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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 II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [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: 07/28/2023] [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.
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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 Universitary 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
- Emergency Department, 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
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2
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van Zundert AAJ, Gatt SP, van Zundert TCRV, Hagberg CA, Pandit JJ. Supraglottic Airway Devices: Present State and Outlook for 2050. Anesth Analg 2024; 138:337-349. [PMID: 38215712 DOI: 10.1213/ane.0000000000006673] [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: 01/14/2024]
Abstract
Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents. A close match is needed between the shape and profile of SGDs and the laryngeal inlet. An adequate first seal (with the respiratory tract) and a good fit at the second seal of the distal cuff and the gastrointestinal tract are most desirable. Vision-guided insertion techniques are ideal and should be the way forward. This article recommends the use of third-generation vision-incorporated-video SGDs, which allow for direct visualization of the insertion process, corrective maneuvers, and, when necessary, insertion of a nasogastric tube (NGT) and/or endotracheal tube (ETT) intubation. A videoscope embedded within the SGD allows a visual check of the glottis opening and position of the epiglottis. This design affords the benefit of confirming and/or correcting a SGD's position in the midline and rotation in the sagittal plane. The first clinically available video laryngeal mask airways (VLMAs) and multiple prototypes are being tested and used in anesthesia. Existing VLMAs are still not perfect, and further improvements are recommended. Additional modifications in multicamera technology, to obtain a panoramic view of the SGD sitting correctly in the hypopharynx and to prove that correct sizes have been used, are in the process of production. Ultimately, any device inserted orally-SGD, ETT, NGT, temperature probe, transesophageal scope, neural integrity monitor (NIM) tubes-could benefit from correct vision-guided positioning. VLMAs also allow for automatic recording, which can be documented in clinical records of patients, and could be valuable during teaching and research, with potential value in case of legal defence (with an airway incident). If difficulties occur with the airway, documentation in the patient's file may help future anesthesiologists to better understand the real-time problems. Both manufacturers and designers of SGDs may learn from optimally positioned SGDs to improve the design of these airway devices.
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Affiliation(s)
- André A J van Zundert
- From the Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, & The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen P Gatt
- Department of Anaesthesia, University of New South Wales, Kensington, New South Wales, Australia
- Department of anaesthesia, Udayana University, Bali, Indonesia
| | | | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaideep J Pandit
- Department of Anaesthesia, University of Oxford, Oxford, United Kingdom
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3
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Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med 2023; 13:1327. [PMID: 37763095 PMCID: PMC10532647 DOI: 10.3390/jpm13091327] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
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Affiliation(s)
- Sophie A. Saul
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Patrick A. Ward
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Alistair F. McNarry
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
- Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK
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Athanassoglou V, O'Sullivan EP, van Zundert A, Pandit JJ. New guidelines for research in airway device evaluation: time for an updated approach (ADEPT-2) to the Difficult Airway Society's 'ADEPT' strategy? J Clin Monit Comput 2023; 37:345-350. [PMID: 36125636 PMCID: PMC9486783 DOI: 10.1007/s10877-022-00911-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022]
Abstract
In this article we present the learning from a clinical study of airway device evaluation, conducted under the framework of the Difficult Airway Society (DAS, UK) 'ADEPT' (airway device evaluation project team) strategy. We recommend a change in emphasis from small scale randomised controlled trials conducted as research, to larger-scale observational, post-marketing evaluation audits as a way of obtaining more meaningful information.
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Affiliation(s)
- V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - A van Zundert
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- The University of Queensland, Brisbane, QLD, Australia
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- University of Oxford, Oxford, UK.
- St John's College, Oxford OX1 3JP, Oxford, 01865-221590, UK.
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Ní Eochagáin A, Athanassoglou V, Cumberworth A, Morris O, Corbett S, Jefferson H, O'Sullivan EP, Pandit JJ. Assessing a novel second generation laryngeal mask airway using the 'ADEPT' approach: results from the LMA® Protector™ observational study. J Clin Monit Comput 2023; 37:517-524. [PMID: 36063277 PMCID: PMC9441326 DOI: 10.1007/s10877-022-00910-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
To address the problem of lack of clinical evidence for airway devices introduced to the market, the Difficult Airway Society (UK) developed an approach (termed ADEPT; Airway Device Evaluation Project Team) to standardise the model for device evaluation. Under this framework we assessed the LMA Protector, a second generation laryngeal mask airway. A total of 111 sequential adult patients were recruited and the LMA Protector inserted after induction of general anaesthesia. Effective insertion was confirmed by resistance to further distal movement, manual ventilation, and listening for gas leakage at the mouth. The breathing circuit was connected to the airway channel and airway patency confirmed with manual test ventilation at 20 cm H20 (water) pressure for 3 s. Data was collected in relation to the time for placement, intraoperative performance and postoperative performance of the airway device. Additionally, investigators rated the ease of insertion and adequacy of lung ventilation on a 5-point scale. The median (interquartile range [range]) time taken to insertion of the device was 31 (26-40[14-780]) s with the ability to ventilate after device insertion 100 (95% CI 96.7- 100)%. Secondary endpoints included one or more manoeuvres 60.3 (95% CI 50.6-69.5)% cases requiring to assist insertion; a median ease of insertion score of 4 (2-5[3-5]), and a median adequacy of ventilation score of 5 (5-5[4-5]). However, the first time insertion rate failure was 9.9% (95% CI 5.1-17.0%). There were no episodes of patient harm recorded, particularly desaturation. The LMA Protector appears suitable for clinical use, but an accompanying article discusses our reflections on the ADEPT approach to studying airway devices from a strategic perspective.
