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López Viloria C, Torío Marcos M, Díez Burón F. [Implementation of a difficult airway unit: A latent need in our days]. J Healthc Qual Res 2024; 39:198-199. [PMID: 38212184 DOI: 10.1016/j.jhqr.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Affiliation(s)
- C López Viloria
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de León, León, España.
| | - M Torío Marcos
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de León, León, España
| | - F Díez Burón
- Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de León, León, España
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ecker H, Kolvenbach S, Herff H, Wetsch WA. Intubation using VieScope vs. Video laryngoscopy in full personal protective equipment - a randomized, controlled simulation trial. BMC Anesthesiol 2021; 21:288. [PMID: 34809581 PMCID: PMC8606276 DOI: 10.1186/s12871-021-01502-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND VieScope is a new type of laryngoscope, with a straight, transparent and illuminated blade, allowing for direct line of sight towards the larynx. In addition, VieScope is disposed of after single patient use, which can avoid cross-contaminations of contagious material. This has gained importance especially when treating patients with highly contagious infectious diseases, such as during the SARS-CoV2 pandemic. In this context, VieScope has not been evaluated yet in a clinical study. MATERIAL AND METHODS This study compared intubation with VieScope to video-laryngoscopy (GlideScope) in normal and difficult airway in a standardized airway manikin in a randomized controlled simulation trial. Thirty-five medical specialists were asked to perform endotracheal intubation in full personal protective equipment (PPE). Primary endpoint was correct tube position. First-pass rate (i.e., success rate at the first attempt), time until intubation and time until first correct ventilation were registered as secondary endpoints. RESULTS For correct tracheal tube placement, there was no significant difference between VieScope and GlideScope in normal and difficult airway conditions. VieScope had over 91% fist-pass success rate in normal airway setting. VieScope had a comparable success rate to GlideScope in difficult airway, but had a significantly longer time until intubation and time until ventilation. CONCLUSION VieScope and GlideScope had high success rates in normal as well as in difficult airway. There was no unrecognized esophageal intubation in either group. Overall time for intubation was longer in the VieScope group, though in an acceptable range given in literature. Results from this simulation study suggest that VieScope may be an acceptable alternative for tracheal intubation in full PPE. TRIAL REGISTRATION The study was registered at the German Clinical Trials Register www.drks.de (Registration date: 09/11/2020; TrialID: DRKS00023406 ).
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Affiliation(s)
- Hannes Ecker
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Simone Kolvenbach
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Holger Herff
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Balakrishnan S, Oldenburg AL. All-fiber probes for endoscopic optical coherence tomography of the large airways. Appl Opt 2021; 60:6385-6392. [PMID: 34612872 PMCID: PMC8672310 DOI: 10.1364/ao.431010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Endoscopic optical coherence tomography of large airways poses unique challenges. A hybrid lens is described that consists of a section of coreless fiber and graded index fiber (GIF), followed by a ball lens section. This design produces low numerical aperture beams better suited for large airway imaging. The performance of this lens is compared against conventional GIF and ball lens designs. Forward- and side-viewing probes were modeled, fabricated, and tested. The impact of a sheath on the beam profile was also investigated. Probes with working distances larger than 10 mm and depth-of-focus exceeding 12 mm are demonstrated with the proposed design.
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Affiliation(s)
- Santosh Balakrishnan
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Amy L. Oldenburg
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- University of North Carolina at Chapel Hill, Biomedical Research Imaging Center, Chapel Hill, North Carolina 27599, USA
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Affiliation(s)
- Thomas Heidegger
- From the Department of Anesthesia, Spital Grabs, Grabs, and the Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern - both in Switzerland; and the Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Adánez Martínez MG, Leal Costa C, García López JA, Torres Ganfornina M, Ramos Morcillo AJ, Hernández Ruipérez T, García Palenciano C, Díaz Agea JL. Perception of level of knowledge, skills, and safety before and after training to perform videolaryngoscopy with the Intubox barrier system for airway management in patients with COVID-19. Emergencias 2021; 33:93-99. [PMID: 33750049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The main objective was to describe physicians’ perception of their knowledge, skill, and safety before and after training to perform videolaryngoscopy while using the Intubox barrier system when managing the airway of a patient with the coronavirus 2019 disease (COVID-19). The secondary objective was to assess the safety afforded by the barrier by means of visually evaluating particle dispersion during intubation. MATERIAL AND METHODS Single-arm clinical simulation trial. The participants were physicians who received training in both a lowfidelity and a high-fidelity simulation zone. The participants assessed their knowledge, skill, and safety when using the Intubox before and after training using a specially designed and validated questionnaire. Droplet contamination was estimated visually. RESULTS Twenty-seven physicians with a mean (SD) age of 40 (10.8) years participated; 63% were women. They perceived their knowledge, skill, and safety to be significantly higher after training. Droplet contamination was seen to decrease when airway management maneuvers were done with the barrier in place. CONCLUSION After simulation training the emergency physicians judged their knowledge, skill, and safety to be greater when they used the barrier during airway management in patients with COVID-19. The combined use of a laryngoscope and the Intubox barrier resulted in less particle dispersion during intubation.
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Affiliation(s)
- María Gracia Adánez Martínez
- Servicio de Urgencias Hospitalarias, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, España
| | | | - José Antonio García López
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | - Máximo Torres Ganfornina
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
| | | | - Tomás Hernández Ruipérez
- Servicio de Urgencias Hospitalarias, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad Católica de Murcia (UCAM), Murcia, España
| | - Carlos García Palenciano
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, España
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Ozbilgin S, Kuvaki B, Şimşek HK, Saatli B. Comparison of airway management without neuromuscular blockers in laparoscopic gynecological surgery. Medicine (Baltimore) 2021; 100:e24676. [PMID: 33607806 PMCID: PMC7899844 DOI: 10.1097/md.0000000000024676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/16/2021] [Indexed: 01/05/2023] Open
Abstract
New generation supraglottic airway devices are suitable for airway management in many laparoscopic surgeries. In this study, we evaluated and compared the ventilation parameters of the laryngeal mask airway-supreme (LM-S) and endotracheal tube (ETT) when a neuromuscular blocker (NMB) agent was not used during laparoscopic gynecological surgery. The second outcome was based on the evaluation of the surgical view because it may affect the surgical procedure.This was a randomized study that enrolled 100 patients between 18 and 65 years old with an ASA I-II classification. Patients were divided into 2 groups: Group ETT and Group LM-S. Standard anesthesia and ventilation protocols were administered to patients in each group. Ventilation parameters [airway peak pressure (Ppeak), mean airway pressure (Pmean), total volume, and oropharyngeal leak pressure] were recorded before, after, and during peritoneal insufflation and before desufflation, as well as after the removal of the airway device. Perioperative surgical view quality and the adequacy of the pneumoperitoneum were also recorded.The data of 100 patients were included in the statistical analysis. The Ppeak values in Group ETT were significantly higher in the second minute after airway device insertion. The Ppeak and Pmean values in Group ETT were significantly higher before desufflation and after removal of the airway device. No significant differences were found between the groups in terms of adequacy of the pneumoperitoneum or quality of the surgical view.The results of this study showed that gynecological laparoscopies can be performed without using a NMB. Satisfactory conditions for ventilation and surgery can be achieved while sparing the use of muscle relaxants in both groups despite the Trendelenburg position and the pneumoperitoneum of the patients, which are typical for laparoscopic gynecological surgery. The results are of clinical significance because they show that the use of a muscle relaxant is unnecessary when supraglottic airways are used for these surgical procedures.
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Affiliation(s)
| | | | | | - Bahadir Saatli
- Department of Obstetrics and Gynecology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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9
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Ismail A, Nunez J. Points & Pearls: Supraglottic airway devices for pediatric airway management in the emergency department. Pediatr Emerg Med Pract 2020; 17:e1-e2. [PMID: 33080126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Arooma Ismail
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, NY
| | - Jeranil Nunez
- Assistant Medical Director, Pediatric Emergency Medicine, Mount Sinai Beth Israel; Associate Professor of Clinical Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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10
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White LD, Thang C, Hodsdon A, Melhuish TM, Barron FA, Godsall MG, Vlok R. Comparison of Supraglottic Airway Devices With Endotracheal Intubation in Low-Risk Patients for Cesarean Delivery: Systematic Review and Meta-analysis. Anesth Analg 2020; 131:1092-1101. [PMID: 32925330 DOI: 10.1213/ane.0000000000004618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The safety and adverse event rate of supraglottic airway (SGA) devices for cesarean delivery (CD) is poorly characterized. The primary aims of this review were to determine whether the first-pass success was higher and time to insertion for SGA was faster than endotracheal intubation for elective CD. The secondary aim was to determine the airway-related adverse event rate associated with SGA use compared to endotracheal intubation in elective CD under general anesthesia (GA). METHODS Six databases were systematically searched until September 2019. Included studies reported on the use of SGA in comparison to endotracheal tube intubation. A comparative meta-analysis between SGA and endotracheal intubation was performed using RevMan 5.3 software. Dichotomous outcomes were reported using an odds ratio (OR) with 95% confidence interval (CI). The results for continuous outcomes were reported using a weighted mean difference (WMD) with 95% CI. RESULTS Fourteen studies with 2236 patients compared SGA and endotracheal intubation. Overall, there was no statistically significant difference in first-attempt success rate (OR = 1.92; 95% CI, 0.85-4.32; I = 0%; P = .44). There was no clinically significant difference in time to insertion (WMD = -15.80 seconds; 95% CI, -25.30 to -6.31 seconds; I= 100%; P = .001). Similarly, there was no difference in any adverse event rate except sore throat which was reduced with the use of an SGA (OR = 0.16; 95% CI, 0.08-0.32; I= 53%; P < .001). CONCLUSIONS Despite the reasonable insertion success rate and safety profile of SGAs demonstrated in this meta-analysis, the analysis remains underpowered and therefore inconclusive. At present, further studies are required before the use of an SGA as the first-line airway for an elective CD can be recommended.
