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Biomedical subjects

W H Rosenblatt

Publications and source records attributed to W H Rosenblatt.

At least 19 recordsLinked to original sources
PubMed2006

Use of the fibreoptic intubating LMA-CTrach in two patients with difficult airways.

We report two patients with difficult airways who underwent tracheal intubation using the new fibreoptic intubating Laryngeal Mask Airway CTrach. The imaging technology of the LMA-CTrach was decisive in the management of these two patients. The first patient had lingual tonsillar hyperplasia, and an omega-shaped retroflexed epiglottis. The second patient had a C2-occipital fusion and was completely unable to extend her head. Given the anatomical difficulties encountered, it was likely that intubation would have been difficult or impossible through the LMA-Fastrach. The aim of this report is to describe the successful use of this new intubating laryngeal mask airway in these two challenging patients.

Aged↗
PubMed2006

The LMA CTrach in airway resuscitation: six case reports.

We report six patients with unexpected difficult airways who underwent tracheal intubation using the Laryngeal Mask Airway CTrach. All these patients had failed orotracheal intubation using direct laryngoscopy and gum elastic bougie placement. Fibreoptic bronchoscopy failed in two of these patients due to blood and secretions in the airway. This report describes the successful use of this new intubating laryngeal mask in these cases, all of whom were intubated on the first attempt with this new device.

Adult↗
PubMed2001

Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways.

BACKGROUND: The laryngeal mask airway (LMA; LMA North America, Inc., San Diego, CA) has a well-established role in the emergency and elective treatment of patients with difficult-to-manage airways (DA). In this study, the authors report their clinical experience with the intubating LMA (LMA-Fastrach; LMA North America, Inc., San Diego, CA) in 254 patients with different types of DA. METHODS: The authors reviewed the anesthetic and medical records of patients with DA in whom the LMA-Fastrach was used electively or emergently at four institutions from October 1997 through October 2000. In each case, the number of insertion and intubation attempts was recorded. Success rates for blind and fiber optically guided intubation through the LMA-Fastrach were calculated, up to a maximum of five attempts per patient. RESULTS: The LMA-Fastrach was used in 257 procedures performed in 254 patients with DA, including patients with Cormack-Lehane grade 4 views; patients with immobilized cervical spines; patients with airways distorted by tumors, surgery, or radiation therapy; and patients wearing stereotactic frames. Insertion of the LMA-Fastrach was accomplished in three attempts or fewer in all patients. The overall success rates for blind and fiber optically guided intubations through the LMA-Fastrach were 96.5% and 100.0%, respectively. CONCLUSIONS: The LMA-Fastrach was used successfully in a high percentage of patients who presented with a variety of DA. The clinical experience presented herein indicates that this device may be particularly useful in the emergency and elective treatment of patients in whom intubation with a rigid laryngoscope has failed and in the treatment of patients with immobilized cervical spines.

Adolescent↗
PubMed1999

The intubating laryngeal mask: use of a new ventilating-intubating device in the emergency department.

The intubating laryngeal mask airway (ILM) was introduced in 1997 as a modification of the classic laryngeal mask airway. In addition to serving as an elective or emergency ventilating device, it is designed to allow blind intubation. We report 3 cases of airway management in the emergency department of Yale-New Haven Hospital where the ILM was used to establish ventilation and intubation in patients in whom direct laryngoscopy had failed. The 3 cases are representative of situations commonly seen in the ED: the obtunded and apneic ("crash airway") patient, failed rapid sequence intubation, and the recognized difficult airway/awake intubation. In all 3 cases, a clear airway was established on initial placement of the ILM, and intubation was achieved on the first attempt at blind advancement of the endotracheal tube. Although the ILM may be an important addition to the armamentarium of the emergency physician, proficiency in its use requires practice under controlled conditions. We suggest that the emergency physician seek out elective practice in either a teaching workshop or hospital operating theater.

Adult↗
PubMed1998

Practice patterns in managing the difficult airway by anesthesiologists in the United States.

UNLABELLED: Despite the availability of several techniques and devices for the management of the difficult airway, little information has been published regarding the prevalence of their use by anesthesiologists in the United States. To determine current practice patterns, we surveyed clinicians using a questionnaire consisting of 14 difficult airway scenarios. Anesthesiologists were requested to indicate their likely approach to anesthetic induction (e.g., awake but sedated, general anesthesia with spontaneous ventilation, general anesthesia with apnea after assuring a patent airway, or general anesthesia with apnea) and the primary device they would use to intubate (e.g., direct laryngoscopy [DL], flexible fiberoptic bronchoscope [FOB], rigid fiberoptic device, surgical airway, retrograde intubation kit, laryngeal mask airway, gum elastic bougie, or Combitube). The availability of these devices was also determined (in room at all times, available "stat," available if arranged preoperatively, or not available). The survey was mailed to 1000 randomly chosen active members of the American Society of Anesthesiologists. Second and third surveys were mailed to non responders. Four hundred seventy-two completed surveys were returned. Responses by demographic groups were compared by using chi 2 analysis. DL and FOB-aided tracheal intubation techniques were chosen for most cases by most anesthesiologists (P < 0.05). Anesthesiologists with > 10 yr of clinical experience and those older than 55 yr of age preferred DL with apneic conditions (P < 0.05). Anesthesiologists who had attended workshops within the last 5 yr had greater availability of retrograde guidewire equipment and FOBs (P < 0.05). There was little use of newer alternative airway devices. IMPLICATIONS: Although the teaching of alternative methods of securing a difficult airway has become ubiquitous, most anesthesiologists rely on direct laryngoscopy and fiberoptic-aided intubation in most clinical circumstances. Although workshops in the management of the difficult airway may have resulted in increased use of the fiberoptic bronchoscope and the availability of retrograde guidewire intubation equipment, other devices have not enjoyed such an increase.

