Sub-mental vs. retromolar intubation
Anaesthesia (Impact Factor: 3.38). 12/2006; 61(11):1123-4. DOI: 10.1111/j.1365-2044.2006.04849.x
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ABSTRACT: Summary form only given. Erosion calculations of the first wall system during regular operation and during plasma disruptions were made. Estimates were obtained with the DISRUP code. Disruptions that could take place at the peak of the ignited phase of the IGNITEX discharge were considered. Plasma disruptions were simulated by means of detailed equilibrium simulations. Both thermal quench and current quench were considered. The thermomechanical stress levels in the first wall system of IGNITEX bring an ignited plasma disruption were evaluated. A fully three-dimensional finite-element stress analysis was conducted. It was assumed that the first wall material behavior is adequately characterized by a decoupled thermomechanical response. Both melting and evaporation of the coating material were included in the analysis. Computations were performed with the finite-element program ABAQUS
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ABSTRACT: In craniofacial trauma patients, oral route endotracheal intubation may thwart the accuracy of dental occlusion and nasotracheal intubation carries the risk of intracranial invasion in skull base fracture cases. Between November 2005 and June 2006, patients receiving facial bone fracture operations at Kaohsiung Medical University Hospital were enrolled in this study. Intraoperatively, the endotracheal tube was pushed to either the retromolar space or the missing tooth space and secured by two 4.0 silk stitches. Then, surgeons could perform the usual procedure to explore the fracture sites, check the occlusion and correct the deviated nose without limitation. Also, for better understanding the time needed for various intubation techniques, a time-measuring study was performed. Ninety-one patients were treated by this method. Most of them were satisfied with the result of occlusion and nasal contour. Only 2 patients received second surgery to correct nasal deformity. One hundred seventeen anesthesia procedures were checked. In average, an experienced anesthesiologist could successfully intubate a patient in less than 105 seconds. The advantages and reported complications of different intubation methods were discussed. This retromolar position and tooth fixation technique allowed surgeons to correct the dental occlusion and nasal deformity simultaneously. It has served well for zygoma fracture, maxilla fracture, and Le Fort II fracture patients. It is worthy of consideration in management of middle face trauma patients involving occlusion change and nasal deviation.
Article: Submental Intubation: a review[Show abstract] [Hide abstract]
ABSTRACT: A literature review was performed to analyse the evidence supporting submental intubation and to aid in the development of a new airway algorithm in craniofacial surgery patients. A systematic search of Pub Med, OVID, the Cochrane Database and Google Scholar between January 1984 and April 2011 was performed. Measured variables included the outcome, complications, publishing specialty journal and method of intubation including technique modifications, indications for the procedure, devices utilized and the total procedure time to complete the submental intubation. Of the 842 patient cases from 41 articles represented in the review, the success rate was 100%. Minor complications were reported in 60 patients and included superficial skin infections (N=23), damage to the tube apparatus (N=10), fistula formation (N=10), right mainstem bronchus tube dislodgement/obstruction (N=5), hypertrophic scarring (N=3), accidental extubation in paediatric patients (N=2), excessive bronchial flexion (N=2), lingual nerve paresthesia (N=1), venous bleeding (N=2), mucocele (N=1), and dislodgement of the throat pack sticker in the submental wound (N=1). The average reported time to complete a submental intubation was 9.9 min. Submental intubation is a safe, effective and time efficient method for securing an airway when increased surgical exposure or restoration of occlusion is a priority.