1
|
Wu YH, Huang KY, Tseng ACC. Development of an Artificial Intelligence-Based Image Recognition System for Time-Sequence Analysis of Tracheal Intubation. Anesth Analg 2024; 139:357-365. [PMID: 38381700 DOI: 10.1213/ane.0000000000006934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Total intubation time (TIT) is an objective indicator of tracheal intubation (TI) difficulties. However, large variations in TIT because of diverse initial and end targets make it difficult to compare studies. A video laryngoscope (VLS) can capture images during the TI process. By using artificial intelligence (AI) to detect airway structures, the start and end points can be freely selected, thus eliminating the inconsistencies. Further deconstructing the process and establishing time-sequence analysis may aid in gaining further understanding of the TI process. METHODS We developed a time-sequencing system for analyzing TI performed using a #3 Macintosh VLS. This system was established and validated on 30 easy TIs performed by specialists and validated using TI videos performed by a postgraduate-year (PGY) physician. Thirty easy intubation videos were selected from a cohort approved by our institutional review board (B-ER-107-088), and 6 targets were labeled: the lip, epiglottis, laryngopharynx, glottic opening, tube tip, and a black line on the endotracheal tube. We used 887 captured images to develop an AI model trained using You Only Look Once, Version 3 (YOLOv3). Seven cut points were selected for phase division. Seven experts selected the cut points. The expert cut points were used to validate the AI-identified cut points and time-sequence data. After the removal of the tube tip and laryngopharynx images, the durations between 5 identical cut points and sequentially identified the durations of 4 intubation phases, as well as TIT. RESULTS The average and total losses approached 0 within 150 cycles of model training for target identification. The identification rate for all cut points was 92.4% (194 of 210), which increased to 99.4% (179 of 180) after the removal of the tube tip target. The 4 phase durations and TIT calculated by the AI model and those from the expert exhibited strong Pearson correlation (phase I, r = 0.914; phase II, r = 0.868; phase III, r = 0.964; and phase IV, r = 0.949; TIT, r = 0.99; all P < .001). Similar findings were obtained for the PGY's observations (r > 0.95; P < .01). CONCLUSIONS YOLOv3 is a powerful tool for analyzing images recorded by VLS. By using AI to detect the airway structures, the start and end points can be freely selected, resolving the heterogeneity resulting from the inconsistencies in the TIT cut points across studies. Time-sequence analysis involving the deconstruction of VLS-recorded TI images into several phases should be conducted in further TI research.
Collapse
Affiliation(s)
- Yu-Hwa Wu
- From the Department of Anesthesia, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kun-Yi Huang
- Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Alex Chia-Chih Tseng
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
2
|
He Y, Zhang Z, Li R, Hu D, Gao H, Liu Y, Liu H, Feng S, Liu H, Zhong M, Li Y, Wang Y, Ma W. National survey on the current status of airway management in China. Sci Rep 2024; 14:15627. [PMID: 38972909 PMCID: PMC11228041 DOI: 10.1038/s41598-024-66526-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
Apparently, understanding airway management status may help to reduce risk and improve clinical practice. Given these facts, our team conducted a second survey on the current status of airway management for mainland China following our 2016 national airway survey. The national survey was conducted from November 7 to November 28, 2022. An electronic survey was sent to the New Youth Anesthesia Forum, where Chinese anesthesiologists completed the questionnaire via WeChat. A total of 3783 respondents completed the survey, with a response rate of 72.14%. So far, in 2022, 34.84% of anesthesiologists canceled or delayed surgery at least once due to difficult airway. For the anticipated difficult airway management, 66.11% of physicians would choose awake intubation under sedation and topical anesthesia, while the percentage seeking help has decreased compared to the 2016 survey. When encountering an emergency, 74.20% of respondents prefer to use the needle cricothyrotomy, albeit less than a quarter have actually performed it. Anesthesiologists with difficult airway training experience reached 72.96%, with a significant difference in participation between participants in Tier 3 hospitals and those in other levels of hospitals (P < 0.001). The videolaryngoscope, laryngeal mask, and flexible intubation scope were equipped at 97.18%, 95.96%, and 62.89%, respectively. Additionally, the percentage of brain damage or death caused by difficult airways was significantly decreased. The study may be the best reference for understanding the current status of airway management in China, revealing the current advancements and deficiencies. The future focus of airway management remains on training and education.
Collapse
Affiliation(s)
- Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Zhengze Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Ruogen Li
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Die Hu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Huan Gao
- Department of Anesthesiology, Fangcheng County People's Hospital, Henan, People's Republic of China
| | - Yurui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Siqi Feng
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Huihui Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Ming Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, Guangzhou, 510405, Guangdong, People's Republic of China.
| |
Collapse
|
3
|
Lohse R, Wagner N, Kristensen MS. Palpation Versus Ultrasonography for Identifying the Cricothyroid Membrane in Case of a Laterally Deviated Larynx: A Randomized Trial. Anesth Analg 2024; 139:195-200. [PMID: 38295131 DOI: 10.1213/ane.0000000000006867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Large neck circumference and displacement of the trachea due to pathology increase the risk of failed identification of the cricothyroid membrane and cricothyroidotomy. We investigated whether ultrasound aids in the successful identification of the cricothyroid membrane in a model of an obese neck with midline deviation of the trachea. METHODS We developed silicone neck models that were suitable for both palpation and ultrasonography and where the trachea deviated laterally from the midline to either side. After reading a book chapter and participating in a 25-minute lecture and a 15- to 23-minute hands-on demonstration and rehearsal of ultrasonography for identification of the cricothyroid membrane, anesthesiologists and anesthesiology residents randomly performed identification with either ultrasound or palpation on 1 of 2 neck models. RESULTS We included 57 participants, of whom 29 and 28 were randomized to palpation and ultrasound, respectively. Correct identification of the cricothyroid membrane was achieved by 21 (75.0%) vs 1 (3.5%) of participants in the ultrasound versus palpation groups (risk ratio [RR], 21.8 [95% confidence interval {CI}, 3.1-151.0]). The tracheal midline position in the sagittal plane was identified correctly by 24 (85.7%) vs 16 (55.2%) of participants in the ultrasound versus palpation groups (RR, 1.6 [95% CI, 1.1-2.2]). CONCLUSIONS Identification of the cricothyroid membrane in a model of an obese neck with midline deviation of the trachea was more often successful with ultrasound compared to palpation. Our study supports the potential use of ultrasound before induction of anesthesia and airway management in this group of patients, and it may even be applied in emergency situations when ultrasound is readily available. Further studies in human subjects should be conducted.
Collapse
Affiliation(s)
- Robin Lohse
- From the Department of Anaesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | |
Collapse
|
4
|
Athanassoglou V, Rogers A, Hofmeyr R. In-hospital management of the airway in trauma. BJA Educ 2024; 24:238-244. [PMID: 38899315 PMCID: PMC11184475 DOI: 10.1016/j.bjae.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
| | - A. Rogers
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R. Hofmeyr
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
5
|
Crístian de Carvalho C, Iliff HA, Santos Neto JM, Potter T, Alves MB, Blake L, El-Boghdadly K. Effectiveness of preoxygenation strategies: a systematic review and network meta-analysis. Br J Anaesth 2024; 133:152-163. [PMID: 38599916 DOI: 10.1016/j.bja.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Preoxygenation is universally recommended before induction of general anaesthesia to prolong safe apnoea time. The optimal technique for preoxygenation is unclear. We conducted a systematic review to determine the preoxygenation technique associated with the greatest effectiveness in adult patients having general anaesthesia. METHODS We searched six databases for randomised controlled trials of patients aged ≥16 yr, receiving general anaesthesia in any setting and comparing different preoxygenation techniques and methods. Our primary effectiveness outcome was safe apnoea time, and secondary outcomes included incidence of arterial oxygen desaturation; lowest SpO2 during airway management; time to end-tidal oxygen concentration of 90%; and [Formula: see text] and [Formula: see text] at the end of preoxygenation. We assessed the quality of evidence according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) recommendations. RESULTS We included 52 studies of 3914 patients. High-flow nasal oxygen with patients in a head-up position was most likely to be associated with a prolonged safe apnoea time when compared with other strategies, with a mean difference (95% credible interval) of 291 (138-456) s and 203 (79-343) s compared with preoxygenation with a facemask in the supine and head-up positions, respectively. Subgroup analysis of studies without apnoeic oxygenation also showed high-flow nasal oxygen in the head-up position as the highest ranked technique, with a statistically significantly delayed mean difference (95% credible interval) safe apnoea time compared with facemask in supine and head-up positions of 222 (63-378) s and 139 (15-262) s, respectively. High-flow nasal oxygen was also the highest ranked technique for increased [Formula: see text] at the end of preoxygenation. However, the incidence of arterial desaturation was less likely to occur when a facemask with pressure support was used compared with other techniques, and [Formula: see text] was most likely to be lowest when preoxygenation took place with patients deep breathing in a supine position. CONCLUSIONS Preoxygenation of adults before induction of general anaesthesia was most effective in terms of safe apnoea time when performed with high-flow nasal oxygen with patients in the head-up position in comparison with facemask alone. Also, high-flow nasal oxygen in the head-up position is likely to be the most effective technique to prolong safe apnoea time among those evaluated. Clinicians should consider this technique and patient position in routine practice. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42022326046.
Collapse
Affiliation(s)
| | - Helen A Iliff
- Department of Anaesthesia, The Grange University Hospital, Cwmbran, UK
| | | | - Thomas Potter
- Department of Anaesthesia and Perioperative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Max B Alves
- Hospital Universitário Onofre Lopes, Natal, Brazil
| | - Lindsay Blake
- University of Arkansas for Medical Sciences Library, Little Rock, AR, USA
| | - Kariem El-Boghdadly
- Department of Anaesthesia and Perioperative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK. https://twitter.com/@elboghdadly
| |
Collapse
|
6
|
He Y, Liu Y, Zhang Z, Liu H, Hu D, Feng S, Li R, Wang Y, Ma W. Impact of airway devices and emergency airway techniques characteristics on airway adverse events in mainland China: a cross-sectional study. Minerva Anestesiol 2024; 90:607-617. [PMID: 39021136 DOI: 10.23736/s0375-9393.24.18035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
BACKGROUND Novel airway devices are becoming widely available, yet it is unclear whether the techniques or preferences of airway practitioners for airway management have been impacted. Given these facts, a cross-sectional study of the current status of airway management in mainland China was conducted and compared with previous survey findings. METHODS The national survey was conducted from November 7th to November 28th, 2022. An electronic survey was sent to the New Youth Anesthesia Forum to examine the availability of airway devices, preference for front-of-neck access (FONA) techniques, the incidence of adverse airway events, and the status of airway management training. RESULTS Questionnaires were completed by 3783 respondents, with a response rate of 72.14%. So far, the availability of optical airway devices has improved dramatically, with the availability of videolaryngoscopes reaching 97.18%. When encountering "cannot intubate, cannot ventilate" (CICV) scenarios, the majority of respondents would prefer needle cricothyrotomy to establish FONA. However, less than a quarter of respondents had actually performed it. Moreover, the incidence of airway adverse events from 2016 to 2022 was 11.48%, of which 5.13% were brain damage or death. Multivariate logistic regression analysis revealed that the ability to perform FONA techniques (odds ratio [OR] 0.23, 95% CI: 0.16, 0.32; P<0.001) and the availability of difficult airway management carts or kits (OR 0.59, 95% CI 0.41, 0.85; P=0.005) were associated with a lower incidence of airway adverse events. CONCLUSIONS Optical airway devices can overcome some of the challenges posed by difficult airways, yet the CICV scenario remains a major obstacle. The future focus of airway management should be training, particularly for complicated emergency airway techniques.
