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Zhang T, Zhao KY, Zhang P, Li RH. Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study. Trials 2023; 24:599. [PMID: 37735666 PMCID: PMC10512610 DOI: 10.1186/s13063-023-07641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways. METHODS A total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed. RESULTS All patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05). CONCLUSIONS In patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope. TRIAL REGISTRATION Chinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.
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Affiliation(s)
- Tao Zhang
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui, China
| | - Kai-Yuan Zhao
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui, China
| | - Ping Zhang
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui, China
| | - Ren-Hu Li
- Department of Anesthesiology, Lu'an Hospital of Anhui Medical University, Lu'an, Anhui, China.
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2
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Saracoglu A, Saracoglu KT, Sorbello M, Çakmak G, Greif R. The influence of the COVID-19 pandemic on videolaryngoscopy: a cross-sectional before-and-after survey. Anaesthesiol Intensive Ther 2023; 55:93-102. [PMID: 37587879 PMCID: PMC10415602 DOI: 10.5114/ait.2023.129278] [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: 01/19/2023] [Accepted: 05/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Guidelines and consensus statements recommend the use of videola-ryngoscopes (VLs) in airway management of patients with COVID-19. However, there is a lack of knowledge about which types of videolaryngoscopes are used, differences of use between countries, and how the COVID-19 pandemic influenced their use. The primary aim of this before-and-after cross-sectional survey study was to assess the frequency of the use of videolaryngoscopy in the operation theatres in different countries. Also, the preferred characteristics of videolaryngoscopes were assessed. METHODS With Ethics Committee approval, a questionnaire was distributed among anaes-thesiologists through the European Airway Management Society's network in 2019 before and in 2021 during the COVID-19 pandemic. Responses to the questions were analysed and presented as descriptive statistics. RESULTS We reached out to 791 anaesthesiologists; 155 (19.5%) returned the first questionnaire, and 91 (11.5%) returned the second survey. Videolaryngoscopes were used in 24.1% of cases before COVID-19 and in 43.1% after the pandemic ( P < 0.001). We revealed that the availability of videolaryngoscopes increased to 100% in all centres during the pandemic. Routine use of videolaryngoscopes in all cases increased from 12.5% to 38.9%. The type of videolaryngoscope and the blade preference did not change during this period ( P = 1.000). CONCLUSIONS This survey reflects that the COVID-19 pandemic significantly increased the availability and use of videolaryngoscopes in operating theatres, and that more anaesthesiologists now use them routinely in all cases. The preferred type of VL or blade did not change during the pandemic.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anaesthesiology, ICU & Perioperative Medicine, Aisha Bint Hamad Al Attiyah Hospital, HMC, Doha, Qatar
- School of Medicine, Qatar University Doha, Qatar
| | - Kemal Tolga Saracoglu
- School of Medicine, Qatar University Doha, Qatar
- Department of Anaesthesiology, ICU & Perioperative Medicine, Hazm Mebaireek General Hospital HMC, Doha, Qatar
| | - Massimiliano Sorbello
- Department of Anaesthesiology and Intensive Care, AOU Policlinico San Marco Catania, Catania, Italy
| | - Gül Çakmak
- Department of Anaesthesiology and Intensive Care, Marmara University, Istanbul, Turkey
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital Inselspital, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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3
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Elshazly M, Medhat M, Marzouk S, Samir EM. Video Laryngoscope versus USB borescope aided endotracheal intubation in adults with anticipated difficult airway: a prospective randomized controlled study. Korean J Anesthesiol 2022; 75:331-337. [PMID: 35581709 PMCID: PMC9346273 DOI: 10.4097/kja.22222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Video laryngoscopes are approved equipment for difficult airway intubations. The borescope, which was introduced during the coronavirus disease 2019 (COVID-19) era, is placed over a direct laryngoscope blade to provide an economical video laryngoscope. In the current study, we investigated the use of an endotracheal tube mounted over a USB borescope versus a video laryngoscope in patients with suspected difficult airways. Methods After obtaining informed consent, 120 adult patients with suspected difficult airways undergoing elective surgery were included in this study. Patients were randomized into the USB borescope and video laryngoscope groups. The primary outcome was time to successful intubation. The secondary outcomes included hemodynamic changes, anesthetist’s satisfaction, and the incidence of complications. Results Intubation time was comparable between the two groups (video laryngoscope: 30.63 s and borescope: 28.35 s; P = 0.166). However, the view was clearer (P = 0.026) and the incidence of fogging was lower (P = 0.015) with the video laryngoscope compared to the borescope. Conversely, anesthetist’s satisfaction frequency was higher with the borescope than with the video laryngoscope (P < 0.001). Conclusions The video laryngoscope provided a better view and less fogging with an intubation time that was comparable to that of the borescope; however, the higher cost of the video laryngoscope limits its availability. Therefore, the borescope is a low-cost, readily available device that can be used for intubating patients with potentially difficult airways.
