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Improving styletted oral tracheal intubation: rational use of the OTSU

L’amélioration de Vintubation oro-trachéale : l’utilisation rationnelle du SIOTJ

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Abstract

Purpose

To introduce an improved method of styletted oral laryngoscopic tracheal intubation.

Description of the technique

The oral tracheal stylet unit (OTSU) is constructed using a commonly available intubating stylet combined with an ordinary endotracheal tube (ETT). The ETT/stylet is created by a series of specific 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 the tracheal tube, as it slides along the stationary stylet, is at an absolute minimum.

Successful tracheal intubation is based on the following concepts: (a) The j-shaped OTSU, when correctly directed through the airway, passes freely from the mouth to the larynx, the laryngoscopic channel; (b) The tip of the ETT must first be placed between the vocal cords with every intubation. The trachéal tube is then launched and advanced into the trachea by sliding along and off a stationary stylette; (c) Only minimal force is required to propel the ETT during intubation; (d) Resistance to placement, launch or advancement means the tip of the OTSU has come into physical contact with the patient’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 ability to differentiate where the ETT tip is located depends primarily on interpreting 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 describe an improvement of the technique, based on solid physical principles and years of experience, that should prove useful both for routine intubations and unexpected difficult airways.

Résumé

Objectif

Présenter une méthode améliorée d’intubation laryngoscopique oro-trachéale avec stylet.

Description de la, technique

Le stylet d’intubation oro-trachéal (SIOT) est le résultat de la combinaison d’un stylet d’intubation habituellement disponible et d’un tube endotrachéal (TET) ordinaire. Le TET/stylet est créé à la suite d’opérations spécifiques visant à produire un SIOT, chaque opération suivant un modèle et une forme réglementaires qui permettent au tube trachéal de se séparer librement du stylet. Après la construction, chaque unité est testée pour confirmer que la résistance frictionnelle créée par le tube trachéal qui glisse le long du stylet fixe est réduite au strict minimum.

L’intubation trachéale réussie se fonde sur les concepts suivants : (a) Le SIOT en forme de J, lorsqu’il est correctement poussé dans les voies aériennes, passe librement de la bouche au larynx, le canal laryngoscopique; (b) La pointe du TET doit d’abord être placée entre les cordes vocales pour chaque intubation. Le TET est alors introduit et avancé en glissant dans la trachée à distance du stylet fixe; (c) Seule une force minimale est nécessaire pour pousser le TET pendant l’intubation; (d) La résistance à la mise en place, à l’introduction ou à l’avancée signifie que la pointe du SIOT est entrée en contact avec les voies aériennes du patient; (e) Lorsque l’épiglotte masque le larynx, le bout du SIOT est utilisé pour explorer l’hypopharynx et repérer la glotte. La possibilité de savoir où se situe la pointe du TET dépend principalement de l’interprétation des sensations tactiles et de la pression transmises du biseau du SIOT à la main. L’intubation trachéale réussie est celle qui répond à tous les critères de mise en place, d’introduction et de poussée du tube.

Conclusion

L’intubation avec un stylet oro-trachéale est bien connue. Toutefois, nous décrivons une amélioration de la technique, fondée sur de solides principes physiques et des années d’expérience, ce qui devrait se révéler utile autant pour les intubations normales que pour les cas d’intubation difficile inattendue.

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Correspondence to Russell B. P. Stasiuk.

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Stasiuk, R.B.P. Improving styletted oral tracheal intubation: rational use of the OTSU. Can J Anesth 48, 911–918 (2001). https://doi.org/10.1007/BF03017359

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Keywords

  • Endotracheal Tube
  • Tracheal Intubation
  • Tracheal Tube
  • Difficult Airway
  • Difficult Intubation