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Affiliation(s)
- Leigh D White
- From the Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Christopher Thang
- From the Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Anthony Hodsdon
- Graduate Medicine, University of Wollongong, NSW, Australia
- Department of Anaesthetics, Wollongong Hospital, Wollongong, NSW, Australia
| | - Thomas M Melhuish
- Intensive Care Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Fiona A Barron
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - M Guy Godsall
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
| | - Ruan Vlok
- Department of Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia
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Martín-Pereira J, Gómez-Salgado J, García-Iglesias JJ, Romero-Martín M, Gómez-Urquiza JL. Laryngeal tubes and laryngeal mask devices for supraglottic airway management in out-of-hospital emergency care: a systematic review. Emergencias 2020; 31:417-428. [PMID: 31777215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Various supraglottic devices are currently available for airway management and are used widely in emergency situations because they are easy to position. We undertook a systematic review of the literature comparing laryngeal tubes and various laryngeal mask airway devices (LMAs) to determine which ones can be used most efficiently in emergencies. Nine databases were searched, as follows: Cochrane Library Plus, MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Global Health, Nursing & Allied Health Database, CUIDEN, the Web of Science, and ScienceDirect. We collected studies published between 2014 and 2019 in Spanish, English, French, and Portuguese that compared laryngeal tubes to LMAs of different types for supraglottic airway management. Eighteen studies were selected for analysis after critical reading. Significant differences were not seen between tubes and LMAs with respect to most variables, but in certain contexts the oropharyngeal seal and speed of insertion were superior with laryngeal tubes; however, when fiberoptic bronchoscopes were then inserted the view of the glottis was poor. The different contexts in which these devices are used and the scarcity of studies comparing laryngeal tubes to LMAs does not allow us to identify clear differences among them with respect to efficiency. However, tubes seem to offer poorer visibility of the glottis according to evaluation with fiberoptic scopes, a factor to bear in mind if tracheal intubation, which is considered the gold standard, might become necessary.
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Affiliation(s)
| | - Juan Gómez-Salgado
- Área de Medicina Preventiva y Salud Pública, Dpto. de Sociología, Trabajo Social y Salud Pública, Facultad de Ciencias del Trabajo, Universidad de Huelva, Huelva, España. Universidad Espíritu Santo, Guayaquil, Ecuador
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12
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Hart J, Tracy R, Johnston M, Brown S, Stephenson C, Kegg J, Waymack J. Recommendations for Prehospital Airway Management in Patients with Suspected COVID-19 Infection. West J Emerg Med 2020; 21:809-812. [PMID: 32726247 PMCID: PMC7390580 DOI: 10.5811/westjem.2020.5.47540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/25/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
In light of the rapid spread of coronavirus disease 2019 (COVID-19) across the United States, the Centers for Disease Control and Prevention (CDC) and hospitals nationwide have developed new protocols to address infection control as well as the care of critical patients. Airway management has been particularly difficult; the challenge of quickly establishing an airway in patients must be balanced by the risk of aerosolizing respiratory secretions and putting the provider at risk of infection. Significant attention has been given to developing protocols for the emergency department and critical care units, but little guidance regarding establishing airway and respiratory support for patients in the prehospital setting has been made available. While some of the recommendations can be extrapolated from hospital guidelines, other factors such as environment and available resources make these protocols unfeasible. Through review of current literature the authors established recommendations regarding airway management and the provision of respiratory support to patients developing respiratory failure related to COVID-19.
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Affiliation(s)
- James Hart
- Southern Illinois University School of Medicine, Department of Emergency Medicine, Springfield, Illinois
| | - Rebecca Tracy
- Southern Illinois University School of Medicine, Department of Emergency Medicine, Springfield, Illinois
| | - Matthew Johnston
- Southern Illinois University School of Medicine, Department of Emergency Medicine, Springfield, Illinois
| | - Sara Brown
- Memorial Medical Center, Springfield, Illinois
| | - Connor Stephenson
- Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jason Kegg
- Southern Illinois University School of Medicine, Department of Emergency Medicine, Springfield, Illinois
- State of Illinois EMS Medical Director, Department of Public Health, Springfield, Illinois
| | - James Waymack
- Southern Illinois University School of Medicine, Department of Emergency Medicine, Springfield, Illinois
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13
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McMurray R, Becker L, Olsen KF, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J 2020; 88:123-129. [PMID: 32234203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Using deep sedation, adjunct airway devices such as oral or nasal airways are frequently required to maintain airway patency. Traditional oral airways (TOAs, made of rigid plastic) or nasal airways (made of pliable materials) can be associated with adverse effects, contributing to a trend of anesthesia providers placing nasal airways orally. A clinical observational study and an electronic provider survey were conducted to examine this emerging practice. The observation study objective was to investigate reported postoperative sore throat occurrence associated with use of either a nontraditional airway (nasal airway used orally) or TOA in deep sedation procedures (N = 243). Patients receiving nontraditional airways reported significantly less postoperative sore throat than those receiving TOAs (17% vs 40%, respectively; P < .001). These results prompted a broader exploration into airway practices of anesthesia providers via an electronic survey. Most respondents (n = 293) reported adverse effects, including gagging/coughing on insertion, oral cavity injury, and bleeding with TOAs. More than half (52.8%) reported using nasal airways orally. These results suggest a clinical void in current airway management options for deep sedation. Providers indicated the need for airway devices that provide a patent airway while mitigating adverse effects associated with commonly used airways.
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Affiliation(s)
- Roxanne McMurray
- is an assistant program director, Nurse Anesthesia specialty, and a clinical assistant professor at the University of Minnesota School of Nursing in Minneapolis, Minnesota, and is a staff anesthetist with Community Anesthesia Professionals, a department of Minnesota Gastroenterology PA in St Paul, Minnesota
| | - Logan Becker
- is a staff anesthetist for Glencoe Regional Health Services in Glencoe, Minnesota. He is also affiliate faculty at the University of Minnesota School of Nursing
| | - Kelley Frost Olsen
- is a staff anesthetist for Sanford Bemidji Medical Center in Bemidji, Minnesota
| | - Megan McMurray
- is a current resident at Southern Illinois University in Springfield, Illinois
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14
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Marinho S, Frias P, Oliveira I, Silva R, Rodrigues F, Paiva A. Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:212-214. [PMID: 32178913 DOI: 10.1016/j.redar.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.
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Affiliation(s)
- S Marinho
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | - P Frias
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Oliveira
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - R Silva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - F Rodrigues
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Paiva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
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15
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Kang J, Xue C, Lou Z, Scholp A, Zhang Y, Jiang JJ. The Therapeutic Effects of Straw Phonation on Vocal Fatigue. Laryngoscope 2020; 130:E674-E679. [PMID: 31971264 DOI: 10.1002/lary.28498] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Straw phonation has been investigated for its vocal warm-up effects on healthy populations and therapeutic effects on voice patients. The purpose of this article was to determine whether it is beneficial for vocal fatigue. STUDY DESIGN Prospective cohort study METHODS: Twenty-five healthy participants were recruited into 1-hour vocal loading tasks followed by 10-minute vocal rest or straw phonation on 2 different days. Various parameters including phonation threshold pressure (PTP), mean airflow, closed quotient (CQ), current speaking effort level (EFFT), and laryngeal discomfort (DISC) were acquired at baseline, after vocal load, and after the intervention. RESULTS Increased PTP, EFFT, and DISC were observed after vocal load. Decreased PTP, EFFT, and DISC were then acquired after both vocal rest or straw phonation. More significant improvements were obtained in straw phonation when compared with vocal rest. Additionally, significantly increased mean flow and decreased CQ were obtained after straw phonation when compared to vocal rest. CONCLUSIONS Straw phonation has the potential to adjust aerodynamics within the vocal tract leading to improved vocal efficiency, optimized vibration mode, and attenuated vocal fatigue. This study provided a promising treatment for vocal fatigue that could have wide clinical relevance to voice users with high voice demands. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E674-E679, 2020.