Collapse
Affiliation(s)
- Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yurui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhengze Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Die Hu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Siqi Feng
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruogen Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China -
| |
Collapse
|
7
|
Yi Y, Kim DH, Choi EJ, Hong SB, Oh DK. The effect of a dedicated intensivist staffing to a medical emergency team on airway management in general wards. Medicine (Baltimore) 2024; 103:e38571. [PMID: 38905417 PMCID: PMC11191976 DOI: 10.1097/md.0000000000038571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/23/2024] [Indexed: 06/23/2024] Open
Abstract
Although medical emergency teams (METs) have been widely introduced, studies on the importance of a dedicated intensivist staffing to METs are lacking. A single-center retrospective before-and-after study was performed. Deteriorating patients who required emergency airway management in general wards by MET were included in this study. We divided the study period according to the presence of a dedicated intensivist staff in MET: (1) non-staffed period (from January 2016 to February 2018, n = 971) and (2) staffed period (from March 2018 to December 2019, n = 651), and compared emergency airway management-related variables and outcomes between the periods. Among 1622 patients included, mean age was 63.0 years and male patients were 64.2% (n = 1042). The first-pass success rate was significantly increased in the staffed period (85.9% in the non-staffed vs 89.2% in the staffed; P = .047). Compliance to rapid sequence intubation was increased (9.4% vs 34.4%; P < .001) and vocal cords were more clearly open (P < .001) in the staffed period. The SpO2/FiO2 ratio (median [interquartile range], 125 [113-218] vs 136 [116-234]; P = .007) and the ROX index (4.6 [3.4-7.6] vs 5.1 [3.6-8.5]; P = .013) at the time of intubation was higher in the staffed period, suggesting the decision on intubation was made earlier. The post-intubation hypoxemia was less commonly occurred in the staffed period (7.2% vs 4.2%, P = .018). In multivariate analysis, the rank of operator was a strong predictor of the first-pass success (adjusted OR [95% CI], 2.280 [1.639-3.172]; P < .001 for fellow and 5.066 [1.740-14.747]; P < .001 for staff, relative to resident). In our hospital, a dedicated intensivist staffing to MET was associated with improved emergency airway management in general wards. Staffing an intensivist to MET needs to be encouraged to improve the performance of MET and the patient safety.
Collapse
Affiliation(s)
- Yehyeon Yi
- Department of Pulmonology, Seoul Medical Center, Seoul, Republic of Korea
| | - Da-Hye Kim
- Medical Emergency Team, Asan Medical Center, Seoul, Republic of Korea
| | - Eun-Joo Choi
- Medical Emergency Team, Asan Medical Center, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Medical Emergency Team, Asan Medical Center, Seoul, Republic of Korea
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Oh
- Department of Pulmonology, Dongkang General Hospital, Ulsan, Republic of Korea
| |
Collapse
|
8
|
Zhong M, Xia R, Zhou J, Zhang J, Yi X, Yang A. The comparison of preoxygenation methods before endotracheal intubation: a network meta-analysis of randomized trials. Front Med (Lausanne) 2024; 11:1379369. [PMID: 38912343 PMCID: PMC11190303 DOI: 10.3389/fmed.2024.1379369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Preoxygenation before endotracheal intubation (ETI) maintains asphyxiated oxygenation and reduces the risk of hypoxia-induced adverse events. Previous studies have compared various preoxygenation methods. However, network meta-analyses (NMAs) of the combined comparison of preoxygenation methods is still lacking. Methods We searched for studies published in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Review Manager version 5.3 was used to evaluate the risk of bias. The primary outcome of this meta-analysis was low oxygen saturation (SpO2) during ETI. The secondary outcomes included SpO2 <80%, SpO2 <90%, and apnea time during ETI. NMA was performed using R 4.1.2 software gemtc packages in RStudio. Results A total of 15 randomized controlled trials were included in this study. Regarding the lowest SpO2, the noninvasive ventilation (NIV) with high-flow nasal cannula (HFNC) group performed better than the other groups. For SpO2 <80%, the NIV group (0.8603467) performed better than the HFNC (0.1373533) and conventional oxygen therapy (COT, 0.0023) groups, according to the surface under the cumulative ranking curve results. For SpO2 <90%, the NIV group (0.60932667) performed better than the HFNC (0.37888667) and COT (0.01178667) groups. With regard to apnea time, the HFNC group was superior to the COT group (mean difference: -50.05; 95% confidence interval: -90.01, -10.09; P = 0.01). Conclusion Network analysis revealed that NIV for preoxygenation achieved higher SpO2 levels than HFNC and COT and offered a more significant advantage in maintaining patient oxygenation during ETI. Patients experienced a longer apnea time after HFNC preoxygenation. The combination of NIV with HFNC proved to be significantly superior to other methods. Given the scarcity of such studies, further research is needed to evaluate its effectiveness. Systematic review registration identifier CRD42022346013.
Collapse
Affiliation(s)
- Ming Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Rong Xia
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Junyu Zhou
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Jing Zhang
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Xia Yi
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Anbo Yang
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| |
Collapse
|
9
|
Maldonado NG, Thompson M, Srihari C, Holtzman L, Liu J, Otero R, Chowdhury MAB, Fernandez R. Institution of a difficult airway response team for emergency department patients with anticipated or encountered difficult airways: Descriptive analysis of a 5-year experience at an academic teaching hospital. J Am Coll Emerg Physicians Open 2024; 5:e13175. [PMID: 38707982 PMCID: PMC11066591 DOI: 10.1002/emp2.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives This study aimed to describe characteristics and outcomes associated with difficult airway response team (DART) encounters in the emergency department (ED). Methods We performed a descriptive analysis of a prospective, single-center database of DART encounters in the ED from April 1, 2016 to March 31, 2021 cross-referenced with retrospective chart review. Adult ED patients ≥18 years old for whom a DART was activated were eligible. We prospectively collected activation characteristics, intubation indications, operator characteristics, and intubation methods used for DART encounters. Retrospective chart review was conducted to obtain patient demographics and outcome variables. Descriptive analyses were computed for all outcomes. Results We analyzed 89 DART encounters. No intubation attempts were made prior to DART activation in 52 cases (58.4%). The most common indications for intubation were angioedema (n = 17, 19.1%) or other airway obstruction (n = 15, 16.9%). A definitive airway was established by anesthesiology (n = 46, 51.7%), emergency medicine (n = 25, 28.1%), trauma surgery (n = 9, 10.1%), and ENT (n = 5, 5.6%). The most common method of intubation used to establish a definitive airway was video laryngoscopy with a bougie or D-blade (n = 29, 32.6%) followed by flexible fiberoptic intubation (n = 19, 21.3%). A surgical airway was required in eight encounters (cricothyrotomy [n = 4, 4.5%]; tracheostomy [n = 4, 4.5%]). Cases were managed in the ED (n = 73, 82%), operating room (OR) (n = 10, 11.2%), and intensive care unit (ICU) (n = 1, 1.1%). All patients requiring intubation had an endotracheal or surgical airway established. Conclusion Our findings provide important insights regarding ED DART utilization and have implications when considering institution of a DART in the ED.
Collapse
Affiliation(s)
- Nicholas G. Maldonado
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Meredith Thompson
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Caroline Srihari
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Liam Holtzman
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Jonathan Liu
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Rolando Otero
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | | | - Rosemarie Fernandez
- Department of Emergency MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
- University of Florida College of Medicine Center for Experiential Learning and SimulationGainesvilleFloridaUSA
| |
Collapse
|
10
|
Shen C, Shi Y. The Prevalence of Difficult Airway and Associated Risk Factors in Pediatric Patients: A Cross-sessional Observational Study. J Craniofac Surg 2024; 35:1192-1196. [PMID: 38578083 DOI: 10.1097/scs.0000000000010114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Difficult airway remains a great challenge in pediatric anesthesia practice. Previously published data show the prevalence of difficult airways in pediatric population varies in a wide range. However, there is a lack of studies in the Asian region. METHODS This cross-sectional single-center study was conducted in a tertiary pediatric hospital in China from October 2022 to October 2023. The patients who underwent elective surgery under general anesthesia with tracheal intubation were recruited consecutively. Data on patient characteristics, airway assessment, and airway management information were collected. Multivariable logistic regression analysis was performed to detect the independent variables of difficult airway in pediatric patients. RESULTS A total of 18,491 pediatric patients were included in this study. The overall incidence of difficult airways was 0.22%, 39% of whom were unanticipated. Very few previous airway management information was available in the patients presented with a known difficult airway. Patients with younger age, higher American Society of Anesthesiologists (ASA) physical status classification grade, and presented for craniofacial and thoracic surgery were associated with higher incidence of difficult airway. Further multivariable logistic regression analysis revealed that age ≤28 days (OR=50.48), age between 28days and 1 year (OR=6.053), craniofacial surgery (OR=1.81), and thoracic surgery (OR=0.2465) were independent risk factors of increased incidence of difficult airway. CONCLUSIONS Our study showed the prevalence of difficult airways in pediatric surgical patients. Patient characteristics, age, and type of surgery were identified as the independent factors associated with increased occurrence of difficult airways. Unanticipated difficult airway was not unusual in our study population, even for the patients with previous surgical history.
Collapse
Affiliation(s)
- Chen Shen
- Department of Anesthesiology, Children's Hospital of Fudan University, Minhang District, Shanghai, China
| | | |
Collapse
|
11
|
Haag AK, Tredese A, Bordini M, Fuchs A, Greif R, Matava C, Riva T, Scquizzato T, Disma N. Emergency front-of-neck access in pediatric anesthesia: A narrative review. Paediatr Anaesth 2024; 34:495-506. [PMID: 38462998 DOI: 10.1111/pan.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Children undergoing airway management during general anesthesia may experience airway complications resulting in a rare but life-threatening situation known as "Can't Intubate, Can't Oxygenate". This situation requires immediate recognition, advanced airway management, and ultimately emergency front-of-neck access. The absence of standardized procedures, lack of readily available equipment, inadequate knowledge, and training often lead to failed emergency front-of-neck access, resulting in catastrophic outcomes. In this narrative review, we examined the latest evidence on emergency front-of-neck access in children. METHODS A comprehensive literature was performed the use of emergency front-of-neck access (eFONA) in infants and children. RESULTS Eighty-six papers were deemed relevant by abstract. Finally, eight studies regarding the eFONA technique and simulations in animal models were included. For all articles, their primary and secondary outcomes, their specific animal model, the experimental design, the target participants, and the equipment were reported. CONCLUSION Based on the available evidence, we propose a general approach to the eFONA technique and a guide for implementing local protocols and training. Additionally, we introduce the application of innovative tools such as 3D models, ultrasound, and artificial intelligence, which can improve the precision, safety, and training of this rare but critical procedure.
