1
|
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.
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 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
| |
Collapse
|
2
|
Ratajczyk P, Dolder P, Szmyd B, Gomez-Rios MA, Hogendorf P, Durczyński A, Gaszyński T. Comparison of UESCOPE VL 400, I-View, Non-Channeled Airtraq Videolaryngoscopes and Macintosh Laryngoscope for Tracheal Intubation in Simulated Out-of-Hospital Conditions: A Randomized Crossover Manikin Study. Healthcare (Basel) 2024; 12:452. [PMID: 38391827 PMCID: PMC10887893 DOI: 10.3390/healthcare12040452] [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: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the study was to test the hypothesis that the results obtained with three different types of video laryngoscopes (UESCOPE VL-400, I-View, Non-Channeled Aitraq) with and without an endotracheal stylet should be better than the results obtained with a Macintosh laryngoscope in a simulated out-of-hospital scenario by a person without clinical experience. Primary outcome measures were the time taken to successfully achieve tracheal intubation (TI). Secondary outcomes included the grade of glottic view (Cormack and Lehane grades 1-4), the incidence of successful TI, the number of audible dental clicks indicating potential dental damage, the level of effort required to perform TI, and the operator's comfort during the procedure. The time required to achieve tracheal intubation successfully was significantly longer with the Macintosh laryngoscope and Airtraq than with the other video laryngoscopes. The use of the stylet significantly reduced the time required for tracheal intubation with the Macintosh laryngoscope (21.8 sec. vs. 24.0 sec., p = 0.026), UESCOPE VL 400 (18.1 sec. vs. 23.4 sec., p = 0.013), and Airtraq (22.7 sec. vs. 34.5 sec., p < 0.001). There were no significant differences in intubation time when using the I-View with or without stylets. No differences were observed in the Cormack-Lehane grading. The success rate of intubation was 100% for the Macintosh and I-View laryngoscopes used with or without stylets and for the UESCOPE VL 400 and Airtraq laryngoscopes used with stylets. Without stylets, the success rate of intubation was 96.6% for the UESCOPE VL 400 and 86.6% for the Airtraq. There were no significant differences in the risk of dental damage between the Macintosh, UESCOPE VL 400, I-View, and Airtraq laryngoscopes, regardless of the use of stylets (without and with stylets). The use of stylets significantly reduced dental damage only for the Airtraq laryngoscope: 8 (26.6%) vs. 2 (6.6%). Statistically significant differences in perceived exertion were observed between the mentioned laryngoscopes, both with and without stylets. However, there were no differences in the comfort of use between the laryngoscopes, regardless of the use of stylets (without and with stylets. The use of stylets led to better comfort in the case of the Macintosh (2.5 vs. 3, p = 0.043) and UESCOPE VL 400 (2 vs. 3, p = 0.008) laryngoscopes. In our study, the I-View and UESCOPE VL-400 video laryngoscopes provided better intubation results than the Macintosh laryngoscope in terms of time needed to intubate, glottis visibility, and reduction in dental damage. The use of the stylet did not significantly improve the intubation results compared to the results obtained in direct laryngoscopy. Due to the small study group and the manikin model, additional studies should be performed on a larger study group.
Collapse
Affiliation(s)
- Paweł Ratajczyk
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Przemyslaw Dolder
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Bartosz Szmyd
- Department of Neurosurgery and Neuro-Oncology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Manuel A Gomez-Rios
- Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
- Anesthesiology, Perioperative Medicine and Pain Management Research Group, 15006 A Coruña, Spain
- Spanish Difficult Airway Group (GEVAD), 15006 A Coruña, Spain
| | - Piotr Hogendorf
- Department of General and Transplant Surgery, Medical University of Lodz, 90-419 Lodz, Poland
| | - Adam Durczyński
- Department of General and Transplant Surgery, Medical University of Lodz, 90-419 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, 90-419 Lodz, Poland
| |
Collapse
|
3
|
Ming Y, Chu S, Yang K, Zhang Z, Wu Z. Network meta-analysis of comparative efficacy and safety of intubation devices in children. Sci Rep 2023; 13:18626. [PMID: 37903873 PMCID: PMC10616294 DOI: 10.1038/s41598-023-45173-5] [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: 01/05/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
To evaluate the comparative efficacy and safety of different intubation devices on intubation outcomes in pediatric intubation. We identified relevant studies from previous meta-analyses and literature retrieval in PubMed, EMBASE, and Cochrane Library. The primary outcome was the first-pass success (FPS), and the secondary outcome included the time to intubation (TTI) and the risk of local complications (LC). Network meta-analysis was performed using STATA 14.0. Twenty-three randomized comparative trials (RCTs) including 12 devices were included. Compared with Macintosh, Airtraq (odds ratio [OR] = 13.05, 95% confidence interval [CI] = 4.68 to 36.38), Miller (OR = 4.77, 95%CI = 1.32 to 17.22), Glidescope (OR = 2.76, 95%CrI = 1.60 to 4.75) and McGrath (OR = 4.61, 95%CI = 1.18 to 17.99) obtained higher PFS. Meanwhile, Airtraq was superior to Glidescope (OR = 0.21, 95%CI = 0.07 to 0.65) for PFS. For TTI, Canada was superior to other intubation devices, as well as CMAC was superior to TruViewEVO2, Glidescope, and StorzDCI. Airtraq lowered the risk of LC compared with Macintosh and Pentax but there was no statistical difference between Airtraq and KingVision. Airtraq may be the optimal option for FPS, Canada for TTI, and KingVision for LC in pediatric intubation.
Collapse
Affiliation(s)
- Yu Ming
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, 430023, Hubei, China
| | - Shujuan Chu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kai Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zhouyang Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
4
|
Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Pers Med 2022; 12:jpm12030363. [PMID: 35330362 PMCID: PMC8954588 DOI: 10.3390/jpm12030363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/12/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The efficacy and safety of videolaryngoscopes (VLs) for tracheal intubation is still conflicting and changeable according to airway circumstances. This study aimed to compare the efficacy and safety of several VLs in patients undergoing general anesthesia. Methods: Medline, EMBASE, and the Cochrane Library were searched until 13 January 2020. The following VLs were evaluated compared to the Macintosh laryngoscope (MCL) by network meta-analysis for randomized controlled trials (RCTs): Airtraq, Airwayscope, C-MAC, C-MAC D-blade (CMD), GlideScope, King Vision, and McGrath. Outcome measures were the success and time (speed) of intubation, glottic view, and sore throat (safety). Results: A total of 9315 patients in 96 RCTs were included. The highest-ranked VLs for first-pass intubation success were CMD (90.6 % in all airway; 92.7% in difficult airway) and King Vision (92% in normal airway). In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view). These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence.
Collapse
|
5
|
Ozkan AS, Akbas S, Karaaslan E, Polat N. Comparison of the effects of the McGRATH MAC, C-MAC, and Macintosh laryngoscopes on the intraocular pressures of non-ophthalmic patients: A prospective, randomised, clinical trial. Anaesth Crit Care Pain Med 2021; 40:100974. [PMID: 34740845 DOI: 10.1016/j.accpm.2021.100974] [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: 06/09/2021] [Revised: 08/01/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In this prospective, randomised study, we compared the effects of the Macintosh, McGRATH MAC, and C-MAC laryngoscopes on intraocular pressure (IOP) and haemodynamics of non-ophthalmic patients during endotracheal intubation. METHODS One hundred and twenty adult patients undergoing non-ophthalmic surgeries performed in the supine position under general anaesthesia requiring orotracheal intubation were included in this study. The patients were separated randomly and prospectively into 3 groups: Macintosh group (n = 40), McGRATH MAC group (n = 40), and C-MAC group (n = 40). Mean arterial pressure (MAP), heart rate (HR) and IOP of left and right eye were measured at specified times. RESULTS There were no significant differences with regard to patients characteristics. After intubation, the HR increased significantly in the Macintosh group when compared to the other groups (p = 0.001) and the MAP increased significantly in the Macintosh group when compared to the McGRATH MAC group (p = 0.001) and the C-MAC group (p < 0.001). The IOP values increased in the Macintosh group when compared to the McGRATH MAC group (p < 0.001) and the C-MAC group (p < 0.001) after intubation. Additionally, there was a significant difference between the McGRATH MAC group and C-MAC group in the IOP values of the eyes after intubation (p < 0.001). According to the evaluation within the groups, there were significant differences in all of the groups at all times when compared with the baseline values (p < 0.001). CONCLUSIONS In this study, we concluded that the C-MAC VL may be preferable when compared to the Macintosh and McGRATH MAC laryngoscopes for use in ophthalmic patients in whom a rise in the IOP is undesirable.