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Affiliation(s)
- A Ní Eochagáin
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - V Athanassoglou
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Cumberworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - O Morris
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - S Corbett
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - H Jefferson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E P O'Sullivan
- Consultant Anaesthetist St. James's Hospital, Dublin, Ireland
| | - J J Pandit
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- University of Oxford, Oxford, UK.
- St John's College, Oxford, OX1 3JP, UK.
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Videolaryngoscopy in neonates: A narrative review exploring the current state of the art. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2023. [DOI: 10.1016/j.tacc.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Zhi J, Yan FX, Wei LX, Yang D, Deng XM. Intubation using video laryngeal mask airway SaCoVLM and laryngeal mask airway Ambu® Aura-i in anesthetized children with microtia: a randomized controlled study. J Clin Monit Comput 2022; 37:857-865. [PMID: 36550347 DOI: 10.1007/s10877-022-00949-4] [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: 06/09/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
The Ambu Aura-i laryngeal mask is considered to be a device for blind intubation as well as for fiberoptic guided intubation. The novel video laryngeal airway mask SaCoVLM is a supraglottic airway device that allows intubation under direct vision. We hypothesized that success rates for device placement and tracheal intubation with the SaCoVLM would be comparable with the Ambu Aura-i mask. A prospective, randomized clinical trial was conducted from March 2021 to December 2021. One hundred and twenty patients were enrolled and randomized in the study. Direct intubation was performed with the SaCoVLM, and fiberoptic guided intubation was performed with the Ambu Aura-i mask. The primary outcome measure was the first success rate of LMA placement. Secondary outcome measures were the time from device placement and time from endotracheal intubation (as well as the time for LMA removal after successful intubation), differences in airway leak pressure, fiberoptic grade of the laryngeal view, and incidence of blood staining. The first success rate of LMA placement was similar for the two devices. There was no difference in the time for successful endotracheal intubation between the Ambu Aura-i and SaCoVLM groups (24.1 s ± 6.3 versus 25.7 s ± 2.1; p > 0.05). The time for removal was slower in the SaCoVLM group than in the Ambu Aura-i group (20.8 s ± 0.8 versus 14.7 s ± 6.1; p < 0.01). The airway leak pressure was higher in the SaCoVLM group than in the Ambu Aura-i group (27.0 s ± 1.0 versus 22.3 s ± 3.6; p < 0.01), and the incidence of blood staining was higher in the SaCoVLM group (16.7%). The SaCoVLM has an overall comparable performance to the Ambu Aura-i mask. However, the SaCoVLM is better relative to direct intubation without the assistance of a flexible intubation scope, which reduces the device's demand.
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Affiliation(s)
- Juan Zhi
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Fu-Xia Yan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North-li-shi Rd, Xicheng District, Beijing, 100037, China
| | - Ling-Xin Wei
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| | - Xiao-Ming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
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Hinrichs-Krapels S, Ditewig B, Boulding H, Chalkidou A, Erskine J, Shokraneh F. Purchasing high-cost medical devices and equipment in hospitals: a systematic review. BMJ Open 2022; 12:e057516. [PMID: 36581959 PMCID: PMC9438058 DOI: 10.1136/bmjopen-2021-057516] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To systematically review academic literature for studies on any processes, procedures, methods or approaches to purchasing high-cost medical devices and equipment within hospitals in high-income countries. METHODS On 13 August 2020, we searched the following from inception: Cost-Effectiveness Analysis Registry, EconLit and ProQuest Dissertations & Theses A&I via ProQuest, Embase, MEDLINE, and MEDLINE in Process via Ovid SP, Google and Google Scholar, Health Management and Policy Database via Ovid SP, IEEE Xplore Digital Library, International HTA Database, NHS EED via CRD Web, Science Citation Index-Expanded, Conference Proceedings Citation Index-Science, and Emerging Sources Citation Index via Web of Science, Scopus, and Zetoc conference search. Studies were included if they described the approach to purchasing (also known as procurement or acquisition) of high-cost medical devices and/or equipment conducted within hospitals in high-income countries between 2000 and 2020. Studies were screened, data extracted and results summarised in tables under themes identified. RESULTS Of 9437 records, 24 were included, based in 12 different countries and covering equipment types including surgical robots, medical imaging equipment, defibrillators and orthopaedic implants. We found heterogeneity in methods and approaches; including descriptions of processes taking place within or across hospitals (n=14), out of which three reported cost savings; empirical studies in which hospital records or participant data were analysed (n=8), and evaluations or pilots of proposed purchasing processes (n=2). Studies emphasise the importance of balancing technical, financial, safety and clinical requirements for device selection through multidisciplinary involvement (especially clinical engineers and clinicians) in decision-making, and the potential of increasing evidence-based purchasing decisions using approaches such as hospital-based health technology assessments, ergonomics and device 'user trials'. CONCLUSIONS We highlight the need for more empirical work that evaluates purchasing approaches or interventions, and greater specificity in study reporting (eg, equipment type, evaluation outcomes) to build the evidence base required to influence policy and practice for medical equipment purchasing. PROTOCOL REGISTRATION This review was registered in Open Science Framework: Shokraneh F, Hinrichs-Krapels S, Chalkidou A et al. Purchasing high-cost medical equipment in hospitals in OECD countries: A systematic review. Open Science Framework 2021; doi:10.17605/OSF.IO/GTXN8. Available at: https://osf.io/gtxn8/ (accessed 12 February 2022).
