Soichiro Yamashita1, Shinji Takahashi2, Yoshiko Osaka2, Kenzo Fujikura3, Koya Tabata3, Makoto Tanaka2. 1. Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: soichi2003@aol.com. 2. Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 3. Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Japan.
Abstract
STUDY OBJECTIVE: To evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method. DESIGN: Prospective, randomized, controlled study. SETTING: Operating room, university hospital. PATIENTS: Eighty children <2 years old scheduled for elective surgery undergoing general anesthesia. INTERVENTIONS: Trachlight was used for the transillumination method. After intubation, patients were randomly assigned to 1 of 2 groups: (1) deliberate bronchial intubation with subsequent withdrawal of the TT to 2 cm above the carina (main-stem group) or (2) transmitted visual signal from a bright light at the TT tip on the skin at the suprasternal notch after inserting the Trachlight into the TT (transillumination group). MEASUREMENTS: The TT tip position was assessed by chest radiograph after the procedure. Appropriate TT placement was defined when the TT tip was located between the sternoclavicular junction and 1 cm above the carina. MAIN RESULTS: Appropriate TT placement was found in 31 (80%) of 39 patients in the transillumination group and 26 (65%) of 40 in the main-stem group. The transillumination method had higher rate of appropriate TT placement than the main-stem method (P = .15; risk ratio, 1.22; 95% confidence interval, 0.93-1.61). Seven patients (18%) had proximal TT placement, and 1 (3%) had distal TT placement in the transillumination group. In the main-stem group, 7 patients (18%) had proximal TT placement, and 7 (18%) had distal TT placement. CONCLUSIONS: The transillumination method was reliable for appropriate TT placement in small children <2 years old undergoing general anesthesia, although the transillumination method was not found to be better compared with the main-stem method.
RCT Entities:
STUDY OBJECTIVE: To evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method. DESIGN: Prospective, randomized, controlled study. SETTING: Operating room, university hospital. PATIENTS: Eighty children <2 years old scheduled for elective surgery undergoing general anesthesia. INTERVENTIONS: Trachlight was used for the transillumination method. After intubation, patients were randomly assigned to 1 of 2 groups: (1) deliberate bronchial intubation with subsequent withdrawal of the TT to 2 cm above the carina (main-stem group) or (2) transmitted visual signal from a bright light at the TT tip on the skin at the suprasternal notch after inserting the Trachlight into the TT (transillumination group). MEASUREMENTS: The TT tip position was assessed by chest radiograph after the procedure. Appropriate TT placement was defined when the TT tip was located between the sternoclavicular junction and 1 cm above the carina. MAIN RESULTS: Appropriate TT placement was found in 31 (80%) of 39 patients in the transillumination group and 26 (65%) of 40 in the main-stem group. The transillumination method had higher rate of appropriate TT placement than the main-stem method (P = .15; risk ratio, 1.22; 95% confidence interval, 0.93-1.61). Seven patients (18%) had proximal TT placement, and 1 (3%) had distal TT placement in the transillumination group. In the main-stem group, 7 patients (18%) had proximal TT placement, and 7 (18%) had distal TT placement. CONCLUSIONS: The transillumination method was reliable for appropriate TT placement in small children <2 years old undergoing general anesthesia, although the transillumination method was not found to be better compared with the main-stem method.
Authors: Vivian Welch; J Jull; J Petkovic; R Armstrong; Y Boyer; L G Cuervo; Sjl Edwards; A Lydiatt; D Gough; J Grimshaw; E Kristjansson; L Mbuagbaw; J McGowan; D Moher; T Pantoja; M Petticrew; K Pottie; T Rader; B Shea; M Taljaard; E Waters; C Weijer; G A Wells; H White; M Whitehead; P Tugwell Journal: Implement Sci Date: 2015-10-21 Impact factor: 7.327