Adult↗
PubMed1998

The palm print as a sensitive predictor of difficult laryngoscopy in diabetics.

BACKGROUND: Grading of the ink impression made by the palm of the hand has been proposed as a means of screening diabetic patients in whom tracheal intubation may be difficult because of glycosylation of both metacarpal and cervical joints. The current study was designed to test the predictability of the palm print and other airway evaluation indices in a diabetic population. METHOD: 83 adult, diabetic patients scheduled for surgery under general anesthesia were evaluated preoperatively using 4 physical examination indices predictive of difficult laryngoscopy and intubation: Mallampati classification, thyromental distance, head extension, and palm print. Following induction of anesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index was calculated. RESULTS: The palm print had the highest sensitivity of all indices (100%). The other 3 indices failed to detect 9 to 13 difficult laryngoscopies. CONCLUSION: We believe that in the diabetic population, the palm print index may be a sensitive marker of difficult intubation. It is possible that other airway evaluation indices would prove more sensitive, and have greater utility, in distinct populations as compared to when they are applied to all patients.

Adult↗
PubMed1997

Assessment of the economic impact of an overage reduction program in the operating room.

STUDY OBJECTIVES: To delineate excessive supply preparation in the operating rooms (ORs) of Yale-New Haven Hospital, and to measure the reduction in such overage as a result of nursing and administration cost-containment efforts. DESIGN: Before and after trial. SETTING: Inpatient ORs of Yale-New Haven Hospital. INTERVENTIONS: After the initial documentation of overage, several cost-containment measures were instituted, including nursing education, review of overage data, and updating of surgical request lists. MEASUREMENTS AND MAIN RESULTS: The hospital cost of case-specific overage generated by all surgical procedures performed during two 2.5-month periods in 1992 and 1994 (before and after the interventions) were compared. One-thousand three hundred eighteen cases in 1992 were compared with 1,367 cases in 1994. A 45% reduction in mean per case overage occurred between the two assessment periods. Extrapolation of the data to the incidence of similar cases throughout the United States projected a comparable savings. CONCLUSIONS: Efforts to increase the efficiency of OR supply management can be measured, in part, by overage evaluation, which can serve as a resource for focusing efforts at cost-containment.

Cost Control↗
PubMed1996

Focused versus operating room-wide recovery of unused supplies for overseas reconstructive surgery.

Proliferation of programs that recover surplus operating room supplies may effectively address the needs of volunteer overseas surgical efforts. However, these programs tend to garner supplies highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies generated by plastic and reconstructive procedures, we extrapolated the inventory of 71 consecutive cases from our 33,000-case database. Additionally, we examined the recovery of 7 specific supplies from all cases performed at Yale-New Haven Hospital over a 3-year period. Though consistency is unlikely when only plastic and reconstructive surgical cases are examined, operating room-wide recovery may be a reliable source of usable materials.

Connecticut↗
PubMed1996

Recovery of unused operating room supplies for overseas orthopedic surgery.

Recovery of surplus operating room (OR) materials may contribute needed supplies to volunteer overseas surgical efforts. However, recovery often generates supplies that are highly heterogeneous in nature. In order to evaluate the nature and quantity of supplies useful to orthopedic surgical missions, the present investigation evaluated the material generated from 381 consecutive orthopedic cases performed during three 3-month assessment periods over 3 years. The amount of recovered material varied markedly within and among procedure types as well as surgeons. Nevertheless, the long-term, OR-wide recovery program at Yale-New Haven Hospital has provided a highly reliable source of usable materials over the 4-year life of the program.

Equipment and Supplies↗
PubMed1993

Case-by-case assessment of recoverable materials for overseas donation from 1318 surgical procedures.

OBJECTIVE: To provide a mechanism for addressing the need for consistency and projection in overseas donation of surgical supplies, we conducted a case-by-case inventory of unused materials recovered from all surgical procedures in our facility over a 2.5-month period. DESIGN: Unused surgical supplies were recovered in coded bags from individual cases and inventoried. SETTING: Inpatient operating rooms at Yale-New Haven Hospital. MAIN OUTCOME MEASURE: The weight and dollar value of recovered materials were tallied for each case type; these were then extrapolated according to the frequency with which each procedure is performed in the United States to provide an estimate of the impact of a nationwide recovery program. RESULTS: The value of supplies recovered ranged from $1 (bone marrow transplant) to greater than $40 (liver and vulva/perineum procedures). By extrapolation to case-specific data from the National Hospital Discharge Survey (1990), we estimate that a nationwide recovery program could yield more than $193 million in charitable material and reduce operating room waste by more than 1.7 million kilograms (1948 tons). CONCLUSIONS: Consistency and organization would contribute greatly to efforts to alleviate existing medical supply needs in the developing world. This case-by-case assessment should enable participating centers to project more effectively the outcome of such collections and allow the coordination of efforts. Though unlikely to be adopted by all operating theaters in the United States, the potential charitable contributions from a nationwide recovery program are significant.

Charities↗