Med J Malaysia. 2025 Dec;80(Suppl 8):43-47.
ABSTRACT
INTRODUCTION: Accidental oesophageal intubation is a significant cause of death or neurological injury during anaesthesia in the perioperative period, making it crucial to confirm the correct placement of the tracheal tube immediately. In the operating room, anaesthesiologists typically use indirect methods to verify tracheal tube positioning. Ultrasonography (USG) can be employed to confirm whether the endotracheal tube (ETT) is correctly placed in the trachea. This study evaluates the use of USG in supervising a trainee during intubation and also examines the time it takes for USG to identify the tube's entry into the trachea or oesophagus in real-time.
MATERIALS AND METHODS: The study included 90 patients with ASA physical status 1 and 2 who were scheduled for elective surgeries under general anaesthesia. Preoperative data were collected on patient characteristics, airway measurements, and baseline haemodynamic parameters. Anaesthetic management was kept consistent across all participants. The 90 patients were divided into three groups of 30 each, with intubation performed by either an intern, resident, or faculty member, assigned through computergenerated randomisation. A high-frequency linear ultrasound probe (9-14MHz) was placed at the suprasternal notch and slightly moved to the left. In this view, at the level of the suprasternal notch, the oesophagus appears posterolateral to the trachea. During laryngoscopy, the Cormack-Lehane grade was recorded. The anaesthesiologist performing the ultrasound simultaneously measured the time taken to confirm endotracheal intubation. In cases of oesophageal intubation, the "double track" sign was used for identification, and the time required to make this identification was recorded. The times for confirming intubation into the trachea and oesophagus were documented for all three groups. SPSS Version 20.0 software was used for statistical analysis. The study employed mean, standard deviation, chi-square test, ANOVA, and Duncan Multiple Range Test (DMRT) for data analysis.
RESULTS: The patient characteristics and demographic data showed no significant statistical differences. Oesophageal intubation was detected as quickly as 2 seconds, and the average time in seconds to confirm endotracheal tube placement was recorded for each group as follows: Faculty < Resident < Intern (Mean time: 17.5 < 26.8 < 53.6 seconds). The ANOVA test indicated statistically significant differences in tracheal intubation times among the three groups. Further analysis with the Duncan Multiple Range Test (DMRT) confirmed that the timing differences between the groups were statistically significant.
DISCUSSION: Ultrasound is a valuable tool in training scenarios where a physician supervises less experienced practitioners. It provides a fast and reliable method for confirming correct endotracheal intubation.
PMID:41456142