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From the Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, South Korea.
Address correspondence to: Dr. Duk-Kyung Kim, MD, Assistant Professor, Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, 1 Hwayang-Dong, Gwanggin-Gu, Seoul, 143-701, South Korea. Phone: 82-2-2030-5442; Fax: 82-2-2030-5422; E-mail: dikei{at}kuh.ac.kr
Purpose: Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique.
Methods: A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90° counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation.
Results: After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P = 0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P = 0.018).
Conclusion: Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability.
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