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Affiliation(s)
- Saba Hinrichs-Krapels
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
- The Policy Institute, King's College London, London, UK
| | - Bor Ditewig
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | | | - Anastasia Chalkidou
- King's Technology Evaluation Centre (KiTEC), London Institute for Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jamie Erskine
- King's Technology Evaluation Centre (KiTEC), London Institute for Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Farhad Shokraneh
- King's Technology Evaluation Centre (KiTEC), London Institute for Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Endlich Y, Hore PJ, Baker PA, Beckmann LA, Bradley WP, Chan KLE, Chapman GA, Jephcott CGA, Kruger PS, Newton A, Roessler P. Updated guideline on equipment to manage difficult airways: Australian and New Zealand College of Anaesthetists. Anaesth Intensive Care 2022; 50:430-446. [PMID: 35722809 DOI: 10.1177/0310057x221082664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways) is accompanied by a detailed background paper (PG56(A)BP 2021, https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.
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Affiliation(s)
- Yasmin Endlich
- Department of Anaesthesia and Acute Pain Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, Australia.,Faculty of Anaesthesia, University of Adelaide, Adelaide, Australia
| | - Phillipa J Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
| | - Linda A Beckmann
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - William P Bradley
- Department of Anaesthesia and Perioperative Medicine, The Alfred, Melbourne, Australia.,Faculty of Anaesthesia, Monash University, Melbourne, Australia
| | - Kah L E Chan
- Department of Anaesthesia and Acute Pain Medicine, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Gordon A Chapman
- Department of Anaesthesia, Royal Perth Hospital, Perth, Australia.,Faculty of Anaesthesia, University of Western Australia, Perth, Australia
| | | | - Peter S Kruger
- Department of Intensive Care Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Alastair Newton
- Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, Australia.,Retrieval Services Queensland, Brisbane, Australia
| | - Peter Roessler
- Safety and Advocacy Unit, Australian and New Zealand College of Anaesthetists, Melbourne, Australia
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Formation of an Airway Lead Network: an essential patient safety initiative. Br J Anaesth 2021; 128:225-229. [PMID: 34893313 DOI: 10.1016/j.bja.2021.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/20/2022] Open
Abstract
We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway management are published and revised regularly, uniform implementation of such guidelines are applied sporadically throughout the hospital and prehospital settings. The primary roles of an Airway Lead are to ensure supply, quality and storage of airway equipment, promote the use of current practice guidelines as well as the organisation of training and audits. Locally, the Airway Lead may chair a multi-disciplinary airway committee within their organisation; an Airway Lead Network enables Airway Leads to share common problems and solutions to promote optimal airway management on a national level. Support from governing bodies is an essential part of this structure.
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11
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Price L, Carter P, Hodzovic I, Alderman M, Hughes G, Phillips P, Varadarajan V, Wilkes A. An assessment of introducers used for airway management. Anaesthesia 2021; 77:293-300. [PMID: 34861743 DOI: 10.1111/anae.15624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Abstract
Different introducers are available to assist with tracheal intubation. Subtle differences in the design of introducers can have a marked effect on safety and performance. The Difficult Airway Society's Airway Device Evaluation Project Team proposal states that devices should only be purchased for which there is at least a case-control study on patients assessing airway devices. However, resources are not currently available to carry out a case-control study on all introducers available on the market. This study comprised a laboratory and manikin-based investigation to identify introducers that could be suitable for clinical investigation. We included six different introducers in laboratory-based assessments (design characteristics) and manikin-based assessments involving the participation of 30 anaesthetists. Each anaesthetist attempted placement in the manikin's trachea with each of the six introducers in a random order. Outcomes included first-time insertion success rate; insertion success rate; number of attempts; time to placement; and distance placed. Each anaesthetist also completed a questionnaire. First-time insertion success rate depended significantly on the introducer used (p = 0.0016) and varied from 47% (Armstrong and P3) to 77% (Intersurgical and Frova). Median time to placement (including oesophageal placement) varied from 10 s (Eschmann and Frova) to 20 s (P3) (p = 0.0025). Median time to successful placement in the trachea varied from 9 s (Frova) to 22 s (Armstrong) (p = 0.037). We found that the Armstrong and P3 devices were not as acceptable as other introducers and, without significant improvements to their design and characteristics, the use of these devices in studies on patients is questionable. The study protocol is suitable for differentiating between different introducers and could be used as a basis for assessing other types of devices.
