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Batuwitage B, Nishikawa K, Mercer S, McDonald A, Charters P. Reply to: the use of advanced airway management devices in clinical practice. Eur J Anaesthesiol 2016; 33:470-471. [PMID: 26825018 DOI: 10.1097/eja.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Bisanth Batuwitage
- From the Portsmouth Hospitals NHS Trust, UK (BB); General Sagami Kosei Hospital, Japan (KN); and Aintree University Hospital NHS Foundation Trust, UK (SM, AM, PC)
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Van Zundert AAJ, Skinner MW, Van Zundert TCRV, Luney SR, Pandit JJ. Value of knowing physical characteristics of the airway device before using it. Br J Anaesth 2016; 117:12-6. [PMID: 27147543 DOI: 10.1093/bja/aew106] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- A A J Van Zundert
- Department of Anaesthesiology, Royal Brisbane and Women's Hospital, and the School of Medicine and Biomedical Sciences, The University of Queensland, Butterfield Street, Brisbane, QLD 4029, Australia
| | - M W Skinner
- Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - T C R V Van Zundert
- Department of Anaesthesia, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - S R Luney
- Deparment of Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK University of Birmingham, Birmingham, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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54
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Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli G, Nabecker S, Theiler L. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth 2016; 116:670-9. [DOI: 10.1093/bja/aew058] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/22/2022] Open
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55
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Pieters BMA, Wilbers NER, Huijzer M, Winkens B, van Zundert AAJ. Comparison of seven videolaryngoscopes with the Macintosh laryngoscope in manikins by experienced and novice personnel. Anaesthesia 2016; 71:556-64. [DOI: 10.1111/anae.13413] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B. M. A. Pieters
- Department of Anaesthesia, Pain and Palliative Medicine; Radboud University Medical Centre; Nijmegen the Netherlands
| | - N. E. R. Wilbers
- Department of Anaesthesia and Intensive Care Medicine; St. Jans Gasthuis; Cooperation Anaesthesia Weert u.a; Weert the Netherlands
| | - M. Huijzer
- Department of Anaesthesia; University Medical Centre Utrecht; Utrecht the Netherlands
| | - B. Winkens
- Department of Methodology and Statistics; Maastricht University; CAPHRI School for Public Health and Primary Care; Maastricht the Netherlands
| | - A. A. J. van Zundert
- The University of Queensland, Faculty of Medicine and Biomedical Sciences, Department of Anaesthesia and Perioperative Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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56
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Affiliation(s)
- H.-J. Priebe
- Universitatsklinikum Freiburg; Freiburg im Breisgau Germany
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57
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Mushambi MC. Obstetric tracheal intubation guidelines and cricoid pressure - a reply. Anaesthesia 2016; 71:346-7. [DOI: 10.1111/anae.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. C. Mushambi
- Obstetric Anaesthetists' Association and Difficult Airway Society Difficult and Failed Intubation in Obstetrics Working Group
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58
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Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2016; 70:1286-306. [PMID: 26449292 PMCID: PMC4606761 DOI: 10.1111/anae.13260] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/16/2022]
Abstract
The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the 'can't intubate, can't oxygenate' situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how to awaken or proceed with surgery. The background paper covers recommendations on drugs, new equipment, teaching and training.
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Affiliation(s)
- M C Mushambi
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | - S M Kinsella
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - M Popat
- Nuffield Department of Anaesthesia, Oxford University Hospital NHS Trust, Oxford, UK
| | - H Swales
- Department of Anaesthesia, University Hospitals Southampton Foundation Trust, Southampton, UK
| | - K K Ramaswamy
- Department of Anaesthesia, Northampton General Hospital, Northampton, UK
| | - A L Winton
- Department of Anaesthesia, St Michael's Hospital, Bristol, UK
| | - A C Quinn
- Department of Anaesthesia, James Cook University Hospital, Middlesborough, UK.,Leeds University, Leeds, UK
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59
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Price G. Videolaryngoscopy in real patients - a welcome change. Anaesthesia 2016; 71:240-1. [PMID: 26750417 DOI: 10.1111/anae.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- G Price
- St. John's Hospital, Livingstone, UK.
