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Choi J, Lee Y, Kang GH, Jang YS, Kim W, Choi HY, Kim JG. Educational suitability of new channel-type video-laryngoscope with AI-based glottis guidance system for novices wearing personal-protective-equipment. Medicine (Baltimore) 2022; 101:e28890. [PMID: 35244042 PMCID: PMC8896493 DOI: 10.1097/md.0000000000028890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/04/2022] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to determine which of 4 laryngoscopes, including A-LRYNGO, a newly developed channel-type video-laryngoscope with an embedded artificial intelligence-based glottis guidance system, is appropriate for tracheal intubation training in novice medical students wearing personal protective equipment (PPE).Thirty healthy senior medical school student volunteers were recruited. The participants underwent 2 tests with 4 laryngoscopes: Macintosh, McGrath, Pentax Airway-Scope and A-LRYNGO. The first test was conducted just after a lecture without any hands-on workshop. The second test was conducted after a one-on-one hands-on workshop. In each test, we measured the time required for tracheal intubation, intubation success rate, etc, and asked all participants to complete a short questionnaire.The time to completely insert the endotracheal tube with the Macintosh laryngoscope did not change significantly (P = .177), but the remaining outcomes significantly improved after the hands-on workshop (all P < .05). Despite being novice practitioners with no intubation experience and wearing PPE, the, 2 channel-type video-laryngoscopes were associated with good intubation-related performance before the hands-on workshop (all P < .001). A-LRYNGO's artificial intelligence-based glottis guidance system showed 93.1% accuracy, but 20.7% of trials were guided by the vocal folds.To prepare to manage the airway of critically ill patients during the coronavirus disease 2019 pandemic, a channel-type video-laryngoscope is appropriate for tracheal intubation training for novice practitioners wearing PPE.
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Affiliation(s)
- Jaesoon Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Yoonje Lee
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Hyun Young Choi
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, College of Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea
- Hallym Biomedical Informatics Convergence Research Center, College of Medicine, Hallym University, Seoul, Korea
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Kim KN, Jeong MA, Oh YN, Kim SY, Kim JY. Efficacy of Pentax airway scope versus Macintosh laryngoscope when used by novice personnel: A prospective randomized controlled study. J Int Med Res 2017; 46:258-271. [PMID: 28835153 PMCID: PMC6011290 DOI: 10.1177/0300060517726229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether intubation education using the Pentax Airway Scope (AWS) in normal airways is more useful than direct laryngoscopy (Macintosh laryngoscope) in novice personnel. Methods Eleven intern doctors without intubation experience performed 60 sequential intubations with each device on a manikin and 10 sequential intubations in adult patients. The time required for successful intubation, percentage of glottic opening (POGO) score, number of intubation attempts, and number of dental injuries were analyzed for each intubation technique. Results The mean (standard deviation) time required for successful intubation decreased as the number of intubations increased and was significantly shorter with the Pentax AWS than direct laryngoscope [22.6 (7.3) vs. 29.6 (10.0) and 33.0 (8.0) vs. 44.7 (5.6) s, respectively] in both the manikin and clinical studies. The Pentax AWS was also associated with higher POGO scores than the direct laryngoscope [81.7 (8.9) vs. 55.1 (13.2) and 80.9 (9.7) vs. 49.6 (16.5), respectively] and fewer intubation attempts. Fewer dental injuries occurred with the Pentax AWS in the manikin study. Conclusions Novices performed intubation more rapidly and easily with an improved laryngeal view using the Pentax AWS. We suggest that intubation education with video laryngoscopy should be mandatory along with direct laryngoscope training.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - You Na Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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Ambrosio A, Marvin K, Perez C, Byrnes C, Gaconnet C, Cornelissen C, Brigger M. Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy. OTO Open 2017; 1:2473974X17707916. [PMID: 30480183 PMCID: PMC6239019 DOI: 10.1177/2473974x17707916] [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: 02/05/2017] [Revised: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 01/21/2023] Open
Abstract
Objective Difficult airway management is a key skill required by all pediatric
physicians, yet training on multiple modalities is lacking. The objective of
this study was to compare the rate of, and time to, successful advanced
infant airway placement with direct laryngoscopy, video-assisted
laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway
simulator. This study is the first to compare the success with 3 methods for
difficult airway management among pediatric trainees. Study Design Randomized crossover pilot study. Setting Tertiary academic medical center. Methods Twenty-two pediatric residents, interns, and medical students were tested.