Collapse
Affiliation(s)
- Ahmet Selim Ozkan
- Department of Anaesthesiology and Reanimation, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
| | - Erol Karaaslan
- Department of Anaesthesiology and Reanimation, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Nihat Polat
- Department of Opthalmology, Inonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
6
|
Downey AW, Duggan LV, Adam Law J. A systematic review of meta-analyses comparing direct laryngoscopy with videolaryngoscopy. Can J Anaesth 2021; 68:706-714. [PMID: 33512660 PMCID: PMC7845281 DOI: 10.1007/s12630-021-01921-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE In the preceding 20 years, many randomized-controlled trials and meta-analyses have compared direct Macintosh laryngoscopy with videolaryngoscopy. The videolaryngoscope blades have included both traditional Macintosh blades and hyperangulated blades. Macintosh and hyperangulated blades differ in their geometry and technique for tracheal intubation; certain patient populations may benefit from one blade type over another. The primary objective of this systematic review was to assess whether published meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy have accounted for the videolaryngoscope blade type. Secondary objectives evaluated heterogeneity among practitioner experience and specialty, clinical context, patient population, and original primary study outcomes. SOURCE A search was performed across Ovid Medline, Ovid Embase, ClinicalKey, PubMed, TRIP, AccessAnesthesiology, Google Scholar, and ANZCA discovery. A systematic review identified meta-analyses which compared direct Macintosh laryngoscopy to videolaryngoscopy. There were no patient age or clinical specialty restrictions. Exclusion criteria included non-English language, studies comparing non-Macintosh blade to videolaryngoscopy, and studies in awake patients. PRINCIPAL FINDINGS Twenty-one meta-analyses were identified that were published between 1 January 2000 and 7 May 2020. Macintosh and hyperangulated videolaryngoscope blades were combined in most studies (16/21; 76%). Heterogeneity was also present among practitioner experience (20/21; 95%), clinician specialty (15/21; 71%), and clinical locations (10/21; 48%). Adult and pediatric patients were combined or not defined in 5/21 studies (24%). The primary outcomes of the meta-analyses varied, with the most common (7/21; 33%) being first-pass tracheal intubation success. CONCLUSIONS Heterogeneity across important clinical variables is common in meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy. To better inform patient care, future videolaryngoscopy research should differentiate blade type, clinical context, and patient-related primary outcomes.
Collapse
Affiliation(s)
- Andrew W Downey
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia.
| | - Laura V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - J Adam Law
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
7
|
Davies M, Hodzovic I. Videolaryngoscopy post COVID-19. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 36:49-51. [PMID: 38620283 PMCID: PMC7513920 DOI: 10.1016/j.tacc.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Iljaz Hodzovic
- Intensive Care and Pain Medicine, Centre for Medical Education, Cardiff University, Aneurin Bevan University Health Board, UK
| |
Collapse
|
8
|
Gupta A, Sharma R, Gupta N. Evolution of videolaryngoscopy in pediatric population. J Anaesthesiol Clin Pharmacol 2021; 37:14-27. [PMID: 34103817 PMCID: PMC8174446 DOI: 10.4103/joacp.joacp_7_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
Direct laryngoscopy has remained the sole method for securing airway ever since the inception of endotracheal intubation. The recent introduction of video-laryngoscopes has brought a paradigm shift in the pratice of airway management. It is claimed that they improve the glottic view and first pass success rates in adult population. The airway management in children is more challenging than adults. The role of videolaryngoscopy for routine intubation in children is not clearly proven. This review attempts to discuss various videolaryngosocpes available for use in pediatric patients.
Collapse
Affiliation(s)
- Anju Gupta
- Department of Anaesthesia, Pain Medicine and Criticial Care, All India Institute of Medical Sciences, Delhi, India
| | - Ridhima Sharma
- Department of Anesthesiology, SPHPGTI, Noida, Uttar Pradesh, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Care, DRBRAIRCH, AIIMS, Delhi, India
| |
Collapse
|
9
|
Hofmeyr R, Elhouni A. Endoscopic airway equipment part 1: physical principles. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s3.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of advanced endoscopic airway equipment has become increasingly important to the provision of safe anaesthesia for patients with complex anatomical and pathological conditions. Fundamental to the correct selection and use of the equipment is an understanding of the physical properties underlying its construction and function. This relies primarily on conventional optics, fibreoptics, video sensors and light-emitting diode technology.
Collapse
|
10
|
Soltani AE, Maleki A, Espahbodi E, Goudarzi M, Ariana P, Takzare A. Comparison of the Laryngoscopic View using Macintosh and Miller Blades in Children Less than Four Years Old. J Med Life 2020; 13:431-434. [PMID: 33072220 PMCID: PMC7550157 DOI: 10.25122/jml-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study aimed to compare Miller and Macintosh laryngoscopes in zero to 4-year-old children. A total of 72 children with a score of I and II, according to the American Society of Anesthesiologists (ASA) physical status classification, who were candidates for elective surgery with general anesthesia and tracheal intubation were enrolled in the study. The children were divided into two equal groups (36 persons) according to used laryngoscope: Miller laryngoscope (group 1) and Macintosh laryngoscope (group 2). Observations and all laryngoscopies were performed by a single experienced anesthesiologist. Heart rate, systolic blood pressure, non-invasive arterial blood pressure, and hemoglobin saturation were measured and recorded. The number of endotracheal intubation attempts and complications were also recorded for both groups. In terms of gender, the first group consisted of 88.9% boys and 11.1% girls, and the second group consisted of 66.6% boys and 33.3% girls (p-value=0.05). The mean age was 16.7 months in the first group and 17.7 months in the second group (p-value=0.5). The mean weight of the children was 16988.5 g and 16300 g in the Miller and Macintosh groups, respectively (p-value=0.9). Regarding the Cormack-Lehane classification system, 5 patients were classified as grade 1 (13.9%), 14 patients as grade 2 (38.9%), 15 patients as grade 3 (41.7%), and 2 patients as grade 4 (5.6%) in the Macintosh group. In contrast, in the Miller group, 5 patients were classified as grade 1 (13.9%), 27 patients as grade 2 (75%), and 4 patients as grade 3 (11.1%) (p-value=0.004). These results can provide more data about the tracheal intubation method with the Macintosh and Miller laryngoscopes, the ease of intubation, and the best laryngoscopic view with each blade.
Collapse
Affiliation(s)
- Alireza Ebrahim Soltani
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahid Maleki
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Espahbodi
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Goudarzi
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Parastou Ariana
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Takzare
- Anaesthesiology Department, Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
11
|
|
12
|
Martin M, Decamps P, Seguin A, Garret C, Crosby L, Zambon O, Miailhe AF, Canet E, Reignier J, Lascarrou JB. Nationwide survey on training and device utilization during tracheal intubation in French intensive care units. Ann Intensive Care 2020; 10:2. [PMID: 31900637 PMCID: PMC6942097 DOI: 10.1186/s13613-019-0621-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background Intubation is a lifesaving procedure that is often performed in intensive care unit (ICU) patients, but leads to serious adverse events in 20–40% of cases. Recent trials aimed to provide guidance about which medications, devices, and modalities maximize patient safety. Videolaryngoscopes are being offered in an increasing range of options and used in broadening indications (from difficult to unremarkable intubation). The objective of this study was to describe intubation practices and device availability in French ICUs. Materials and methods We conducted an online nationwide survey by emailing an anonymous 26-item questionnaire to physicians in French ICUs. A single questionnaire was sent to either the head or the intubation expert at each ICU. Results Of 257 ICUs, 180 (70%) returned the completed questionnaire. The results showed that 43% of intubators were not fully proficient in intubation; among them, 18.8% had no intubation training or had received only basic training (lectures and observation at the bedside). Among the participating ICUs, 94.4% had a difficult intubation trolley, 74.5% an intubation protocol, 92.2% a capnography device (used routinely to check tube position in 69.3% of ICUs having the device), 91.6% a laryngeal mask, 97.2% front-of-neck access capabilities, and 76.6% a videolaryngoscope. In case of difficult intubation, 85.6% of ICUs used a bougie (154/180) and 7.8% switched to a videolaryngoscope (14/180). Use of a videolaryngoscope was reserved for difficult intubation in 84% of ICUs (154/180). Having a videolaryngoscope was significantly associated with having an intubation protocol (P = 0.043) and using capnography (P = 0.02). Airtraq® was the most often used videolaryngoscope (39.3%), followed by McGrath®Mac (36.9%) then by Glidescope® (14.5%). Conclusion Nearly half the intubators in French ICUs are not fully proficient with OTI. Access to modern training methods such as simulation is inadequate. Most ICUs own a videolaryngoscope, but reserve it for difficult intubations.