Collapse
Affiliation(s)
- Anna-Katharina Haag
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alberto Tredese
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Martina Bordini
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Clyde Matava
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tommaso Scquizzato
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Disma
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| |
Collapse
|
12
|
Eum D, Ji YJ, Kim HJ. Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial. Anaesthesia 2024; 79:603-610. [PMID: 38114306 DOI: 10.1111/anae.16202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
Hyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre-anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.
Collapse
Affiliation(s)
- D Eum
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Y J Ji
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - H J Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
13
|
Bacher V, Németh M, Rendeki S, Tornai B, Rozanovic M, Pankaczi A, Oláh J, Farkas J, Chikhi M, Schlégl Á, Maróti P, Nagy B. Comparison of Macintosh Laryngoscope, King Vision ®, VividTrac ®, AirAngel Blade ®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices-A Non-Inferiority Trial. J Clin Med 2024; 13:3213. [PMID: 38892925 PMCID: PMC11173105 DOI: 10.3390/jcm13113213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Endotracheal intubation (ETI) is a cornerstone of airway management. The gold standard device for ETI is still the direct laryngoscope (DL). However, video laryngoscopes (VLs) are now also widely available and have several proven advantages. The VL technique has been included in the major airway management guidelines. During the COVID-19 pandemic, supply chain disruption has raised demand for 3D-printed medical equipment, including 3D-printed VLs. However, studies on performance are only sparsely available; thus, we aimed to compare 3D-printed VLs to the DL and other VLs made with conventional manufacturing technology. Methods: Forty-eight medical students were recruited to serve as novice users. Following brief, standardized training, students executed ETI with the DL, the King Vision® (KV), the VividTrac® (VT), the AirAngel Blade® (AAB), and a custom-made 3D-printed VL (3DVL) on the Laerdal® airway management trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma, and user satisfaction. Results: The KV and VT are proved to be superior (p < 0.05) to the DL in both scenarios. The 3DVL's performance was similar (p > 0.05) or significantly better than that of the DL and mainly non-inferior (p > 0.05) compared to the KV and VT in both scenarios. Regardless of the scenario, the AAB proved to be inferior (p < 0.05) even to the DL in the majority of the variables. The differences between the devices were more pronounced in the difficult airway scenario. The user satisfaction scores were in concordance with the aforementioned performance of the scopes. Conclusions: Based upon our results, we cannot recommend the AAB over the DL, KV, or VT. However, as the 3DVL showed, 3D printing indeed can provide useful or even superior VLs, but prior to clinical use, meticulous evaluation might be recommended.
Collapse
Affiliation(s)
- Viktor Bacher
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Márton Németh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Szilárd Rendeki
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Balázs Tornai
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Martin Rozanovic
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Andrea Pankaczi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - János Oláh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - József Farkas
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Anatomy, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Melánia Chikhi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Ádám Schlégl
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Orthopedics, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Péter Maróti
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- 3D Printing & Visualization Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| |
Collapse
|
14
|
Renberg M, Karlsson T, Dahlquist A, Luckhurst C, Gustavsson J, Arborelius U, Risling M, Günther M. The anesthesiologist's guide to swine trauma physiology research: a report of two decades of experience from the experimental traumatology laboratory. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02542-7. [PMID: 38780782 DOI: 10.1007/s00068-024-02542-7] [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: 12/26/2023] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Swine are one of the major animal species used in translational research, with unique advantages given the similar anatomic and physiologic characteristics as man, but the investigator needs to be familiar with important differences. This article targets clinical anesthesiologists who are proficient in human monitoring. We summarize our experience during the last two decades, with the aim to facilitate for clinical and non-clinical researchers to improve in porcine research. METHODS This was a retrospective review of 337 swine with a mean (SD) weight 60 (4.2) kg at the Experimental Traumatology laboratory at Södersjukhuset (Stockholm south general hospital) between 2003 and 2023, including laboratory parameters and six CT-angiography examinations. RESULTS Swine may be ventilated through the snout using a size 2 neonatal mask. Intubate using a 35 cm miller laryngoscope and an intubating introducer. Swine are prone to alveolar atelectasis and often require alveolar recruitment. Insert PA-catheters through a cut-down technique in the internal jugular vein, and catheters in arteries and veins using combined cut-down and Seldinger techniques. Cardiopulmonary resuscitation is possible and lateral chest compressions are most effective. Swine are prone to lethal ventricular arrhythmias, which may be reversed by defibrillation. Most vital parameters are similar to man, with the exception of a higher core temperature, higher buffer bases and increased coagulation. Anesthesia methods are similar to man, but swine require five times the dose of ketamine. CONCLUSION Swine share anatomical and physiological features with man, which allows for seamless utilization of clinical monitoring equipment, medication, and physiological considerations.
Collapse
Affiliation(s)
- Mattias Renberg
- Department of Clinical Science and Education Södersjukhuset, Section of Anesthesiology and Intensive care, Stockholm, Sweden
| | - Tomas Karlsson
- Department of Clinical Science and Education Södersjukhuset, Section of Anesthesiology and Intensive care, Stockholm, Sweden
| | - Albin Dahlquist
- Department of Clinical Science and Education Södersjukhuset, Section of Anesthesiology and Intensive care, Stockholm, Sweden
| | - Claire Luckhurst
- Department of Clinical Science and Education Södersjukhuset, Section of Anesthesiology and Intensive care, Stockholm, Sweden
| | - Jenny Gustavsson
- Department of Neuroscience, Section of Experimental Traumatology, Karolinska Institutet, Biomedicum- 8B, SE-171 77, Stockholm, Sweden
| | - Ulf Arborelius
- Department of Neuroscience, Section of Experimental Traumatology, Karolinska Institutet, Biomedicum- 8B, SE-171 77, Stockholm, Sweden
| | - Mårten Risling
- Department of Neuroscience, Section of Experimental Traumatology, Karolinska Institutet, Biomedicum- 8B, SE-171 77, Stockholm, Sweden
| | - Mattias Günther
- Department of Clinical Science and Education Södersjukhuset, Section of Anesthesiology and Intensive care, Stockholm, Sweden.
- Department of Neuroscience, Section of Experimental Traumatology, Karolinska Institutet, Biomedicum- 8B, SE-171 77, Stockholm, Sweden.
| |
Collapse
|
15
|
Xu X, Ma H, Zhang Y, Liu W, Jung B, Li X, Shen L. Efficacy of bougie first approach for endotracheal intubation with video laryngoscopy during continuous chest compression: a randomized crossover manikin trial. BMC Anesthesiol 2024; 24:181. [PMID: 38773386 PMCID: PMC11106944 DOI: 10.1186/s12871-024-02560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression. METHODS This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute. RESULTS A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants. CONCLUSIONS The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings. TRIAL REGISTRATION Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.
Collapse
Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Haobo Ma
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yuelun Zhang
- Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China
| | - Boris Jung
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Intensive Care Unit, Lapeyronie Teaching Hospital, Montpellier University, Montpellier, France
- Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Xu Li
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing, 100730, China.
| |
Collapse
|
16
|
García-García F, Lee DJ, Mendoza-Garcés FJ, García-Gutiérrez S. Reliable prediction of difficult airway for tracheal intubation from patient preoperative photographs by machine learning methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 248:108118. [PMID: 38489935 DOI: 10.1016/j.cmpb.2024.108118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Estimating the risk of a difficult tracheal intubation should help clinicians in better anaesthesia planning, to maximize patient safety. Routine bedside screenings suffer from low sensitivity. OBJECTIVE To develop and evaluate machine learning (ML) and deep learning (DL) algorithms for the reliable prediction of intubation risk, using information about airway morphology. METHODS Observational, prospective cohort study enrolling n=623 patients who underwent tracheal intubation: 53/623 difficult cases (prevalence 8.51%). First, we used our previously validated deep convolutional neural network (DCNN) to extract 2D image coordinates for 27 + 13 relevant anatomical landmarks in two preoperative photos (frontal and lateral views). Here we propose a method to determine the 3D pose of the camera with respect to the patient and to obtain the 3D world coordinates of these landmarks. Then we compute a novel set of dM=59 morphological features (distances, areas, angles and ratios), engineered with our anaesthesiologists to characterize each individual's airway anatomy towards prediction. Subsequently, here we propose four ad hoc ML pipelines for difficult intubation prognosis, each with four stages: feature scaling, imputation, resampling for imbalanced learning, and binary classification (Logistic Regression, Support Vector Machines, Random Forests and eXtreme Gradient Boosting). These compound ML pipelines were fed with the dM=59 morphological features, alongside dD=7 demographic variables. Here we trained them with automatic hyperparameter tuning (Bayesian search) and probability calibration (Platt scaling). In addition, we developed an ad hoc multi-input DCNN to estimate the intubation risk directly from each pair of photographs, i.e. without any intermediate morphological description. Performance was evaluated using optimal Bayesian decision theory. It was compared against experts' judgement and against state-of-the-art methods (three clinical formulae, four ML, four DL models). RESULTS Our four ad hoc ML pipelines with engineered morphological features achieved similar discrimination capabilities: median AUCs between 0.746 and 0.766. They significantly outperformed both expert judgement and all state-of-the-art methods (highest AUC at 0.716). Conversely, our multi-input DCNN yielded low performance due to overfitting. This same behaviour occurred for the state-of-the-art DL algorithms. Overall, the best method was our XGB pipeline, with the fewest false negatives at the optimal Bayesian decision threshold. CONCLUSIONS We proposed and validated ML models to assist clinicians in anaesthesia planning, providing a reliable calibrated estimate of airway intubation risk, which outperformed expert assessments and state-of-the-art methods. Our novel set of engineered features succeeded in providing informative descriptions for prognosis.