Participants were provided 1 training session by faculty using a normal
infant manikin. Subjects then performed all 3 of the aforementioned advanced
airway modalities in a randomized order on a difficult airway model of a
Robin sequence. Success was defined as confirmed endotracheal intubation or
correct LMA placement by the testing instructor in ≤120 seconds. Results Direct laryngoscopy demonstrated a significantly higher placement success
rate (77.3%) than video-assisted laryngoscopy (36.4%, P =
.0117) and LMA (31.8%, P = .0039). Video-assisted
laryngoscopy required a significantly longer amount of time during
successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct
laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6
seconds; 95% CI, 24.7-48.4). Conclusions Pediatric trainees demonstrated significantly higher success using direct
laryngoscopy in a difficult airway simulator model. However, given the
potential lifesaving implications of advanced airway adjuncts, including
video-assisted laryngoscopy and LMA placement, more extensive training on
adjunctive airway management techniques may be useful for trainees.
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Affiliation(s)
- Art Ambrosio
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, Oceanside, California, USA
| | - Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Colleen Perez
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Chelsie Byrnes
- Division of Critical Care, Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, USA
| | - Cory Gaconnet
- Division of Pediatric Anesthesia, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Chris Cornelissen
- Division of Cardiac Anesthesia, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Matthew Brigger
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA
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Wolf LE, Aguirre JA, Vogt C, Keller C, Borgeat A, Bruppacher HR. Transfer of skills and comparison of performance between king vision® video laryngoscope and macintosh blade following an AHA airway management course. BMC Anesthesiol 2017; 17:5. [PMID: 28125969 PMCID: PMC5267392 DOI: 10.1186/s12871-016-0296-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background To potentially optimize intubation skill teaching in an American Heart Association® Airway Management Course® for novices, we investigated the transfer of skills from video laryngoscopy to direct laryngoscopy and vice versa using King Vision® and Macintosh blade laryngoscopes respectively. Methods Ninety volunteers (medical students, residents and staff physicians) without prior intubation experience were randomized into three groups to receive intubation training with either King Vision® or Macintosh blade or both. Afterwards they attempted intubation on two human cadavers with both tools. The primary outcome was skill transfer from video laryngoscopy to direct laryngoscopy assessed by first attempt success rates within 60 s. Secondary outcomes were skill transfer in the opposite direction, the efficacy of teaching both tools, and the success rates and esophageal intubation rates of Macintosh blade versus King Vision®. Results Performance with the Macintosh blade was identical following training with either Macintosh blade or King Vision® (unadjusted odds ratio [OR] 1.09, 95% confidence interval [95% CI] 0.5–2.6). Performance with the King Vision® was significantly better in the group that was trained on it (OR 2.7, 95% CI 1.2–5.9). Success rate within 60 s with Macintosh blade was 48% compared to 52% with King Vision® (OR 0.85, 95% CI 0.4–2.0). Rate of esophageal intubations with Macintosh blade was significantly higher (17% versus 4%, OR 5.0, 95% CI 1.1–23). Conclusions We found better skill transfer from King Vision® to Macintosh blade than vice versa and fewer esophageal intubations with video laryngoscopy. For global skill improvement in an airway management course for novices, teaching only video laryngoscopy may be sufficient. However, success rates were low for both devices. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0296-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas E Wolf
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - José A Aguirre
- Division of Anesthesia, Balgrist University Hospital, Zurich, Switzerland
| | - Christian Vogt
- Division of Anesthesia, Balgrist University Hospital, Zurich, Switzerland
| | - Christian Keller
- Department of Anesthesiology, Schulthess Clinic, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Alain Borgeat
- Division of Anesthesia, Balgrist University Hospital, Zurich, Switzerland