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60
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Shaikh A, Robinson PN, Hasan M. The Tulip GT® airway versus the facemask and Guedel airway: a randomised, controlled, cross-over study by Basic Life Support-trained airway providers in anaesthetised patients. Anaesthesia 2015; 71:315-9. [PMID: 26684684 DOI: 10.1111/anae.13328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/27/2022]
Abstract
We performed a randomised, controlled, cross-over study of lung ventilation by Basic Life Support-trained providers using either the Tulip GT® airway or a facemask with a Guedel airway in 60 anaesthetised patients. Successful ventilation was achieved if the provider produced an end-tidal CO2 > 3.5 kPa and a tidal volume > 250 ml in two of the first three breaths, within 60 sec and within two attempts. Fifty-seven (95%) providers achieved successful ventilation using the Tulip GT compared with 35 (58%) using the facemask (p < 0.0001). Comparing the Tulip GT and facemask, the mean (SD) end-tidal CO2 was 5.0 (0.7) kPa vs 2.5 (1.5) kPa, tidal volume was 494 (175) ml vs 286 (186) ml and peak inspiratory pressure was 18.3 (3.4) cmH2 O vs 13.6 (7) cmH2 O respectively (all p < 0.0001). Forty-seven (78%) users favoured the Tulip GT airway. These results are similar to a previous manikin study using the same protocol, suggesting a close correlation between human and manikin studies for this airway device. We conclude that the Tulip GT should be considered as an adjunct to airway management both within and outside hospitals when ventilation is being undertaken by Basic Life Support-trained airway providers.
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Affiliation(s)
- A Shaikh
- Central Surgery and Accident and Emergency Department, James Paget University Hospital, Gorleston, Norfolk, UK.,Department of Anaesthesia, Northwick Park Hospital, Middlesex, UK
| | - P N Robinson
- Department of Anaesthesia, Northwick Park Hospital, Middlesex, UK
| | - M Hasan
- Department of Anaesthesia, University College Hospital, London, UK
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61
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Marshall SD, Pandit JJ. Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation. Anaesthesia 2015; 71:131-7. [PMID: 26670262 DOI: 10.1111/anae.13354] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very 'radical evolution'.Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises.All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption.
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Affiliation(s)
- S D Marshall
- Department of Anaesthesia, Peninsula Health, Melbourne, Australia. .,Department of Anaesthesia, Peri-operative Medicine, Central Clinical School, Monash University, Melbourne, Australia.
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.,St John's College, Oxford, UK
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62
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Jagannathan N, Hajduk J, Sohn L, Huang A, Sawardekar A, Gebhardt ER, Johnson K, De Oliveira GS. A randomised comparison of the Ambu®AuraGain™and the LMA®supreme in infants and children. Anaesthesia 2015; 71:205-12. [DOI: 10.1111/anae.13330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/30/2022]
Affiliation(s)
- N. Jagannathan
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - J. Hajduk
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - L. Sohn
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - A. Huang
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - A. Sawardekar
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - E. R. Gebhardt
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - K. Johnson
- Department of Anesthesia; Ann and Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois USA
| | - G. S. De Oliveira
- Department of Anesthesia; Feinberg School of Medicine; Northwestern University; Chicago Illinois USA
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63
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Greenland K. Art of airway management: the concept of ‘Ma’ (Japanese:, when ‘less is more’). Br J Anaesth 2015; 115:809-12. [DOI: 10.1093/bja/aev298] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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64
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King W, Teare J, Vandrevala T, Cartwright S, Mohammed KB, Patel B. Evaluation of a novel Surgicric® cricothyroidotomy device for emergency tracheal access in a porcine model. Anaesthesia 2015; 71:177-84. [PMID: 26572240 DOI: 10.1111/anae.13275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/21/2022]
Abstract
A can't intubate, can't ventilate scenario can result in morbidity and death. Although a rare occurrence (1:50 000 general anaesthetics), it is crucial that anaesthetists maintain the skills necessary to perform cricothyroidotomy, and are well-equipped with appropriate tools. We undertook a bench study comparing a new device, Surgicric(®) , with two established techniques; the Melker Emergency Cricothyroidotomy, and a surgical technique. Twenty-five anaesthetists performed simulated emergency cricothyroidotomy on a porcine model, with the primary outcome measure being insertion time. Secondary outcomes included success rate, tracheal trauma and ease of use. The surgical technique was fastest. The median (IQR [range]) was 81 (62-126 [37-300]) s, followed by the Melker 124 (100-217 [71-300]) s, and the Surgicric 127 (68-171 [43-300]), p = 0.003. The Surgicric device was the most traumatic, as evaluated by a blinded Ear, Nose and Throat surgeon. Subsequently, the authors contacted the device manufacturer, who has now modified the kit in the hope that its clinical application might be improved. Further studies are required to evaluate the revised model.