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Affiliation(s)
- Jing Kang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Xue
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Zhewei Lou
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Yi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Hudson IL, Blackburn MB, Staudt AM, Ryan KL, Mann-Salinas EA. Analysis of Casualties That Underwent Airway Management Before Reaching Role 2 Facilities in the Afghanistan Conflict 2008-2014. Mil Med 2020; 185:10-18. [PMID: 32074383 DOI: 10.1093/milmed/usz383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Airway compromise is the second leading cause of potentially survivable death on the battlefield. The purpose of this study was to better understand wartime prehospital airway patients. MATERIALS AND METHODS The Role 2 Database (R2D) was retrospectively reviewed for adult patients injured in Afghanistan between February 2008 and September 2014. Of primary interest were prehospital airway interventions and mortality. Prehospital combat mortality index (CMI-PH), hemodynamic interventions, injury mechanism, and demographic data were also included in various statistical analyses. RESULTS A total of 12,780 trauma patients were recorded in the R2D of whom 890 (7.0%) received prehospital airway intervention. Airway intervention was more common in patients who ultimately died (25.3% vs. 5.6%); however, no statistical association was found in a multivariable logistic regression model (OR 1.28, 95% CI 0.98-1.68). Compared with U.S. military personnel, other military patients were more likely to receive airway intervention after adjusting for CMI-PH (OR 1.33, 95% CI 1.07-1.64). CONCLUSIONS In the R2D, airway intervention was associated with increased odds of mortality, although this was not statistically significant. Other patients had higher odds of undergoing an airway intervention than U.S. military. Awareness of these findings will facilitate training and equipment for future management of prehospital/prolonged field care airway interventions.
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Affiliation(s)
- Ian L Hudson
- US Army Institute of Surgical Research is United States of America (USA), 3698 Chambers Pass, San Antonio TX 78234, USA
| | - Megan B Blackburn
- US Army Institute of Surgical Research is United States of America (USA), 3698 Chambers Pass, San Antonio TX 78234, USA
| | - Amanda M Staudt
- US Army Institute of Surgical Research is United States of America (USA), 3698 Chambers Pass, San Antonio TX 78234, USA
| | - Kathy L Ryan
- US Army Institute of Surgical Research is United States of America (USA), 3698 Chambers Pass, San Antonio TX 78234, USA
| | - Elizabeth A Mann-Salinas
- US Army Institute of Surgical Research is United States of America (USA), 3698 Chambers Pass, San Antonio TX 78234, USA
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Paetow G, Logue C, TenBrink W, Zarzar R, Driehorst M, Brown L, Jensen A, Omodt S, Hart D. In-situ simulation for the detection of latent risk threats in a hyperbaric medicine department. Undersea Hyperb Med 2020; 47:211-216. [PMID: 32574437 DOI: 10.22462/04.06.2020.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Simulation (SIM) can be used in the quality improvement process to discover latent risk threats (LRTs) by running in-situ simulation cases in the clinical environment. We utilized this methodology in the hyperbaric chamber to run six in-situ SIM sessions between February 2017 and January 2019. The debriefing portion of each SIM was used to discuss and document all discovered LRTs. These safety threats were aggregated and categorized, resulting in a total of 22 unique LRTs. LRTs included problems or challenges with equipment, team education, policy/processes, communications, and medications. At a three-month follow-up, the hyperbaric leadership team had addressed each of the 22 unique LRTs. SIM can be used to identify, categorize and prioritize LRTs in an effective manner, in order to improve the health care delivery system in a hyperbaric medicine department.
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Affiliation(s)
- Glenn Paetow
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - Chris Logue
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - William TenBrink
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - Rochelle Zarzar
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - Mindi Driehorst
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - Lisa Brown
- Hennepin Healthcare, Interdisciplinary Simulation & Education Center, Minneapolis, Minnesota U.S
| | - Andrea Jensen
- Hennepin Healthcare, Department of Hyperbaric Medicine, Minneapolis, Minnesota U.S
| | - Steven Omodt
- Hennepin Healthcare, Department of Hyperbaric Medicine, Minneapolis, Minnesota U.S
| | - Daniell Hart
- Hennepin Healthcare, Department of Hyperbaric Medicine, Minneapolis, Minnesota U.S
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Schauer SG, April MD, Fairley R, Uhaa N, Hudson IL, Johnson MD, Keen DE, De Lorenzo RA. A Comparison of the iGel Versus Cricothyrotomy by Combat Medics Using a Synthetic Cadaver Model: A Randomized, Controlled Pilot study. J Spec Oper Med 2020; 20:68-72. [PMID: 33320315 DOI: 10.55460/a3ru-hns9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Background: Airway obstruction is the second leading cause of potentially preventable death on the battlefield. Prior to 2017, the Committee on Tactical Combat Casualty Care (CoTCCC) recommended the surgical cricothyrotomy as the definitive airway of choice. More recently, the CoTCCC has recommended the iGel™ as the supraglottic airway (SGA) of choice. Data comparing these methods in medics are limited. We compared first-pass placement success among combat medics using a synthetic cadaver model. Methods: We conducted a randomized cross-over study of United States Army combat medics using a synthetic cadaver model. Participants performed a surgical cricothyrotomy using a method of their choosing versus placement of the SGA iGel in random order. The primary outcome was first-pass success. Secondary outcomes included time-to-placement, complications, placement failures, and self-reported participant preferences. Results: Of the 68 medics recruited, 63 had sufficient data for inclusion. Most were noncommissioned officers in rank (54%, E6-E7), with 51% reporting previous deployment experience. There was no significant difference in first-pass success (P = .847) or successful cannulation with regard to the two devices. Time-to-placement was faster with the iGel (21.8 seconds vs. 63.8 seconds). Of the 59 medics who finished the survey, we found that 35 (59%) preferred the iGel and 24 (41%) preferred the cricothyrotomy. Conclusions: In our study of active duty Army combat medics, we found no significant difference with regard to first-pass success or overall successful placement between the iGel and cricothyrotomy. Time-to-placement was significantly lower with the iGel. Participants reported preferring the iGel versus the cricothyrotomy on survey. Further research is needed, as limitations in our study highlighted many shortcomings in airway research involving combat medics.
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Yui MS, Tominaga Q, Lopes BCP, Eckeli AL, Rabelo FAW, Küpper DS, Valera FCP. Nasal vs. oronasal mask during PAP treatment: a comparative DISE study. Sleep Breath 2019; 24:1129-1136. [PMID: 31797217 DOI: 10.1007/s11325-019-01976-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/02/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study evaluated the upper airway pattern of obstruction in individuals undergoing drug-induced sleep endoscopy (DISE) exam with positive airway pressure (PAP), and compared this effect through a nasal or oronasal mask. METHODS Prospective study. Patients requiring PAP due to obstructive sleep apnea (OSA) were evaluated through DISE at three different moments: (1) a baseline condition (without PAP); (2) PAP treatment with a nasal mask; and (3) PAP with an oronasal mask at the same pressure. The conditions were compared intra-individually, following VOTE classification. A TOTAL VOTE score (the sum of VOTE scores observed for each anatomical site) was also applied to compare intra-individual results. RESULTS Thirteen patients were enrolled in the study. All patients presented multi-level pharyngeal obstruction at baseline condition. In six patients, the pattern of obstruction differed according to the mask. Nasal mask significantly decreased the obstruction score when compared with baseline condition both in velum (P value < 0.05) and oropharynx regions (P value < 0.005). TOTAL VOTE score was also significantly lower during nasal mask evaluation when compared with basal condition (P value < 0.005). Remarkably, oronasal mask with the same pressure was not as effective as nasal masks. Obstruction levels observed at the tongue base or epiglottis levels were more resistant to PAP treatment. CONCLUSIONS Collapse in velum and oropharyngeal sites is more compliant to PAP than obstruction at lower levels of the pharynx, either with nasal or oronasal masks. Nasal mask is superior to prevent pharyngeal collapse than oronasal devices under the same pressure.
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Affiliation(s)
- Mariane S Yui
- ENT Division, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900-12o andar, Ribeirão Preto-São Paulo, CEP 14049-900, Brazil
| | - Quedayr Tominaga
- ENT Division, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900-12o andar, Ribeirão Preto-São Paulo, CEP 14049-900, Brazil
| | - Bruno C P Lopes
- Anesthesiology Division, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Alan L Eckeli
- Neurosciences Department, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Daniel S Küpper
- ENT Division, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900-12o andar, Ribeirão Preto-São Paulo, CEP 14049-900, Brazil
| | - Fabiana C P Valera
- ENT Division, Clinics Hospital, Medical School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900-12o andar, Ribeirão Preto-São Paulo, CEP 14049-900, Brazil.