| | - Heinz R Bruppacher
- Department of Anesthesiology, Schulthess Clinic, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland. .,SkillsLab, Deanery, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Ishio J, Komasawa N, Miyazaki Y, Kido H, Minami T. LMA-ProSeal insertion by novice doctors as affected by a 90° bend created by an intubating stylet: a randomized clinical trial. J Clin Anesth 2016; 34:145-50. [PMID: 27687362 DOI: 10.1016/j.jclinane.2016.03.072] [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: 06/15/2015] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE This study aimed to test the hypothesis that insertion of the supraglottic device LMA-ProSeal (ProSeal) by novice doctors in anesthetized patients can be improved by using an intubating stylet to create a 90° bend and that better sealing pressure is achieved. DESIGN Randomized clinical trial. SETTING Operating room. PATIENTS Seventy adult patients scheduled for elective surgery under general anesthesia using ProSeal with American Society of Anesthesiologists physical status 1 to 3. INTERVENTIONS ProSeal were inserted with the 90° bend created by the intubating stylet (90D group, 35 patients) or not (ie, conventional insertion; C group, 35 patients). MEASUREMENTS The number of attempts to successful insertion, sealing pressure, subjective difficulty of insertion by novice doctors, and postoperative pharyngeal pain or hoarseness were compared between groups. MAIN RESULTS The total number of insertion attempts for the 90D and control groups were 1 (24 and 8, respectively), 2 (8 and 13), 3 (3 and 9), and failure (0 and 5), respectively, showing significant differences between groups (P<.001). Sealing pressure was significantly higher in the 90D group than in the C group (90D group, 23.3±3.7cm H2O; C group, 19.5±2.6cm H2O; P<.001), and the subjective difficulty of insertion was significantly lower in the 90D group (90D group, 27.3±17.6mm; C group, 55.4±22.8mm; P<.001). The incidence of postoperative pharyngeal pain and hoarseness did not differ significantly between groups. CONCLUSIONS Our results suggest that creating a 90° bend using an intubating stylet facilitates ProSeal insertion by novice doctors, as reflected by higher successful insertion rates, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.
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Affiliation(s)
- Junichi Ishio
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Nobuyasu Komasawa
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan.
| | - Yu Miyazaki
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Haruki Kido
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Osaka 569-8686, Japan
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Bahathiq AO, Abdelmontaleb TH, Newigy MK. Learning and performance of endotracheal intubation by paramedical students: Comparison of GlideScope(®) and intubating laryngeal mask airway with direct laryngoscopy in manikins. Indian J Anaesth 2016; 60:337-42. [PMID: 27212721 PMCID: PMC4870947 DOI: 10.4103/0019-5049.181595] [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] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: GlideScope video laryngoscope (GVL) and intubating laryngeal mask airway (I-LMA) may be used to facilitate intubation and secure the airway in patients with normal and abnormal airways. The aim of this study was to evaluate whether (GVL) and (I-LMA) facilitate and improve the tracheal intubation success rate and could be learned and performed easily by paramedic students when compared with Macintosh direct laryngoscopy (DL). Methods: This study was a prospective, randomised crossover trial that included 100 paramedic students. Macintosh DL, I-LMA and GVL were tested in both normal and difficult airway scenarios. Each participant was allowed up to three intubation attempts with each device, in each scenario. The time required to perform tracheal intubation, the success rate, number of intubation attempts and of optimisation manoeuvres and the severity of dental trauma were recorded. Statistical analysis was performed using Chi-square, one-way ANOVA, or Kruskal-Wallis test as appropriate, followed by post hoc test. Results: GVL and I-LMA required less time to successfully perform tracheal intubation, showed a greater success rate of intubation, reduced the number of intubation attempts and optimization manoeuvres required and reduced the severity of dental trauma compared to Macintosh DL in both normal and difficult airway scenarios. Conclusion: GVL and I-LMA provide better airway management than Macintosh DL in both normal and difficult airway scenarios.