Collapse
Affiliation(s)
- M Martin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - P Decamps
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - A Seguin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - C Garret
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - L Crosby
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - O Zambon
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - A F Miailhe
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - E Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - J Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France
| | - J B Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, 44093, Nantes Cedex 9, France.
| | | |
Collapse
|
13
|
Varsha AV, George G, Pillai R, Sahajanandan R. Comparative evaluation of hemodynamic responses and ease of intubation with airtraq video laryngoscope versus macintosh laryngoscope in patients with ischemic heart disease. Ann Card Anaesth 2019; 22:365-371. [PMID: 31621670 PMCID: PMC6813704 DOI: 10.4103/aca.aca_120_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: Hemodynamic responses during laryngoscopy can potentially precipitate ischemia in patients with coronary artery disease. There are conflicting reports regarding the hemodynamic stress responses between the conventional Macintosh and video laryngoscopes. There is a paucity of studies regarding the same in cardiac surgical patients. Materials and Methods: A prospective, randomized control study to compare the hemodynamic responses and ease of intubation using Airtraq video laryngoscope and Macintosh laryngoscope in patients with ischemic heart disease. Results: Seventy patients were randomized into two groups. Baseline variables including age, weight, Mallampati score, and comorbidities were comparable between the two groups. There was statistically significant elevation in mean heart rate in the Macintosh group at 2nd-min (P = 0.02) and 3rd-min (P = 0.05) postintubation. Similarly, there was a significant increase in mean arterial pressure at 2nd (P = 0.06), 3rd (P = 0.03), and 4th (P = 0.03) in the Macintosh group. The time for laryngoscopy and Intubation Difficulty Scale was significantly better in the Airtraq group (P = 0.001 and 0.001). However, the median time to intubation was longer in the Airtraq group (13 s vs. 11 s, P = 0.05). Laryngoscopy view was better with Airtraq even in patients with Mallampati score 3 (ten patients). The incidence of trauma was same in both the groups. Conclusion: Airtraq provides the better hemodynamic stability and ease of intubation and may be considered superior to conventional Macintosh laryngoscope for intubation in patients with ischemic heart disease.
Collapse
Affiliation(s)
- A V Varsha
- Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Gladdy George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rahul Pillai
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Raj Sahajanandan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
14
|
Comparing Four Video Laryngoscopes and One Optical Laryngoscope with a Standard Macintosh Blade in a Simulated Trapped Car Accident Victim. Emerg Med Int 2019; 2019:9690839. [PMID: 31662911 PMCID: PMC6791209 DOI: 10.1155/2019/9690839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background Tracheal intubation still represents the “gold standard” in securing the airway of unconscious patients in the prehospital setting. Especially in cases of restricted access to the patient, video laryngoscopy became more and more relevant. Objectives The aim of the study was to evaluate the performance and intubation success of four different video laryngoscopes, one optical laryngoscope, and a Macintosh blade while intubating from two different positions in a mannequin trial with difficult access to the patient. Methods A mannequin with a cervical collar was placed on the driver's seat. Intubation was performed with six different laryngoscopes either through the driver's window or from the backseat. Success, C/L score, time to best view (TTBV), time to intubation (TTI), and number of attempts were measured. All participants were asked to rate their favored device. Results Forty-two physicians participated. 100% of all intubations performed from the backseat were successful. Intubation success through the driver's window was less successful. Only with the Airtraq® optical laryngoscope, 100% success was achieved. Best visualization (window C/L 2a; backseat C/L 2a) and shortest TTBV (window 4.7 s; backseat 4.1 s) were obtained when using the D-Blade video laryngoscope, but this was not associated with a higher success through the driver's window. Fastest TTI was achieved through the window (14.2 s) when using the C-MAC video laryngoscope and from the backseat (7.3 s) when using a Macintosh blade. Conclusions Video laryngoscopy revealed better results in visualization but was not associated with a higher success. Success depended on the approach and familiarity with the device. We believe that video laryngoscopy is suitable for securing airways in trapped accident victims. The decision for an optimal device is complicated and should be based upon experience and regular training with the device.
Collapse
|
15
|
Abdallah SI, Gaballah KM. Endotracheal Intubation Criteria and Stress Response: Airtraq versus Macintosh Laryngoscopes - A Prospective Randomized Controlled Trial. Anesth Essays Res 2019; 13:430-436. [PMID: 31602057 PMCID: PMC6775823 DOI: 10.4103/aer.aer_80_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Airtraq® is a single-use video laryngoscope used to facilitate tracheal intubation in both expected and unexpected difficult airways. Aims: We hypothesized that Airtraq laryngoscope would facilitate better intubation criteria and lower stress response to laryngoscopy in comparison to the Macintosh laryngoscope. Materials and Methods: In this randomized, single-blinded, prospective study, 70 adult patients were randomly assigned to be intubated with either Airtraq (Group AT) or Macintosh (Group M) laryngoscope (35 patients in each). The primary outcomes involved intubation time, first-attempt success rate, time to best laryngoscopic view, and percentage of glottic opening (POGO) score. Other recorded parameters involved the hemodynamic and intraocular pressure (IOP) responses to laryngoscopy and intubation and complications during and after laryngoscopy and after extubation. Serum samples were collected before anesthesia induction and 2 min after intubation and analyzed for epinephrine, cortisol, and glucose. Results: Group AT had significantly higher POGO score and significantly shorter intubation time and time to best laryngoscopic view than Group M (P < 0.001). The first-attempt success rate was 97.1% in Group AT and 94.3% in Group M (P = 0.55). Postoperatively, laryngospasm and sore throat were encountered in 2.9% of Group M patients compared to 0% in Group AT (P = 1.00). The heart rate, mean arterial pressure, IOP, serum epinephrine, and cortisol were significantly increased in Group M than Group AT. Conclusion: In comparison to the Macintosh laryngoscope, Airtraq conferred significantly better intubation criteria and lesser stress response to laryngoscopy and intubation.
Collapse
Affiliation(s)
- Sabry Ibrahim Abdallah
- Department of Anaesthesiology, Faculty of Medicine, Menoufia University, Al Minufiyah, Egypt
| | - Khaled Mohamed Gaballah
- Department of Anaesthesiology, Faculty of Medicine, Menoufia University, Al Minufiyah, Egypt
| |
Collapse
|
16
|
Iglesias González JL, Gómez-Ríos MA, Poveda Marina JL, Calvo-Vecino JM. Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:552-557. [PMID: 30177221 DOI: 10.1016/j.redar.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. METHODS 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. RESULTS The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. CONCLUSIONS Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy.
Collapse
Affiliation(s)
- J L Iglesias González
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - M A Gómez-Ríos
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, España; Grupo Español de Vía Aérea Difícil (GEVAD); Grupo de Investigación Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, España.
| | - J L Poveda Marina
- Departamento de Bioestadística, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J M Calvo-Vecino
- Departamento de Anestesiología y Medicina Perioperatoria, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| |
Collapse
|
17
|
Russell TM, Hormis A. Should the Glidescope video laryngoscope be used first line for all oral intubations or only in those with a difficult airway? A review of current literature. J Perioper Pract 2018; 28:322-333. [PMID: 30035689 DOI: 10.1177/1750458918788985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question 'Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?' A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.