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Affiliation(s)
- W King
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - J Teare
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - T Vandrevala
- Research Design Service, Kingston Hospital, Surrey, UK
| | - S Cartwright
- ENT Department, Guy's and St Thomas' Hospitals, London, UK
| | - K B Mohammed
- Research and Development Department, The Royal Marsden Hospital, London, UK
| | - B Patel
- Surrey Peri-operative Anaesthesia Critical Care Collaborative Research Group, Anaesthetic Department, Royal Surrey County Hospital, Guildford, Surrey, UK
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65
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Wallace CD, Foulds LT, McLeod GA, Younger RA, McGuire BE. A comparison of the ease of tracheal intubation using a McGrath MAC(®) laryngoscope and a standard Macintosh laryngoscope. Anaesthesia 2015; 70:1281-5. [PMID: 26336853 DOI: 10.1111/anae.13209] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/30/2022]
Abstract
We compared the McGrath MAC(®) videolaryngoscope when used as both a direct and an indirect laryngoscope with a standard Macintosh laryngoscope in patients without predictors of a difficult tracheal intubation. We found higher median Intubation Difficulty Scores with the McGrath MAC as a direct laryngoscope, 1 (0-3 [0-5]) than when using it as an indirect videolaryngoscope, 0 (0-1 [0-5]) or when using the Macintosh laryngoscope, 0 (0-1 [0-5]), p = 0.04. This was mirrored in the subjective user reporting, scored out of 10, of difficulty for each method 3.0 (2.0-3.4 [0.5-80]); 2.0 (1.0-3.9 [0-70]) and 2.0 (1.0-3.3 [0-70]), respectively (p = 0.01). This difficulty is in part explained by the poorer laryngeal views recorded using the Cormack and Lehane classification system (p < 0.001) and reflected in the higher than normal operator force required (25%, 4%, 8% for each method, respectively, p < 0.001) and the increased use of rigid intubation aids (21%, 6%, 2%, respectively, p < 0.001). There was no difference between the groups in time taken to intubate or incidence of complications. There was no statistical difference in the performances as measured between the McGrath MAC used as an indirect videolaryngoscope and the Macintosh laryngoscope. We cannot recommend that the McGrath videolaryngoscope be used as a direct laryngscopic device in place of the Macintosh.
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Affiliation(s)
- C D Wallace
- Department of Anaesthetics, Ninewells Hospital, Dundee, UK
| | - L T Foulds
- Department of Anaesthetics, Ninewells Hospital, Dundee, UK
| | - G A McLeod
- Institute of Academic Anaesthesia, University of Dundee, Dundee, UK
| | - R A Younger
- Department of Anaesthetics, Perth Royal Infirmary, Perth, UK
| | - B E McGuire
- Department of Anaesthetics, Ninewells Hospital, Dundee, UK
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66
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Abstract
A prepared airway practitioner performs safe airway management, displaying skill, knowledge, and a full awareness of human factors, within a culture of safety. The education of prepared practitioners should include deliberate practice and distributed learning and should aim for expertise rather than mere competence. Translational outcomes from improved education and training can significantly decrease patient morbidity and mortality.
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Affiliation(s)
- Paul Baker
- Department of Anaesthesiology, University of Auckland, Level 12, Room 081, Auckland Support Building 599, Park Road, Grafton, Private Bag 92019, Auckland 1142, New Zealand.