Collapse
Affiliation(s)
| | - Dae-Jin Lee
- School of Science & Technology, IE University - Madrid (Madrid), Spain.
| | - Francisco J Mendoza-Garcés
- Galdakao-Usansolo University Hospital, Anaesthesia & Resuscitation Service - Galdakao (Basque Country), Spain.
| | - Susana García-Gutiérrez
- Galdakao-Usansolo University Hospital, Research Unit - Galdakao (Basque Country), Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) - Madrid (Madrid), Spain.
| |
Collapse
|
17
|
Son WG, Sung T, Shin D, Rhee S, Nam C, Kim M, Park C, Lee J, Kim J, Lee I. Evaluation of a novel, low-cost, 3D printed video laryngoscope with borescope in anesthetized Beagle dogs. Vet Anaesth Analg 2024; 51:266-270. [PMID: 38565449 DOI: 10.1016/j.vaa.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To develop and evaluate a low-cost three-dimensional (3D)-printed video laryngoscope (VLVET) for use with a commercial borescope. STUDY DESIGN Instrument development and pilot study. ANIMALS A total of six adult male Beagle dogs. METHODS The VLVET consisted of a laryngoscope handle and a Miller-type blade, and a detachable camera holder that attached to various locations along the blade. The laryngoscope and camera holder were 3D-printed using black polylactic acid filament. Dogs were premedicated with intravenous (IV) medetomidine (15 μg kg-1) and anesthesia induced with IV alfaxalone (1.5 mg kg-1). The VLVET, combined with a borescope, was used for laryngeal visualization and intubation. Performance was evaluated by comparing direct and video-assisted views in sternal recumbency. The borescope camera was sequentially positioned at 2, 4, 6, 8 and 10 cm from the blade tip (distanceLARYNX-CAM), which was placed on the epiglottis during intubation or laryngoscopy. At the 10 cm distanceLARYNX-CAM, laryngeal visualization was sequentially scored at inter-incisor gaps of 10, 8, 6, 4 and 2 cm. Laryngeal visualization scores (0-3 range, with 0 = obstructed and 3 = unobstructed views) were statistically analyzed using the Friedman's test. RESULTS Under direct visualization, the 2 cm distanceLARYNX-CAM had a significantly lower score compared with all other distanceLARYNX-CAM (all p = 0.014) because the view was obstructed by the camera holder and borescope camera. With both direct and camera-assisted views, visualization scores were higher at inter-incisor gaps ≥ 4 cm compared with 2 cm (all p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE During laryngoscopy and intubation, the VLVET and borescope facilitated both direct and video laryngoscopy at distanceLARYNX-CAM in Beagle dogs when inter-incisor gaps were ≥ 4 cm.
Collapse
Affiliation(s)
- Won-Gyun Son
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Taehoon Sung
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Donghwi Shin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Suehyung Rhee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Changhoon Nam
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Minha Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Chailin Park
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jungha Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Junsoo Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Inhyung Lee
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
18
|
Heard AM, Lacquiere DA, Gordon HL, Douglas SG, Avis HJ. A case series of the Royal Perth Hospital cannula-first approach in the 'can't intubate, can't oxygenate' scenario. Anaesth Intensive Care 2024; 52:159-167. [PMID: 38546511 DOI: 10.1177/0310057x231214548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. We present eight cases in which a cannula-first Royal Perth Hospital approach was successfully implemented during an airway crisis. We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers.
Collapse
Affiliation(s)
- Andrew Mb Heard
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - David A Lacquiere
- South Australian Ambulance Service MedSTAR, Adelaide, Australia
- Pulse Anaesthetics, Adelaide, Australia
| | - Helen L Gordon
- Anaesthetic Department, Dorset County Hospital, Dorchester, UK
| | - Scott G Douglas
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - Hans J Avis
- Department of Anaesthesia, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Marshall S. Best practices in cognitive aid design for clinical emergencies. Br J Anaesth 2024; 132:1007-1008. [PMID: 38262853 DOI: 10.1016/j.bja.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Affiliation(s)
- Stuart Marshall
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Peninsula Health, Melbourne, VIC, Australia.
| |
Collapse
|
20
|
Ward PA, McNarry AF. Maximising the benefit of new technologies in airway management. Indian J Anaesth 2024; 68:412-414. [PMID: 38764956 PMCID: PMC11100643 DOI: 10.4103/ija.ija_337_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- Patrick A. Ward
- Consultant Anaesthetist NHS Lothian, Department of Anaesthesia St John's Hospital, Howden, Livingston, United Kingdom
| | - Alistair F. McNarry
- Consultant Anaesthetist NHS Lothian, Department of Anaesthesia St John's Hospital, Howden, Livingston, United Kingdom
- Department of Anaesthesia, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| |
Collapse
|
21
|
Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
Collapse
Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
| |
Collapse
|
22
|
Schmutz A, Breddin I, Draxler R, Schumann S, Spaeth J. Comparison of Force Distribution during Laryngoscopy with the C-MAC D-BLADE and Macintosh-Style Blades: A Randomised Controlled Clinical Trial. J Clin Med 2024; 13:2623. [PMID: 38731150 PMCID: PMC11084539 DOI: 10.3390/jcm13092623] [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: 03/26/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Background: The geometry of a laryngoscope's blade determines the forces acting on the pharyngeal structures to a relevant degree. Knowledge about the force distribution along the blade may prospectively allow for the development of less traumatic blades. Therefore, we examined the forces along the blades experienced during laryngoscopy with the C-MAC D-BLADE and blades of the Macintosh style. We hypothesised that lower peak forces are applied to the patient's pharyngeal tissue during videolaryngoscopy with a C-MAC D-BLADE compared to videolaryngoscopy with a C-MAC Macintosh-style blade and direct laryngoscopy with a Macintosh-style blade. Beyond that, we assumed that the distribution of forces along the blade differs depending on the respective blade's geometry. Methods: After ethical approval, videolaryngoscopy with the D-BLADE or the Macintosh blade, or direct laryngoscopy with the Macintosh blade (all KARL STORZ, Tuttlingen, Germany), was performed on 164 randomly assigned patients. Forces were measured at six positions along each blade and compared with regard to mean force, peak force and spatial distribution. Furthermore, the duration of the laryngoscopy was measured. Results: Mean forces (all p < 0.011) and peak forces at each sensor position (all p < 0.019) were the lowest with the D-BLADE, whereas there were no differences between videolaryngoscopy and direct laryngoscopy with the Macintosh blades (all p > 0.128). With the D-BLADE, the forces were highest at the blade's tip. In contrast, the forces were more evenly distributed along the Macintosh blades. Videolaryngoscopy took the longest with the D-BLADE (p = 0.007). Conclusions: Laryngoscopy with the D-BLADE resulted in significantly lower forces acting on pharyngeal and laryngeal tissue compared to Macintosh-style blades. Interestingly, with the Macintosh blades, we found no advantage for videolaryngoscopy in terms of force application.
Collapse
Affiliation(s)
- Axel Schmutz
- Department of Anaesthesiology and Critical Care, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany (J.S.)
| | - Ingo Breddin
- Department of Anaesthesiology and Critical Care, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany (J.S.)
| | | | - Stefan Schumann
- Department of Anaesthesiology and Critical Care, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany (J.S.)
| | - Johannes Spaeth
- Department of Anaesthesiology and Critical Care, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany (J.S.)
| |
Collapse
|
23
|
Vetrugno L, Deana C, Colaianni-Alfonso N, Tritapepe F, Fierro C, Maggiore SM. Noninvasive respiratory support in the perioperative setting: a narrative review. Front Med (Lausanne) 2024; 11:1364475. [PMID: 38695030 PMCID: PMC11061466 DOI: 10.3389/fmed.2024.1364475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Abstract
The application of preoperative noninvasive respiratory support (NRS) has been expanding with increasing recognition of its potential role in this setting as a physiological optimization for patients with a high risk of developing atelectasis and postoperative pulmonary complications (PPC). The increased availability of high-performance anesthesia ventilator machines providing an easy way for NRS support in patients with reduced lung function should not be under-evaluated. This support can reduce hypoxia, restore lung volumes and theoretically reduce atelectasis formation after general anesthesia. Therapeutic purposes should also be considered in the perioperative setting, such as preoperative NRS to optimize treatment of patients' pre-existing diseases, e.g., sleep-disordered breathing. Finally, the recent guidelines for airway management suggest preoperative NRS application before anesthesia induction in difficult airway management to prolong the time needed to secure the airway with an orotracheal tube. This narrative review aims to revise all these aspects and to provide some practical notes to maximize the efficacy of perioperative noninvasive respiratory support.
Collapse
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotecnological Science, “G. D’Annunzio” Chieti-Pescara University, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | | | - Fabrizio Tritapepe
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Carmen Fierro
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, SS. Annunziata Hospital, G. D’Annunzio University, Chieti, Italy
| |
Collapse
|
24
|
Delle Cave JA, Larcheveque SR, Martin E, O’Toole E. Pilot cadaveric study on the feasibility of cricothyroidotomy and the associated complications in 30 cats. Front Vet Sci 2024; 11:1365780. [PMID: 38650852 PMCID: PMC11034611 DOI: 10.3389/fvets.2024.1365780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives The study's primary goal was to assess the feasibility of the cricothyroidotomy technique (CTT) in cats and evaluate its success rate (i.e., secure airway access). Secondary outcomes were the assessment of the subjective difficulty of airway access based on body score condition and weight. Further secondary outcomes consisted of procedural time and scoring of associated complications. The current study hypothesized that the CTT procedure would provide secure airway access with a reasonable success rate. Materials and methods A prospective experimental study assessing the performance of CTT and associated complications was conducted on 30 feline cadavers. A procedural datasheet was completed to subjectively grade difficulty of landmark palpation, guide placement and tube placement and expected success of the procedure. A dissection was then performed post-procedure by a blinded observer to evaluate for any associated damages. Results CTT was successful in securing an airway in 100% of the cats. The time to completion of the CTT was rapid, with a median time of 49 s (ranging from 31 to 90 s) for securing an airway. Of importance, this procedure was judged to be overall easy (median "ease of procedure score" of 7/10; ranging from 3 to 10) by the experimenters. The post-procedural lesion rate was elevated (76.7%) in this population of cats, though based on the lesion scores, was deemed mild in 73.9% of the cases. Clinical significance CTT warrants consideration as the primary option for emergency front-of-neck airway access for cats although further studies are necessary.
Collapse
|
25
|
Cook TM, Oglesby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:368-379. [PMID: 38031494 DOI: 10.1111/anae.16187] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied complications of the airway and respiratory system during anaesthesia care including peri-operative cardiac arrest. Among 24,721 surveyed cases, airway and respiratory complications occurred commonly (n = 421 and n = 264, respectively). The most common airway complications were: laryngospasm (157, 37%); airway failure (125, 30%); and aspiration (27, 6%). Emergency front of neck airway was rare (1 in 8370, 95%CI 1 in 2296-30,519). The most common respiratory complications were: severe ventilation difficulty (97, 37%); hyper/hypocapnia (63, 24%); and hypoxaemia (62, 23%). Among 881 reports to NAP7 and 358 deaths, airway and respiratory complications accounted for 113 (13%) peri-operative cardiac arrests and 32 (9%) deaths, with hypoxaemia as the most common primary cause. Airway and respiratory cases had higher and lower survival rates than other causes of cardiac arrest, respectively. Patients with obesity, young children (particularly infants) and out-of-hours care were overrepresented in reports. There were six cases of unrecognised oesophageal intubation with three resulting in cardiac arrest. Of these cases, failure to correctly interpret capnography was a recurrent theme. Cases of emergency front of neck airway (6, approximately 1 in 450,000) and pulmonary aspiration (11, approximately 1 in 25,000) leading to cardiac arrest were rare. Overall, these data, while distinct from the 4th National Audit Project, suggest that airway management is likely to have become safer in the last decade, despite the surgical population having become more challenging for anaesthetists.
