
AU - Shechter, Pinhas
AU - Priel, Israel
AU - Loberboim, Mordechai
AU - Weinbroum, Avi A.
PY - 2006/3
Y1 - 2006/3
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.
AB - 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.
KW - Bronchial intubation
KW - Chest auscultation
KW - Detection
KW - Rapiscope
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U2 - 10.1016/j.jclinane.2005.08.008
DO - 10.1016/j.jclinane.2005.08.008
M3 - Article
C2 - 16563329
AN - SCOPUS:33645059443
SN - 0952-8180
VL - 18
SP - 118
EP - 123
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
IS - 2
ER -