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Affiliation(s)
- L Price
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - P Carter
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - I Hodzovic
- Department of Anaesthetics, Royal Gwent Hospital, Newport, UK
| | - M Alderman
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - G Hughes
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
| | - P Phillips
- Surgical Materials Testing Laboratory, Princess of Wales Hospital, Bridgend, UK
| | - V Varadarajan
- Department of Anaesthetics, Princess of Wales Hospital, Bridgend, UK
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12
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Not so clear cut: Cultivating successful surgical cricothyroidotomy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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de Villiers C, Alphonsus C, Eave D, Hofmeyr R. Innovation in low-cost video-laryngoscopy: Intubator V1-Indirect compared with Storz C-MAC in a simulated difficult airway. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Iliff HA, El-Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan-Pak-Kee V, O'Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia 2021; 77:82-95. [PMID: 34545943 PMCID: PMC9291554 DOI: 10.1111/anae.15585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 12/16/2022]
Abstract
Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri‐operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high‐quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post‐thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post‐haematoma evacuation care; day‐case thyroid surgery; training; consent and pre‐operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.
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Affiliation(s)
- H A Iliff
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, 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
| | - 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
| | - J Davis
- Department of Otolaryngology Head and Neck Surgery, Medway NHS Foundation Trust, Gillingham, UK
| | - A Harris
- Patient Representative, London, UK
| | - S Khan
- Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Lan-Pak-Kee
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - J O'Connor
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
| | - L Powell
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, UK
| | - G Rees
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK
| | - T S Tatla
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
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15
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Vivian VH, Anaes D, L Pardon T, Van Zundert AAJ. Modified Retrograde Nasal Intubation: A New Airway Technique and Devices. Anesth Prog 2021; 68:107-113. [PMID: 34185866 DOI: 10.2344/anpr-68-02-03] [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: 04/19/2020] [Accepted: 01/20/2021] [Indexed: 11/11/2022] Open
Abstract
Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a "cannot intubate, cannot ventilate" scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices.
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Affiliation(s)
| | - Dip Anaes
- General Practitioner-Anesthesiologist, Sunshine Coast, QLD, Australia
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16
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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17
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Kapoor D, Singh J, Mitra S, Viswanath O, Kaye AD, Urits I, Orhurhu V. Gnana Laryngeal Airway in Clinical Practice: A Prospective Observational Study. Turk J Anaesthesiol Reanim 2019; 48:280-287. [PMID: 32864642 PMCID: PMC7434353 DOI: 10.5152/tjar.2019.00243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/15/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The Gnana Laryngeal Airway (GLA) device, a novel supraglottic airway device, is similar to the LMA-Classic in basic design, but with an additional suction port on the convex portion of the laryngeal mask to remove the saliva. We evaluated the GLA device in terms of ease and time to insertion, the number of attempts, oropharyngeal leak pressure (OLP), correct placement, and complications in adult patients undergoing elective surgical procedures. Methods After general anaesthesia, the GLA device was inserted in ASA Class I–II consecutive patients aged 18–60 years, who were scheduled for elective surgeries lasting <2h. An independent observer noted (1) 10 consecutive successful GLA device insertions, all on the first attempt; (2) 10 consecutive device insertions, each <20 second in duration; and (3) 10 consecutive patients with the mean leak <10%. The criteria were fulfilled in 50 consecutive patients. Results In 72% of patients, the GLA device was successfully placed on the first attempt and was effortless in 64%. Between the first 10 and last 10 consecutive patients of the total 50, the ease-of-insertion grade progressively decreased (mean±standard deviation [SD]: 2.80±0.25 to 1.30±0.15, p<0.0001) and so did insertion time in seconds (28.70±1.87 to 14.20±0.79, p<0.0001). The post-insertion, OLP and airway compliance progressively increased, while the cuff inflation volume, peak airway pressure and airway resistance progressively decreased, along with minimal side effects and malposition. Conclusion The GLA device insertion became progressively easier and faster; thus, such a device is promising and warrants further clinical evaluation.
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Affiliation(s)
- Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Omar Viswanath
- Valley Anaesthesiology and Pain Consultants, Phoenix, AZ; Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA
| | - Alan David Kaye
- Department of Anaesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University School of Medicine, Shreveport, Louisiana, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anaesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anaesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
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18
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Ahmad I, El-Boghdadly K, Bhagrath R, Hodzovic I, McNarry AF, Mir F, O'Sullivan EP, Patel A, Stacey M, Vaughan D. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2019; 75:509-528. [PMID: 31729018 PMCID: PMC7078877 DOI: 10.1111/anae.14904] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 12/13/2022]
Abstract
Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high‐quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post‐tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.
