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J Clin Anesth. 2006 Mar;18(2):118-23.

Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy.

Author information

1
Department of Anesthesia, Edith Wolfson Medical Center, Holon 58100, Israel. tezri@netvision.net.il

Abstract

STUDY OBJECTIVE:

Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation.

DESIGN:

Prospective, double-blind, crossover study.

SETTING:

University hospital.

PATIENTS:

Forty non-obese patients (BMI <28 kg.m(-2)), aged 18 to 80 years, American Society of Anesthesiologists risk class I-III, who underwent elective laparoscopic cholecystectomy were enrolled in this double-blind, prospective study.

INTERVENTIONS:

After endotracheal intubation by one anesthesiologist, two other anesthesiologists assessed the tracheal tube's positioning by either the Rapiscope or chest auscultation; the results of one anesthesiologist's measurement were concealed from the other.

MEASUREMENTS:

Assessments of the endotracheal tube tip's position were performed after intubation, head-down, and head-up positioning, after maximal abdominal insufflation and before extubation. At the same time points, Sp(O2), ET(CO2), and peak inspiratory pressures were also recorded.

MAIN RESULTS:

Postintubation Rapiscope assessment revealed normal tracheal positioning of the tube's tip in all patients. Changes in tube's position were subsequently detected by the Rapiscope in 16 patients. In 8 cases, the tip moved endobronchially. Half of the endobronchial intubations occurred after maximal abdominal insufflation and the other half after changing the table position from neutral to 30 degrees head-down. Chest auscultation detected bronchial intubation in two cases only (P = .01). There were 4 additional events of downward movements and 4 events of cephalad migration of the tube's tip identified by the Rapiscope only. ET(CO2), Sp(O2), and peak inspiratory pressures did not change in patients who did experience bronchial intubation.

CONCLUSION:

The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential.

PMID:
16563329
DOI:
10.1016/j.jclinane.2005.08.008
[Indexed for MEDLINE]
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