Collapse
Affiliation(s)
| | - Anil Hormis
- 2 Consultant in Anaesthesia & Critical Medicine, Honorary Professor, Sheffield Hallam University
| | | |
Collapse
|
18
|
Hoshijima H, Maruyama K, Mihara T, Mieda T, Shiga T, Nagasaka H. Airtraq® reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials. J Clin Anesth 2018; 47:86-94. [PMID: 29635148 DOI: 10.1016/j.jclinane.2018.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope. DESIGN Meta-analysis. SETTING Operating room. MEASUREMENTS The primary outcome of this meta-analysis was to determine whether laryngoscopy using the Airtraq® reduced hemodynamic responses-heart rate (HR) and mean blood pressure (MBP)-at 60 s (s) after tracheal intubation compared to laryngoscopy with the Macintosh laryngoscope. Pooled differences in these hemodynamic responses between the two devices were expressed as weighted mean difference with 95% confidence intervals. We then conducted trial sequential analysis (TSA). The secondary outcome was to investigate whether the Airtraq® reduce the hemodynamic response at 120 s, 180 s, and 300 s after tracheal intubation compared to the Macintosh laryngoscope. We also conducted sensitivity analysis of the hemodynamic responses to tracheal intubation with the laryngoscopes using a multivariate random effects model accounting for within-study correlation of the longitudinal data. MAIN RESULTS From electronic databases, we selected 11 randomized controlled trials for studies that enrolled subjects satisfying our inclusion criteria. Compared with the Macintosh laryngoscope, the Airtraq® significantly reduced both HR and MBP at 60 s after tracheal intubation. In secondary outcome, the Airtraq® significantly reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. TSA showed that total sample size reached the required information size for both HR and MBP. The sensitivity analysis revealed that the Airtraq® reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. CONCLUSIONS The Airtraq® attenuates the hemodynamic response at 60 s after tracheal intubation compared with the Macintosh laryngoscope. (GRADE: Low) These results were supported by the sensitivity analysis. TSA suggested that the total sample size was exceeded TSA monitoring boundary both HR and MBP.
Collapse
Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| |
Collapse
|
19
|
Liao CC, Liu FC, Li AH, Yu HP. Video laryngoscopy-assisted tracheal intubation in airway management. Expert Rev Med Devices 2018; 15:265-275. [DOI: 10.1080/17434440.2018.1448267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Chia-Chih Liao
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Allen H. Li
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
20
|
Hoshijima H, Denawa Y, Tominaga A, Nakamura C, Shiga T, Nagasaka H. Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis. J Clin Anesth 2018; 44:69-75. [DOI: 10.1016/j.jclinane.2017.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/23/2017] [Accepted: 11/03/2017] [Indexed: 01/23/2023]
|
21
|
Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2017; 5:CD011413. [PMID: 28539007 PMCID: PMC6481531 DOI: 10.1002/14651858.cd011413.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. OBJECTIVES To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. SELECTION CRITERIA We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. DATA COLLECTION AND ANALYSIS We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. MAIN RESULTS We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that are awaiting classification and two ongoing studies.Trial results show that a longer intubation time was required when indirect laryngoscopy, or videolaryngoscopy, was used instead of direct laryngoscopy (12 trials; n = 798; mean difference (MD) 5.49 seconds, 95% confidence interval (CI) 1.37 to 9.60; I2 = 90%; very low-quality evidence). Researchers found no significant differences between direct and indirect laryngoscopy on assessment of success of the first attempt at intubation (11 trials; n = 749; risk ratio (RR) 0.96, 95% CI 0.91 to 1.02; I2 = 67%; low-quality evidence) and observed that unsuccessful intubation (five trials; n = 263) was significantly increased in the indirect laryngoscopy, or videolaryngoscopy, group (RR 4.93, 95% CI 1.33 to 18.31; I2 = 0%; low-quality evidence). Five studies reported the effect of intubation on oxygen saturation (n = 272; very low-quality evidence). Five children had desaturation during intubation: one from the direct laryngoscopy group and four from the indirect laryngoscopy, or videolaryngoscopy, group.Two studies (n = 100) reported other haemodynamic responses to intubation (very low-quality evidence). One study reported a significant increase in heart rate five minutes after intubation in the indirect laryngoscopy group (P = 0.007); the other study found that the heart rate change in the direct laryngoscopy group was significantly less than the heart rate change in the indirect laryngoscopy, or videolaryngoscopy, group (P < 0.001). A total of five studies (n = 244; very low-quality evidence) looked at evidence of trauma resulting from intubation. Investigators reported that only two children from the direct laryngoscopy group had trauma compared with no children in the indirect laryngoscopy, or videolaryngoscopy, group.Use of indirect laryngoscopy, or videolaryngoscopy, improved the percentage of glottic opening (five trials; n = 256). Studies noted no significant difference in Cormack and Lehane score (C&L) grade 1 (three trials; n = 190; RR 1.06, 95% CI 0.93 to 1.21; I2 = 59%). AUTHORS' CONCLUSIONS Evidence suggests that indirect laryngoscopy, or videolaryngoscopy, leads to prolonged intubation time with an increased rate of intubation failure when compared with direct laryngoscopy (very low-quality evidence due to imprecision, inconsistency, and study limitations). Review authors had difficulty reaching conclusions on adverse haemodynamic responses and other adverse effects of intubation, as only a few children were reported to have these outcomes. Use of indirect laryngoscopy, or videolaryngoscopy, might lead to improved vocal cord view, but marked heterogeneity between studies made it difficult for review authors to reach conclusions on this outcome.
Collapse
Affiliation(s)
| | - Robert S Phillips
- University of YorkCentre for Reviews and DisseminationYorkUKYO10 5DD
| | - Davinder Singh
- Leeds General InfirmaryPaediatric Intensive Care Unit L47Great George StLeedsUKLS1 3EX
| | | | - Joanne L Lumsden
- Leeds Teaching Hospitals TrustPaediatric Intensive Care Unit L47PICU Office, D Floor Clarendon Wing, Leeds General InfirmaryLeedsUKLS2 9NS
| | | |
Collapse
|
22
|
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
|
23
|
Watt S, Kalpan J, Kolli V. Case report of the use of videolaryngoscopy in thyroid goiter masses: An airway challenge. Int J Surg Case Rep 2016; 27:119-121. [PMID: 27598013 PMCID: PMC5013246 DOI: 10.1016/j.ijscr.2016.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/12/2016] [Accepted: 06/12/2016] [Indexed: 11/26/2022] Open
Abstract
Videolaryngoscopy is a valuable tool in management of a difficult airway. Goiters can involve both upper and lower airway obstruction. Thyroid masses can lead to difficulty in both ventilation and intubation.
Introduction The use of videolaryngoscopy continues to play a larger role in the approach to patients with airway pathology. Looking specifically at patients with potential difficulty in ventilation and intubation due to thyroid goiter, video laryngoscopy may provide a faster and easier technique to secure the airway compared to direct laryngoscopy. Presentation of case In the case we will present to you, a 60-year-old female with a large goiter presented to a community hospital emergency room where she was found to be in respiratory distress with increased work of breathing. Urgent subtotal thyroidectomy was planned. The patient was intubated using a Glidescope technique and the airway was secured in a safe and timely fashion. Discussion/Conclusion A literature review of PubMed and Web of Science of the use of videolaryngoscopy in goiter, difficult airway, and airway obstruction yielded information supporting the use of the video laryngoscopy as a first choice for laryngoscopy with a proven benefit over direct laryngoscopy.