Collapse
Affiliation(s)
- T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
| | - F Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Royal College of Anaesthetists, London, UK
| | - R A Armstrong
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Royal College of Anaesthetists, London, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Royal College of Anaesthetists, London, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| |
Collapse
|
26
|
Wylie NW, Durrant EL, Phillips EC, De Jong A, Schoettker P, Kawagoe I, de Pinho Martins M, Zapatero J, Graham C, McNarry AF. Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic: The report of the VL-iCUE survey with responses from 96 countries. Eur J Anaesthesiol 2024; 41:296-304. [PMID: 37962353 DOI: 10.1097/eja.0000000000001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The potential benefit of videolaryngoscopy use in facilitating tracheal intubation has already been established, however its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and after the early phases of the pandemic, whether institutions had acquired new devices during the COVID-19 pandemic, and whether there had been teaching on the devices acquired. DESIGN We designed a survey with 27 questions made available via the Joint Information Scientific Committee JISC online survey platform in English, French, Spanish, Chinese, Japanese and Portuguese. This was distributed through 18 anaesthetic and airway management societies. SETTING The survey was open for 54 to 90 days in various countries. The first responses were logged on the databases on 28 October 2021, with all databases closed on 26 January 2022. Reminders to participate were sent at the discretion of the administering organisations. PARTICIPANTS All anaesthetists and airway managers who received the study were eligible to participate. MAIN OUTCOME MEASURES Videolaryngoscopy use before the COVID-19 pandemic and at the time of the survey. RESULTS We received 4392 responses from 96 countries: 944/4336 (21.7%) were from trainees. Of the 3394 consultants, 70.8% (2402/3394) indicated no change in videolaryngoscopy use, 19.9% (675/3394) increased use and 9.3% (315/3393) reduced use. Among trainees 65.5% (618/943) reported no change in videolaryngoscopy use, 27.7% (261/943) increased use and 6.8% (64/943) reduced use. Overall, videolaryngoscope use increased by 10 absolute percentage points following the pandemic. CONCLUSIONS Videolaryngoscopy use increased following the early phase of the COVID-19 pandemic but this was less than might have been expected.
Collapse
Affiliation(s)
- Nia W Wylie
- From the South East Scotland School of Anaesthesia, NHS Lothian, Edinburgh UK (NWW, ELD, ECP), Department of Anesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France (ADJ), Department of Anesthesiology, Lausanne University Hospital, Switzerland (PS), Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Graduate School of Medicine, Japan (IK), Department of Anesthesia, Critical Care and Pain Medicine, Central Hospital of the Military Police of Rio de Janeiro, Rio de Janeiro, Brazil (MP), Hospital Clínic de Barcelona, Spain (JZ), Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, UK (CG), Western General and St Johns Hospitals, NHS Lothian, Edinburgh UK (AFMN)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Morand S, Gleizal A. Cricothyroidotomy in extreme emergency: A case report of a real-life experience in three steps and less than 30 s using a single blade. Int J Surg Case Rep 2024; 117:109526. [PMID: 38503163 PMCID: PMC10963650 DOI: 10.1016/j.ijscr.2024.109526] [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: 01/19/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cricothyroidotomy is often the last resort when conventional ventilation devices prove ineffective. The conventional procedure that involves several steps and requires the completion of a preoperative checklist. This report describes a novel approach to cricothyroidotomy, allowing quick access to the cricothyroid membrane in fewer steps. CASE PRESENTATION We present the case of a 26-year-old male with Schimmelpenning syndrome, exhibiting significant anatomical deformity. Following surgery for temporomandibular joint replacement, the patient developed a hematoma requiring urgent intervention. During nasotracheal intubation, the patient experienced a significant drop in oxygen saturation, which required prompt cricothyroidotomy. The procedure was performed in less than 30 s using a single blade for incising the tissues and the surgeon's hands for dissection and retraction. The procedure resulted in immediate recovery of the patient's oxygen saturation. CLINICAL DISCUSSION In contrast to previously reported multi-step procedures, this study reports a simpler three-step cricothyroidotomy. The technique involves a vertical skin incision, blunt dissection using the surgeon's fingers, and a horizontal incision on the cricothyroid membrane. The procedure was executed with the patient in a semi-reclined position, optimizing time efficiency. CONCLUSION This case highlights the efficacy of a rapid cricothyroidotomy technique in extreme emergencies. The presented technique requires minimal instrumentation and can be completed quickly in an emergency situation, even in the presence of anatomical variations.
Collapse
Affiliation(s)
- S Morand
- Maxillofacial Surgery Department, Lyon Croix Rousse Hospital, 103 Grande rue de la Croix Rousse, 69004 Lyon, France.
| | - A Gleizal
- Maxillofacial Surgery Department, Lyon Croix Rousse Hospital, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| |
Collapse
|
28
|
Ahmad I, El-Boghdadly K. Time for confidential enquiries into airway complications? Anaesthesia 2024; 79:349-352. [PMID: 38114266 DOI: 10.1111/anae.16210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Affiliation(s)
- I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| |
Collapse
|
29
|
Tannheimer M, Reinke M, Lechner R. Comparison of Laryngeal Mask Airway Seal Between Anesthesiologists and Individuals Without Previous Airway Experience. J Emerg Med 2024; 66:e470-e476. [PMID: 38461134 DOI: 10.1016/j.jemermed.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 03/11/2024]
Abstract
BACKGROUND Tracheal intubation is the gold standard for airway management in emergency medicine, but more difficult to apply for inexperienced individuals than laryngeal mask airway (LMA). OBJECTIVE The aim of our study was to investigate if inexperienced individuals are able to secure the airway with the help of LMA after a short introduction. A second aim was to evaluate Thiel-fixed specimens against unfixed ones. METHODS In a body donor model, LMA application was evaluated between medical students without previous airway experience and anesthesiologists by comparing the sealing of the larynx using a water column applied to the esophagus. RESULTS LMAs were successfully applied in 46 out of 55 (83.6%) attempts by medical students and in 30 out of 39 (76.9%) attempts by anesthesiologists. Among medical students, 14.1% of all LMA applications were primarily leaky, compared with 18.8% in anesthesiologists. Esophageal sealing was better in Thiel-fixed specimens (leakage 10.9%) compared with unfixed specimens (leakage 22.9%). Our data showed no significant difference between anesthesiologists and medical students in terms of sealing of LMA. Therefore, we conclude that medical students without previous airway experience can quickly learn to apply LMA sufficiently and thus, achieve aspiration protection similar to anesthesiologists. CONCLUSION Medical students without previous airway experience can successfully insert LMAs after a short introduction. Thiel-fixed specimens are suitable for studies as well as for training in LMA application.
Collapse
Affiliation(s)
- Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, Ulm, Germany; Department of General and Visceral Surgery, Krankenhaus Blaubeuren, Blaubeuren, Germany
| | - Martin Reinke
- Institute of Anatomy and Cell Biology, University of Ulm, Ulm, Germany; Department of Pediatric Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Raimund Lechner
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bundeswehr Hospital Ulm, Ulm, Germany; Medical Service, Police Baden-Württemberg, Stuttgart, Germany
| |
Collapse
|
30
|
Kokulu K, Alkan E, Sert ET, Mutlu H, Turkucu C, Akar EH. Determination of the Cricothyroid Membrane Height by Age and Sex and Optimal Tracheal Tube Size. Laryngoscope 2024; 134:1825-1830. [PMID: 37815152 DOI: 10.1002/lary.31102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The primary aim of this study was to determine the average cricothyroid membrane (CTM) height in healthy volunteers, and the secondary aim was to determine the hypothetical success rate for emergency cricothyrotomy with a tracheal tube with an 8.0 mm outer diameter. METHODS This study included healthy volunteers aged 18 years and older. The participants' clinical characteristics were recorded, and their CTM height was measured using ultrasound, with their necks placed sequentially in the neutral and extension positions. The relationship between the CTM height and sex, age, height, weight, body mass index, and sternomental distance was evaluated using linear regression analysis. An equation that could estimate the height of the CTM was obtained with the parameters found significant in this analysis. RESULTS Of the 340 participants, 208 (61.2%) were male. The mean (SD) height of the CTM in the extension position was 9.60 (1.54) mm, and it was significantly shorter in the women than in the men (8.72 [1.19] mm vs. 10.16 [1.48] mm, p < 0.001). Among the participants of short stature, the CTM was significantly shorter, regardless of sex. The hypothetical success rate for emergency cricothyrotomy was 93.3% for the males and 73.5% for the females. The equation for estimating the height of the CTM in the extension position was determined as -4.36 + 5.27 × height (m) + 0.32 × sternomental distance (cm). CONCLUSIONS Since the CTM height may differ according to age, sex, and height, cricothyrotomy sets should be available in various outer diameters. LEVEL OF EVIDENCE NA Laryngoscope, 134:1825-1830, 2024.
Collapse
Affiliation(s)
- Kamil Kokulu
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Ender Alkan
- Department of Radiology, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Radiology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Ekrem T Sert
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Cagri Turkucu
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| | - Emin H Akar
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray, Turkey
| |
Collapse
|
31
|
Duffy CC, Bass GA, Yi W, Rouhi A, Kaplan LJ, O'Sullivan E. Teaching Airway Management Using Virtual Reality: A Scoping Review. Anesth Analg 2024; 138:782-793. [PMID: 37467164 DOI: 10.1213/ane.0000000000006611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Airway management, a defined procedural and cognitive skillset embracing routine tracheal intubation and emergency airway rescue, is most often acquired through an apprenticeship model of opportunistic learning during anesthesia or acute care residency training. This training engages a host of modalities to teach and embed skill sets but is generally time- and location-constrained. Virtual reality (VR)-based simulation training offers the potential for reproducible and asynchronous skill acquisition and maintenance, an advantage that may be important with restricted trainee work hours and low frequency but high-risk events. In the absence of a formal curriculum from training bodies-or expert guidance from medical professional societies-local initiatives have filled the VR training void in an unstructured fashion. We undertook a scoping review to explore current VR-based airway management training programs to assess their approach, outcomes, and technologies to discover programming gaps. English-language publications addressing any aspect of VR simulation training for airway management were identified across PubMed, Embase, and Scopus. Relevant articles were used to craft a scoping review conforming to the Scale for quality Assessment of Narrative Review Articles (SANRA) best-practice guidance. Fifteen studies described VR simulation programs to teach airway management skills, including flexible fibreoptic bronchoscopic intubation (n = 10), direct laryngoscopy (n = 2), and emergency cricothyroidotomy (n = 1). All studies were single institution initiatives and all reported different protocols and end points using bespoke applications of commercial technology or homegrown technologic solutions. VR-based simulation for airway management currently occurs outside of a formal curriculum structure, only for specific skill sets, and without a training pathway for educators. Medical educators with simulation training and medical professional societies with content expertise have the opportunity to develop consensus guidelines that inform training curricula as well as specialty technology use.