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Affiliation(s)
- Adil Omar Bahathiq
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah Mukarramah, Saudi Arabia
| | - Tharwat Helmy Abdelmontaleb
- Department of Anesthesia Technology, College of Applied Medical Sciences, Umm Al Qura University, Makkah Mukarramah, Saudi Arabia
| | - Mohammed Khairt Newigy
- Department of Anesthesia Technology, College of Applied Medical Sciences, Umm Al Qura University, Makkah Mukarramah, Saudi Arabia
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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.
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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
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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.
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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
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Ambrosio A, Pfannenstiel T, Bach K, Cornelissen C, Gaconnet C, Brigger MT. Difficult Airway Management for Novice Physicians. Otolaryngol Head Neck Surg 2014; 150:775-8. [DOI: 10.1177/0194599814521380] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To detect a difference in (1) intubation success and (2) successful intubation times between novice physicians using a Macintosh-style or video-assisted laryngoscope on a difficult airway manikin. Study Design Prospective randomized trial. Setting Academic, tertiary medical center. Methods Forty first-year residents across a variety of disciplines with fewer than 5 total live intubations were recruited for the study. Testing took place during orientation prior to commencement of clinical duties. The entire group was provided training by faculty otolaryngologists and anesthesiologists using both laryngoscope types on a manikin airway simulator in a standard intubating scenario. Subjects were then randomized into 2 testing groups, using either a Macintosh laryngoscope or video-assisted laryngoscope in a difficult intubation scenario. The difficult airway simulation entailed oral cavity/oropharyngeal obstruction using inflation of the tongue, as well as cervical spine immobilization with a rigid collar preventing extension and elevation of the head and limiting oral cavity opening. Success was defined as a confirmed endotracheal intubation by the testing instructor in 120 seconds or less. Results The Macintosh laryngoscope group (n = 19) had an intubation success rate of 47.4% with a mean intubation time of 69.0 seconds (95% confidence interval [CI]: 52.7, 85.2). The video-assisted group (n = 21) demonstrated a significantly higher success rate of 100% ( P < .0001) and a decreased mean intubation time of 23.1 seconds (95% CI: 18.4, 27.8; P < .0001). The mean difference in success rate between groups was 52.6% (95% CI: 30.0%, 75.3%). Conclusions Novice physicians with little to no prior intubation experience showed significantly higher intubation success with lower intubation times using a video-assisted laryngoscope in a difficult airway manikin simulator.
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Affiliation(s)
- Art Ambrosio
- Department of Otolaryngology–Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Travis Pfannenstiel
- Department of Otolaryngology–Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
- Otology/Neurotology & Skull Base Surgery, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Kevin Bach
- Department of Otolaryngology–Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Chris Cornelissen
- Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Cory Gaconnet
- Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Matthew T. Brigger
- Department of Otolaryngology–Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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10
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Yang T, Hou J, Li J, Zhang X, Zhu X, Ni W, Mao Y, Deng X. Retrograde Light-guided Laryngoscopy for Tracheal Intubation. Anesthesiology 2013; 118:1059-64. [DOI: 10.1097/aln.0b013e31828877c0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
Tracheal intubation with conventional laryngoscopy requires many trials until beginners are sufficiently skilled in intubating patients safely. To facilitate intubation, the authors used retrograde light-guided laryngoscopy (RLGL) and compared its feasibility with conventional direct laryngoscopy (DL).
Methods:
Twenty operators participated in a prospective, randomized, open-label, parallel-arm study. These operators intubated 205 patients randomly according to a computer-generated procedure by using either DL or RLGL (five intubations with each technique). The primary outcome was the success rate of tracheal intubation. The authors evaluated the success rate of tracheal intubation, the time to glottic exposure and tracheal intubation, and the Cormack and Lehane grades.