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68
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69
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Zoric L, Savoldelli GL. Evidence base in airway management training. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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70
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Gill RL, Jeffrey ASY, McNarry AF, Liew GHC. The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys. Anesthesiol Res Pract 2015; 2015:152014. [PMID: 25628653 PMCID: PMC4299561 DOI: 10.1155/2015/152014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/07/2014] [Accepted: 12/07/2014] [Indexed: 11/17/2022] Open
Abstract
Fibreoptic intubation, high frequency jet ventilation, and videolaryngoscopy form part of the Royal College of Anaesthetists compulsory higher airway training module. Curriculum delivery requires equipment availability and competent trainers. We sought to establish (1) availability of advanced airway equipment in UK hospitals (Survey I) and (2) if those interested in airway management (Difficult Airway Society (DAS) members) had access to videolaryngoscopes, their basic skill levels and teaching competence with these devices and if they believed that videolaryngoscopy was replacing conventional or fibreoptic laryngoscopy (Survey II). Data was obtained from 212 hospitals (73.1%) and 554 DAS members (27.6%). Most hospitals (202, 99%) owned a fiberscope, 119 (57.5%) had a videolaryngoscope, yet only 62 (29.5%) had high frequency jet ventilators. DAS members had variable access to videolaryngoscopes with Airtraq 319 (59.6%) and Glidescope 176 (32.9%) being the most common. More DAS members were happy to teach or use videolaryngoscopes in a difficult airway than those who had used them more than ten times. The majority rated Macintosh laryngoscopy as the most important airway skill. Members rated fibreoptic intubation and videolaryngoscopy skills equally. Our surveys demonstrate widespread availability of fibreoptic scopes, limited availability of videolaryngoscopes, and limited numbers of experienced videolaryngoscope tutors.
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Affiliation(s)
- Rachel L. Gill
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Audrey S. Y. Jeffrey
- Department of Anaesthesia, St. John's Hospital, NHS Lothian, Livingston EH54 6PP, UK
| | - Alistair F. McNarry
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Geoffrey H. C. Liew
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- Department of Anaesthesia, Singapore General Hospital, Singapore 169608
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71
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Chandra P, Frerk C. Complications of airway management and how to avoid them. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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72
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Kristensen MS, Teoh WH, Asai T. Which supraglottic airway will serve my patient best? Anaesthesia 2014; 69:1189-92. [DOI: 10.1111/anae.12856] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- M. S. Kristensen
- Department of Anaesthesia; Rigshospitalet; University Hospital of Copenhagen; Copenhagen Denmark
| | - W. H. Teoh
- Department of Women's Anaesthesia; KK Women's and Children's Hospital; Singapore
| | - T. Asai
- Department of Anaesthesiology; Dokkyo Medical University Koshigaya Hospital; Koshigaya Saitama Japan
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73
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Karalapillai D, Darvall J, Mandeville J, Ellard L, Graham J, Weinberg L. A review of video laryngoscopes relevant to the intensive care unit. Indian J Crit Care Med 2014; 18:442-52. [PMID: 25097357 PMCID: PMC4118510 DOI: 10.4103/0972-5229.136073] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The incidence of difficult direct intubation in the intensive care unit (ICU) is estimated to be as high as 20%. Recent advances in video-technology have led to the development of video laryngoscopes as new intubation devices to assist in difficult airway management. Clinical studies indicate superiority of video laryngoscopes relative to conventional direct laryngoscopy in selected patients. They are therefore an important addition to the armamentarium of any clinician performing endotracheal intubation. We present a practical review of commonly available video laryngoscopes with respect to design, clinical efficacy, and safety aspects relevant to their use in the ICU.
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Affiliation(s)
| | - Jai Darvall
- Department of Intensive Care, Royal Melbourne Hopsital, Australia
| | | | - Louise Ellard
- Department of Anaesthesia, Austin Hospital, Australia
| | - Jon Graham
- Department of Anaesthesia, Austin Hospital, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, Australia ; Department of Surgery, University of Melbourne, Australia
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74
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Greenland KB, Irwin MG. Airway management--'spinning silk from cocoons' ( - Chinese idiom). Anaesthesia 2014; 69:296-300. [PMID: 24641634 DOI: 10.1111/anae.12621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- K B Greenland
- Burns, Trauma and Critical Care Research Centre, School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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75
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Robinson PN, Shaikh A, Sabir NM, Vaughan DJA, Kynoch M, Hasan M. A pilot study to examine the effect of the Tulip oropharyngeal airway on ventilation immediately after mask ventilation following the induction of anaesthesia. Anaesthesia 2014; 69:707-11. [PMID: 24773326 DOI: 10.1111/anae.12662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 12/12/2022]
Abstract
The Tulip airway is an adult, disposable, single-sized oropharyngeal airway, that is connectable to an anaesthetic circuit. After a standardised induction of anaesthesia in 75 patients, the ease of insertion, intracuff pressure and intracuff volume were measured, as were the end-tidal carbon dioxide levels, airway pressures and tidal volumes over three breaths. Successful first-time insertion was achieved in 72 patients (96%, CI 88.8-99.2%) and after two attempts in 74 patients (99%, CI 92.8-100%). There was outright failure only in one patient. In 60 patients (80%, CI 72.2-90.4%), the Tulip airway provided a patent airway without additional manoeuvres, but in 14 patients, jaw thrust or head extension was necessary for airway patency. The main need for these adjuncts appeared to be an initial under-inflation of the cuff. These promising results are consistent with recent manikin studies using this device.