Collapse
Affiliation(s)
- Caoimhe C Duffy
- From the Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Yi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen O'Sullivan
- Department of Anaesthesia, Intensive Care, and Pain, St. James' Hospital, Dublin, Ireland
- Department of Anaesthesia, Trinity College, Dublin, Ireland
| |
Collapse
|
32
|
Kumar A, Gupta N, Bhargava T, Gupta A, Kumar V, Bharti SJ, Garg R, Mishra S, Bhatnagar S, Malhotra RK. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC ® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anaesth 2024; 71:503-510. [PMID: 38243098 DOI: 10.1007/s12630-023-02687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.
Collapse
Affiliation(s)
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
- Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India.
| | - Tanvi Bhargava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev K Malhotra
- Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
33
|
Zhou Y, Gao H, Wang Q, Zhi J, Liu Q, Xia W, Duan Q, Yang D. Impact of simulation-based training on bougie-assisted cricothyrotomy technique: a quasi-experimental study. BMC MEDICAL EDUCATION 2024; 24:356. [PMID: 38553688 PMCID: PMC10981348 DOI: 10.1186/s12909-024-05285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Cricothyrotomy is a lifesaving surgical technique in critical airway events. However, a large proportion of anesthesiologists have little experience with cricothyrotomy due to its low incidence. This study aimed to develop a multisensory, readily available training curriculum for learning cricothyrotomy and evaluate its training effectiveness. METHODS Seventy board-certificated anesthesiologists were recruited into the study. Participants first viewed an instructional video and observed an expert performing the bougie-assisted cricothyrotomy on a self-made simulator. They were tested before and after a one-hour practice on their cricothyrotomy skills and evaluated by a checklist and a global rating scale (GRS). Additionally, a questionnaire survey regarding participants' confidence in performing cricothyrotomy was conducted during the training session. RESULTS The duration to complete cricothyrotomy was decreased from the pretest (median = 85.0 s, IQR = 72.5-103.0 s) to the posttest (median = 59.0 s, IQR = 49.0-69.0 s). Furthermore, the median checklist score was increased significantly from the pretest (median = 30.0, IQR = 27.0-33.5) to the posttest (median = 37.0, IQR = 35.5-39.0), as well as the GRS score (pretest median = 22.5, IQR = 18.0-25.0, posttest median = 32.0, IQR = 31.0-33.5). Participants' confidence levels in performing cricothyrotomy also improved after the curriculum. CONCLUSION The simulation-based training with a self-made simulator is effective for teaching anesthesiologists to perform cricothyrotomy.
Collapse
Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Huibin Gao
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qianyu Wang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Juan Zhi
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Weipeng Xia
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Qirui Duan
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shijingshan District, Beijing, 100144, China.
| |
Collapse
|
34
|
Won D, Kim H, Chang JE, Lee JM, Kim TK, Kim H, Min SW, Hwang JY. Comparison of the effects of paratracheal pressure and cricoid pressure on placement of the i-gel ® supraglottic airway: a randomized clinical trial. Can J Anaesth 2024:10.1007/s12630-024-02741-1. [PMID: 38507025 DOI: 10.1007/s12630-024-02741-1] [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: 11/03/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Anesthesiologists can use supraglottic airway devices as a rescue technique for failed intubation even in patients with an increased risk of gastric regurgitation. In this randomized study, we aimed to evaluate the effects of cricoid pressure and paratracheal pressure on placement of the i-gel® (Intersurgical Ltd., Wokingham, Berkshire, UK). METHODS After induction of anesthesia in 76 adult patients, we inserted the i-gel under paratracheal or cricoid pressure, and assessed the success rate of i-gel insertion, resistance during insertion, time required for insertion, accuracy of the insertion location, tidal volumes, and peak inspiratory pressure with or without each maneuver after i-gel insertion. RESULTS The overall success rate of insertion was significantly higher under paratracheal pressure than under cricoid pressure (36/38 [95%] vs 27/38 [71%], respectively; difference, 24%; 95% confidence interval [CI], 8 to 40; P = 0.006]. Resistance during insertion was significantly lower under paratracheal pressure than under cricoid pressure (P < 0.001). The time required for insertion was significantly shorter under paratracheal pressure than under cricoid pressure (median [interquartile range], 18 [15-23] sec vs 28 [22-38] sec, respectively; difference in medians, -10; 95% CI, -18 to -4; P < 0.001). Fibreoptic examination of the anatomical alignment of the i-gel in the larynx revealed no significant difference in the accuracy of the insertion location between the two maneuvers (P = 0.31). The differences in tidal volume and peak inspiratory pressure with or without the maneuvers were significantly lower with paratracheal pressure than with cricoid pressure (P = 0.003, respectively). CONCLUSIONS Insertion of the i-gel supraglottic airway was significantly more successful, easier, and faster while applying paratracheal pressure than cricoid pressure. STUDY REGISTRATION ClinicalTrials.gov (NCT05377346); first submitted 11 May 2022.
Collapse
Affiliation(s)
- Dongwook Won
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Hyerim Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jee-Eun Chang
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Tae Kyong Kim
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Honghyeon Kim
- Department of Anesthesiology & Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong-Won Min
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin-Young Hwang
- College of Medicine, Seoul National University, Seoul, Republic of Korea.
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea.
| |
Collapse
|
35
|
He R, Fang Y, Jiang Y, Yao D, Li Z, Zheng W, Liu Z, Luo N. High-flow nasal oxygenation versus face mask oxygenation for preoxygenation in patients undergoing double-lumen endobronchial intubation: protocol of a randomised controlled trial. BMJ Open 2024; 14:e080422. [PMID: 38485472 PMCID: PMC10941151 DOI: 10.1136/bmjopen-2023-080422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION With the growing emphasis on swift recovery, minimally invasive thoracic surgery has advanced significantly. Video-assisted thoracoscopic surgery (VATS) has seen rapid development, and the double-lumen tube (DLT) remains the most dependable method for tracheal intubation in VATS. However, hypoxaemia during DLT intubation poses a threat to the perioperative safety of thoracic surgery patients. Recently, transnasal high-flow nasal oxygen (HFNO) has shown promise in anaesthesia, particularly in handling short-duration hypoxic airway emergencies. Yet, its application in the perioperative period for patients undergoing pulmonary surgery with compromised cardiopulmonary function lacks evidence, and there are limited reliable clinical data. METHODS AND ANALYSIS A prospective, randomised, controlled, single-blind design will be employed in this study. 112 patients aged 18-60 years undergoing elective VATS-assisted pulmonary surgery will be enrolled and randomly divided into two groups: the nasal high-flow oxygen group (H group) and the traditional mask transnasal oxygen group (M group) in a 1:1 ratio. HFNO will be used during DLT intubation for the prevention of asphyxia in group H, while conventional intubation procedures will be followed by group M. Comparison will be made between the two groups in terms of minimum oxygen saturation during intubation, hypoxaemia incidence during intubation, perioperative complications and postoperative hospital days. ETHICS AND DISSEMINATION Approval for this study has been granted by the local ethics committee at Shenzhen Second People's Hospital. The trial results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT05666908.
Collapse
Affiliation(s)
- Ren He
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yuxiang Fang
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yonghan Jiang
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Da Yao
- Department of Thoracic Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhi Li
- Department of Anesthesiology, Second People' s Hospital of Futian District, Shenzhen, China
| | - Weijun Zheng
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhiheng Liu
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Nanbo Luo
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| |
Collapse
|
36
|
Law JA, Kovacs G. Airway guidelines: Addressing the gaps. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:137-140. [PMID: 38272352 DOI: 10.1016/j.redare.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- J A Law
- Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - G Kovacs
- Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary Site, Halifax, Nova Scotia, Canada
| |
Collapse
|
37
|
Zhao F, Zhou ZY, Wang YQ, Jiang YT, Wang YXJ, Yu H, Yu HG, Bu LY, Lu ZJ, Yao GR, Yan SX. A Convenient and Effective Preoxygenation Technique for Prolonging Deep Inspiration Breath-Hold Duration With a Venturi Mask With a 50% Oxygen Concentration. Pract Radiat Oncol 2024; 14:e87-e96. [PMID: 37871850 DOI: 10.1016/j.prro.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Voluntary deep inspiration breath-hold (DIBH) is commonly used in radiation therapy (RT), but the short duration of a single breath-hold, estimated to be around 20 to 40 seconds, is a limitation. This prospective study aimed to assess the feasibility and safety of using a simple preoxygenation technique with a Venturi mask to prolong voluntary DIBH. METHODS AND MATERIALS The study included 33 healthy volunteers and 21 RT patients. Preoxygenation was performed using a Venturi mask with a 50% oxygen concentration. Paired t tests compared the duration of a single DIBH in room air and after 5, 15, and 30 minutes of preoxygenation in healthy volunteers. Sustainability of breath-hold and tolerability of heart rate and blood pressure were assessed for multiple DIBH durations in both volunteers and patients. RESULTS In healthy volunteers, a 15-minute preoxygenation significantly prolonged the duration of a single DIBH by 24.95 seconds compared with 5-minute preoxygenation (89 ± 27.76 vs 113.95 ± 30.63 seconds; P < .001); although there was a statistically significant increase in DIBH duration after 30-minute preoxygenation, it was only extended by 4.95 seconds compared with 15-minute preoxygenation (113.95 ± 30.63 vs 118.9 ± 29.77 seconds; P < .01). After 15-minute preoxygenation, a single DIBH lasted over 100 seconds in healthy volunteers and over 80 seconds in RT patients, with no significant differences among 6 consecutive cycles of DIBH. Furthermore, there were no significant differences in heart rate or blood pressure after DIBHs, including DIBH in room air and 6 consecutive DIBHs after 15-minute preoxygenation (all P > .05). CONCLUSIONS Preoxygenation with a 50% oxygen concentration for 15 minutes effectively prolongs the duration of 6 cycles of DIBH both in healthy volunteers and RT patients. The utilization of a Venturi mask to deliver 50% oxygen concentration provides a solution characterized by its convenience, good tolerability, and effectiveness.