Results:
Compared with DL, the success rate was greater in the RLGL group for all five intubations (72% vs. 47%; rate difference, 25%; 95% CI [11.84–38.16%], P < 0.001). This was associated with a shorter time to glottic exposure (median [25th and 75th percentile]; 27 [15; 42] vs. 45 [30; 73] s, P < 0.001), shorter intubation time (66 [44; 120] vs. 120 [69; 120] s, P < 0.001), and decreased throat soreness (mean ± SD; visual analog scale, 2.1 ± 0.9 vs. 3.7 ± 1.0 cm, P = 0.001) in the RLGL group compared to the DL group.
Conclusion:
RLGL is an alternative intubation technique. In our study, it enables beginners to intubate patients more successfully and quickly than conventional DL.
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Affiliation(s)
- Tao Yang
- Attending Doctor, Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University, Shanghai, PR China
| | - Jiong Hou
- Associate Professor Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University
| | - Jinbao Li
- Associate Professor, Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University
| | - Xu Zhang
- Research Fellow, Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University
| | - Xiaoyan Zhu
- Associate Professor, Department of Physiology, Second Military Medical University
| | - Wen Ni
- Associate Professor, Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University
| | - Yanfei Mao
- Resident, Departments of SICU, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Xiaoming Deng
- Professor, Department of Anesthesiology and Intensive Care Medicine, Changhai Hospital, Second Military Medical University
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Kaki AM, Almarakbi WA, Fawzi HM, Boker AM. Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students' hands: A manikin study. Saudi J Anaesth 2012; 5:376-81. [PMID: 22144924 PMCID: PMC3227306 DOI: 10.4103/1658-354x.87266] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6(th) year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools. SETTING AND DESIGN Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital. METHODS FIFTY MEDICAL STUDENTS PERFORMED EITHER ORAL OR NASAL TRACHEAL INTUBATION USING THE FOLLOWING FOUR INTUBATING TOOLS: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres' use among different airway tools were recorded. RESULTS In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope (P<0.001). Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008). CONCLUSIONS New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.
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Affiliation(s)
- Abdullah M Kaki
- Department of Anaesthesia, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Prossliner H, Braun P, Paal P. Anaesthesia in medical emergencies. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivität der supraglottischen Atemwegssicherung. Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1413-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Kuppusamy A, Azhar N. Comparison of bougie-guided insertion of Proseal laryngeal mask airway with digital technique in adults. Indian J Anaesth 2011; 54:35-9. [PMID: 20532069 PMCID: PMC2876913 DOI: 10.4103/0019-5049.60494] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Proseal™ laryngeal mask airway (PLMA™, Laryngeal Mask Company, UK) was designed to improve ventilatory characteristics and offer protection against regurgitation and gastric insufflation. The PLMA is a modified laryngeal mask airway with large ventral cuff, dorsal cuff and a drain tube. These modifications improve seal around glottis and enable better ventilatory characteristics. The drain tube prevents gastric distension and offers protection against aspiration. There were occasional problems, like failed insertion and inadequate ventilation, in placing PLMA™ using the classical digital technique. To overcome these problems, newer placement techniques like thumb insertion technique, introducer tool placement and gum elastic bougie (GEB)-aided placement were devised. We compared classical digital placement of PLMA™ with gum elastic bougie-aided technique in 60 anaesthetised adult patients (with 30 patients in each group) with respect to number of attempts to successful placement, effective airway time, airway trauma during insertion, postoperative airway morbidity and haemodynamic response to insertion. The number of attempts to successful placement, airway trauma during insertion and haemodynamic response to insertion were comparable among the two groups, while effective airway time and oropharyngeal leak pressure were significantly higher in bougie- guided insertion of PLMA. Postoperatively, sore throat was more frequent with digital technique while dysphagia was more frequent with bougie guided technique. Hence gum elastic bougie guided, laryngoscope aided insertion of PLMA is an excellent alternate to classical digital technique.