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Affiliation(s)
- Mohamed Elshazly
- Department of anesthesia, surgical ICU, and pain management, faculty of medicine, Cairo University, Cairo, Egypt
| | - Mark Medhat
- Department of anesthesia, surgical ICU, and pain management, faculty of medicine, Cairo University, Cairo, Egypt
| | | | - Enas Mohamed Samir
- Department of anesthesia, surgical ICU, and pain management, faculty of medicine, Cairo University, Cairo, Egypt
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4
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Cumberworth A, Lewith H, Sud A, Jefferson H, Athanassoglou V, Pandit JJ. Major complications of airway management: a prospective multicentre observational study. Anaesthesia 2022; 77:640-648. [PMID: 35254669 DOI: 10.1111/anae.15668] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with 'predicted easy' airways were rare (approximately 1 in 14,200), but 45 times more common in those with 'predicted difficult' airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.
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Affiliation(s)
- A Cumberworth
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Lewith
- Department of Anaesthetics, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - A Sud
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Jefferson
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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Kumar PP, Ambulkar RP, Ranganathan P, Patil S. Use of the McGRATH™ MAC videolaryngoscope to evaluate the ability of anesthetists to give effective cricoid pressure: An interventional study. J Anaesthesiol Clin Pharmacol 2022; 38:417-422. [PMID: 36505204 PMCID: PMC9728443 DOI: 10.4103/joacp.joacp_513_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/17/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims The application of cricoid pressure (CP) for rapid sequence induction is questioned on two grounds: its effectiveness in clinical settings and its impact on the laryngeal view. The main reason cited for its ineffectiveness is the lack of knowledge and training in its correct application. This study assessed, the performance of anesthetists in applying effective CP in a clinical setting. Material and Methods Eighty-five ASA I/II adult patients posted for elective surgery requiring oral endotracheal intubation with nasogastric tube (NGT) placement participated in the study. Eighty-five anesthetists divided into five groups based on their level of experience were randomly chosen to apply CP after induction of anesthesia. An experienced anesthetist performed videolaryngoscopy and attempted NGT insertion. The primary outcome was effectiveness of CP defined as the inability to pass the NGT into the esophageal opening. We also noted that the glottic view with and without CP and the effectiveness of CP across different levels of experience of anesthetists. Results Of the 85 anesthetists, 61 (71.8%) applied effective CP. The effectiveness improved with experience (first-year residents-11/17 [64.7%], second-year residents-11/17 [64.7%], third-year residents-10/17 [58.8%], senior residents-13/17 [76.5%], and consultants-16/17 [94.1%]) (P = 0.157). Post hoc analysis showed higher effectiveness among anesthetists with >3 years of experience (85.3%) compared with <3 years of experience (62.7%) (P = 0.024). CP did not always impede the laryngeal view, rather it has no effect or actually improves the glottic view in many instances (81%). Conclusion CP is effective in occluding the esophageal lumen without hampering glottic view in the majority of the cases, and its effectiveness improves with experience.
