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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 March;67(3):127-32

language: English

Application of the self-inflating bulb to a hollow intubating introducer

Tuzzo D. M., Frova G.

From the I Servizio di Anestesia e Rianimazione Spedali Civili, Brescia


Background. The aspi­ra­tion ­test, per­formed by a ­self-inflat­ing ­bulb (SIB), is a sim­ple and reli­able meth­od to ­detect an acci­den­tal esoph­a­geal intu­ba­tion. The aim of the ­study, in ­case of employ­ment of a hol­low intu­bat­ing intro­duc­er (HII), was to ver­i­fy the pos­sibil­ity to direct­ly per­form the ­test ­with the intro­duc­er and its effi­ca­cy in allow­ing the detec­tion of its posi­tion.
Methods. Experimental ­design: pros­pec­tive, ran­dom­ized ­study. Environment: oper­at­ing the­a­ter in a uni­ver­sity hos­pi­tal. Patients: ­adult ­patients, with­out evi­dence of gas­tro-esoph­a­geal or tra­che­o­bron­chi­al pathol­o­gies, sched­uled for elec­tive sur­gery. Interventions: ­patients ­were ran­dom­ized in two ­groups T (HII was ­placed in tra­chea) and E (HII was posi­tioned in the esoph­a­gus). Under gen­er­al anes­the­sia, a HII was ­placed in ­either the tra­chea or the esoph­a­gus. A blind­ed anes­the­sio­lo­gist con­nect­ed the SIB to the HII and per­formed the ­test ­twice. Measurements: the anes­the­sio­lo­gist ­inferred the posi­tion of the ­device, ­based on the re-infla­tion ­observed.
Results. One hun­dred sub­jects ­were stud­ied. In ­group E ­patients, a ­prompt and com­plete re-infla­tion of the ­bulb was nev­er ­observed and the anes­the­sio­lo­gist cor­rect­ly ­inferred the posi­tion of the HII. Occasionally (3.5% of cas­es), in ­group T ­patients, a pre­vent­ed or incom­plete re-infla­tion of the ­bulb ­occurred, lead­ing to an incor­rect judg­ment of the HII posi­tion.
Conclusions. The aspi­ra­tion ­test ­with the SIB ­allows the prop­er detec­tion of the intro­duc­er in esoph­a­gus. When ­used in com­bi­na­tion ­with a HII, ­both ­time and ­local trau­ma asso­ciat­ed ­with an erro­ne­ous, intro­duc­er-guid­ed esoph­a­geal intu­ba­tion in ­case of dif­fi­cult laryn­gos­co­py may be ­reduced.

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