Airway management is the most important duty of an anesthetist, so more attention should be paid on different educational approaches in tackling difficult airway. Having problems in airway control leads to terrible consequences such as hypoxia and aspiration. Intubation with fiberoptic is a useful method for a safe airway management. When neck movement is not possible due to cervical spine injury or when direct laryngoscopy and vocal cord vision is not possible, awake oral or nasal fiberoptic Intubation or under general anesthesia is very useful. This study’s aim is to introduce a useful scopic device for Intubation.

Introduction: In spite of the recent improvements in prenatal and postnatal cares, there is an increase of respiratory distress in premature newborns that need to be put on ventilators. Due to intratracheal Intubation and ventilation systems, there is an increase of ventilator-associated infection among such neonates; thus, calling for more attention and evaluation. Accurate diagnosis and immediate treatment of these infections may decrease the onset of respiratory complications, the cost due to prolonged hospitalization, drug consumption and neonatal mortality.Materials and Methods: This is a cross-sectional study. The sampling technique used for the study was easy and based on goals. The population of the study were selected among intubated newborns in neonatal intensive care of Bahman 22nd Hospital in Mashhad. The subjects were diagnosed for Respiratory Distresses (RDS) during the years 2006 to 2007. Tracheal culture was done and antibiograms were created for all the cases while changing the tube. Also, the results of blood culture, the number of tubes being changed, the duration of Intubation and the number of suctions were studied. Having completed the information forms, the data were evaluated with SPSS software running Fisher test and K2.Results: Among 100 neonates who were studied, 34 cases had positive tracheal culture. The organisms identified included: Coagulase positive staph (30%), C. Negative staph (23%) and E. coli (23%). The results of blood culture were positive in 6% of the cases. 40% of the subjects were suctioned 10-12 times a day and 60% of them were put on intubators 3-5 days and 50% of them had their tracheal tubes changed 3 to 4 times during hospitalization period.Conclusion: Repeated sterile suctioning as well as reducing the time of Intubation and the number of tube changing diminished the formation of organism colonization in trachea.

This technical note aims to introduce a new approach for Intubation of patients with restricted mouth opening in cases that conventional and fiberoptic-assisted endotracheal Intubation are not possible. The proposed technique is a modification to the previously well-established retrograde Intubation method. The main advantage of this new technique is the employment of fiberscope for direct visualization which eliminates the use of guide wire. The endotracheal tube enters through the nostril and is railroaded using the fiberscope as a guide. Using this new technique can prevent the complications of tracheostomy and the traditional retrograde Intubation in patients that anterograde Intubation is not feasible. The promising result of conducting the Intubation with this approach can be considered the basis for future clinical investigation.

Aim and Background: Tracheal Intubation remains the choice method for keeping airways open during mechanical ventilation. Among the various methods, standard method of direct laryngoscopy generally used by non-skilled staff increases the risk of failure. This study was performed to evaluate and compare the results of tracheal Intubation using laryngeal masks vs. glidescope led by novice personnel.Methods and Materials: This descriptive-prospective study were conducted on 31 trainees and interns of Birjand University of Medical Sciences. Each of the participants randomly intubated two patient with laryngeal mask airway or glidescope, and the results were recorded a professional as observer. The maximum authorized turn to try tracheal Intubation was once per person with a time limit of 90 seconds. If the participant had two unsuccessful tries or due to a problem regarding the Intubation process an anesthesiologist took the control and performed the Intubation and the Intubation try by the study participant was considered unsuccessful.Findings: Tracheal Intubation success rate in laryngoscopic and laryngeal mask airway (LMA) was 90.3% and 96.8%, respectively (P=0.325). Average time of tracheal Intubation in laryngeal mask airway and laryngoscopy group was 29.25 ± 3.90 and 48.25 ± 4.90 (P<0.001).Conclusions: Results of this study suggest a higher rate of success as well as faster Intubation for laryngeal mask airway. Due to the cost and feasibility of using this method, the researchers recommend that hospitals should focus on training with and providing laryngeal mask airways.

Purpose: To compare success rates of external dacryocystorhinostomy (DCR) with and without bicanalicular silicone Intubation for management of primary acquired nasolacrimal duct obstruction.Methods: In a randomized clinical trial study, 52 patients with primary acquired nasolacrimal duct obstruction underwent external DCR. Patients were randomly enrolled into two groups. In the 1st group, external DCR was performed without Intubation and in the 2nd one, monocanalicular Intubation was used. All patients were followed for at least 3 months. Subjective and objective signs were evaluated by Munk score and irrigation & aspiration respectively. Demographic data such as age, gender, subjective and objective success were collected and analyzed.Results: Overall, 26 eyes were enrolled in each group. Mean age of patients was 44.5±18.5 years in the monocanalicular silicone Intubation group and 48.3±21.2 years in the group without Intubation, (P=0.502). Success in group one (without Intubation) was achieved objectively in 24 of 26 eyes (92.3%) and subjectively in 25 of 26 eyes (96.1%) compared to 22 of 26 eyes (84.6%) and 24 of 26 eyes (92.3%) in the monocanalicular silicone Intubation group (P=0.5). Mean follow-up was 7.2±2.5 in group one and 7±2.2 in group two (P=0.76).Conclusion: Although external dacryocystorhinostomy without Intubation had marginally higher success rates, this difference is not statistically significant. It seems that surgeon’s experience and surgical techniques play the main role irrespective of performing Intubation.

Background: Endotracheal Intubation is a potentially high-risk aerosol-generating procedure. So, an Intubation box (I-Box) is designed for personal protection during Intubation. This study aimed to compare the outcomes of endotracheal Intubation with and without an I-box in COVID-19 patients. Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of Intubation including duration of Intubation, first-pass success Intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful Intubation were compared between the two groups. Results: The time of Intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success Intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032). Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to Intubation and the number of attempts for successful Intubation and reduced the rate of first-pass success Intubation and visibility.