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Affiliation(s)
- Anand Kuppusamy
- Department of Anaesthesiology, Madras Medical College, Chennai - 600 003, Tamilnadu, India
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Hwang J, Han S, Hwang J, Oh A, Park S, Kim J. The McIvor blade improves insertion of the LMA ProSeal™ in children. Can J Anaesth 2011; 58:796-801. [PMID: 21691935 DOI: 10.1007/s12630-011-9540-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/13/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The McIvor blade, a tongue retractor with a thin curved blade, is used to improve the operating field during a tonsillectomy. We compared the success rate and incidence of complications between digital insertion and McIvor blade-guided insertion of the laryngeal mask airway (LMA™) ProSeal™ when performed by anesthesia residents in children. METHODS A total of 134 anesthetized non-paralyzed pediatric patients were included in the study. Patients were allocated randomly to one of two groups, i.e., Digital group (LMA ProSeal insertion using the digital insertion technique) or McIvor group (LMA ProSeal insertion using the Mclvor blade-guided technique). All patients were managed by anesthesia residents who were unskilled in using each technique. We assessed success rates of insertion at the first attempt, insertion time for an effective airway, and postoperative blood staining. RESULTS The success rate of insertion at the first attempt was higher in the McIvor group than in the Digital group (97% vs 78%, respectively; P = 0.003), and insertion time with a successful first attempt was shorter in the McIvor group than in the Digital group (20.5 [4.5] sec vs 22.8 [6.7] sec, respectively; P = 0.021). The overall insertion time for an effective airway was also shorter in the McIvor group than in the Digital group (20.9 [5.7] sec vs 26.0 [9.8] sec, respectively; P < 0.001). Blood staining was more frequent in the Digital group than in the McIvor group (23% vs 6%, respectively; P = 0.035). CONCLUSION When inserting the LMA ProSeal in children, anesthesia residents were more successful using the McIvor blade-guided insertion technique than using the digital insertion technique. (ClinicalTrials.gov number, NCT01191619).
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Affiliation(s)
- Jinyoung Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea
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16
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Kleine-Brueggeney M, Theiler L, Urwyler N, Vogt A, Greif R. Randomized trial comparing the i-gel™ and Magill tracheal tube with the single-use ILMA™ and ILMA™ tracheal tube for fibreoptic-guided intubation in anaesthetized patients with a predicted difficult airway. Br J Anaesth 2011; 107:251-7. [PMID: 21652616 DOI: 10.1093/bja/aer103] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The i-gel™ is a single-use supraglottic airway device (SAD) that allows fibreoptic-guided tracheal intubation through the device. Until now, no prospective data for this procedure are available. Therefore, in a prospective randomized controlled trial, we evaluated fibreoptic-guided tracheal intubation with a standard Rüsch™ PVC tracheal tube (TT) through the i-gel™ compared with the single-use ILMA™ (sILMA™) TT through the sILMA™ in patients with a predicted difficult airway. METHODS With ethics committee approval and written informed consent, 160 patients were randomly assigned to either SAD. After placement of the SAD, a fibreoptic bronchoscope was introduced into the trachea as a railroad for the TT. Primary outcome variable was the first-attempt fibreoptic-guided intubation success rate. Secondary variables included time for insertion and intubation, airway leak pressures, fibreoptic view, and adverse events. Data are presented as mean (sd) or percentages. A P-value of < 0.05 was considered statistically significant. RESULTS Fibreoptic-guided intubation was successful at the first attempt in 76 patients (96%) using the i-gel™ and in 71 patients (90%) using the sILMA™ (P=0.21). Most of the failed intubations were rescued by conventional laryngoscopy. Airway leak pressure was higher for the sILMA™. There were no problems during removal of either type of SAD. CONCLUSIONS Fibreopic-guided tracheal intubation through the i-gel™ using a standard Rüsch™ Magill TT is successful and an alternative to the sILMA™ with the sILMA™ TT.
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Affiliation(s)
- M Kleine-Brueggeney
- Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, and University of Bern, Switzerland
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Theiler L, Kleine-Brueggeney M, Urwyler N, Graf T, Luyet C, Greif R. Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway. Br J Anaesth 2011; 107:243-50. [PMID: 21652615 DOI: 10.1093/bja/aer102] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). METHODS With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). RESULTS Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. CONCLUSIONS Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel™.