Collapse
Affiliation(s)
- Stacey Watt
- University at Buffalo, Women and Children's Hospital of Buffalo, Department of Anesthesia, 219 Bryant Street, Buffalo, N.Y., 14222, United States.
| | - Jonathan Kalpan
- University at Buffalo, Anesthesiology Resident, United States.
| | | |
Collapse
|
24
|
Detweiler BN, Kollmorgen LE, Umberham BA, Hedin RJ, Vassar BM. Risk of bias and methodological appraisal practices in systematic reviews published in anaesthetic journals: a meta-epidemiological study. Anaesthesia 2016; 71:955-68. [DOI: 10.1111/anae.13520] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- B. N. Detweiler
- Institutional Research and Analytics; Oklahoma State University Center for Health Sciences; Tulsa Oklahoma USA
| | - L. E. Kollmorgen
- Institutional Research and Analytics; Oklahoma State University Center for Health Sciences; Tulsa Oklahoma USA
| | - B. A. Umberham
- Institutional Research and Analytics; Oklahoma State University Center for Health Sciences; Tulsa Oklahoma USA
| | - R. J. Hedin
- Institutional Research and Analytics; Oklahoma State University Center for Health Sciences; Tulsa Oklahoma USA
| | - B. M. Vassar
- Institutional Research and Analytics; Oklahoma State University Center for Health Sciences; Tulsa Oklahoma USA
| |
Collapse
|
25
|
Ertürk T, Deniz S, Şimşek F, Purtuloğlu T, Kurt E. Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success. Turk J Anaesthesiol Reanim 2016; 43:181-7. [PMID: 27366492 DOI: 10.5152/tjar.2015.38278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Endotracheal intubation of patients is an effective method for controlling airway and breathing. However, laryngoscopy and endotracheal intubation is not easy in every case. There is a recent abundance of equipment used for controlling ventilation and intubation. Airtraq is one of those equipments. In this study, our main objective is to compare the success rates of the Airtraq and Macintosh (direct and classic) laryngoscopes in endotracheal intubation. METHODS In this single-center, prospective, randomized, clinical study was performed on 80 patients who were operated under general anesthesia, ASA I-II, 18-65 years old. Patients were intubated using two different endotracheal intubation tools. Group A was intubated using the Macintosh (direct and classic) laryngoscope, meanwhile Group B was intubated using the Airtraq laryngoscope. Patients' snoring complaints, modified Mallampati scores, sternomental distances, thyromental distances, interincisor distance measurements and Cormack-Lehane (C-L) laryngoscopic classification, upper lip bite test results, intubation time, number of intubation attempts, maneuvers and techniques used for facilitating intubation and complications arising from intubation were recorded. RESULTS There was a statistically significant difference between the groups in terms of C-L scores (p=0.041). In all, 8 patients in the Macintosh group, and 2 patients in the Airtraq group were C-L grade III. In intubation of the Airtraq group, only 3 patients required facilitating techniques, meanwhile in intubation of the Macintosh group 15 patients we had to use one or more facilitating maneuver. The rate of Mallampati scoring "difficult" was 4/6 in the Macintosh and 2/11 in Airtraq laryngoscopy groups (p=0.553). CONCLUSION In cases with seemingly difficult intubations, we believe the Airtraq laryngoscope has an advantage over the Macintosh laryngoscope, owing to its better view of the oropharyngeal and glottic areas in addition to facilitating intubation in patients with limited head extension.
Collapse
Affiliation(s)
- Tuna Ertürk
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy, Ankara, Turkey
| | - Süleyman Deniz
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Fatih Şimşek
- Department of Anaesthesiology and Reanimation, Ardahan Military Hospital, Ardahan, Turkey
| | - Tarık Purtuloğlu
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy, Ankara, Turkey
| | - Ercan Kurt
- Department of Anaesthesiology and Reanimation, Gülhane Military Medical Academy, Ankara, Turkey
| |
Collapse
|
26
|
Saraçoğlu A, Dal D, Baygın Ö, Göğüş FY. Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study. Turk J Anaesthesiol Reanim 2016; 44:76-80. [PMID: 27366562 DOI: 10.5152/tjar.2016.79553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Training students on simulators before allowing their direct contact with patients is well accepted. There is no clinical or manikin-based simulation study in the literature comparing tracheal intubation with Airtraq, laryngeal mask airway (LMA) CTrach and Macintosh laryngoscopes performed by medical students having no prior intubation experience. METHODS After obtaining written informed consents, 123 participants were included in the study. The participants were asked to intubate the manikin five times with each device randomly. After all the participants had completed their fifth intubations, the measurements were performed. The primary outcome variables were the first-attempt success rate and the time for a successful intubation, while the secondary outcome variables were to determine the scores of dental trauma, the difficulty visual analogue scale and the optimization manoeuvres. RESULTS The LMA CTrach group revealed a significantly higher number of intubation attempts. The mean time for a successful intubation was the longest in the LMA CTrach group (17.66±8.22 s, p<0.05). Students defined the Airtraq as the easiest to use and the Macintosh laryngoscope as the most difficult device to use and learn. Dental trauma severity was significantly lower in the Airtraq group than in the other groups (p<0.05), and it was found to be 0 in 81.1% in the Airtraq group. The head extension optimization manoeuvre rate was significantly higher with the Macintosh laryngoscope than with the Airtraq laryngoscope (p<0.05). CONCLUSION This study, in which different types of laryngoscopes were compared, revealed that the Airtraq laryngoscope has advantages, such as shorter intubation duration, less additional optimization manoeuvres, less dental trauma intensity and is easier to learn compared with the LMA CTrach and Macintosh laryngoscopes.
Collapse
Affiliation(s)
- Ayten Saraçoğlu
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Didem Dal
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Ömer Baygın
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| | - Fevzi Yılmaz Göğüş
- Department of Anaesthesiology and Reanimation, Marmara University School of Medicine, İstanbul, Turkey
| |
Collapse
|
27
|
Claret PG, Asencio R, Rogier D, Roger C, Fournier P, Tran TA, Sebbane M, Bobbia X, Emmanuel de La Coussaye J. Comparison of Miller and Airtraq laryngoscopes for orotracheal intubation by physicians wearing CBRN protective equipment during infant resuscitation: a randomized crossover simulation study. Scand J Trauma Resusc Emerg Med 2016; 24:35. [PMID: 27004945 PMCID: PMC4804507 DOI: 10.1186/s13049-016-0228-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the performance of orotracheal intubation with the Miller laryngoscope compared with the Airtraq laryngoscope by emergency and pediatric physicians wearing CBRN-PPE type III on infant manikins with conventional airway. We hypothesized that in this situation, the orotracheal intubation with the Airtraq laryngoscope would be faster and more effective than with the Miller laryngoscope. METHODS This was a prospective, randomized, crossover, single-center study who recruited emergency department physicians on a voluntary basis. Each physician performed a total of 20 intubation trials while in CBRN-PPE with the two intubation techniques, Miller and Airtraq. Intubations by each airway device were tested over ten consecutive runs. The order of use of one or the other devices was randomized with a ratio of 1:1. The primary endpoint was overall orotracheal intubation success. RESULTS Fifty-five emergency and pediatric physicians were assessed for eligibility. Forty-one physicians were included in this study and 820 orotracheal intubation attempts were performed. The orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller (99% vs. 92%; p-adjusted <.001). The orotracheal intubation and glottis visualization times decreased with the number of attempts (p <.001). The median orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope (15 s vs. 20 s; p-adjusted <.001). The median glottis visualization time with the Airtraq laryngoscope and with the Miller laryngoscope were not different (6.0 s vs. 7.5 s; p-adjusted =.237). Thirty-four (83 %) physicians preferred the Airtraq laryngoscope versus 6 (15 %) for the Miller (p-adjusted <.001). DISCUSSION For tracheal intubation by physicians wearing CBRN-PPE during infant resuscitation simulation, we showed that the orotracheal intubation success rate with the Airtraq laryngoscope was higher than with the Miller laryngoscope and that orotracheal intubation time with the Airtraq laryngoscope was lower than with the Miller laryngoscope. CONCLUSIONS It seems useful to train the physicians in emergency departments in the use of pediatric Airtraq and for the management of CBRN risks.