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Abstract
RATIONALE Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. PATIENT CONCERNS A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. DIAGNOSES Laryngoscopy-guided endotracheal intubation was expected to be difficult in LDP. INTERVENTIONS After the induction of anesthesia, a non-inflatable LMA was introduced into the laryngopharynx with the patient in LDP. He was then maneuvered into a supine position and removal of the LMA was followed by endotracheal intubation. OUTCOMES The surgery for the removal of the hematoma was performed in a prone position. The airway intubated with an endotracheal tube was well maintained during the entire surgery. LESSONS LMA is a useful device for airway management in patients in LDP who cannot lie supine.
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Abstract
The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.
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Affiliation(s)
- Andrey Akopov
- 6/8 L/Tolstoy Street, Saint-Petersburg 197022, Russia.
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22
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Abstract
Awake craniotomy is a unique technique utilized for mapping neuro and motor function during neurosurgical procedures close to eloquent brain tissue. Since active communication is required only during surgical manipulation of eloquent brain tissue and the patient is "sedated" during other parts of the procedure, different methods for anesthesia management have been explored. Furthermore, airway management ranges from spontaneous breathing to oro or nasotracheal intubation. Case reports have described the use of laryngeal masks (LMs) previously; however, its safety compared to tracheal intubation has not been assessed.We conducted a retrospective analysis of 30 patients that underwent awake craniotomy for tumor surgery to compare the feasibility and safety of different airway management strategies. Nasal fiberoptic intubation (FOI) was performed in 21 patients while 9 patients received LM for airway management. Ventilation, critical events, and perioperative complications were evaluated.Cannot intubate situation occurred in 4 cases reinserting the tube after awake phase, while no difficulties were described reinserting the LM (P < .0001). Furthermore, duration of mechanical ventilation after tumor removal was significantly lower in the LM group compared to FOI group (62 ± 24 vs. 339 ± 82 [min] mean ± sem, P < .0001). Postoperatively, 2 patients in each group were diagnosed with and treated for respiratory complications including pneumonia, without statistical significance between groups.In summary, LM is a feasible airway management method for patients undergoing awake craniotomy, resulting in reduced ventilation duration compared to FOI procedure.
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Affiliation(s)
| | - Sven Klaschik
- Department of Anesthesiology and Intensive Care Medicine
| | - Ági Güresir
- Department of Neurosurgery, University Medical Center, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Patrick Jakobs
- Department of Anesthesiology and Intensive Care Medicine
| | - Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine
| | - Hartmut Vatter
- Department of Neurosurgery, University Medical Center, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Tobias Hilbert
- Department of Anesthesiology and Intensive Care Medicine
| | - Erdem Güresir
- Department of Neurosurgery, University Medical Center, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine
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Abstract
BACKGROUND Laryngeal masks are increasingly used in place of endotracheal intubation or face masks for maintaining the airway during surgery. OBJECTIVES Compare the insertion time and other features of the Baska and I-gel masks in patients undergoing general anesthesia for urological surgery. DESIGN Randomized-controlled, single-blind study. SETTINGS Urology surgical operating rooms of a tertiary care hospital. SUBJECTS AND METHODS We enrolled concomitant patients whose surgery was expected to last less than two hours. Following premedication and adequate relaxation, subjects were randomly allocated to the I-gel mask or the Baska mask. Computer-generated random numbers were used for randomization with sealed opaque envelopes for allocation concealment. MAIN OUTCOME MEASURES The primary outcome measure of the study was the time required for laryngeal mask airway (LMA) insertion. Also, the number of device placement attempts, the number of postoperative signs and symptoms (cough, breath holding, laryngeal spasm, lip trauma, blood on the mask), and laryngopharyngeal morbidity scores at 1 and 24 hours postoperatively. SAMPLE SIZE 211 met inclusion criteria, 200 participants completed the study. RESULTS Compared to I-gel, the Baska mask required a longer time for insertion, and its airway pressure was higher. The median (minimum-maximum) duration of LMA insertion in the Baska and I-gel groups was 14 (6-25) and 7 (5-12) seconds, respectively (z=-10.934; P<.001). The mean (SD) airway pressures were significantly different between the two groups (15.8 [1.9] and 14.9 [1.7] cm/H2O for Baska and I-gel, respectively; t=3.668; P<.001). Seal pressure was not significantly different between the groups (0.08 [0.2] vs. 0.07 [0.2] cm/H2O in the Baska and I-gel groups, respectively, (t=1.35; P=.194). CONCLUSIONS The Baska and I-gel masks are similar in most respects. Both have reasonably acceptable insertion times and can be used for selected surgical procedures. LIMITATIONS The requirement for more vigorous training is a limitation of the Baska mask. Results could differ with patients younger than 18 years of age or obese patients. CONFLICT OF INTEREST None. CLINICAL TRIAL REGISTRY Not registered.
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Affiliation(s)
- Duygu Kara
- From the Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Cafer Mutlu Sarikas
- From the Department of Anesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Feng YM, Wan D, Guo R. The consequence of endotracheal intubation in a 95-years old man for 839 days: A case report. Medicine (Baltimore) 2019; 98:e16678. [PMID: 31374047 PMCID: PMC6708996 DOI: 10.1097/md.0000000000016678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The benefits of prolonged endotracheal intubation (ETI) in comparison to early tracheotomy is still over the controversy. Little information is available in concern to prolonged ETI more than years. We report the consequence of oral ETI in a 95-year old man for 839 days. PATIENT CONCERNS This patient was transferred to the intensive care unit due to sputum asphyxia and respiratory arrest. Timely ETI was performed. However, as a neurological insult, extubation had a high risk of failure due to the insufficient ability of sputum clearance. In addition, his family members refused further surgical interventions including tracheotomy. DIAGNOSES Prolonged ETI occurred in this patient. On day 240 and 329 after ETI, 3D airway image did not reveal laryngeal stenosis or laryngeal lesions. On day 459 and 662, ET tube (ETT) exchanged was performed and the balloon became stiff and inelasticity. INTERVENTIONS Although a possible tracheoesophageal fistula was suspected by imaging findings on day 547, the gastroscopy did not reveal the fistula on the esophagus. Enteral nutrition was delivered through the gastric tube, while the mediastinal infection was not observed during subsequent follow-up of computed tomography. OUTCOMES He received tracheostomy due to acute sputum obstruction within ETT and abrupt oxygen desaturation on day 839. LESSONS During prolonged ETI, more attention should focus on airway humidification, proper cuff pressure and optimal time for tube exchange in order to avoid severe complications.
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Affiliation(s)
- Yan-mei Feng
- Department of Respiratory and Critical Care Medicine
| | - Dong Wan
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Rui Guo
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Sachdev A, Chhawchharia R. Flexible Fiberoptic Bronchoscopy in Pediatric Practice. Indian Pediatr 2019; 56:587-593. [PMID: 31333214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Flexible fiberoptic bronchoscopy a vital diagnostic and therapeutic procedure for assessing the airway. Its logistics, clinical indications and utility need to be elucidated in pediatric context. Pediatric flexible fibreoptic bronchoscopy is useful for diagnosis of airway anomalies, bronchoalveolar lavage for diagnostic and therapeutic purposes, and interventions like foreign body removal. Newer ultra-thin bronchoscopes can be used to perform this procedure in children of all ages. Pediatric flexible bronchoscopy is a valuable diagnostic and therapeutic tool in the hands of skilled personnel when used judiciously.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India. Correspondence to: Dr Anil Sachdev, Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
| | - Ritika Chhawchharia
- Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Kim MS, Park JH, Lee KY, Choi SH, Jung HH, Kim JH, Lee B. Influence of head and neck position on the performance of supraglottic airway devices: A systematic review and meta-analysis. PLoS One 2019; 14:e0216673. [PMID: 31071171 PMCID: PMC6508869 DOI: 10.1371/journal.pone.0216673] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background Changes in head and neck position may significantly affect the performance of supraglottic airway devices (SADs) by altering the pharyngeal structure. Purpose This systematic review and meta-analysis aimed to elucidate the effect of changes in head and neck position on performance of SADs. Data source Bibliographic databases, including PubMed, EMBASE, the Cochrane library, and the Web of Science. Study eligibility criteria Prospective studies investigating the effects of head and neck positions on the performance of SADs. Methods A random effect model was applied in the all analyses. Subgroup analysis was performed according to the type of device and the age of patient. The oropharyngeal leak pressure was the primary outcome measure. Secondary outcome measures included peak inspiratory pressure, fibreoptic view, and ventilation score (PROSPERO, CRD42017076971). Results Seventeen studies met the eligibility criteria. Overall, the oropharyngeal leak pressure significantly increased (mean difference 4.07 cmH2O; 95% confidence interval 3.30 to 4.84) during neck flexion with adverse effects on ventilation and fibreoptic view. Conversely, the oropharyngeal leak pressure decreased (mean difference −4.05; 95% confidence interval −4.90 to −3.20) during neck extension with no significant effect on ventilation or fibreoptic view. Rotation of the head and neck did not significantly affect SAD performance. Conclusions The reduced oropharyngeal leak pressure in the extended neck position was not associated with impaired ventilation except with the air-Q self-pressurizing airway. The flexed neck position significantly worsens ventilation and the alignment between the SAD and glottis despite improving the seal except with the air-Q self-pressurizing airway and LMA Proseal.