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Affiliation(s)
- L Theiler
- Department of Anesthesiology and Pain Therapy, Inselspital, University Hospital Bern, and University of Bern, Switzerland
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Abstract
PURPOSE OF REVIEW Recently, notable progress has been made in the field of anesthesia drugs and airway management. RECENT FINDINGS Anesthesia in prehospital emergencies and in the emergency department is reviewed and guidelines are discussed. SUMMARY Preoxygenation should be performed with high-flow oxygen delivered through a tight-fitting face mask with a reservoir. Ketamine may be the induction agent of choice in hemodynamically unstable patients. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. Experienced healthcare providers may consider prehospital anesthesia induction. Moderately experienced healthcare providers should optimize oxygenation, hasten hospital transfer and only try to intubate a patient whose life is threatened. When intubation fails twice, ventilation should be performed with an alternative supraglottic airway or a bag-valve-mask device. Lesser experienced healthcare providers should completely refrain from intubation, optimize oxygenation, hasten hospital transfer and ventilate patients only in life-threatening circumstances with a supraglottic airway or a bag-valve-mask device. Senior help should be sought early. In a 'cannot ventilate-cannot intubate' situation, a supraglottic airway should be employed and, if ventilation is still unsuccessful, a surgical airway should be performed. Capnography should be used in every ventilated patient. Clinical practice is essential to retain anesthesia and airway management skills.
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Ayoub CM, Kanazi GE, Al Alami A, Rameh C, El-Khatib MF. Tracheal intubation following training with the GlideScope® compared to direct laryngoscopy. Anaesthesia 2010; 65:674-8. [DOI: 10.1111/j.1365-2044.2010.06335.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Paal P, Herff H, Mitterlechner T, von Goedecke A, Brugger H, Lindner KH, Wenzel V. Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation 2010; 81:148-54. [PMID: 19942337 DOI: 10.1016/j.resuscitation.2009.10.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 10/05/2009] [Accepted: 10/24/2009] [Indexed: 12/23/2022]
Abstract
AIMS To review anaesthesia in prehospital emergencies and in the emergency room, and to discuss guidelines for anaesthesia indication; pre-oxygenation; anaesthesia induction and drugs; airway management; anaesthesia maintenance and monitoring; side effects and training. METHODS A literature search in the PubMed database was performed and 87 articles were included in this non-systematic review. CONCLUSIONS For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir. In haemodynamically unstable patients, ketamine may be the induction agent of choice. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. An experienced health-care provider may consider prehospital anaesthesia induction. A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a patient in extremis. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. A lesser experienced health-care provider should completely refrain from intubation, optimise oxygenation, fasten hospital transfer and only in extremis ventilate with an alternative supra-glottic airway or a bag-valve-mask device. With an expected difficult airway, the patient should be intubated awake. With an unexpected difficult airway, bag-valve-mask ventilation should be resumed and an alternative supra-glottic airway device inserted. Senior help should be called early. In a "can-not-ventilate, can-not-intubate" situation an alternative airway should be tried and if unsuccessful because of severe upper airway pathology, a surgical airway should be performed. Ventilation should be monitored continuously with capnography. Clinical training is important to increase airway management skills.