Collapse
Affiliation(s)
- Pierre-Géraud Claret
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France. .,EA 2415, Clinical Research University Institute, Montpellier University, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France.
| | - Renaud Asencio
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Damien Rogier
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Claire Roger
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Philippe Fournier
- Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Tu-Anh Tran
- Department of Pediatrics, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Mustapha Sebbane
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Xavier Bobbia
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| | - Jean Emmanuel de La Coussaye
- Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, 1 place du Professeur Robert Debré, Nîmes, 30029, France
| |
Collapse
|
28
|
Gómez-Ríos MÁ, Pinegger S, de Carrillo Mantilla M, Vizcaino L, Barreto-Calvo P, Paech MJ, Gómez-Ríos D, López-Calviño B. [A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin]. Rev Bras Anestesiol 2016; 66:289-97. [PMID: 26993409 DOI: 10.1016/j.bjan.2016.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/28/2014] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.
Collapse
Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha.
| | - Stephan Pinegger
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - María de Carrillo Mantilla
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Lucia Vizcaino
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Purísima Barreto-Calvo
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Michael J Paech
- Unidade de Farmacologia, Farmácia e Anestesiologia, Faculdade de Medicina e Farmacologia, Universidade da Austrália Ocidental, Perth, Austrália
| | - David Gómez-Ríos
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Beatriz López-Calviño
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| |
Collapse
|
29
|
Nekhendzy V. Primus Inter Pares? The Angle of View Varies. Anesth Analg 2016; 122:597-600. [PMID: 26891386 DOI: 10.1213/ane.0000000000001131] [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)
- Vladimir Nekhendzy
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
30
|
Evaluation of a smartphone camera system to enable visualization and image transmission to aid tracheal intubation with the Airtraq® laryngoscope. J Anesth 2016; 30:514-7. [DOI: 10.1007/s00540-016-2141-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/16/2016] [Indexed: 11/26/2022]
|
31
|
Gavrilovska-Brzanov A, Jarallah MA, Cogliati A, Mojsova-Mijovska M, Mijuskovic D, Slaveski D. Evaluation of the Hemodynamic Response to Endotracheal Intubation Comparing the Airtraq(®) with Macintosh Laryngoscopes in Cardiac Surgical Patients. Acta Inform Med 2015; 23:280-4. [PMID: 26635435 PMCID: PMC4639328 DOI: 10.5455/aim.2015.23.280-284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/05/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction: Cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation. The Airtraq® optical laryngoscope is a single-use rigid video laryngoscope that has been developed to facilitate tracheal intubation. There are limited studies comparing differences in the circulatory responses to Airtraq® and direct Macintosh larynngoscopy in cardiac patients. Aim: The purpose of our study was to evaluate whether there was clinically significant difference between the hemodynamic response to orotracheal intubation guided by either of the two devices (Airtraq® and Macintosh laryngoscopes) in patients who underwent coronary artery bypass grafting surgery. Material and methods: In this clinical study we analyzed the hemodynamic response to endotracheal intubation performed with Airtraq® or Macintosh laryngoscopes in patients who underwent elective coronary artery bypass graft surgery under general anesthesia. Results: We analyzed: blood pressure (systolic, diastolic, mean), heart rate and peripheral oxygen saturation (all notified before induction in anesthesia, immediately after induction, at the time of intubation and thereafter one and five minutes after intubation). We also recorded the maximal values of blood pressure and heart rate, as well as calculated the product of heart rate and systolic blood pressure. There were statistically significant differences in the hemodynamic response between the groups. At the time of intubation, there was significant inter-group difference in heart rate, systolic, diastolic and mean blood pressure. Endotracheal intubation with Macintosh laryngoscope was accompanied by significant increase in blood pressure and heart rate compared to Airtraq® group. Conclusion: The Airtraq® laryngoscope performed better than the Macintosh laryngoscope in terms of hemodynamic to the patient undergoing routine coronary artery bypass graft surgery.
Collapse
Affiliation(s)
| | | | - Andrea Cogliati
- Cardiac Surgery Department, Sabah Al Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Maja Mojsova-Mijovska
- Clinic for Anesthesia Reanimation and Intensive Care University Clinical Center "Mother Theresa", Skopje, Macedonia
| | - Dragan Mijuskovic
- Cardiac Surgery Department, Sabah Al Ahmed Cardiac Center, Kuwait City, Kuwait
| | - Dimce Slaveski
- Cardiac Surgery Department, Sabah Al Ahmed Cardiac Center, Kuwait City, Kuwait
| |
Collapse
|
32
|
Suppan L, Tramèr MR, Niquille M, Grosgurin O, Marti C. Alternative intubation techniques vs Macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2015; 116:27-36. [PMID: 26133898 PMCID: PMC4681615 DOI: 10.1093/bja/aev205] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Immobilization of the cervical spine worsens tracheal intubation conditions. Various intubation devices have been tested in this setting. Their relative usefulness remains unclear. Methods. We searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials comparing any intubation device with the Macintosh laryngoscope in human subjects with cervical spine immobilization. The primary outcome was the risk of tracheal intubation failure at the first attempt. Secondary outcomes were quality of glottis visualization, time until successful intubation, and risk of oropharyngeal complications. Results. Twenty-four trials (1866 patients) met inclusion criteria. With alternative intubation devices, the risk of intubation failure was lower compared with Macintosh laryngoscopy [risk ratio (RR) 0.53; 95% confidence interval (CI) 0.35–0.80]. Meta-analyses could be performed for five intubation devices (Airtraq, Airwayscope, C-Mac, Glidescope, and McGrath). The Airtraq was associated with a statistically significant reduction of the risk of intubation failure at the first attempt (RR 0.14; 95% CI 0.06–0.33), a higher rate of Cormack–Lehane grade 1 (RR 2.98; 95% CI 1.94–4.56), a reduction of time until successful intubation (weighted mean difference −10.1 s; 95% CI −3.2 to −17.0), and a reduction of oropharyngeal complications (RR 0.24; 95% CI 0.06–0.93). Other devices were associated with improved glottis visualization but no statistically significant differences in intubation failure or time to intubation compared with conventional laryngoscopy. Conclusions. In situations where the spine is immobilized, the Airtraq device reduces the risk of intubation failure. There is a lack of evidence for the usefulness of other intubation devices.
Collapse
Affiliation(s)
- L Suppan
- Division of Emergency Medicine, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 2, CH-1211 Geneva 14, Switzerland
| | - M R Tramèr
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M Niquille
- Division of Emergency Medicine, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 2, CH-1211 Geneva 14, Switzerland
| | - O Grosgurin
- Division of Emergency Medicine, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 2, CH-1211 Geneva 14, Switzerland
| | - C Marti
- Division of Emergency Medicine, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 2, CH-1211 Geneva 14, Switzerland
| |
Collapse
|
33
|
Gómez-Ríos MÁ, Pinegger S, de Carrillo Mantilla M, Vizcaino L, Barreto-Calvo P, Paech MJ, Gómez-Ríos D, López-Calviño B. A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin. Braz J Anesthesiol 2015; 66:289-97. [PMID: 27108827 DOI: 10.1016/j.bjane.2014.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.