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Affiliation(s)
- P N Robinson
- Department of Anaesthesia, Northwick Park Hospital, Middlesex, UK
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76
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Abstract
Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted.
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Affiliation(s)
- Ramesh Ramaiah
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Debasmita Das
- Department of Microbiology, Kasturba Medical College, Mangalore, India
| | - Sanjay M Bhananker
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Aaron M Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington, Harborview Medical Center, Seattle, Washington, USA
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Abdulla S, Abdulla S, Schwemm KP, Eckhardt R, Abdulla W. Making endotracheal intubation easy and successful, particularly in unexpected difficult airway. Int J Crit Illn Inj Sci 2014; 4:24-8. [PMID: 24741494 PMCID: PMC3982366 DOI: 10.4103/2229-5151.128009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Difficult intubation, most often due to poor view of the vocal cords on laryngoscopy is an intermittent and often challenging problem for clinically practicing anesthesiologists, maxillofacial surgeons, ear nose, and throat (ENT), emergency, and critical care physicians. Purpose: We present a new approach for facilitating difficult intubation and evaluate its efficacy in a retrospective observational study. Settings and Design: Operating room, emergency department, intensive care unit (ICU), retrospective observational study. Materials and Methods: A semirigid 5.6 Rüsch tracheal tube introducer (bougie) with its soft tip protruding at least 6 cm (=4 digits) beyond the distal end of the tube was used. After its insertion through the larynx under laryngoscopy, the tube was gently advanced upon rotation at 360° clockwise. Statistical Analysis: Descriptive. Results: Anesthesia services were analyzed on 10,363 patients over 12 months. In 2453 patients (23.7%) (Group A) intubated in the usual way, difficulties were encountered in 63 patients (2.6%). They were managed either with tube rotation technique (n = 60) or Bonfils endoscope (n = 3). In contrast, 2807 patients (27.1%) (Group B) were intubated using tube rotation technique with introducer. Difficult intubations occurred only in three patients (0.11%) who could be managed with tube rotation by experienced consultant anesthesiologists. Conclusions: The tube rotation technique for intubation was introduced during the Gulf War and has been practiced for the past 19 years without any obvious damage to the trachea in Germany. However, it should be used only by physicians being well familiar with this technique. In addition, well designed controlled studies are needed.
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Affiliation(s)
- Susanne Abdulla
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Sina Abdulla
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany
| | - Karl-Peter Schwemm
- Department of Anesthesiology, Marienkrankenhaus Papenburg, A Teaching Hospital of the University Medical School, Hannover, Germany
| | - Regina Eckhardt
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany
| | - Walied Abdulla
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Department of Anesthesiology, Marienkrankenhaus Papenburg, A Teaching Hospital of the University Medical School, Hannover, Germany ; Johannes Gutenberg University Mainz, Mainz, Germany
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78
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Affiliation(s)
- M R Rai
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
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79
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[Rare problem with the insertion of a Supreme™ laryngeal mask airway device. Case of the trimester]. ACTA ACUST UNITED AC 2013; 61:e20-2. [PMID: 24156888 DOI: 10.1016/j.redar.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
A breast tumor was resected under general anesthesia. After induction, the airway was managed with a Supreme™ laryngeal mask airway device. The insertion of the laryngeal mask airway device, the insertion of the orogastric tube through the drain tube, as well as the mechanical ventilation, were very difficult from the beginning. On removing the laryngeal mask airway device to solve the problem, it was observed that the drain tube was broken, and the orogastric tube had passed into the anterior, laryngeal part of the device through the split. It was later found out that the laryngeal mask airway device, as well as the whole manufacturing batch, had suffered a design modification: the cuff was constructed with a softer material without reinforcement in the tip, and the drain tube had a heat-sealing defect that facilitated the break. The incident was reported to the local supplier and the manufacturer, and the defective batch of laryngeal mask airway devices was recalled. The incident was also reported to other hospitals via SENSAR, to warn other users of the potential dangers of the design modification in the Supreme™ laryngeal mask airway.