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Affiliation(s)
- Pooja Prakash Kumar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India,Department of Anesthesia, University of Massachusetts Medical School, USA
| | - Reshma P. Ambulkar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India,Address for correspondence: Dr. Reshma P. Ambulkar, Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Priya Ranganathan
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Sanika Patil
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, Maharashtra, India,Department of Anaesthesia, Ipswich Hospital East Suffolk and North Essex NHS FoundationTrust, UK
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Pirlich N, Dutz M, Wittenmeier E, Kriege M, Didion N, Ott T, Piepho T. Current practice of German anesthesiologists in airway management : Results of a national online survey. Anaesthesist 2021; 71:190-197. [PMID: 34453552 DOI: 10.1007/s00101-021-01025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a worldwide consensus among experts that guidelines and algorithms on airway management contribute to improved patient safety in anesthesia. The present study aimed to determine the current practice of airway management of German anesthesiologists and assess the safety gap, defined as the difference between observed and recommended practice, amongst these practitioners. OBJECTIVE To determine the effect of implementing the guidelines on airway management practice in Germany amongst anesthesiologists and identify potential safety gaps. METHODS A survey was conducted in September 2019 by contacting all registered members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) via email. The participants were asked about their personal and institutional background, adherence to recommendations of the current German S1 guidelines and availability of airway devices. RESULTS A total of 1862 DGAI members completed the questionnaire (response rate 17%). The main outcome was that anesthesiologists mostly adhered to the guidelines, yet certain recommendations, particularly pertaining to specifics of preoxygenation and training, showed a safety gap. More than 90% of participants had a video laryngoscope and half had performed more than 25 awake intubations using a flexible endoscope; however, only 81% had a video laryngoscope with a hyperangulated blade. An estimated 16% of all intubations were performed with a video laryngoscope, and 1 in 4 participants had performed awake intubation with it. Nearly all participants had cared for patients with suspected difficult airways. Half of the participants had already faced a "cannot intubate, cannot oxygenate" (CICO) situation and one in five had to perform an emergency front of neck access (eFONA) at least once. In this case, almost two thirds used puncture-based techniques and one third scalpel-based techniques. CONCLUSION Current practice of airway management showed overall adherence to the current German guidelines on airway management, yet certain areas need to be improved.
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Affiliation(s)
- Nina Pirlich
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
| | - Matthias Dutz
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Nicole Didion
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Ott
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Tim Piepho
- Department of Anaesthesiology and Intensive Care, Brothers of Mercy Hospital, Trier, Germany
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7
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Gerber D, Eberle B, Erdoes G. Checking the integrity of eyes in prone position: A novel application of video laryngoscopes. SAGE Open Med Case Rep 2021; 9:2050313X211015885. [PMID: 34094563 PMCID: PMC8141984 DOI: 10.1177/2050313x211015885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
Perioperative visual loss is a rare but severe complication after surgery in prone position. One of several mechanisms is direct ophthalmic compression. This can be avoided through optimal positioning and padding of the head, but position and integrity of the eyes need to be checked at regular intervals. We describe the use of a conventional video laryngoscope during vascular surgery in prone position as a simple solution for intermittent monitoring of external integrity of the eyes and size of the pupils. This requires no additional material and allows documentation of the findings. Our method might reduce complications and improve patient outcome.
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Affiliation(s)
- Daniel Gerber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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8
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Smith C, McNarry AF. Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management? CURRENT ANESTHESIOLOGY REPORTS 2020; 10:370-377. [PMID: 32837344 PMCID: PMC7369438 DOI: 10.1007/s40140-020-00404-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Airway management remains a source of significant morbidity and mortality. This review considers recent summaries of complications and looks toward strategies to improve practice using a coordinated approach. Recent Findings A safety gap can exist between national recommendations and local practice. A lack of attention to end tidal carbon dioxide has repeatedly contributed to airway mismanagement. Clinicians must be trained in newer airway devices (videolaryngoscopes or supraglottic airways) to use them effectively. Time must be found to teach rarely performed skills (e.g., front-of-neck access). Both larger and smaller hospitals have benefitted from an airway lead or response team, coordinating education programs, ensuring the adoption of guidelines, standardizing equipment, and recognizing the role of human factors and ergonomics. Summary Even in the twenty-first century, the incidence of airway-related morbidity and mortality can be reduced, by an institutionally supported, coordinated approach to the whole process of airway care.
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Affiliation(s)
- Carolyn Smith
- South East Scotland School of Anaesthesia, St John’s Hospital, Livingston, EH54 6PP UK
| | - Alistair F. McNarry
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh, EH4 2XU UK
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9
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Gibbins M, Kelly FE, Cook TM. Airway management equipment and practice: time to optimise institutional, team, and personal preparedness. Br J Anaesth 2020; 125:221-224. [PMID: 32624185 PMCID: PMC7298468 DOI: 10.1016/j.bja.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Matthew Gibbins
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Fiona E Kelly
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Tim M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK; Bristol Medical School, University of Bristol, Bristol, UK.