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Affiliation(s)
- Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Heuer JF, Stiller M, Rathgeber J, Eich C, Züchner K, Bauer M, Timmermann A. [Evaluation of the new supraglottic airway devices Ambu AuraOnce and Intersurgical i-gel. Positioning, sealing, patient comfort and airway morbidity]. Anaesthesist 2009; 58:813-20. [PMID: 19669103 DOI: 10.1007/s00101-009-1600-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Supraglottic airway devices (SGAD) have become more important in airway management over the past years and an objective comparison of the available devices is in order. METHODS In a prospective study the four SGADs LMA-Classic(cLMA), LMA-ProSeal (PLMA), Ambu AuraOnce and Intersurgical i-gel were compared in groups of 40 patients in ambulatory surgery, with respect to the feasibility of positioning, leak tightness, patient comfort and airway morbidity. The seal test of the airway devices was carried out with a specially constructed pneumotachograph. RESULTS Adequate placement on the first attempt was achieved in 92.5% with the cLMA, 85% with the PLMA, 92.5% with the AuraOnce and 82.5% with the i-gel (p>0.05). There were no clinically relevant differences in mean insertion times: cLMA 13.8 s (+/-3.4 s), PLMA 13 s (+/-3.2 s), AuraOnce 11.2 s (+/-2.7 s; p<0.05) and 13.9 s (+/-3.6 s) with the i-gel. A tight seal at a constant oropharyngeal pressure of 15 cmH(2)O was achieved in 85% of the cases (34 cases) with the cLMA, 90% (36 cases) with the PLMA, 97.5% (39 cases) with the AuraOnce and 72.5% (29 cases) with the i-gel (p<0.05). A tight seal at a constant oropharyngeal pressure of 20 cmH(2)O was seen in 62.5% with the cLMA, 60% with the PLMA, 67.5% with the AuraOnce and in 50% with the i-gel of the cases (p>0.05). Airway morbidity was not observed in any group. Significantly more patients complained of a sore throat after using the cLMA (p<0.05). CONCLUSION The tested SGADs were comparable with regard to ease of insertion, insertion times and airway morbidity. Considering leak tightness and patient comfort the PLMA and the AuraOnce fared better with regard to tightness of seal and patient comfort.
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Affiliation(s)
- J F Heuer
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Göttingen.
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Kim YY, Lee SK, Yi JS. Comparison between the index finger insertion and catheter-guided insertion techniques for airway placement of a ProSeal™ laryngeal mask by inexperienced personnel. Korean J Anesthesiol 2009; 56:634-638. [DOI: 10.4097/kjae.2009.56.6.634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yu Yil Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Sang Kyi Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Institute for Medical Sciences, Chonbuk National University Medical School, Jeonju, Korea
| | - Ji Sun Yi
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Timmermann A, Cremer S, Heuer J, Braun U, Graf B, Russo S. Larynxmaske LMA Supreme™. Anaesthesist 2008; 57:970-5. [DOI: 10.1007/s00101-008-1425-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [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]
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Timmermann A, Russo SG, Eich C, Roessler M, Braun U, Rosenblatt WH, Quintel M. The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians. Anesth Analg 2007; 104:619-23. [PMID: 17312220 DOI: 10.1213/01.ane.0000253523.80050.e9] [Citation(s) in RCA: 229] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rapid establishment of a patent airway in ill or injured patients is a priority for prehospital rescue personnel. Out-of-hospital tracheal intubation can be challenging. Unrecognized esophageal intubation is a clinical disaster. METHODS We performed an observational, prospective study of consecutive patients requiring transport by air and out-of-hospital tracheal intubation, performed by primary emergency physicians to quantify the number of unrecognized esophageal and endobronchial intubations. Tracheal tube placement was verified on scene by a study physician using a combination of direct visualization, end-tidal carbon dioxide detection, esophageal detection device, and physical examination. RESULTS During the 5-yr study period 149 consecutive out-of-hospital tracheal intubations were performed by primary emergency physicians and subsequently evaluated by the study physicians. The mean patient age was 57.0 (+/-22.7) yr and 99 patients (66.4%) were men. The tracheal tube was determined by the study physician to have been placed in the right mainstem bronchus or esophagus in 16 (10.7%) and 10 (6.7%) patients, respectively. All esophageal intubations were detected and corrected by the study physician at the scene, but 7 of these 10 patients died within the first 24 h of treatment. CONCLUSION The incidence of unrecognized esophageal intubation is frequent and is associated with a high mortality rate. Esophageal intubation can be detected with end-tidal carbon dioxide monitoring and an esophageal detection device. Out-of-hospital care providers should receive continuing training in airway management, and should be provided additional confirmatory adjuncts to aid in the determination of tracheal tube placement.
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Affiliation(s)
- Arnd Timmermann
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August University, Goettingen, Germany.
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