Collapse
Affiliation(s)
- Feng Zhao
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| | - Zi-Yang Zhou
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yi-Qi Wang
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yan-Ting Jiang
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Yi-Xiang J Wang
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Hao Yu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Graduate School, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hao-Gang Yu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Lu-Yi Bu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhong-Jie Lu
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Guo-Rong Yao
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| | - Sen-Xiang Yan
- Department of Radiation Oncology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
| |
Collapse
|
38
|
Riva T, Goerge S, Fuchs A, Greif R, Huber M, Lusardi AC, Riedel T, Ulmer FF, Disma N. Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model. Paediatr Anaesth 2024; 34:225-234. [PMID: 37950428 DOI: 10.1111/pan.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Rapid-sequence tracheotomy and scalpel-bougie tracheotomy are two published approaches for establishing emergency front-of-neck access in infants. It is unknown whether there is a difference in performance times and success rates between the two approaches. AIMS The aim of this cross-over randomized control trial study was to investigate whether the two approaches were equivalent for establishing tracheal access in rabbit cadavers. The underlying hypothesis was that the time to achieve the tracheal access is the same with both techniques. METHODS Between May and September 2022, thirty physicians (pediatric anesthesiologists and intensivists) were randomized to perform front-of-neck access using one and then the other technique: rapid-sequence tracheotomy and scalpel-bougie tracheotomy. After watching training videos, each technique was practiced four times followed by a final tracheotomy during which study measurements were obtained. Based on existing data, an equivalence margin was set at ∆ = ±10 s for the duration of the procedure. The primary outcome was defined as the duration until tracheal tube placement was achieved successfully. Secondary outcomes included success rate, structural injuries, and subjective participant self-evaluation. RESULTS The median duration of the scalpel-bougie tracheotomy was 48 s (95% CI: 37-57), while the duration of the rapid-sequence tracheotomy was 59 s (95% CI: 49-66, p = .07). The difference in the median duration between the two approaches was 11 s (95% CI: -4.9 to 29). The overall success rate was 93.3% (95% CI: 83.8%-98.2%). The scalpel-bougie tracheotomy resulted in significantly fewer damaged tracheal rings and was preferred among participants. CONCLUSIONS The scalpel-bougie tracheotomy was slightly faster than the rapid-sequence tracheotomy and favored by participants, with fewer tracheal injuries. Therefore, we propose the scalpel-bougie tracheostomy as a rescue approach favoring the similarity to the adult approach for small children. The use of a comparable equipment kit for both children and adults facilitates standardization, performance, and logistics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05499273.
Collapse
Affiliation(s)
- Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Goerge
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Robert Greif
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
- University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea C Lusardi
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Thomas Riedel
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Francis F Ulmer
- Division of Pediatric Intensive Care Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicola Disma
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| |
Collapse
|
39
|
Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Collapse
Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
40
|
Maioli DT, Andrade CF, Bevilacqua Filho CT, Schmidt AP. High-flow nasal therapy: a game-changer in anesthesia and perioperative medicine? BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744466. [PMID: 37742828 DOI: 10.1016/j.bjane.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- Desire T Maioli
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Hospital Tacchini, Clínica de Anestesiologia e Tratamento da Dor Bento Gonçalves, Bento Gonçalves, RS, Brazil
| | - Cristiano F Andrade
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil
| | - Clovis T Bevilacqua Filho
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil
| | - André P Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Instituto de Ciências Básicas da Saúde (ICBS), Departamento de Bioquímica, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil.
| |
Collapse
|
41
|
Booth AW, Pungsornruk K, Llewellyn S, Sturgess D, Vidhani K. Airway management of adult epiglottitis: a systematic review and meta-analysis. BJA OPEN 2024; 9:100250. [PMID: 38230383 PMCID: PMC10789606 DOI: 10.1016/j.bjao.2023.100250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
Background Adult epiglottitis is a life-threatening airway emergency where airway protection is the immediate priority. Despite its importance, the optimal approach to airway management remains unclear. We performed a systematic review of the airway management for adult epiglottitis, including meta-analysis of trends over time. Methods We systematically searched PubMed, Ovid MEDLINE®, and Embase® for adult epiglottitis studies that described the airway management between 1980 and 2020. The primary outcome was the prevalence of airway intervention. Secondary outcomes were prevalence of tracheal intubation, tracheostomy, and failed intubation. A random-effects model meta-analysis was performed with subgroups defined by decade of study publication. Cases that described the specific method of airway intervention and severity of epiglottitis were included in a separate technique summary. Results Fifty-six studies with 10 630 patients were included in the meta-analysis. The overall rate of airway intervention was 15.6% (95% confidence interval [CI] 12.9-18.8%) but the rate decreased from 20% to 10% between 1980 and 2020. The overall rate of tracheal intubation was 10.2% (95% CI 7.1-13.6%) and that of failed intubation was 4.2% (95% CI 1.4-8.0%). The airway technique summary included 128 cases, of which 75 (58.6%) were performed awake and 53 (41.4%) involved general anaesthesia. We identified 32 cases of primary technique failure. Conclusion The rate of airway intervention for adult epiglottitis has decreased over four decades to a current level of 10%. Tracheal intubation is a high-risk scenario with a 1 in 25 failure rate. Specific technique selection is most likely influenced by contextual factors including the severity of epiglottitis.
Collapse
Affiliation(s)
- Anton W.G. Booth
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Karla Pungsornruk
- Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia
| | - Stacey Llewellyn
- Statistics Unit, QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - David Sturgess
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- The University of Queensland (UQ) and Surgical Treatment and Rehabilitation Service (STARS), Brisbane, Australia
| | - Kim Vidhani
- Department of Anaesthesia, Princess Alexandra Hospital – Southern Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
42
|
Deng CJ, Nie S, Mai JX, Zou DC, Deng W, Huang X, Xie Q, Huang W, Jiang W, Huang XB, Xiang YT, Zheng W, Ning YP. Narrative Review and Consensus Recommendations for the Use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Modified Electroconvulsive Therapy. ALPHA PSYCHIATRY 2024; 25:282-289. [PMID: 38798804 PMCID: PMC11117428 DOI: 10.5152/alphapsychiatry.2024.231463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/08/2024] [Indexed: 05/29/2024]
Abstract
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a safe, effective, and novel technique that is currently being used in electroconvulsive therapy (ECT). This study aimed to summarize the clinical practices of THRIVE use in ECT to aid physicians and institutions in implementing the best practice guidelines for ECT. Thus, we reviewed the current literature and presented our consensus on the application of THRIVE in ECT in daily clinical practice. This consensus provides information regarding THRIVE use in ECT, including its safety, effectiveness, procedures, precautions, special case management, and application in special populations. Moreover, it guides the standardized use of THRIVE in ECT.
Collapse
Affiliation(s)
- Can-Jin Deng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Sha Nie
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Jian-Xin Mai
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - De-Cheng Zou
- Department of Psychiatry, The Third People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Wei Deng
- Department of Psychiatry, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiong Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Qin Xie
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Wei Huang
- Shenzhen Kangning Hospital and Shenzhen Mental Health Center, Shenzhen, China
| | - Wei Jiang
- Shenzhen Kangning Hospital and Shenzhen Mental Health Center, Shenzhen, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xing-Bing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yu-Tao Xiang
- Department of Public Health and Medicinal Administration, Unit of Psychiatry, Institute of Translational Medicine, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Wei Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yu-Ping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
43
|
Mayhew D, Palmer K, Wilson I, Watson S, Stepien KM, Jenkins P, Gadepalli C. Airway and Anaesthetic Management of Adult Patients with Mucopolysaccharidoses Undergoing Cardiac Surgery. J Clin Med 2024; 13:1366. [PMID: 38592237 PMCID: PMC10932343 DOI: 10.3390/jcm13051366] [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: 01/09/2024] [Revised: 02/13/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Mucopolysaccharidoses (MPSs) are rare congenital lysosomal storage disorders due to a deficiency of enzymes metabolising glycosaminoglycans, leading to their accumulation in tissues. This multisystem disease often requires surgical intervention, including valvular cardiac surgery. Adult MPSs have complex airways making anaesthesia risky. Methods: We report novel three-dimensional (3D) modelling airway assessments and multidisciplinary peri-operative airway management. Results: Five MPS adults underwent cardiac surgery at the national MPS cardiac centre (type I = 4, type II = 1; ages 20, 24, 33, 35, 37 years; two males, three females). All had complex airway abnormalities. Assessments involved examination, nasendoscopy, imaging, functional studies, 3D reconstruction, virtual endoscopy, virtual reality and simulation using computerised, physical modelling. Awake oral fibre-optic intubation was achieved via airway conduit. Staged extubation was performed on the first post-operative day under laryngo-tracheoscopic guidance. The post-operative period involved chest physiotherapy and occupational therapy. All patients had safe intubation, ventilation and extubation. Four had good cardiac surgical outcomes, one (MPS type I; age 35 years) was inoperable due to endocarditis. None had post-operative airway complications. Conclusions: Expertise from cardiovascular-heart team, multidisciplinary airway management, use of novel techniques is vital. Traditional airway assessments are insufficient, so ENT input, radiology and computerised methods to assess and simulate the airway in 3D by collaboration with clinical engineering is essential.
Collapse
Affiliation(s)
- David Mayhew
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; (D.M.); (K.P.)
| | - Kenneth Palmer
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK; (D.M.); (K.P.)
| | - Ian Wilson
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK;
| | - Stuart Watson
- Medical Physics Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Karolina M. Stepien
- Adult Inherited Metabolic Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Petra Jenkins
- Adult Congenital Heart Disease Centre, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK;
| | - Chaitanya Gadepalli
- Ear Nose and Throat Department, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester M6 8HD, UK
- School of Medical Education, The University of Manchester, Manchester M14 4PX, UK
| |
Collapse
|
44
|
Morton S, Spurgeon Z, Ashworth C, Samouelle J, Sherren PB. Cardiorespiratory consequences of attenuated fentanyl and augmented rocuronium dosing during protocolised prehospital emergency anaesthesia at a regional air ambulance service: a retrospective study. Scand J Trauma Resusc Emerg Med 2024; 32:12. [PMID: 38347604 PMCID: PMC10863113 DOI: 10.1186/s13049-024-01183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Pre-Hospital Emergency Anaesthesia (PHEA) has undergone significant developments since its inception. However, optimal drug dosing remains a challenge for both medical and trauma patients. Many prehospital teams have adopted a drug regimen of 3 mcg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium ('3:2:1'). At Essex and Herts Air Ambulance Trust (EHAAT) a new standard dosing regimen was introduced in August 2021: 1 mcg/kg fentanyl, 2 mg/kg ketamine and 2 mg/kg rocuronium (up to a maximum dose of 150 mg) ('1:2:2'). The aim of this study was to evaluate the cardiorespiratory consequences of a new attenuated fentanyl and augmented rocuronium dosing regimen. METHODS A retrospective study was conducted at EHAAT as a service evaluation. Anonymized records were reviewed from an electronic database to compare the original ('3:2:1') drug dosing regimen (December 2019-July 2021) and the new ('1:2:2') dosing regimen (September 2021-May 2023). The primary outcome was the incidence of absolute hypotension within ten minutes of induction. Secondary outcomes included immediate hypertension, immediate hypoxia and first pass success (FPS) rates. RESULTS Following exclusions (n = 121), 720 PHEA cases were analysed (360 new vs. 360 original, no statistically significant difference in demographics). There was no difference in the rate of absolute hypotension (24.4% '1:2:2' v 23.8% '3:2:1', p = 0.93). In trauma patients, there was an increased first pass success (FPS) rate with the new regimen (95.1% v 86.5%, p = 0.01) and a reduced incidence of immediate hypoxia (7.9% v 14.8%, p = 0.05). There was no increase in immediate hypertensive episodes (22.7% vs. 24.2%, p = 0.73). No safety concerns were identified. CONCLUSION An attenuated fentanyl and augmented rocuronium dosing regimen showed no difference in absolute hypotensive episodes in a mixed cohort of medical and trauma patients. In trauma patients, the new regimen was associated with an increased FPS rate and reduced episodes of immediate hypoxia. Further research is required to understand the impact of such drug dosing in the most critically ill and injured subpopulation.
