title: Transtracheal puncture: a forgotten procedure.
abstract: Transtracheal puncture has long been known as a safe, low-cost procedure. However, with the advent of bronchoscopy, it has largely been forgotten. Two researchers have suggested the use of α-amylase activity to diagnose salivary aspiration, but the normal values of this enzyme in tracheobronchial secretions are unknown. We aimed to define the normal values of α-amylase activity in tracheobronchial secretions and verify the rate of major complications of transtracheal puncture. From October 2009 to June 2011, we prospectively evaluated 118 patients without clinical or radiological signs of salivary aspiration who underwent transtracheal puncture before bronchoscopy. The patients were sedated with a solution of lidocaine and diazepam until they reached a Ramsay sedation score of 2 or 3. We then cleaned the cervical region and anesthetized the superficial planes with lidocaine. Next, we injected 10 mL of 2% lidocaine into the tracheobronchial tree. Finally, we injected 10 mL of normal saline into the tracheobronchial tree and immediately aspirated the saline with maximum vacuum pressure to collect samples for measurement of the α-amylase level. The α-amylase level mean ± SE, median, and range were 1914 ± 240, 1056, and 24-10,000 IU/L, respectively. No major complications (peripheral desaturation, subcutaneous emphysema, cardiac arrhythmia, or hemoptysis) occurred among 118 patients who underwent this procedure. Transtracheal aspiration is a safe, low-cost procedure. We herein define for the first time the normal α-amylase levels in the tracheobronchial secretions of humans.
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
authors.forename: E P
authors.initials: EP
authors.lastname: Almeida
authors.affiliation: Departamento de Clínica, Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, MG, Brasil.
authors.forename: A C
authors.initials: AC
authors.lastname: Almeida
authors.affiliation: Departamento de Clínica, Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, MG, Brasil.
authors.forename: F F
authors.initials: FF
authors.lastname: Almeida
authors.affiliation: Departamento de Cirurgia, Faculdade de Ciências Médicas e da Saúde, Juiz de Fora, MG, Brasil.
authors.forename: J
authors.initials: J
authors.lastname: Montessi
authors.affiliation: Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
authors.forename: C A
authors.initials: CA
authors.lastname: Gomes
authors.affiliation: Departamento de Endoscopia, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
authors.forename: L E V V C
authors.initials: LE
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019152:Paracentesis / Q000379:methods*; D011446:Prospective Studies; D012016:Reference Values; D014132:Trachea / Q000201:enzymology* / Q000378:metabolism; D055815:Young Adult; D000516:alpha-Amylases / Q000032:analysis*
chemical_list: D000516:alpha-Amylases