Affiliation:
1. VMMC & Safdarjang Hospital, New Delhi.
Abstract
Background & Aims:
Successful bronchoscopy does not mean successful intubation. Advancement of the ETT is blind and often difficult. Using the two-scope technique, we compared the polyvinylchloride tube with the flexometallic tube to determine which one was easier to railroad over the flexoscope.
Methods:
A radomised comparative study was conducted on 40 patients aged 18-65 years of American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia. Patients with anticipated difficult airway, oral, head or neck surgery and pregnant women were excluded. A paediatric flexoscope was inserted through the nostril till the glottis was visible. An adult flexoscope was inserted till carina for orotracheal intubation and railroading of the endotracheal tube was done under vision of the paediatric flexoscope. Incidence and site of impingement were noted. Manoeuvres used to relieve impingement were jaw lift, withdrawal and 90° anti-clockwise tube rotation. Intubation time was also noted.
Results:
The overall incidence of impingement was 25% (10/40). Incidence of impingement was 35% (7/20) in polyvinylchloride group and 15% (3/20) in the flexometallic group (p>0.05). The 10% difference in impingement rates between the two groups was statistically non-significant. The site of impingement was at right arytenoids in 90% (9/10) cases. 90° anti-clockwise rotation relieved impingement in all cases where it was used (9/9). There was no significant difference in the time taken for intubation with the PVC and flexometallic tubes.
Conclusion:
Polyvinylchloride and flexometallic tubes are comparable in terms of ease of orotracheal intubation using a flexoscope. The commonest site of obstruction to the advancement of endotracheal tube is the right arytenoid. The 90° anticlockwise rotational-manoeuvre relieved impingement.
JOURNAL/ijana/04.03/01762628-202203001-00131/inline-graphic1/v/2022-09-30T091728Z/r/image-tiff