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Affiliation(s)
- I Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - R Bhagrath
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - I Hodzovic
- Department of Anaesthesia, Cardiff University School of Medicine, Cardiff, UK.,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - A F McNarry
- Department of Anaesthesia, NHS Lothian, Edinburgh, UK
| | - F Mir
- Department of Anaesthesia, St. George's University Hospital NHS Foundation Trust, London, UK
| | - E P O'Sullivan
- Department of Anaesthesia, St James's Hospital, Dublin, Ireland
| | - A Patel
- Department of Anaesthesia, Royal National Throat Nose and Ear Hospital and University College London Hospitals NHS Foundation Trust, London, UK
| | - M Stacey
- Department of Anaesthesia, Cardiff and Vale NHS Trust (HEIW), Cardiff, UK
| | - D Vaughan
- Department of Anaesthesia, Northwick Park Hospital, London, UK
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19
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Engelhardt T, Fiadjoe JE, Weiss M, Baker P, Bew S, Echeverry Marín P, von Ungern-Sternberg BS. A framework for the management of the pediatric airway. Paediatr Anaesth 2019; 29:985-992. [PMID: 31402534 DOI: 10.1111/pan.13716] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/30/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
Critical airway incidents in children are a frequent problem in pediatric anesthesia and remain a significant cause of morbidity and mortality. Young children are at particular risk in the perioperative period. Delayed management of airway obstruction can quickly lead to serious complications due to the short apnea tolerance in children. A simple, time critical, and pediatric-specific airway management approach combined with dedicated teaching, training, and frequent practice will help to reduce airway-related pediatric morbidity and mortality. There is currently no pediatric-specific universal framework available to guide practice. Current algorithms are modifications of adult approaches which are often inappropriate because of differences in age-related anatomy, physiology, and neurodevelopment. A universal and pragmatic approach is required to achieve acceptance across diverse pediatric clinicians, societies, and groups. Such a framework will also help to establish minimum standards for pediatric airway equipment, personnel, and medications whenever pediatric airway management is required.
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Affiliation(s)
- Thomas Engelhardt
- Department of Anaesthesia, Royal Children's Hospital Aberdeen and School of Medicine, University of Aberdeen, Aberdeen, UK.,Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, CA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Markus Weiss
- Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland
| | - Paul Baker
- Consultant Anaesthetist, Starship Children's Hospital, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Stephanie Bew
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Piedad Echeverry Marín
- Anestesióloga pediátrica, Miembro del comité de Anestesia Pediátrica, Sociedad Colombiana de Anestesiología y Reanimación, Anestesióloga del Instituto Rooselvelt, Bogotá, DC, Colombia
| | - Britta S von Ungern-Sternberg
- Medical School, The University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Telethon Kid's Institute, Perth, WA, Australia
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20
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Loughnan A, Deng C, Dominick F, Pencheva L, Campbell D. A single-centre, randomised controlled feasibility pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients. Pilot Feasibility Stud 2019; 5:50. [PMID: 30976455 PMCID: PMC6437851 DOI: 10.1186/s40814-019-0433-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/13/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Most trials comparing effectiveness of laryngoscopy technique use surrogate endpoints. Intubation success is a more appropriate endpoint for comparing effectiveness of techniques or devices. A large pragmatic clinical trial powered for intubation success has not yet been performed. Methods We tested the feasibility of a randomised controlled trial to compare the performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation. The trial was conducted in the Department of Adult and Emergency Anaesthesia at the Auckland City Hospital, New Zealand. Patients over 18 years who required endotracheal intubation and were not known or predicted to be difficult to bag-mask ventilate were eligible for the study. Patients were excluded if they required rapid sequence induction, fibreoptic intubation or were unable to consent due to language barriers or cognitive impairment. Patients were permuted block randomised in groups of 8 to either direct laryngoscopy (DL) or videolaryngoscopy (VL) for the technique of endotracheal intubation. Patients were blinded to laryngoscopic technique; the duty anaesthetist, outcome assessors and statistician were unblinded. Feasibility was assessed on recruitment rate, adherence to group assignment and data completeness. Primary outcome was first-pass success rate, with secondary outcomes of time to intubation (seconds), Intubation Difficulty Score and complication rate. Results One hundred and six patients were randomised and 100 patient results were analysed. Completed data from patients randomised to the DL group (n = 49) was compared with those in the VL group (n = 51). Group adherence and data completeness were 100% and 97%, respectively. First-pass success rate was 83.7% in the direct laryngoscopy group and 72.5% in the videolaryngoscopy group (p = 0.18). Median time to intubation was significantly shorter for direct laryngoscopy when compared to videolaryngoscopy (34 s v 43 s, p = 0.038). Complications included mucosal trauma and airway bleeding which are recognised complications of endotracheal intubation. Conclusion A large, pragmatic, multicentre, randomised controlled trial comparing the relative effectiveness of direct laryngoscopy and indirect videolaryngoscopy is feasible. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12615001267549
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Affiliation(s)