Collapse
Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Stephan Pinegger
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - María de Carrillo Mantilla
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lucia Vizcaino
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Purísima Barreto-Calvo
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Michael J Paech
- Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - David Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Beatriz López-Calviño
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| |
Collapse
|
34
|
Chastel B, Perrier V, Germain A, Seramondi R, Rozé H, Ouattara A. Usefulness of the Airtraq DL™ videolaryngoscope for placing a double-lumen tube. Anaesth Crit Care Pain Med 2015; 34:89-93. [DOI: 10.1016/j.accpm.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
|
35
|
Castañeda Pascual M, Turumbay Ramírez E, Bilbao Ares A, Jimeno García JP, Batllori Gastón M, Hijosa Basarte E. Intubación nasotraqueal con laringoscopio óptico Airtraq® en 2 casos de braquiterapia oral. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
36
|
Pascual MC, Ramírez ET, Ares AB, García JPJ, Gastón MB, Basarte EH. Nasotracheal intubation with Airtraq optical laryngoscope in two cases of oral brachytherapy. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
37
|
Nasotracheal intubation with Airtraq optical laryngoscope in two cases of oral brachytherapy☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543020-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
38
|
Selde W, English K, Heffelfinger M, Eichel J, Ekblad G. Successful airtraq use in an air medical transport system. Air Med J 2014; 33:331-334. [PMID: 25441532 DOI: 10.1016/j.amj.2014.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/18/2014] [Accepted: 07/10/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION There is a large body of literature that shows that the AirTraq device achieves equal or superior rates of successful intubation in all classes of user. A recent prospective human trial of the device questioned the first pass success rate and whether effective training could occur outside the Operating Room (OR). The purpose of this study was to investigate the first pass success rate for intubation with the AirTraq (AT) device utilizing only mannequin training in an air ambulance setting from Aug. 1 2009 to Aug. 1 2012 and compare it to direct laryngoscopy (DL). HYPOTHESIS We hypothesize that the AirTraq device will be as effective overall as direct laryngoscopy, and that this requires no OR training to achieve. METHODS A retrospective chart review of 161 intubations by air ambulance flight nurses from Aug. 1, 2009 to Aug. 1, 2012 was conducted. Data regarding date of service, devices used, number of attempts, rescue device use, and complications was gathered and analyzed. The generalized estimating equation and the chi-squared test were used to evaluate the data. RESULTS 161 intubations were reviewed. 135 met inclusion criteria. Overall first pass success rate for AT was 82% (68/83) and DL was 74% (35/47). Overall first use success rate for AT was 79% (71/90) and DL was 70% (43/61). The overall success rate of intubation for any patient in which either AT or DL was attempted is 96% (130/135). CONCLUSION AirTraq was shown to be as effective as direct laryngoscopy. All air crew training for the AirTraq device was performed on mannequins. The successof the device compared to DL shows that mannequin training is sufficient to implement the AirTraq device for pre-hospital intubation.
Collapse
Affiliation(s)
- William Selde
- Western Michigan School of Medicine, Kalamazoo, MI; Wyoming Medical Center, Casper, WY.
| | - Kyle English
- Western Michigan School of Medicine, Kalamazoo, MI
| | | | | | - Glenn Ekblad
- Western Michigan School of Medicine, Kalamazoo, MI; West Michigan Air Care, Kalamazoo, MI
| |
Collapse
|
39
|
Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth 2014; 24:1056-65. [PMID: 24958249 DOI: 10.1111/pan.12458] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND We reviewed the updated literature and performed a meta-analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). METHODS We searched articles published in English matching the key words 'video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)' AND 'direct laryngoscope' AND 'children (including pediatric, infant, neonate)' in PubMed, Ovid, Google Scholar, and the Cochrane Library databases. Only prospective randomized controlled trials (RCTs), which compared the use of VLs and DLs in children, were included. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95% confidence interval (95% CI) were calculated using the quality effects model of the metaxl 1.3 software for outcome data. RESULTS Fourteen studies were included in this meta-analysis. Although VLs improved the glottis visualization in most children either with normal airways or with potentially difficult intubations, the time to intubation (TTI) was prolonged in comparison to DLs (WMD: 4.9 s; 95% CI: 2.6-7.1). Subgroup analysis showed the GlideScope (WMD: 5.2 s; 95% CI: 2.0-8.5), TruView (WMD: 5.1 s; 95% CI: 0.7-9.5), Storz (WMD: 6.4 s; 95% CI: 4.8-8.1), and Bullard (WMD: 37.5 s; 95% CI: 21.0-54.0) rather than Airtraq (WMD: 0.6 s; 95% CI: -7.7-8.9) prolonged TTI. Although the success rate of the first attempt (RR: 0.96; 95% CI: 0.92-1.00) and associated complications (RR: 1.11; 95% CI: 0.39-3.16) were similar in both groups, VLs were associated with a higher incidence of failure (RR: 6.70; 95% CI: 1.53-29.39). CONCLUSION This meta-analysis demonstrates that although VLs improved glottis visualization in pediatric patients, this was at the expense of prolonged TTI and increased failures. However, further studies are needed to clarify the efficacy and safety of VLs in hands of nonexperts and in children with airway problems.
Collapse
Affiliation(s)
- Yu Sun
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | |
Collapse
|
40
|
Zhao H, Feng Y, Zhou Y. Teaching tracheal intubation: Airtraq is superior to Macintosh laryngoscope. BMC MEDICAL EDUCATION 2014; 14:144. [PMID: 25027257 PMCID: PMC4107482 DOI: 10.1186/1472-6920-14-144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Tracheal intubation with Macintosh laryngoscope is taught to medical students as it is a lifesaving procedure. However, it is a difficult technique to learn and the consequences of intubation failure are potentially serious. The Airtraq optical laryngoscope is a relatively novel intubation device, which allows visualization of the glottic plane without alignment of the oral, pharyngeal, and tracheal axes, possessing advantages over Macintosh for novice personnel. We introduced a teaching mode featured with a progressive evaluation scheme for preparation and performance of tracheal intubation with medical students in this prospective randomized crossover trial who had no prior airway management experience to find the superior one. METHODS Twenty-six medical students of the 8-year programme in the 6th year participated in this trial, when they did their one-week rotation in the department of anaesthesiology. Each of the students intubated 6 patients, who were scheduled for surgeries under general anaesthesia, each laryngoscope for 3 patients respectively. One hundred and forty-nine consecutive patients scheduled for surgical procedures requiring tracheal intubation were enrolled. Patients were randomly allocated to undergo tracheal intubation using Macintosh (n = 75) or Airtraq (n =74) laryngoscope. The progressive evaluation scheme was applied to each intubation attempt. RESULTS Intubation success rate was significantly higher in Airtraq group than Macintosh group (87.8% vs. 66.7%, P < 0.05). Duration of glottis exposure was significantly shorter in Airtraq group compared to Macintosh group (50 ± 19 s vs. 81 ± 27 s, P < 0.001). A grade I Cormack and Lehane glottic view was obtained in 94.6% of patients in the Airtraq group versus 32% of patients in the Macintosh group (P <0.001). Duration of intubation in Airtraq group was significantly shorter (68 ± 21 s vs. 96 ± 22 s, P < 0.05) compared to Macintosh group. CONCLUSIONS Airtraq laryngoscope is easier to master for novice personnel with a higher intubation success rate and shorter intubation duration compared with the Macintosh laryngoscope. TRIAL REGISTRATION Trial registration number is ChiCTR-TRC-13003987, approval date Dec 12, 2013.
Collapse
Affiliation(s)
- Hong Zhao
- Department of Anaesthesiology and Pain Medicine, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, China
| | - Yi Feng
- Department of Anaesthesiology and Pain Medicine, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, China
| | - Yanyan Zhou
- Department of Anaesthesiology and Pain Medicine, Peking University People’s Hospital, 11 Xizhimen South Street, Beijing, China
| |
Collapse
|
41
|
Gellerfors M, Larsson A, Svensén CH, Gryth D. Use of the Airtraq® device for airway management in the prehospital setting--a retrospective study. Scand J Trauma Resusc Emerg Med 2014; 22:10. [PMID: 24484856 PMCID: PMC3922107 DOI: 10.1186/1757-7241-22-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/31/2014] [Indexed: 11/30/2022] Open
Abstract
Background Difficulties with prehospital intubations have encouraged the development of indirect laryngoscopy techniques, facilitating laryngeal visualization. Airtraq® is a relatively new single-use indirect laryngoscope. The Airtraq® has been evaluated in several prehospital mannequin intubation trials. However, prehospital clinical experience with the device is limited. Methods A retrospective medical chart review was performed for patients who underwent prehospital endotracheal intubation in the Stockholm County between January 2008 and December 2012. Both anaesthesiologists and nurse anaesthetists performed prehospital intubations during the study period. All Airtraq® intubations during this period were included in the analysis. The objective was to estimate the success rate of Airtraq® used in a prehospital setting. Results During the 5-year period (January 2008- December 2012), 2453 tracheal intubations were performed. Airtraq® was used in 28 cases (1%). The overall Airtraq® intubation success rate was 68%. Among patients with anticipated or unexpected difficult airway (23/28) the Airtraq® success rate was 61% (14/23). Among patients who underwent drug facilitated or rapid-sequence intubation protocols 4/5 (80%) were successfully intubated with Airtraq®. Conclusion In conclusion, this retrospective study showed a higher Airtraq® success rate than previous prospective prehospital trials. However, compared to other prehospital direct and indirect intubation methods the Airtraq success rate is low. Further clinical trials are necessary to evaluate the role of Airtraq® in the prehospital airway management.