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80
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Oakes ND, Dawar A, Murphy PC. Difficulties using the C-MAC paediatric videolaryngoscope. Anaesthesia 2013; 68:653-4. [PMID: 23662770 DOI: 10.1111/anae.12298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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81
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82
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Kinsella SM. Luers, ethics, research and service evaluation: more than just the sharp end. Anaesthesia 2013; 68:555-7. [DOI: 10.1111/anae.12264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. M. Kinsella
- St Michael's Hospital; University Hospitals Bristol NHS Foundation Trust; Bristol; UK
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83
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Jagannathan N, Sohn LE, Sawardekar A, Gordon J, Shah RD, Mukherji II, Roth AG, Suresh S. A randomized trial comparing the Ambu ® Aura-i ™ with the air-Q ™ intubating laryngeal airway as conduits for tracheal intubation in children. Paediatr Anaesth 2012; 22:1197-204. [PMID: 22971118 DOI: 10.1111/pan.12024] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the clinical performance of the Ambu Aura-i (Aura-i) in children. AIM To compare the Aura-i with the air-Q intubating laryngeal airway (air-Q) for the purposes of fiberoptic-guided tracheal intubation. BACKGROUND The Aura-i is a new supraglottic airway designed for tracheal intubation. MATERIALS/METHODS One hundred twenty children, ages 1 month to 6 years, were randomized to receive either the Aura-i or air-Q, and divided into three equal subgroups (Group 1, 2, 3) based on weight. The time for successful tracheal intubation was primarily assessed. The ease, time, and number of attempts for successful device insertion, leak pressures, fiberoptic grade of laryngeal view, number of attempts time for removal of the device after tracheal intubation, and complications were secondarily assessed. RESULTS Device placement, tracheal intubation, and removal after tracheal intubation were successful in all patients. There were no differences in the time to successful tracheal intubation through the Aura-i (32.9 ± 13.3 s), and the air-Q (33.9 ± 13 s; P = 0.68), or fiberoptic grade of view between devices. There was not a statistically significant correlation between the time to intubation and the fiberoptic grade of laryngeal view in any of the groups. There were no statistically significant differences in the overall leak pressures, air-Q (18.3 ± 6.1 cm H(2) O) vs Aura-i (16 ± 5.1 cm H(2) O; P = 0.05). In Group 1 (5-10 kg), leak pressures were higher with the air-Q (23.4 ± 7.2 cm H(2) O) than the Aura-i (16.1 ± 5.2 cm H(2) O; P = 0.001). There were no statistically significant differences in the time for removal between the two devices (P = 0.11). However, with the size 1.5 Aura-i, the pilot balloon of the tracheal tube was removed in order to facilitate the removal of the device after tracheal intubation. CONCLUSIONS Both devices served as effective conduits for fiberoptic-guided tracheal intubation. The limitation of the narrower proximal airway tube of the size 1.5 Aura-i should be considered if cuffed tracheal tubes are to be utilized.
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Affiliation(s)
- Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA.