- Alice Loughnan
- 1Anaesthetic Department, Kings College Hospital, Ground floor Cheyne Wing, Denmark Hill, Brixton, London, SE5 9RS UK
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21
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The MacGyver bias and attraction of homemade devices in healthcare. Can J Anaesth 2019; 66:757-761. [DOI: 10.1007/s12630-019-01361-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022] Open
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22
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What should we expect in anaesthesia, critical care and pre-hospital care from extra glottic airways? Proven clinical performance for a variety of indications and patients. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Charlesworth M, van Zundert AAJ. Medical device regulation: the need for clinical vigilance and oversight. Anaesthesia 2019; 74:693-695. [PMID: 30793284 DOI: 10.1111/anae.14603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 12/27/2022]
Affiliation(s)
- M Charlesworth
- Department of Cardiothoracic Anaesthesia, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - A A J van Zundert
- Discipline of Anaesthesiology, Royal Brisbane and Women's Hospital, Department of Anaesthesia and Peri-operative Medicine, The University of Queensland, Brisbane, QLD, Australia
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24
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Ahmad I, Onwochei DN, Muldoon S, Keane O, El-Boghdadly K. Airway management research: a systematic review. Anaesthesia 2018; 74:225-236. [DOI: 10.1111/anae.14471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/22/2022]
Affiliation(s)
- I. Ahmad
- Guy's & St Thomas’ NHS Foundation Trust; London UK
- King's College London; UK
| | | | - S. Muldoon
- Department of Anaesthesia; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - O. Keane
- Department of Anaesthesia; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - K. El-Boghdadly
- Guy's & St Thomas’ NHS Foundation Trust; London UK
- King's College London; UK
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25
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Booth AWG, Wyssusek KH, Lee PK, Pelecanos AM, Sturgess D, van Zundert AAJ. Evaluation of the D-FLECT® deflectable-tip bougie in a manikin with a simulated difficult airway. Br J Anaesth 2018; 121:1180-1182. [PMID: 30336865 DOI: 10.1016/j.bja.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022] Open
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26
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Charco-Mora P, Urtubia R, Reviriego-Agudo L. The Vortex model: A different approach to the difficult airway. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:385-393. [PMID: 30037388 DOI: 10.1016/j.redar.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 06/08/2023]
Abstract
Airway management is an essential area in anaesthesia, and anaesthesiologists are considered the most expert professionals to manage airway tasks. However, complications related to inadequate airway management remain the most frequent cause of morbidity and mortality. Algorithmic strategy to solve difficulties fails, due to several factors related to its structure and clinical application. The Vortex Approach has emerged as a response to the limitations found in the algorithmic strategy of managing the difficult airway, by using a cognitive aid strategy to reduce cognitive load and fixation error. This new strategy may represent a solution to the elusive problem of the challenging airway and reduce the complications rate.
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Affiliation(s)
- P Charco-Mora
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España; Vicepresidente de la Sección de Vía Aérea de la SEDAR.
| | - R Urtubia
- Servicio de Anestesiología, Clínica Vespucio, Santiago de Chile, Chile
| | - L Reviriego-Agudo
- Servicio de Anestesiología y Cuidados Críticos, Airway Management Teaching Center (FIDIVA), Universidad de Valencia, Hospital Clínico Universitario de Valencia, Valencia, España
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27
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Reviriego-Agudo L, de Togores-Lopez AR, Charco-Mora P. The significance and weight of manikin studies in airway management. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Yeow C, Greaney L, Foy C, King W, Patel B. Evaluation of a novel cricothyroidotomy introducer in a simulated obese porcine model: a randomised crossover comparison with scalpel cricothyroidotomy. Anaesthesia 2018; 73:1235-1243. [DOI: 10.1111/anae.14321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- C. Yeow
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
| | - L. Greaney
- Department of Oral and Maxillofacial Surgery Royal Surrey County Hospital Guildford UK
| | - C. Foy
- Gloucestershire Research Support Service Gloucestershire Royal Hospital Gloucester UK
| | - W. King
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
| | - B. Patel
- Department of Anaesthesia Royal Surrey County Hospital Guildford UK
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Pandit JJ, Irwin MG. Airway management in critical illness: practice implications of new Difficult Airway Society guidelines. Anaesthesia 2018; 73:544-548. [PMID: 29577242 DOI: 10.1111/anae.14270] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong and Queen Mary Hospital, Hong Kong, HKSAR
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Sneyd J, O'Sullivan E. Modified supraglottic airway for gastroscopy: an advance in patient safety? Br J Anaesth 2018; 120:209-211. [DOI: 10.1016/j.bja.2017.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 01/27/2023] Open
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33
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Cook T, Boniface N, Seller C, Hughes J, Damen C, MacDonald L, Kelly F. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br J Anaesth 2018; 120:173-180. [DOI: 10.1016/j.bja.2017.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