Collapse
Affiliation(s)
- Mikael Gellerfors
- Department of Clinical Science and Education, Section of Anaesthesiology and Intensive Care, Karolinska Institutet, Stockholm South General Hospital, 118 83 Stockholm, Sweden.
| | | | | | | |
Collapse
|
42
|
Ni J, Luo L, Wu L, Luo D. The Airtraq™ laryngoscope as a first choice for parturients with an expected difficult airway. Int J Obstet Anesth 2013; 23:94-5. [PMID: 24331872 DOI: 10.1016/j.ijoa.2013.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/20/2013] [Accepted: 08/31/2013] [Indexed: 12/01/2022]
Affiliation(s)
- J Ni
- Department of Anaesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - L Luo
- Department of Anaesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - L Wu
- Department of Anaesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - D Luo
- Department of Anaesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
43
|
Comparison of the Airtraq and the Macintosh laryngoscope for double-lumen tube intubation. Eur J Anaesthesiol 2013; 30:180-6. [DOI: 10.1097/eja.0b013e32835fe574] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Bensghir M, Chouikh C, Bouhabba N, Fjjouji S, Kasouati J, Azendour H, Kamili ND. [Comparison between the Airtraq, X-Lite, and direct laryngoscopes for thyroid surgery: a randomized clinical trial]. Can J Anaesth 2012; 60:377-84. [PMID: 23264012 DOI: 10.1007/s12630-012-9870-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To compare the performance of the Airtraq, X-Lite, and direct laryngoscopes for tracheal intubation for elective thyroid surgery. METHODS In this randomized prospective study, Patients who were ASA (American Society of Anesthesiologists) I or II physical status I or II and patients undergoing thyroid surgery were included in this randomized prospective study. Patients with attributes for difficult intubation criteria were excluded. After induction of anesthesia with fentanyl, propofol, and cisatracurium, patients were randomized into three groups according to the intubating device used: Airtraq laryngoscope (Airtraq), X-Lite video laryngoscope (X-lLite), and direct laryngoscope with a Macintosh blade (Direct). The primary outcome measurement was the time needed for tracheal intubation. Secondary outcomes included intubation difficulty score (IDS), Cormack-Lehane classification, as well as hemodynamic and respiratory effects. RESULTS One hundred and five patients were included. Mean (standard deviation) time for intubation was 28.2 (2.1) sec in the Airtraq group vs 36.6 (3.7) sec in the X-Lite group (P < 0.001), and 41.1 (4.4) sec in the Direct group (P < 0.001). Compared with to the direct laryngoscope, the Airtraq provided better visualization of the glottis (P = 0.003) with fewer attempts (P < 0.001) and lower IDS (P < 0.001). The intubation difficulty score was lower with the Airtraq than with the X-Lite (P = 0.003). Patients in the X-Lite and Direct groups showed more hemodynamic variations than those in the Airtraq group. There was only one failed intubation, in the direct group. CONCLUSION In thyroid surgery, the Airtraq and X-Lite laryngoscopes decrease time to intubation when compared with direct laryngoscopy.
Collapse
Affiliation(s)
- Mustapha Bensghir
- Pôle d'Anesthésie-Réanimation, Hôpital Militaire Med V, Rabat Agdal, Rabat, Maroc.
| | | | | | | | | | | | | |
Collapse
|
45
|
Pirlich N, Piepho T, Gervais H, Noppens RR. [Indirect laryngoscopy/video laryngoscopy. A review of devices used in emergency and intensive care medicine in Germany]. Med Klin Intensivmed Notfmed 2012; 107:521-30. [PMID: 22926584 DOI: 10.1007/s00063-012-0090-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
Abstract
Airway management in intensive care or emergency medicine is particularly challenging and is often associated with life-threatening complications. An innovation in the field of airway management is the use of indirect laryngoscopy by means of video laryngoscopes. A digital camera or an optical system at the tip of a laryngoscope blade enables an indirect "look around the corner" to the glottis. Studies have shown that the advantages of video laryngoscopes for endotracheal intubation are particularly beneficial in difficult airway situations. However, the successful use in challenging intubations requires experience and regular use in daily practice. This review gives an overview of indirect laryngoscopes commonly used in Germany and also presents new study results for these novel devices.
Collapse
Affiliation(s)
- N Pirlich
- Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstrasse 1, Mainz, Germany
| | | | | | | |
Collapse
|
46
|
Kalbhenn J, Boelke AK, Steinmann D. Prospective model-based comparison of different laryngoscopes for difficult intubation in infants. Paediatr Anaesth 2012; 22:776-80. [PMID: 22646973 DOI: 10.1111/j.1460-9592.2012.03890.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Difficult intubation in infants is uncommon but may be a challenge for the anesthesiologist. Many optical-assisted techniques are available to ease endotracheal placement of tube but have not been systemically evaluated for pediatric practice. AIM The study was performed to compare conventional pediatric Macintosh - with different optical laryngoscopes in difficult endotracheal intubation in infants. We hypothesized that inexperienced anesthetists would perform more successful with optical devices and that differences between the devices would be found. METHODS/MATERIALS In this randomized controlled study, 30 anesthesia residents performed endotracheal intubation in an infant model of difficult airway presenting with airway obstruction and neck immobilization. Primary endpoints were intubation success rate and intubation time. Beyond that glottis view, dental trauma and difficulty of technique were evaluated and measured by a study observer. Macintosh, Airtraq(®), Storz DCI(®) -, and Gyrus Infant Bullard(®) laryngoscopes were used in random order. After standardized briefing every resident had three attempts of at most 120 s with every device to place a 3-mm tube into the trachea. Glottis view and difficulty of technique were rated by the residents using classification of Cormack/Lehane and Visual Analogue Scale (VAS; 0 = easy to 10 = very difficult). RESULTS Success rate was 41% with conventional Macintosh, 43% with Airtraq(®), 62% with Storz DCI(®), and 100% with Bullard(®) laryngoscopes. Median time from passing the lips to first ventilation was 67 s (Storz DCI(®) laryngoscope), 54 s (Macintosh laryngoscope), 45 s (Airtraq(®) laryngoscope), and 21 s (Bullard(®) laryngoscope), respectively. Dental trauma did not occur with Bullard(®) laryngoscope and was frequent with Storz DCI(®) laryngoscope (39%) and Macintosh laryngoscope (42%). Glottis view was best with Bullard(®) laryngoscope (Grade 1 in 100%) and worst with Macintosh laryngoscope (Grade 1 in 2%). Difficulty of technique was rated with a VAS score of 2 (Bullard(®) laryngoscope), 4.5 (Storz DCI(®) laryngoscope) and 6 (Airtraq(®) - and Macintosh laryngoscopes). CONCLUSIONS Inexperienced anesthetists have higher success rates and shorter intubation times with optical-assisted laryngoscopes compared with conventional Macintosh laryngoscope. Gyrus Infant Bullard(®) laryngoscope significantly undertakes best success rate and shortest intubation time with mildest impact to maxillary dents and easiest technique. Our findings support the hypothesis that optical laryngoscopes can be used successfully by inexperienced anesthetists in simulated difficult pediatric airway conditions.
Collapse
Affiliation(s)
- Johannes Kalbhenn
- Department of Anaesthesia and Critical Care Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | | | | |
Collapse
|
47
|
Corso RM, Piraccini E, Agnoletti V, Gambale G. Comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation: some clarification needed. Eur J Anaesthesiol 2012; 29:495-6. [PMID: 22825566 DOI: 10.1097/eja.0b013e328356babb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
|
49
|
Najafi M. Prevention of damage to teeth and gums: an often neglected advantage of indirect laryngoscopy with the Airtraq. Anaesthesia 2012; 67:545. [DOI: 10.1111/j.1365-2044.2012.07124.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Najafi
- Tehran University of Medical Sciences, Tehran Heart Center, Tehran, Iran
| |
Collapse
|
50
|
|