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84
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Cook TM, Pandit JP, Wilkes AR. Introduction and evaluation of new airway devices: Current issues. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Fong AWY, Lam KC, Cheng BCP, Lam KK, Chan MTV. A randomised comparison of InnoScope and Macintosh laryngoscope in simulated difficult tracheal intubation in manikins. Anaesthesia 2012; 68:167-74. [PMID: 23153175 DOI: 10.1111/anae.12086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 11/29/2022]
Abstract
We conducted a crossover randomised study to evaluate the performance of a novel optical stylet, the InnoScope, for tracheal intubation in simulated normal and difficult airways. Twenty-five anaesthetists attempted tracheal intubation on a SimMan 3G simulator using the InnoScope first followed by the Macintosh laryngoscope or vice versa. Three airway scenarios were tested: (1) normal airway; (2) difficult airway with swollen pharynx; and (3) limited neck movement. In each scenario, the laryngeal view, duration of and success rate for tracheal intubation were recorded. Compared with the Macintosh laryngoscope, the use of InnoScope increased the percentage of glottic opening seen by 17% in normal airway, 23% in the difficult airway and 32% with limited neck movement, p < 0.01. Despite this better laryngeal view, successful tracheal intubation achieved with the InnoScope (88.0%) was lower than that for the Macintosh laryngoscope (98.7%), p = 0.008. Using the InnoScope, tracheal intubation during the first attempt was only successful in 48% of cases with difficult airway. In this scenario, the median (interquartile range [range]) duration of tracheal intubation was significantly longer with [corrected] InnoScope compared with the Macintosh laryngoscope, (70 (19-120 [15-120)] s vs 30 [21-58 (15-120)] s, [corrected] p = 0.01. We conclude that an improved laryngeal view with the use of the InnoScope did not translate into better conditions for tracheal intubation.
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Affiliation(s)
- A W Y Fong
- Department of Anaesthesia and Intensive Care, Tuen Mun Hospital, Hong Kong Special Administrative Region, Hong Kong
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86
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87
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van Zundert TCRV, Brimacombe JR, Ferson DZ, Bacon DR, Wilkinson DJ. Archie Brain: celebrating 30 years of development in laryngeal mask airways. Anaesthesia 2012; 67:1375-85. [DOI: 10.1111/anae.12003.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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88
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Bell SF, Morris NG, Rao A, Wilkes AR, Goodwin N. A randomised crossover trial comparing a single-use polyvinyl chloride laryngeal mask airway with a single-use silicone laryngeal mask airway. Anaesthesia 2012; 67:1337-42. [DOI: 10.1111/anae.12004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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89
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McGrath BA, Bates L, Atkinson D, Moore JA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia 2012; 67:1025-41. [DOI: 10.1111/j.1365-2044.2012.07217.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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90
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Alexiev V, Salim A, Kevin LG, Laffey JG. An observational study of the Baska® mask: a novel supraglottic airway. Anaesthesia 2012; 67:640-5. [PMID: 22563956 DOI: 10.1111/j.1365-2044.2012.07140.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Baska mask is a novel supraglottic airway device. We conducted an initial observational study to assess this device in 30 low-risk female patients. All Baska masks were inserted by a single investigator. The overall success rate for device insertion was 96.7% (95% CI 82.8-99.9%), while the success rate for the first insertion attempt was 76.7% (95% CI 57.7-90.1%). The device was easy to insert, with a mean (SD) difficulty score of 0.9 (1.6) on a 10-cm scale. The mean (SD) airway leak pressure was 35.7 (13.3) cmH(2) O. The incidence of throat pain, dysphonia and dysphagia was low. We conclude that the Baska mask demonstrates a level of utility as an alternative supraglottic airway that is worthy of further clinical study.
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Affiliation(s)
- V Alexiev
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Ireland
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91
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Pandit JJ. If it hasn’t failed, does it work? On ‘the worst we can expect’ from observational trial results, with reference to airway management devices. Anaesthesia 2012; 67:578-83. [DOI: 10.1111/j.1365-2044.2012.07155.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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92
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93
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Abstract
The Department of Health aims to eliminate the use of devices with a Luer connector firstly from 'single shot' neuraxial procedures (April 2012) and subsequently from all neuraxial and regional anaesthesia procedures (April 2013). This initiative is important for all anaesthetists, oncologists, paediatricians and neurologists. Once achieved, non-Luer connectors for neuraxial procedures will create one more barrier to wrong-route errors. The period until full implementation and market stability remains problematic. Avoidance of unintended consequences requires professional and individual attention to detail. Considerable progress has been made by manufacturers in the last year in improving the quality and range of equipment available, but despite this not all the necessary equipment is available and there remains a lack of independent evaluation, which is urgently needed to enable clinicians to judge the absolute and relative performance of different connectors. Initial evaluation of devices with new connectors can (and should) take place in a laboratory with rigs and manikins, with patient-based evaluation following after the results of the technical and usability evaluations are available. A structured evaluation of all five current connectors is urgently needed. Non-Luer connectors, however successful, will not create barriers to several type of wrong-route error and solutions to these should also be actively sought. It is clear that the initiative has been more complex than the Health Select Committee, the National Patient Safety Agency and the External Reference Group anticipated, but while there is still much work to be done, we should acknowledge that much progress has been made.