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McNarry A, Patel A. The evolution of airway management – new concepts and conflicts with traditional practice. Br J Anaesth 2017; 119:i154-i166. [DOI: 10.1093/bja/aex385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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García-Aroca MÁ, Pandiella-Dominique A, Navarro-Suay R, Alonso-Arroyo A, Granda-Orive JI, Anguita-Rodríguez F, López-García A. In Response. Anesth Analg 2017; 125:2169-2170. [PMID: 28991123 DOI: 10.1213/ane.0000000000002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Miguel Ángel García-Aroca
- Central University Hospital of Defence "Gómez Ulla", Madrid, Spain, Department of Anesthesiology and Reanimation, Alcalá de Henares University, Madrid, Spain, Research Institute on Higher Education and Science (INAECU) UC3M-UAM, Madrid, Spain Central University Hospital of Defence "Gómez Ulla", Madrid, Spain, Department of Anesthesiology and Reanimation, Alcalá de Henares University, Madrid, Spain, Joint Institute for Biomedical Research of Defence (IMIDEF), Madrid, Spain Department of History of Science and Documentation, University of Valencia, Valencia, Spain University Hospital "12 de Octubre", Madrid, Spain, Department of Respiratory Medicine, Complutense University, Madrid, Spain Historical Sample of the Netherlands, Internationaal Instituut boot Sociale Geschiedenis, Amsterdam, the Netherlands Department of Anesthesiology and Reanimation, University Hospital "Madrid Montepríncipe", Madrid, Spain
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Van Zundert A, Gatt S, Kumar C, van Zundert T, Pandit J. Reply to Tobin and colleagues. Br J Anaesth 2017; 119:844. [DOI: 10.1093/bja/aex311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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38
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Sharma B, Sahai C, Sood J. Extraglottic airway devices: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:189-205. [PMID: 28860875 PMCID: PMC5566319 DOI: 10.2147/mder.s110186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Extraglottic airway devices (EADs) have revolutionized the field of airway management. The invention of the laryngeal mask airway was a game changer, and since then, there have been several innovations to improve the EADs in design, functionality, safety and construction material. These have ranged from changes in the shape of the mask, number of cuffs and material used, like rubber, polyvinylchloride and latex. Phthalates, which were added to the construction material in order to increase device flexibility, were later omitted when this chemical was found to have serious adverse reproductive outcomes. The various designs brought out by numerous companies manufacturing EADs resulted in the addition of several devices to the airway market. These airway devices were put to use, many of them with inadequate or no evidence base regarding their efficacy and safety. To reduce the possibility of compromising the safety of the patient, the Difficult Airway Society (DAS) formed the Airway Device Evaluation Project Team (ADEPT) to strengthen the evidence base for airway equipment and vet the new extraglottic devices. A preuse careful analysis of the design and structure may help in better understanding of the functionality of a particular device. In the meantime, the search for the ideal EAD continues.
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Affiliation(s)
- Bimla Sharma
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Sahai
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayashree Sood
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Nørskov AK, Rosenstock CV, Leahy J, Walsh C. Closing in on the best supraglottic airway for paediatric anaesthesia? Anaesthesia 2017; 72:1167-1170. [PMID: 28737211 DOI: 10.1111/anae.13985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A K Nørskov
- Department of Anaesthesiology and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark
| | - C V Rosenstock
- Department of Anaesthesiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - J Leahy
- Trinity College, Dublin, Ireland
| | - C Walsh
- Health Research Institute and MACSI, University of Limerick, Limerick, Ireland
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40
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Cook T, Kelly F. A national survey of videolaryngoscopy in the United Kingdom. Br J Anaesth 2017; 118:593-600. [DOI: 10.1093/bja/aex052] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 01/28/2023] Open
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41
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Sng BL, Ithnin FB, Mathur D, Lew E, Han NLR, Sia ATH. A preliminary assessment of the LMA protector™ in non-paralysed patients. BMC Anesthesiol 2017; 17:26. [PMID: 28219323 PMCID: PMC5319052 DOI: 10.1186/s12871-017-0323-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The LMA Protector™ is the latest CE marked single use supraglottic airway device. This airway device provides access and functional separation of the respiratory and digestive tracts. There are two ports (male, female ports) to provide suction in the laryngeal region and insertion of the gastric tube. The aim of our study is to assess the ease of use, airway quality, device positioning, airway leak and complications associated with initial clinical experience in LMA Protector™ usage. METHODS This is an initial investigation of LMA Protector™ airway device. We conducted a preliminary assessment in the anaesthetised women who underwent minor gynaecological procedures with spontaneous ventilation in order to evaluate the performance of the airway device. RESULTS Insertion was successful on first and second attempts in 23 (88.5%) and 3 (11.5%) respectively. Median [IQR (range)] insertion time was 19 [17-21(14-58)] seconds. Airway leak pressure was 25.5 [23-29(21-30] cmH2O. On fibreoptic examination via the device, vocal cords were visible in all 26 patients. There were no alternative airway use or airway manipulations required during maintenance of anaesthesia. Six patients had sore throat 24 h after procedures and there was no dysphagia or hoarseness. CONCLUSION This pilot study of the LMA protector shows that the device is easily inserted with fast insertion time, providing a reliable and adequate airway seal. TRIAL REGISTRATION Clinicaltrials.gov Registration NCT02531256 . Retrospectively registered on August 21, 2015.
