PMID- 15105238
OWN - NLM
STAT- MEDLINE
DCOM- 20040519
LR  - 20190704
IS  - 0003-2999 (Print)
IS  - 0003-2999 (Linking)
VI  - 98
IP  - 5
DP  - 2004 May
TI  - Radiologic-assisted endotracheal intubation.
PG  - 1496-8, table of contents
AB  - We accomplished endotracheal intubation by using fluoroscopic direction in a 
      patient presenting a difficult airway both on the basis of a preanesthetic 
      physical examination and on the basis of a potential for cervical cord injury 
      associated with complicated laryngoscopy. Under topical anesthesia, a 
      multipurpose angiographic (MPA) catheter over a Bentson wire was advanced into 
      the trachea under intermittent C-arm fluoroscopic guidance while the occiput, 
      cervical spine, and mandible remained in a neutral position. The endotracheal 
      tube was then easily advanced over the MPA catheter into the trachea, where the 
      location was documented by fluoroscopic view. Because of judicious use of topical 
      anesthesia and the small diameter and flexibility of the MPA catheter, the 
      unsedated patient remained comfortable throughout the procedure. The stored data 
      were later transferred to a compact disk, and a copy was provided to the patient 
      as an adjunct to Medic-Alert. Unlike fiberoscopy, with which the view can be 
      totally obscured by secretions, blood, and abnormal anatomy, the direction and 
      location of the MPA catheter within the airway were easily identifiable 
      throughout the procedure. The small diameter of the MPA (1.5-mm outer diameter) 
      should allow placement of endotracheal tubes as small as 3.0-mm inner 
      diameter--an option not available even with pediatric instruments. Although time 
      was not a consideration, the procedure was accomplished in <12 min with 22 s of 
      fluoroscopy. We believe that with experience, atraumatic intubation of a 
      difficult airway could be accomplished routinely in less than 2 min with 
      radiological-assisted intubation. IMPLICATIONS: Radiologic-assisted intubation 
      facilitated endotracheal intubation without sedation, instrumentation, or 
      significant movement of the occiput, cervical spine, or mandible. The procedure 
      was accomplished in <12 min and with only 22 s of fluoroscopy. This approach 
      provides the ultimate adjunct to the preoperative airway physical evaluation 
      while providing for immediate (or delayed) atraumatic endotracheal intubation. 
      The diagnostic information and procedure can be recorded on a compact disk.
FAU - Reier, Charles E
AU  - Reier CE
AD  - Department of Anesthesia, Jay County Hospital, St. Vincent Randolph Hospital, 
      Winchester, Indiana, USA. rreier@hotmail.com
FAU - Reier, Allan R
AU  - Reier AR
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
SB  - IM
CIN - Anesth Analg. 2005 Feb;100(2):598-9; author reply 599. PMID: 15673904
MH  - Aged
MH  - Angiography
MH  - Fluoroscopy
MH  - Hernia, Ventral/surgery
MH  - Humans
MH  - Intubation, Intratracheal/*methods
MH  - Laryngoscopy/adverse effects
MH  - Male
MH  - Respiratory System/*diagnostic imaging
MH  - Spinal Cord Injuries/prevention & control
EDAT- 2004/04/24 05:00
MHDA- 2004/05/20 05:00
CRDT- 2004/04/24 05:00
PHST- 2004/04/24 05:00 [pubmed]
PHST- 2004/05/20 05:00 [medline]
PHST- 2004/04/24 05:00 [entrez]
AID - 10.1213/01.ane.0000114074.15577.88 [doi]
PST - ppublish
SO  - Anesth Analg. 2004 May;98(5):1496-8, table of contents. doi: 
      10.1213/01.ane.0000114074.15577.88.