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Affiliation(s)
- Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki-Young Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwan Ho Jung
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do, Republic of Korea
| | - Ji-Ho Kim
- Department of Anesthesiology and Pain Medicine, National Health Insurance Service Ilsan Hospital, Goyang City, Gyeonggi-do, Republic of Korea
| | - Bora Lee
- Department of Anesthesiology and Pain Medicine, Severance Hospital and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Vourc’h M, Huard D, Feuillet F, Baud G, Guichoux A, Surbled M, Tissot M, Chiffoleau A, Guitton C, Jaber S, Asehnoune K. Preoxygenation in difficult airway management: high-flow oxygenation by nasal cannula versus face mask (the PREOPTIDAM study). Protocol for a single-centre randomised study. BMJ Open 2019; 9:e025909. [PMID: 31028041 PMCID: PMC6501956 DOI: 10.1136/bmjopen-2018-025909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although preoxygenation and airway management respond to precise algorithms, difficult intubation (DI) remains a daily challenge in intensive care units and in the operating rooms because of its frequent complications, including hypoxaemia. To prevent desaturation during DI, high-flow oxygenation by nasal cannula (HFNC) could prove beneficial. Indeed, contrary to standard preoxygenation device, it can be held in place throughout the intubation trying to perform apnoeic oxygenation during DI. Hence, recent guidelines recommend HFNC during DI, but its relevance has never been evaluated in this setting in a large randomised study until now. METHODS AND ANALYSIS The PREOPTIDAM trial is a prospective, single-centre, randomised, controlled study in Nantes University Hospital. In anticipated DI, we hypothesised that HFNC can decrease the incidence of desaturation ≤94% or face mask ventilation from 16% to 4% compared with standard device. Using a two-sided t-test with a first species risk of 5% and 80% power, a total of 186 patients will be included. Using a computer-generated randomisation, with a 1:1 allocation ratio, patients will be randomised to HFNC or face mask preoxygenation. Randomisation will be stratified on intubation sequence: Rapid sequence intubation or awake fibreoptic intubation. The primary objective is to determine whether HFNC is more efficient than standard oxygenation techniques to prevent desaturation ≤94% or face mask ventilation during DI. Intent-to-treat and per-protocol analysis are planned for the primary outcome. ETHICS AND DISSEMINATION The study project has been approved by an independent ethics committee. Written informed consent will be obtained before study inclusion. Participant recruitment begins in September 2018. Results will be submitted to international peer-reviewed medical journals. TRIAL REGISTRATION NUMBER NCT03604120.
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Affiliation(s)
- Mickael Vourc’h
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
- UPRES EA 3826, "Thérapeutiques Cliniques et Expérimentales des infections", IRS2 Nantes Biotech, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Donatien Huard
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Fanny Feuillet
- Methodology and Biostatistics Platform, Research Promotion Department, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Gabrielle Baud
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Arthur Guichoux
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Marielle Surbled
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Melanie Tissot
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Anne Chiffoleau
- Unité de vigilance des essais cliniques, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
| | - Christophe Guitton
- Centre Hospitalier du Mans, Médecine intensive réanimation, Le Mans, France
| | - Samir Jaber
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Karim Asehnoune
- Service d’Anesthésie-Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
- UPRES EA 3826, "Thérapeutiques Cliniques et Expérimentales des infections", IRS2 Nantes Biotech, Centre Hospitalier Universitaire de Nantes, Nantes, PAYS-DE-LA-LOIRE, France
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Abstract
OBJECTIVE The goal was to develop a pediatric airway stent for treating tracheobronchomalacia that could be used as an alternative to positive pressure ventilation. The design goals were for the stent to allow mucus flow and to resist migration inside the airways, while also enabling easy insertion and removal. METHODS A helical stent design, together with insertion and removal tools, is presented. A mechanics model of stent compression is derived to assist in selecting stent design parameters (pitch and wire diameter) that provide the desired amount of tracheal support, while introducing the minimal amount of foreign material into the airway. Worst-case airway area reduction with stent support is investigated experimentally using a pressurized tracheal phantom matched to porcine tracheal tissue properties. The stent design is then evaluated in a porcine in vivo experiment. RESULTS Phantom testing validated the mechanics model of stent compression. In vivo testing demonstrated that the stent was well tolerated by the animal. Since the helical design covers only a small portion of the epithelium, mucus transport through the stented region was minimally impeded. Furthermore, the screw-like stent resisted migration, while also providing for atraumatic removal through the use of an unscrewing motion during removal. CONCLUSION The proposed stent design and tools represent a promising approach to prevent airway collapse in children with tracheobronchomalacia. SIGNIFICANCE The proposed technology overcomes the limitations of existing airway stents and may provide an alternative to maintaining children on a ventilator.
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Abstract
The nasopharyngeal airway is an important equipment in airway management, a correct placement is crucial for its effectiveness. We measured the nares-to-epiglottis distance (NED) and examined the correlations of the optimal insertion length (NED-1) with patient characteristics and various external facial measurements. We aimed to develop a simple method for estimating the optimal insertion length and to help select an appropriate nasopharyngeal airway.Two hundred patients of ASA grade I & II aged >20 years undergoing elective surgery under general anesthesia were enrolled. We measured nares-to-ear tragus distance (NTD), nares-to-mandibular angle distance (NMD), philtrum-to-ear tragus distance (PTD), and philtrum-to-mandibular angle distance (PMD). The NED was measured by fiber-optic bronchoscope. All measurements were obtained in centimeters. NED-1 (cm) was defined as the optimal insertion length. The patient's sex, age, body weight, body height, and body mass index were recorded.The NED-1 significantly correlated with body weight, body height, NTD, NMD, PTD, and PMD. Backward stepwise multiple linear regression analysis yielded the formula for predicting NED-1: 0.331 - 0.018 × BW + 0.061 × BH + 1.080 × NMD - 1.256 × PMD + 0.697 × PTD (r = 0.640, P < .001). The regression lines of the optimal insertion length versus PTD showed the best fit to the equality line. The measurements of PTD showed the minimal differences from NED-1 and with the most patients showing <1 cm differences from NED-1.The optimal insertion depth of nasopharyngeal airway can easily be predicted by the distance from philtrum-to-ear tragus, and a nasopharyngeal airway of an appropriate size can be selected accordingly.
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Hwang J, Hong B, Kim YH, Lee WH, Jo Y, Youn S, Lim CS. Comparison of laryngeal mask airway supremeTM as non-inflatable cuff device and self-pressurized air-QTM in children: Randomized controlled non-inferiority study. Medicine (Baltimore) 2019; 98:e14746. [PMID: 30855468 PMCID: PMC6417551 DOI: 10.1097/md.0000000000014746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/28/2018] [Accepted: 02/09/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Supraglottic airway (SGA) device with non-inflatable cuff reduce the airway complications associated with cuff hyperinflation. The aim of the study is to determine whether the default setting of Supreme is as effective as the non-inflatable cuff devices. The oropharyngeal leak pressure was measured and compared between the Supreme and Air-Q, a typical non-inflatable cuff device. We hypothesized that the default setting of Supreme is non-inferior to the the Air-Q self-pressurized (SP) in respect to the oropharyngeal leak pressure. METHODS Eighty-four patients aged 1 to 7 years who were scheduled for general anesthesia, participated in the study. The patients were randomly assigned to Supreme group (n = 41) or Air-Q SP group (n = 43). We considered that the primary outcome, oropharyngeal leak pressure of Supreme group would be non-inferior to the Air-Q SP group, within 3 cmH2O. Other outcomes included tidal volume loss, difficulty of insertion, insertion time, and complications. RESULTS The oropharyngeal leak pressure of the Supreme and Air-Q SP was 19.9 ± 4.1 cm H2O and 17.4 ± 2.9 cm H2O, respectively. The mean differences of 2 devices (Air-Q SP-Supreme) were -2.5 cm H2O, (95% confidence interval [-4.0 to -0.9], P = .002). The upper CI was smaller than the non-inferiorty margin (3 cm H2O). This result suggested that the default setting of Supreme was superior to the Air-Q SP with respect to the oropharyngeal leak pressure. However, there were no significant differences in tidal volume loss over time, ease of device insertion score, insertion time, and complications. CONCLUSIONS The Supreme can be used in the default setting in pediatric patients accordingly in terms of tolerable leak pressure and the stability for mechanical ventilation compared with Air-Q SP.