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Affiliation(s)
- Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, Singapore.
| | - Farida Binte Ithnin
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Deepak Mathur
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Eileen Lew
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Nian-Lin Reena Han
- Division of Clinical Support Services, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Alex Tiong-Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, Singapore
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Parikh DA, Jain RA, Lele SS, Tendolkar BA. A cohort evaluation of clinical use and performance characteristics of Ambu ® AuraGain™: A prospective observational study. Indian J Anaesth 2017; 61:636-642. [PMID: 28890558 PMCID: PMC5579853 DOI: 10.4103/ija.ija_285_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIMS Ambu® AuraGain™ (AG) (Ambu, Ballerup, Denmark) is a supraglottic device which has a design facilitating its use as a conduit for intubation. We designed this prospective observational study to assess the ease of AG placement in paralysed patients, determine its position and alignment to the glottis and assess its utility as a conduit for intubation. METHODS One hundred patients, aged 18-60 years, American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia were included in the study. The ease and number of attempts for successful insertion, ease of gastric tube insertion, leak pressures, fibre-optic grade of view, number of attempts and time for tracheal intubation, time for AG removal and complications were recorded. The mean, standard deviation (SD), interquartile range (IQR) and range were calculated. The upper limit of confidence interval for overall failure rate was calculated using Wilson's score method. RESULTS AG was successfully inserted in all patients. The mean (SD) time taken for insertion was 17.32 (8.48) s. The median [IQR] leak pressures were 24 [20-28] cm of H2O. Optimal laryngeal view for intubation was obtained in 68 patients. Eighty-eight patients could be intubated in the first attempt. Five patients could not be intubated. The overall failure rate of device was 9%. CONCLUSION AMBU® AuraGain™ serves as an effective ventilating aid, but caution is suggested before using it as a conduit for endotracheal intubation.
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Affiliation(s)
- Devangi A Parikh
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Ruchi A Jain
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Smita S Lele
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Bharati A Tendolkar
- Department of Anaesthesiology, Lokmanya Tilak Municipal General Hospital, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Sturgess DJ, Greenland KB, Senthuran S, Ajvadi FA, van Zundert A, Irwin MG. Tracheal extubation of the adult intensive care patient with a predicted difficult airway - a narrative review. Anaesthesia 2016; 72:248-261. [PMID: 27804108 DOI: 10.1111/anae.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 12/17/2022]
Abstract
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment. The findings in the section on Intensive Care and Emergency Medicine reinforce the importance of good airway management in the critical care environment and, in particular, the need for appropriate guidelines to improve patient safety. This narrative review focuses on strategies for safe extubation of the trachea for patients with potentially difficult upper airway problems in the intensive care unit.
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Affiliation(s)
- D J Sturgess
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - K B Greenland
- Department of Anaesthesiology, University of Hong Kong, Hong Kong SAR
| | - S Senthuran
- School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - F A Ajvadi
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - A van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong, Hong Kong SAR
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Kleine-Brueggeney M. Airway management in a changing environment: The impact of advances in technology on standard procedures and training. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Ward PA, Irwin MG. Man vs. manikin revisited - the ethical boundaries of simulating difficult airways in patients. Anaesthesia 2016; 71:1399-1403. [DOI: 10.1111/anae.13526] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. A. Ward
- Department of Anaesthesiology; University of Hong Kong; Hong Kong Special Administrative Region
| | - M. G. Irwin
- Department of Anaesthesiology; University of Hong Kong; Hong Kong Special Administrative Region
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Grundy Q. “Whether something cool is good enough”: The role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions. Soc Sci Med 2016; 165:82-91. [DOI: 10.1016/j.socscimed.2016.07.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 07/21/2016] [Accepted: 07/29/2016] [Indexed: 11/27/2022]
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48
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Van Zundert AAJ, Gatt SP, Mahajan RP. Continuing to excel in anaesthesia through the 'big five': teaching, training, testing, quality, and research. Br J Anaesth 2016; 117:276-9. [PMID: 27543520 DOI: 10.1093/bja/aew263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A A J Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital - The University of Queensland, Butterfield Street, Herston, Brisbane, QLD 4029, Australia
| | - S P Gatt
- Department of Anaesthesia, Prince of Wales Hospital, University of NSW, Sydney, NSW, Australia
| | - R P Mahajan
- Department of Anaesthesia and Intensive Care, University of Nottingham, Nottingham, UK
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Chrisman L, King W, Wimble K, Cartwright S, Mohammed K, Patel B. Surgicric 2: A comparative bench study with two established emergency cricothyroidotomy techniques in a porcine model. Br J Anaesth 2016; 117:236-42. [DOI: 10.1093/bja/aew174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 12/13/2022] Open
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50
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Mushambi MC, Ali P, Dyson L, Malik D. A national survey of tracheal tube introducers and associated complications. Anaesthesia 2016; 71:853-4. [PMID: 27291608 DOI: 10.1111/anae.13509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M C Mushambi
- University Hospitals of Leicester, Leicester, UK.
| | - P Ali
- University Hospitals of Leicester, Leicester, UK
| | - L Dyson
- University Hospitals of Leicester, Leicester, UK
| | - D Malik
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
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