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Wylie NW, Phillips EC, Harrington JK, McNarry AF. Videolaryngoscopy utilisation: Facts and opinions. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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11
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Nagy B, Rendeki S. A national survey of videolaryngoscopes and alternative intubation devices in Hungary. PLoS One 2019; 14:e0223645. [PMID: 31600304 PMCID: PMC6786552 DOI: 10.1371/journal.pone.0223645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/25/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Videolaryngoscopy (VL) as a new airway management technique has evolved in recent decades, and a large number of videolaryngoscopes are now available on the market. Most recent major guidelines already recommend the immediate availability and use of VL in difficult airway management scenarios. However, national data on the availability of VL, introduction into practice and patterns of use are rarely published. Therefore, the current study aimed to provide data on VL in Hungary. MATERIALS AND METHODS An electronic survey was designed and popularized with the help of the Hungarian Society of Anaesthesiology and Intensive Therapy to explore the availability, use, and practice of and attitudes toward VL among Hungarian anesthesiologists. The survey was conducted between 01.01.2018 and 31.12.2018. RESULTS In total, 324 duly completed forms were returned and analyzed. Responders were mainly males (58%), specialists (80%) and those involved mainly in anesthesia practice (68%) in the public sector. Two hundred and ten (65%) responders had access to various videolaryngoscopes and were mainly from surgery, intensive care and traumatology units. No responders reported the availability of eight videolaryngoscopes out of the eighteen listed devices, and 32% of the responders had never used any videolaryngoscope in clinical settings. The most commonly available devices were KingVision, MacGrath Mac and Airtraq. Most of the responders reported using videolaryngoscopes mainly for difficult airway management and reported using a fiberscope as the first alternative device. Popular methods for selecting videolaryngoscopes included the following: short clinical trial (n = 67/324), decision of the departmental lead (n = 65/324) and price (n = 54/324). The majority of responders had some training prior to clinical application, but training was mainly voluntary. Overall, 98% of the responders considered videolaryngoscopes beneficial. CONCLUSIONS Approximately two-thirds of Hungarian anesthesiologists have immediate access to videolaryngoscopes, which are used mainly for difficult airway management. The overall attitude towards VL is positive, and many videolaryngoscopes are known and have been used by Hungarian anesthesiologists. However, only a few devices on the market are used commonly. Based on the results, further improvement might be recommended regarding VL training and availability.
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Affiliation(s)
- Bálint Nagy
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
- * E-mail:
| | - Szilárd Rendeki
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Pécs, Hungary
- Department of Operational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Medical Skills Lab, Medical School, University of Pécs, Pécs, Hungary
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12
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Mir F, McNarry A, Asai T. Role of the Difficult Airway Society in improving airway management. Br J Anaesth 2018; 121:12-15. [DOI: 10.1016/j.bja.2018.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
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Evans SW, McCahon RA. Management of the airway in maxillofacial surgery: part 1. Br J Oral Maxillofac Surg 2018; 56:463-468. [PMID: 29907469 DOI: 10.1016/j.bjoms.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/25/2018] [Indexed: 12/17/2022]
Abstract
In part 1 of this review of management of the airway in maxillofacial surgery we discuss preoperative assessment of the airway, and the practical means to deal with difficulties. We review the evidence for videolaryngoscopy and flexible indirect laryngoscopy, together with surgical access to the airway including tracheostomy, cricothyroidotomy, and submental intubation.
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Affiliation(s)
- S W Evans
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre campus, Derby Road, Nottingham, NG7 2UH
| | - R A McCahon
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre campus, Derby Road, Nottingham, NG7 2UH.
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14
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Hunter I, Ramanathan V, Balasubramanian P, Evans DA, Hardman JG, McCahon RA. Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes. Anaesthesia 2016; 71:1191-7. [PMID: 27530359 DOI: 10.1111/anae.13589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Abstract
In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice.
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Affiliation(s)
| | - V Ramanathan
- East Midlands School of Anaesthesia, Nottingham, UK
| | - P Balasubramanian
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D A Evans
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J G Hardman
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Anaesthesia and Critical Care Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - R A McCahon
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK. .,Anaesthesia and Critical Care Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
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15
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Affiliation(s)
- I Ahmad
- Department of Anaesthesia, Guys and St. Thomas' Hospitals, London, UK.
| | - C R Bailey
- Department of Anaesthesia, Guys and St. Thomas' Hospitals, London, UK
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