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Carlson JN, Zive D, Griffiths D, Brown KN, Schmicker RH, Herren H, Sopko G, DiFiore S, Climer D, Herdeman C, Idris A, Nichol G, Wang HE. Variations in the application of exception from informed consent in a multicenter clinical trial. Resuscitation 2019; 135:1-5. [PMID: 30572072 PMCID: PMC6939445 DOI: 10.1016/j.resuscitation.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Exception from infor med consent (EFIC) is allowed using federal regulations 21 CFR 50.24 and facilitates research on patients with critical conditions such as cardiac arrest. Little is known regarding the differences in the application of EFIC requirements such as community consultation (CC), public disclosure (PD) and patient notification. We sought to characterize variations in the fulfillment of EFIC requirements in a national multicenter clinical trial in the United States. METHODS We determined the strategies for fulfillment of EFIC requirements at five regional coordinating centers of the Pragmatic Airway Resuscitation Trial (PART), a cluster-crossover randomized trial comparing airway devices in out-of-hospital cardiac arrest. We collected information from the including site demographics, how CC and PD were implemented, methods undertaken by the site investigative team to meet the local IRB's interpretation, and patient notification timing (post-enrollment). We analyzed the data using descriptive statistics. RESULTS Sites had multiple approaches to CC, including social media advertising, random digit dialing surveys, working with city officials, and websites with embedded surveys. All sites used more than one approach for conducting CC. Public Disclosure activities included press releases through various means, website documentation, and letters to community members and local officials. Time from CC to study approval ranged from 42 days to 253 days. CONCLUSION EFIC implementation varies across sites and highlight community and regional variation. Different EFIC approaches may be needed to effectively accomplish the goals of community consultation, public disclosure, and patient notification.
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Affiliation(s)
- Jestin N Carlson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
| | - Dana Zive
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
| | - Denise Griffiths
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR
| | - Karen N Brown
- Department of Emergency Medicine University of Alabama at Birmingham, Birmingham, AL
| | - Robert H Schmicker
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA
| | - Heather Herren
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA
| | - George Sopko
- National Heart, Lung and Blood Institute, Bethesda, MD
| | - Sara DiFiore
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Dixie Climer
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Caroline Herdeman
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Graham Nichol
- Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Henry E Wang
- Department of Emergency Medicine University of Alabama at Birmingham, Birmingham, AL; Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX
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Higashida M, Komasawa N, Kido H, Minami T. Comparison of Quick Track™ and Melker™ for emergent invasive airway management in Simulated Obese Model. Am J Emerg Med 2019; 37:1388-1389. [PMID: 30660343 DOI: 10.1016/j.ajem.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | - Haruki Kido
- Department of Anesthesiology, Osaka Medical College, Japan
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Lin YC, Liu YT, Wu ZF, Chan SM. The successful application of high flow nasal cannula for awake craniotomy. J Clin Anesth 2019; 55:140-141. [PMID: 30658329 DOI: 10.1016/j.jclinane.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/12/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Yi-Chin Lin
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, ROC
| | - Yin-Tzu Liu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Schauer SG, Naylor JF, Chow AL, Maddry JK, Cunningham CW, Blackburn MB, Nawn CD, April MD. Survival of Casualties Undergoing Prehospital Supraglottic Airway Placement Versus Cricothyrotomy. J Spec Oper Med 2019; 19:91-94. [PMID: 31201758 DOI: 10.55460/d4c5-pvhk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Airway compromise is the second leading cause of preventable death on the battlefield. Unlike a cricothyrotomy, supraglottic airway (SGA) placement does not require an incision and is less technically challenging. We compare the survival of causalities undergoing cricothyrotomy versus SGA placement. METHODS We used a series of emergency department (ED) procedure codes to search within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016. This is a subanalysis of that data set. RESULTS During the study period, 194 casualties had a documented cricothyrotomy and 22 had a documented SGA as the sole airway intervention. The two groups had similar proportions of explosive injuries (57.7% versus 63.6%, p = .328), similar composite injury severity scores (25 versus 27.5, p = .168), and similar AIS for the head, face, extremities, and external body regions. The cricothyrotomy group had lower AIS for the thorax (0 versus 3, p = .019), a trend toward lower AIS for the abdomen (0 versus 0, p = .077), more serious injuries to the head (67.5% versus 45.5%, p = .039), and similar rates of serious injuries to the face (4.6% versus 4.6%, p = .984). Glasgow Coma Scale (GCS) scores were similar on arrival to the ED (3 versus 3, p = .467) as were the proportion of patients surviving to discharge (45.4% versus 40.9%, p = .691). On repeated multivariable analyses, the odds ratios for survival were not significantly different between the two groups. CONCLUSIONS We found no difference in short-term outcomes between combat casualties who received an SGA vs those who received a cricothyrotomy. Military prehospital personnel rarely used either advanced airway intervention during the recent conflicts in Afghanistan and Iraq.
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Ajimi J, Nishiyama J, Masuda R, Hosoi S, Sakamoto R, Murata T, Miura M, Suzuki T. Successful Intubation Using the Airtraq Double Lumen ® with the Universal Adapter for Smartphones ® in a Case of Intubation Difficulty. Tokai J Exp Clin Med 2018; 43:143-147. [PMID: 30488401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The Universal Adapter for Smartphones® c an record s till images and movies during intubation using the monitor display and recording functions of a smartphone. Here, we describe the successful use of the Airtraq Double Lumen® with the Universal Adapter for Smartphones® for airway management during anesthesia in a patient with intubation difficulty. METHODS A 78-year-old man required thoracoscopic upper lobectomy for a pulmonary tumor. Preoperative examination revealed micrognathia, mouth opening equivalent to a three-finger width, Mallampati Class II, mentum-hyoid bone distance equal to a 2.5-finger width, hyoid bone-thyroid cartilage distance equal to a two-finger width, and Class I findings in the Upper Lip Bite Test. After inducing anesthesia and confirming the feasibility of mask ventilation, we administered 70 mg of rocuronium and inserted the Airtraq Double Lumen®. The Universal Adapter for Smartphones® connected to a 4-inch iPod Touch® was attached to its eye cup, through which the iPod Touch displayed images for easy visualization of the glottal area. RESULTS Prompt and smooth intubation with a 35-Fr double-lumen tube (DLT) was achieved. There were no adverse events associated with intubation. CONCLUSION Combination of the Universal Adapter for Smartphones® and the Airtraq Double Lumen® can facilitate smooth tracheal intubation with a DLT in cases of difficult intubation.
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Affiliation(s)
- Junko Ajimi
- Department of Anesthesiology, Hachioji-hospital, Tokai University School of Medicine, 1838 Ishikawamachi, Hachioji, Tokyo 192-0032, Japan:
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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. Rev Esp Anestesiol Reanim (Engl Ed) 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Massoudi N, Fathi M, Nooraei N, Salehi A. A Comparison between the i-gel® and air-Q® Supraglottic Airway Devices Used for the Patients Undergoing General Anesthesia with Muscle Relaxation. Biomed Res Int 2018; 2018:5202957. [PMID: 30581857 PMCID: PMC6276498 DOI: 10.1155/2018/5202957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 04/30/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of the present study was to compare two supraglottic airway (SGA) devices (i.e., the i-gel® © Intersurgical Ltd and air-Q® (Reusable) Cookgas company) in terms of the insertion time, amount of leak during ventilation with maximum positive pressure, and postoperative complications in patients referring to Modarres Hospital in Tehran. METHOD The present double-blind clinical trial was performed on 60 patients undergoing elective surgeries that required general anesthesia with muscle relaxation. Patients were randomly assigned to either i-gel® (n = 30) or Air-Q® (n = 30) groups. RESULTS The mean age, body mass index, duration of surgery, duration of anesthesia, and gender ratio were not significantly different between the two groups. Mean ± SD values of the SGA devices' insertion time (in seconds) in the air-Q® and i-gel® groups were 4.87 ± 1.6 and 6.80 ± 1.2, respectively (P < 0.001). The mean OLP in the Air-Q® group was significantly higher than that of the i-gel® group (35.9 ± 9.6 versus 24.8 ± 3.7, p < 0.001). The frequency of complications occurred after the supraglottic airway insertion was higher in the i-gel® group. However, only in terms of sore throat, the difference between the two groups was statistically significant: 6 (20%) had sore throat (P = 0.024) in the i-gel groups, but in in the Air-Q® groups no one had this side effect after surgery. CONCLUSION It was concluded that the Air-Q® supraglottic airway was placed faster and easier with fewer complications than the i-gel in general anesthesia with muscle relaxation. The frequency of the occurrence of all three complications, cough, sore throat, and blood, on the cuff (6 (20%) was higher in the i-gel group than that in the air-Q® group (cough3 (10%), sore throat 0 (0%), and blood on the cuff 3 (10%) (P < 0.05).