Collapse
Affiliation(s)
- Sarah Morton
- Essex & Herts Air Ambulance Trust, Essex, UK.
- Imperial College London, London, UK.
| | | | | | | | - Peter B Sherren
- Essex & Herts Air Ambulance Trust, Essex, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
45
|
Le Borgne P, Alamé K, Chenou A, Hoffmann A, Burger V, Kepka S, Bilbault P, Le Bastard Q, Martin M, Lascarrou JB. Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey. Eur J Emerg Med 2024; 31:46-52. [PMID: 37812152 DOI: 10.1097/mej.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND IMPORTANCE Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation. OBJECTIVES The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs). SETTINGS AND PARTICIPANTS We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022. INTERVENTION A single questionnaire was sent to a sole referent physician in each ED. OUTCOME MEASURES AND ANALYSIS The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet. MAIN RESULTS Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%). CONCLUSION In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.
Collapse
Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg
| | - Karine Alamé
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Aline Chenou
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Anne Hoffmann
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | | | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg
| | | | - Maelle Martin
- Médecine Intensive Reanimation, Nantes University Hospital, Nantes, France
| | | |
Collapse
|
46
|
Wang CH, Li JD, Wu CY, Wu YC, Tay J, Wu MC, Hsu CH, Liu YK, Chen CS, Huang CH. Application of Machine Learning to Ultrasonography in Identifying Anatomical Landmarks for Cricothyroidotomy Among Female Adults: A Multi-center Prospective Observational Study. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:363-373. [PMID: 38343208 PMCID: PMC11031510 DOI: 10.1007/s10278-023-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 03/02/2024]
Abstract
We aimed to develop machine learning (ML)-based algorithms to assist physicians in ultrasound-guided localization of cricoid cartilage (CC) and thyroid cartilage (TC) in cricothyroidotomy. Adult female volunteers were prospectively recruited from two hospitals between September and December, 2020. Ultrasonographic images were collected via a modified longitudinal technique. You Only Look Once (YOLOv5s), Faster Regions with Convolutional Neural Network features (Faster R-CNN), and Single Shot Detector (SSD) were selected as the model architectures. A total of 488 women (mean age: 36.0 years) participated in the study, contributing to a total of 292,053 frames of ultrasonographic images. The derived ML-based algorithms demonstrated excellent discriminative performance for the presence of CC (area under the receiver operating characteristic curve [AUC]: YOLOv5s, 0.989, 95% confidence interval [CI]: 0.982-0.994; Faster R-CNN, 0.986, 95% CI: 0.980-0.991; SSD, 0.968, 95% CI: 0.956-0.977) and TC (AUC: YOLOv5s, 0.989, 95% CI: 0.977-0.997; Faster R-CNN, 0.981, 95% CI: 0.965-0.991; SSD, 0.982, 95% CI: 0.973-0.990). Furthermore, in the frames where the model could correctly indicate the presence of CC or TC, it also accurately localized CC (intersection-over-union: YOLOv5s, 0.753, 95% CI: 0.739-0.765; Faster R-CNN, 0.720, 95% CI: 0.709-0.732; SSD, 0.739, 95% CI: 0.726-0.751) or TC (intersection-over-union: YOLOv5s, 0.739, 95% CI: 0.722-0.755; Faster R-CNN, 0.709, 95% CI: 0.687-0.730; SSD, 0.713, 95% CI: 0.695-0.730). The ML-based algorithms could identify anatomical landmarks for cricothyroidotomy in adult females with favorable discriminative and localization performance. Further studies are warranted to transfer this algorithm to hand-held portable ultrasound devices for clinical use.
Collapse
Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jia-Da Li
- NTU Joint Research Center for AI Technology and All Vista Healthcare, National Taiwan University, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chen Wu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Joyce Tay
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hang Hsu
- Institute of Information Science, Academia Sinica, Taipei, Taiwan
| | - Yi-Kuan Liu
- NTU Joint Research Center for AI Technology and All Vista Healthcare, National Taiwan University, Taipei, Taiwan
| | - Chu-Song Chen
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.
- Institute of Information Science, Academia Sinica, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
47
|
Lopez-Lopez D, Garcia-Romar A, Neira-Somoza P, Casas-Reza P, Mato-Bua R. Han scale and difficult facemask ventilation: time to add an "R"? Korean J Anesthesiol 2024; 77:165-166. [PMID: 37985949 PMCID: PMC10834725 DOI: 10.4097/kja.23493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/19/2023] [Accepted: 11/20/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- David Lopez-Lopez
- Department of Anesthesiology, Perioperative Care and Pain Medicine, A Coruña University Hospital, A Coruña, Spain
| | - Adrian Garcia-Romar
- Department of Anesthesiology, Perioperative Care and Pain Medicine, A Coruña University Hospital, A Coruña, Spain
| | | | - Pablo Casas-Reza
- Department of Anesthesiology, Perioperative Care and Pain Medicine, A Coruña University Hospital, A Coruña, Spain
| | - Rocio Mato-Bua
- Department of Anesthesiology, Perioperative Care and Pain Medicine, A Coruña University Hospital, A Coruña, Spain
| |
Collapse
|
48
|
Ryoo SH, Park KN, Karm MH. The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review. J Dent Anesth Pain Med 2024; 24:1-17. [PMID: 38362261 PMCID: PMC10864710 DOI: 10.17245/jdapm.2024.24.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.
Collapse
Affiliation(s)
- Seung-Hwa Ryoo
- Department of Dental Anesthesiology, Seoul National University, School of Dentistry, Seoul, Republic of Korea
| | - Kyung Nam Park
- Department of Dental Anesthesiology, Seoul National University, School of Dentistry, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University, School of Dentistry, Seoul, Republic of Korea
| |
Collapse
|
49
|
Ramos RA, Aguiar AR, Lima CG, Resende R. Oropharyngeal Hemorrhage and Difficult Airway Management: A Decision Not to Intubate. J Emerg Med 2024; 66:133-138. [PMID: 38290880 DOI: 10.1016/j.jemermed.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/10/2023] [Accepted: 10/22/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Bleeding in the upper airways is an important cause of airway-related death. A higher incidence of airway management failure and complications after intubation attempts in the emergency department (ED) had been suggested. Airway management of patients with active oropharyngeal hemorrhage may be challenging, leading the clinician to modify the approach. CASE REPORT A 57-year-old woman presented to the ED with oropharyngeal hemorrhage after an extensive invasive dental procedure. She was on long-term warfarin therapy due to aortic and mitral valve replacement, which she suspended 5 days prior and restarted the day after the procedure. Besides the active bleeding, swelling, and hematoma of the face, the patient had other signs of "difficult airway," so there were serious questions on when and how to manage the airway. Several strategies to address the airway were considered, the main point being an early versus later intubation. As the patient remained clinically stable, she was conservatively managed with local hemostasis and coagulopathy reversal. The patient was transferred to the intensive care unit, where she remained stable and was successfully discharged after restart on warfarin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When faced with an oropharyngeal hemorrhage, emergency physicians may be compelled to secure and protect the airway. This could be achieved by planning several strategies. Nevertheless, in selected patients, and considering the circumstances, not addressing the airway is a reasonable and justifiable alternative.
Collapse
Affiliation(s)
- Rui A Ramos
- Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - Ana Rita Aguiar
- Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - Clara Gaio Lima
- Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Senhora da Hora, Portugal
| | - Rita Resende
- Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Senhora da Hora, Portugal
| |
Collapse
|
50
|
Hung TY, Tseng CW, Wen CS, Yu SH, Chen HL, Lee CW, Su YC, Lin CH. Video-stylet vs. channeled hyperangulated videolaryngoscope: Efficacy in simulated Ludwig's angina randomized cadaver trial. Am J Emerg Med 2024; 76:63-69. [PMID: 37995525 DOI: 10.1016/j.ajem.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Ludwig's angina (LA) is a life-threatening infection that can affect the floor of the mouth and neck, potentially causing serious airway obstruction. In such cases, rescue airway management and oxygenation can be challenging due to swelling of the mouth floor, trismus, and limited mouth opening. The aim of this study was to assess the efficacy of the Trachway video-stylet (VS) and Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C) compared to the standard geometric video-laryngoscope (SGVL, Macintosh 3, Trachway) in simulating Ludwig's angina with cadavers. METHODS Three fresh frozen cadavers were prepared with varying degrees of difficulty to simulate the airway conditions of patients with LA, including mouth floor swelling, restricted mouth opening, and trismus. Fifty-five second-year resident physicians from various specialties participated in the study and received training in airway management using SGVL, VS, and HAVL-C devices. Participants were randomly assigned to intubate simulated LA with cadavers using the three devices in a random order, and intubation times and success rates were recorded. Participants also rated the difficulty of intubation using a visual analogue scale (VAS) score. The primary outcome assessed the first-pass intubation success or failure, while the secondary outcomes measured the intubation time and subjective difficulty using a visual analogue scale with different laryngoscopes. RESULTS The success rates for intubation within 90 s were 40% for SGVL, 82% for VS, and 76% for HAVL-C. VS and HAVL-C had significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7, and 95% confidence intervals (CI) of 2.0-5.7 and 1.6-4.6, p < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7-17.8 and 2.4-16.7, p < 0.001, compared to SGVL. The VAS score was significantly correlated with intubation success rate and time. CONCLUSIONS In cases of LA, the use of VS and HAVL-C is preferable over SGVL. These findings suggest that using VS and HAVL-C can improve intubation success rates and reduce intubation time in patients with LA.
Collapse
Affiliation(s)
- Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan.
| | - Cheng-Wei Tseng
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chung-Shiung Wen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Sheng-Han Yu
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| | - Chen-Wei Lee
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien County, Taiwan; Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi City, Taiwan.
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Taiwan; Department of Emergency, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Chieh-Hung Lin
- Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei City, Taiwan
| |
Collapse
|