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Esophageal dilatation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Jennifer Billington, Niyi Ade-Ajayi
This procedure is preceded by rigid esophagoscopy with the child in the supine position and the neck extended on a head ring (Figure 5.2). The index finger of the operator's non-dominant hand is used to pull back the upper teeth and the thumb used to protect the teeth from damage by the esophagoscope. With the esophagoscope advanced to immediately proximal to the stricture, the selected bougie is prepared with hydrophilic gel and gently passed. The ideal grip involves thumb and index finger, supported behind by the middle finger; a gentle rather than a “fist” grip. This is preferred in order to reduce the amount of force applied and thus lessen the risk of perforation. The choice of initial dilator size is based on radiological/endoscopic assessment. Blind bouginage, particularly for first time dilatation, is not recommended.
Practical Procedures
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Insert an introducer first to ‘stiffen’ the tube to facilitate placement, if problematic.Or pass an airway bougie through the cords and then railroad the endotracheal tube over the bougie into the trachea.
Benign oesophageal obstruction
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
The choices are often dictated by availability of equipment and local expertise. Based on evidence or experience, the following can be recommended: Bougies are preferable to balloons for organic stenoses of the oesophagus, because bougie dilatation is probably more effective in dysphagia relief [21].Endoscopic and/or wire-guided methods under radiological control are usually needed for long, tight or tortuous strictures, and those associated with large hiatus herniae or fistulae.Anastomotic strictures are often best dilated with a balloon, because of the short segment of catheter ahead of the dilator.For achalasia, BoTox injection therapy is probably the first choice in the elderly or infirm, because of its safety. For dilatation, a 30-mm diameter × 50-mm long balloon (Rigiflex or similar) is the first choice, because it is predictable and relatively safe.Though there is continuing debate about the merits of surgery for achalasia [22], endoscopists should keep in mind that it is very effective.
“Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery”
Published in Annals of Medicine, 2023
Cem Kaan Parsak, İlker Halvacı, Uğur Topal
For the Floppy–Nissen procedure, the mobilization of the fundus was achieved via a ligature, starting at the level of an imaginary line assumed to transverse the stomach through the lower end of the spleen toward the crural. A 39-F bougie was used routinely in all patients. We recommend the surgical procedure to be standard, to facilitate dissection, and to push the bougie after the fundoplication is completed to understand whether there is a narrowing or not The crural defect was repaired with two to three non-absorbable sutures. A 2*4-cm prolen graft was fixed on the crus with a titanium ProTack™ (Covidien, U.) tacker. The fundus was passed through a window opened posterior to the esophagus, and the 360° fundoplication was completed. In this position, three non-absorbable sutures were made between the two opposing stomach walls, the first of which passed through the esophagus. Patients started to take liquids on a postoperative day 1 and were discharged with a recommendation to ingest only liquids and soft foods for 3–4 weeks after discharge.
Predictors of Definitive Airway Sans Hypoxia/Hypotension on First Attempt (DASH-1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation
Published in Prehospital Emergency Care, 2020
Elizabeth K. Powell, William R. Hinckley, Uwe Stolz, Andrew J. Golden, Amanda Ventura, Jason T. McMullan
Lack of airway secretions/blood and Cormack-Lehand Score of 1 or II were both associated with improved first pass and DASH-1A success. This is somewhat intuitive as improved visualization of the vocal cords likely leads to more rapid intubation and less potential for hypoxia. This emphasizes the importance of suction and optimized positioning and visualization techniques prior to any airway attempts. In the multivariable analyses, use of a bougie was associated with increased overall intubation and DASH-1A success. Though not evident from univariate comparisons, bougie use was significantly associated with both outcomes when controlling for multiple other variables. We suspect that providers used the bougie when they predicted a challenging airway, such as those contaminated by secretions/blood, which may be why the associations were significant only after controlling for other variables. The bougie could be considered and readily available in all patients, whether or not a difficult airway is suspected. A recent study conducted in the emergency department showed a similar association with increased first-pass intubation success when using a bougie (13). As the use of the bougie itself requires training and familiarity we recommend incorporation of the bougie into airway training.
Randomized Comparative Assessment of Three Surgical Cricothyrotomy Devices on Airway Mannequins
Published in Prehospital Emergency Care, 2019
Jillian M. Dorsam, Steven R. Cornelius, Julie B. McLean, Gregory J. Zarow, Alexandra C. Walchak, Sean P. Conley, Paul J. D. Roszko
To ensure standardization between participants, the cricothyrotomy devices were used as designed by the manufacturer, without adding or mixing parts. SC products were unassembled and in original packaging at the time of evaluation. Tactical CricKit® (TCK, North American Rescue, Greer, SC) uses a tracheal-hook to open a gap between the thyroid cartilage and the cricoid cartilage and the tracheal tube insertion is guided with an obturator (Figure 2). The Control-Cric™ System (20) (CC, Pulmodyne, Indianapolis, IL) features a pre-shaped stylet key and knife with integrated tracheal-hook for insertion (Figure 3). Finally, the bougie-assisted technique (BAT) utilizes the Introducer Adult Bougie (SunMed, Largo, FL), an endotracheal introducer with a curved coudé tip to aid in tracheal tube insertion and placement (Figure 4). Each of these methods is fully described in Table 1.