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Affiliation(s)
- Nilofar Massoudi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Fathi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Nooraei
- Anesthesiology Research Center, Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Salehi
- Clinical Research and Development Unit at Shahid Modarres Hospital, Department of Anaesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nagappa M, Wong DT, Cozowicz C, Ramachandran SK, Memtsoudis SG, Chung F. Is obstructive sleep apnea associated with difficult airway? Evidence from a systematic review and meta-analysis of prospective and retrospective cohort studies. PLoS One 2018; 13:e0204904. [PMID: 30286122 PMCID: PMC6171874 DOI: 10.1371/journal.pone.0204904] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Difficult airway management and obstructive sleep apnea may contribute to increased risk of perioperative morbidity and mortality. The objective of this systematic review and meta-analysis (SRMA) is to evaluate the evidence of a difficult airway being associated with obstructive sleep apnea (OSA) patients undergoing surgery. METHODS The standard databases were searched from 1946 to April 2017 to identify the eligible articles. The studies which included adult surgical patients with either suspected or diagnosed obstructive sleep apnea must report at least one difficult airway event [either difficult intubation (DI), difficult mask ventilation (DMV), failed supraglottic airway insertion or difficult surgical airway] in sleep apnea and non-sleep apnea patients were included. RESULTS Overall, DI was 3.46-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 13.5% vs 2.5%; OR 3.46; 95% CI: 2.32-5.16, p <0.00001). DMV was 3.39-fold higher in the sleep apnea vs non-sleep apnea patients (OSA vs. non-OSA: 4.4% vs 1.1%; OR 3.39; 95% CI: 2.74-4.18, p <0.00001). Combined DI and DMV was 4.12-fold higher in the OSA vs. non-OSA patients (OSA vs. non-OSA: 1.1% vs 0.3%; OR 4.12; 95% CI: 2.93-5.79, p <0.00001). There was no significant difference in the supraglottic airway failure rates in the sleep apnea vs non-sleep apnea patients (OR: 1.34; 95% CI: 0.70-2.59; p = 0.38). Meta-regression to adjust for various subgroups and baseline confounding factors did not impact the final inference of our results. CONCLUSION This SRMA found that patients with obstructive sleep apnea had a three to four-fold higher risk of difficult intubation or mask ventilation or both, when compared to non-sleep apnea patients.
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Affiliation(s)
- Mahesh Nagappa
- Department of Anesthesia & Perioperative Medicine, University Hospital, Victoria Hospital and St. Joseph Hospital, London Health Sciences Centre and St. Joseph Health Care, Western University, London, ON, Canada
| | - David T. Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Crispiana Cozowicz
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, United States of America
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Satya Krishna Ramachandran
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, United States of America
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, United States of America
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Lai CJ, Fan SZ, Wang YC, Liu CM. The Performance of Supraglottic Airway Devices at Different Head and Neck Rotation Angles. Asian J Anesthesiol 2018; 56:115-120. [PMID: 30583332 DOI: 10.6859/aja.201809_56(3).0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Supraglottic airway devices (SGAs) have advantages in reducing respiration-associated complications. However, limited studies on the influence of head and neck rotation on the risk of air leakage have been conducted. We hypothesize that different head and neck rotation angles will increase the risk of air leakage when using SGAs. METHODS A prospective, randomized study was conducted with 51 patients in the i-gelTM group and 50 patients in the AuraOnceTM group. The head and neck were subsequently rotated to the following positions: 0 (neutral), 15, 30, 45, and 60 degrees. Airway pressure over 20 cmH2O was defi ned as negative for air leakage. RESULTS The percentage of air leakage was proportional to the increase in rotational degrees at the various rotation angles. The incidence of patients without air leakage at the largest angle (60 degrees) of head and neck rotation in both groups was approximately 80% (i-gelTM: 82.35%; AuraOnceTM: 79.59%).Conclusion: SGAs presented acceptable performance with increased head and neck rotation angles. CONCLUSION SGAs presented acceptable performance with increased head and neck rotation angles.
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Affiliation(s)
- Chih-Jun Lai
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shou-Zen Fan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2018; 320:769-778. [PMID: 30167699 PMCID: PMC6583103 DOI: 10.1001/jama.2018.7044] [Citation(s) in RCA: 223] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiac arrest (OHCA). The optimal method for OHCA advanced airway management is unknown. OBJECTIVE To compare the effectiveness of a strategy of initial LT insertion vs initial ETI in adults with OHCA. DESIGN, SETTING, AND PARTICIPANTS Multicenter pragmatic cluster-crossover clinical trial involving EMS agencies from the Resuscitation Outcomes Consortium. The trial included 3004 adults with OHCA and anticipated need for advanced airway management who were enrolled from December 1, 2015, to November 4, 2017. The final date of follow-up was November 10, 2017. INTERVENTIONS Twenty-seven EMS agencies were randomized in 13 clusters to initial airway management strategy with LT (n = 1505 patients) or ETI (n = 1499 patients), with crossover to the alternate strategy at 3- to 5-month intervals. MAIN OUTCOMES AND MEASURES The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation, survival to hospital discharge, favorable neurological status at hospital discharge (Modified Rankin Scale score ≤3), and key adverse events. RESULTS Among 3004 enrolled patients (median [interquartile range] age, 64 [53-76] years, 1829 [60.9%] men), 3000 were included in the primary analysis. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. Seventy-two hour survival was 18.3% in the LT group vs 15.4% in the ETI group (adjusted difference, 2.9% [95% CI, 0.2%-5.6%]; P = .04). Secondary outcomes in the LT group vs ETI group were return of spontaneous circulation (27.9% vs 24.3%; adjusted difference, 3.6% [95% CI, 0.3%-6.8%]; P = .03); hospital survival (10.8% vs 8.1%; adjusted difference, 2.7% [95% CI, 0.6%-4.8%]; P = .01); and favorable neurological status at discharge (7.1% vs 5.0%; adjusted difference, 2.1% [95% CI, 0.3%-3.8%]; P = .02). There were no significant differences in oropharyngeal or hypopharyngeal injury (0.2% vs 0.3%), airway swelling (1.1% vs 1.0%), or pneumonia or pneumonitis (26.1% vs 22.3%). CONCLUSIONS AND RELEVANCE Among adults with OHCA, a strategy of initial LT insertion was associated with significantly greater 72-hour survival compared with a strategy of initial ETI. These findings suggest that LT insertion may be considered as an initial airway management strategy in patients with OHCA, but limitations of the pragmatic design, practice setting, and ETI performance characteristics suggest that further research is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02419573.
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Affiliation(s)
- Henry E. Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston
- Department of Emergency Medicine, University of Alabama at Birmingham
| | - Robert H. Schmicker
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - Mohamud R. Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | | | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jestin N. Carlson
- Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, Pennsylvania
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Heather Herren
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Neal J. Richmond
- MedStar Mobile Healthcare, Fort Worth, Texas
- currently with Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, Texas
| | | | - Tom P. Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Randal E. Gray
- Department of Emergency Medicine, University of Alabama at Birmingham
| | - Pamela C. Gray
- Department of Emergency Medicine, University of Alabama at Birmingham
| | | | - Pamela C. Owens
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | | | | | - Susanne J. May
- Clinical Trials Center, Department of Biostatistics, University of Washington, Seattle
| | - George R. Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Myron L. Weisfeldt
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham Nichol
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle
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Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA 2018; 320:779-791. [PMID: 30167701 PMCID: PMC6142999 DOI: 10.1001/jama.2018.11597] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE The optimal approach to airway management during out-of-hospital cardiac arrest is unknown. OBJECTIVE To determine whether a supraglottic airway device (SGA) is superior to tracheal intubation (TI) as the initial advanced airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. INTERVENTIONS Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced airway management strategy. MAIN OUTCOMES AND MEASURES The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. RESULTS A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], -0.6% [95% CI, -1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, -0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, -1.5% to 1.8%]). CONCLUSIONS AND RELEVANCE Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days. TRIAL REGISTRATION ISRCTN Identifier: 08256118.
