Improving styletted oral tracheal intubation: rational use of the OTSU

Authors
Citation
Rbp. Stasiuk, Improving styletted oral tracheal intubation: rational use of the OTSU, CAN J ANAES, 48(9), 2001, pp. 911-918
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
ISSN journal
0832-610X → ACNP
Volume
48
Issue
9
Year of publication
2001
Pages
911 - 918
Database
ISI
SICI code
0832-610X(200110)48:9<911:ISOTIR>2.0.ZU;2-R
Abstract
Purpose: To introduce an improved method of styletted oral laryngoscopic tr acheal intubation. Description of the technique: The oral tracheal stylet unit (OTSU) is const ructed using a commonly available intubating stylet combined with an ordina ry endotracheal tube (ETT). The ETT/stylet is created by a series of specif ic steps to form an OTSU, each with a standard shape and design that allows the tracheal tube to separate freely from the stylet. After construction, every unit is tested to confirm that the frictional resistance created by t he tracheal tube, as it slides along the stationary stylet, is at an absolu te minimum. Successful tracheal intubation is based on the following concepts: (a) The j-shaped OTSU, when correctly directed through the airway, passes freely fr om the mouth to the larynx, the laryngoscopic channel; (b) The tip of the E TT must first be placed between the vocal cords with every intubation. The tracheal tube is then launched and advanced into the trachea by sliding alo ng and off a stationary stylette; (c) Only minimal force is required to pro pel the ETT during intubation; (d) Resistance to placement, launch or advan cement means the tip of the OTSU has come into physical contact with the pa tient's airway; (e) When the epiglottis obscures the larynx, the tip of the OTSU is used to explore the hypopharynx and identify the glottis. The abil ity to differentiate where the ETT tip is located depends primarily on inte rpreting the sensations of touch and pressure transmitted from the bevel of the OTSU to the hand. Successful tracheal intubation is accomplished when all criteria for placement, launch, and advancement are met. Conclusion: Styletted oral tracheal intubation is well known. However, we d escribe an improvement of the technique, based on solid physical principles and years of experience, that should prove useful both for routine intubat ions and unexpected difficult airways.