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Affiliation(s)
- T M Cook
- Royal United Hospital, Bath, UK.
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94
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Pandit JJ, Popat MT, Cook TM, Wilkes AR, Groom P, Cooke H, Kapila A, O’Sullivan E. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07113_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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95
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Shaikh A, Robinson PN. An ADEPT apology. Anaesthesia 2012; 67:432-3; author reply 433-4. [DOI: 10.1111/j.1365-2044.2012.07113_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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96
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White MC, Marsh CJ, Beringer RM, Nolan JA, Choi AYS, Medlock KE, Mason DG. A randomised, controlled trial comparing the Airtraq™ optical laryngoscope with conventional laryngoscopy in infants and children. Anaesthesia 2012; 67:226-31. [PMID: 22321076 DOI: 10.1111/j.1365-2044.2011.06978.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Airtraq(™) optical laryngoscope became available in paediatric sizes in the UK in May 2008. We conducted a randomised, controlled trial comparing the Airtraq with conventional laryngoscopy during routine anaesthesia in children. We hypothesised that the Airtraq laryngoscope would perform as well as conventional laryngoscopy. Sixty patients (20 infants and 40 children) were recruited. The mean (SD) intubation time using the Airtraq was longer than conventional laryngoscopy overall (47.3 (32.6) vs 26.3 (11.5) s; p=0.002), though the difference was only significant for children (p=0.003) and not for infants (p=0.29). The Airtraq provided a better view of the larynx compared with conventional laryngoscopy (in infants (percentage of glottic opening scores 100 (95-100 [90-100]) vs 77 (50-90 [40-100]), respectively; p=0.001; visual analogue scores for field of view 9.2 (9.2-9.5 [8.2-10.0]) vs 6.8 (5.1-8.0 [4.7-10.0]), respectively; p=0.001). In children, the Airtraq provided a similar view of the larynx (percentage of glottic opening scores 100 (100-100 [40-100]) vs 100 (90-100 [50-100]), respectively; visual analogue scores for field of view 9.2 (8.6-10.0 [7.0-10.0]) vs 9.2 (8.6-10.0 [5.6-10.0]), respectively; both p>0.05), compared with conventional laryngoscopy.
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Affiliation(s)
- M C White
- Department of Anaesthetics, Bristol Royal Hospital for Children, Bristol, UK.
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97
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Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anaesthesia 2011; 66 Suppl 2:57-64. [PMID: 22074080 DOI: 10.1111/j.1365-2044.2011.06935.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A myriad of new intubation equipment has been introduced commercially since the appearance of Macintosh/Miller blades in the 1940s. We review the role of devices that are relevant to current clinical practice based on their presence in the scientific literature. The comparative performance of new vs traditional direct laryngoscopes, their complications, their use in awake intubation techniques and the prediction of unsuccessful intubation with new devices are reviewed. Manikin studies are of limited value in this area. We conclude that in both predicted and unpredicted difficult or failed intubation, carefully selected new intubation equipment has a high success rate for tracheal intubation. Ideally, such devices should be available in all settings where tracheal intubation is performed. Most importantly, experience and competence with any of the new devices are critical for their successful use in any clinical setting.
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Affiliation(s)
- E C Behringer
- Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California, USA.
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98
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Hodzovic I, Wilkes A. A reply. Anaesthesia 2011. [DOI: 10.1111/j.1365-2044.2011.06975_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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99
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Freundlich RE, Kheterpal S. Perioperative effectiveness research using large databases. Best Pract Res Clin Anaesthesiol 2011; 25:489-98. [DOI: 10.1016/j.bpa.2011.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/22/2011] [Indexed: 12/18/2022]
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100
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Pandit JJ, Cook TM. Guest editors’ commentary: ‘State of the art’ in airway management in 2011. Anaesthesia 2011; 66 Suppl 2:1-2. [DOI: 10.1111/j.1365-2044.2011.06927.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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