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Affiliation(s)
| | - Kim Kirby
- University of the West of England, Glenside Campus, Bristol
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, England
| | - Madeleine Clout
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Michelle J. Lazaroo
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Jerry P. Nolan
- Bristol Medical School, University of Bristol, Bristol, England
- Department of Anaesthesia, Royal United Hospital, Bath, England
| | - Barnaby C. Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Maria Robinson
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Lauren J. Scott
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
- CLAHRC West, Whitefriars, Bristol, England
| | - Helena Smartt
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
| | - Adrian South
- South Western Ambulance Service NHS Foundation Trust, Exeter, England
| | - Elizabeth A. Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Jodi Taylor
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
- Bristol Medical School, University of Bristol, Bristol, England
| | - Matthew Thomas
- Intensive Care Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, England
| | - Sarah Voss
- University of the West of England, Glenside Campus, Bristol
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Chris A. Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, England
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Keller JM, Steinbach TC, Adamson R, Carlbom DJ, Johnson NJ, Clark J, Kritek PA, Çoruh B. ICU Emergencies Simulation Curriculum for Critical Care Fellows: The Difficult Airway. MedEdPORTAL 2018; 14:10744. [PMID: 30800944 PMCID: PMC6346282 DOI: 10.15766/mep_2374-8265.10744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/26/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Management of airway emergencies is a core skill for critical care fellows. There is no standardized training mechanism for difficult airway management among critical care fellowships, although fellows frequently cite management of airway catastrophes as an area of educational need. METHODS Three simulation cases that are each approximately 15 minutes in length are presented. The cases represent airway emergencies encountered in the intensive care unit consisting of angioedema, endotracheal tube dislodgement, and endotracheal tube occlusion. Incorporated into the scenarios are planned incidents of interpersonal conflict requiring negotiation by the learner during a crisis event. The case descriptions are complete, with learning objectives and critical actions as well as all necessary personnel briefs and required equipment. RESULTS The cases were completed over multiple simulation sessions on different days by 11 first-year critical care fellows during the 2016-2017 academic year. All participants demonstrated improvement in self-perceived confidence in airway management skills. DISCUSSION The cases were felt to be realistic and beneficial and led to perceived improvement in management of airway emergencies and leadership during crisis scenarios.
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Affiliation(s)
- Jonathan M. Keller
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Trevor C. Steinbach
- Fellow, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Rosemary Adamson
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
- Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Health Care System
| | - David J. Carlbom
- Associate Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Nicholas J. Johnson
- Assistant Professor, Department of Emergency Medicine, University of Washington School of Medicine
| | - Jennifer Clark
- Respiratory Therapist, Department of Respiratory Therapy, Harborview Medical Center
| | - Patricia A. Kritek
- Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
| | - Başak Çoruh
- Assistant Professor, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine
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Heegeman DJ, Rosandick WD, Boehning-Anderson RH, Woltmann AR. Supraglottic airway device placement by respiratory therapists. Am J Emerg Med 2018; 36:1845-1848. [PMID: 30097274 DOI: 10.1016/j.ajem.2018.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Respiratory Therapists (RTs) are some of the first staff to arrive at in-hospital incidents where cardiopulmonary resuscitation (CPR) is needed, yet at some facilities, their ability to intubate is limited by hospital scope of practice. During the intubation process, CPR is often interrupted which could potentially increase the likelihood of adverse patient outcomes. Training RTs to secure the airway using non-intubation methods may reduce or eliminate time for CPR interruptions and allow for earlier continuous/uninterrupted chest compressions. DESIGN A pilot study was developed to assess the effectiveness of a new policy for RT scope of practice. METHODS RTs were trained for supraglottic airway device placement prior to procedure initiation. After each device insertion event, RTs completed a written survey. Time between cardiac arrest and device insertion, number of insertion attempts, ease of placement, technical specifications of the device, complications, and survival were compiled and compared between supraglottic airway device and endotracheal tube (ETT) placement. RESULTS Procedural information from 23 patients who received a supraglottic airway device during the trial was compared to retrospective data of CPR events requiring intubation from the previous year. Time between initiation of cardiac arrest and advanced airway placement decreased significantly (p < 0.0001) when RTs placed the supraglottic airway device (4.7 min) versus ETT at CPR events the previous year (8.6 min). Device-associated complications were minimal and patient mortality was the same regardless of device. CONCLUSION We propose that more RTs should be trained to insert supraglottic airway devices during inpatient CPR events.
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Affiliation(s)
- David J Heegeman
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA.
| | - William D Rosandick
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
| | | | - Andrew R Woltmann
- Emergency Department, Marshfield Medical Center, 611 Saint Joseph's Avenue, Marshfield, WI 54449, USA
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Oshika H, Koyama Y, Taguri M, Maruyama K, Hirabayashi G, Yamada SM, Kohno M, Andoh T. Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study. Medicine (Baltimore) 2018; 97:e11190. [PMID: 29924038 PMCID: PMC6023683 DOI: 10.1097/md.0000000000011190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. METHODS The authors compared airway rescue performances of the 3 devices-the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. RESULTS The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5-89.5) s, 29.9 (17.1-79.8) s, and 46.7 (21.9-211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. CONCLUSIONS Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.
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Affiliation(s)
- Hiroyuki Oshika
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Yukihide Koyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masataka Taguri
- Department of Biostatics, Yokohama City University Graduate School of Medicine, Yokohama
| | - Koichi Maruyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Go Hirabayashi
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Shoko Merrit Yamada
- Department of Neurosurgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masashi Kohno
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
- Department of Anesthesia, Tomei Atsugi Hospital, Atsugi, Japan
| | - Tomio Andoh
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
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Abstract
This article discusses anesthesia assessment concepts related to airway evaluation and airway maintenance for safe and reliable selection of either open system (entrainment of room air) or closed system (no entrainment of room air) airway devices, which can be used during office-based oral surgical procedures, depending on the needs of a patient. Dental facial and oral structures are integral to an anesthetist's preoperative patient evaluation prior to surgery. The preoperative medical history and physical examination as well as the nature of the oral surgical procedure affect the selection of a proper and safe airway device.
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Affiliation(s)
- Allan Schwartz
- Department of Periodontics, The Center for Advanced Dental Education, Saint Louis University, 3320 Rutger Street, St Louis, MO 63104, USA.
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46
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Mira MD, Valldeperas MI, Socias A, Sarasíbar H, Aguilar Sánchez JL. Large retropharyngeal haematoma. Airway management with Airtraq® laryngoscope. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:229-233. [PMID: 29242030 DOI: 10.1016/j.redar.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
Retropharyngeal haematoma is a life-threatening clinical situation that can lead to a potential obstruction of the upper airway and requires rapid diagnosis. Clinicaly, it can be presented in different ways, depending on its size and growing speed. The first measure is to protect and manage the airway: in most cases this is a difficult airway situation. A retropharyngeal haematoma can be formed due to a previous traumatic history, with or without associated cervical fracture. Treatment of the haematoma is conservative in most cases, with close monitoring until it is reabsorbed in 3-4 weeks, although they can sometimes require surgical evacuation. We present the case of a patient who developed a large retropharyngeal haematoma after minor cervical trauma and describe an approach of the airway using the Airtraq® disposable optical laryngoscope.
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Affiliation(s)
- M D Mira
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España.
| | - M I Valldeperas
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - A Socias
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - H Sarasíbar
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
| | - J L Aguilar Sánchez
- Departamento de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Son Llàtzer (HSLL), Palma de Mallorca, España
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De Silva S. Airway safety in a patient with submandibular swelling. J Perioper Pract 2018; 27:59-60. [PMID: 29328745 DOI: 10.1177/175045891702700305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
A fifty-eight year old gentleman (CH) with a five-day history of toothache presented to the emergency department (ED) with increasing pain with associated submandibular swelling over the last 24-hours. He was an unkempt gentleman who had not consulted his general practitioner or dentist in many years, was unaware of any significant past medical history and was not on any regular medication. He was an obese gentleman with a BMI of 56.
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48
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Francois A, Pedone E. Supraglottic airway for upper gastrointestinal endoscopy in children: A review of 10years' experience. J Clin Anesth 2018; 45:69-70. [PMID: 29291468 DOI: 10.1016/j.jclinane.2017.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Audrice Francois
- Department of Anesthesiology, Loyola University Medical Center, Maywood, USA.
| | - Eric Pedone
- Department of Anesthesiology, Loyola University Medical Center, Maywood, USA.
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Morales Sarabia JE, Romero Serrano E, Granell M, De Andrés J. Airway management of saber-sheath trachea using single use flexible videoscope. Rev Esp Anestesiol Reanim (Engl Ed) 2018; 65:66-67. [PMID: 28911969 DOI: 10.1016/j.redar.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J E Morales Sarabia
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - E Romero Serrano
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital de Tortosa Verge de la Cinta, Tarragona, España
| | - M Granell
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J De Andrés
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia, España
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50
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Food and Drug Administration, HHS. Medical Devices; Anesthesiology Devices; Classification of the External Negative Pressure Airway Aid. Final order. Fed Regist 2017; 82:60865-7. [PMID: 29274631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Food and Drug Administration (FDA or we) is classifying the external negative pressure airway aid into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the external negative pressure airway aid's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.
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