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Galway U, Abdelmalak BB. Not all tracheal tube introducers are created equal. Anaesthesia 2024; 79:1013-1016. [PMID: 39073132 DOI: 10.1111/anae.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ursula Galway
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Basem B Abdelmalak
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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2
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Fernández-Vaquero MA, De Luis-Cabezón N, García-Aroca MA, Álvarez-Avello JM, Vives-Santacana M, Greif R, Martinez-Hurtado ED, Ly-Liu D. Pilot multicenter study to determine the utility of point-of-care ultrasound to predict difficulty of tracheal intubation using videolaryngoscopy with the McGrath™ Mac videolaryngoscope. Front Med (Lausanne) 2024; 11:1406676. [PMID: 39099593 PMCID: PMC11294227 DOI: 10.3389/fmed.2024.1406676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Clinical airway screening tests used to predict difficulties during airway management have low sensitivity and specificity. Point-of-care airway ultrasound has described measurements related to problems with difficult direct laryngoscopy. Nevertheless, the correlation between ultrasound parameters and videolaryngoscopy has not been published yet. The aim of this multicenter, prospective observational pilot study was to evaluate the applicability of clinical parameters and ultrasound measurements to find potential tracheal intubation difficulties when videolaryngoscopy is used. Methods Preoperatively, six clinical airway assessments were performed: (1) modified Mallampati score, (2) thyromental distance, (3) sternomental distance, (4) interincisal distance, (5) upper lip bite test, and (6) neck circumference. Six ultrasound parameters were measured in awake patients: (1) distance from skin to hyoid bone, (2) distance from skin to epiglottis, (3) hyomental distance in neutral head position, (4) hyomental distance in head-extended position, (5) distance from skin to the deepest part of the palate, and (6) sagittal tongue area. And finally, there was one ultrasound measure obtained in anesthetized patients, the compressed sagittal tongue area during videolaryngoscopy. The difficulty for tracheal intubation using a McGrath™ Mac videolaryngoscope, the percentage of glottic opening, and Cormack-Lehane grade were also assessed. Results In this cohort of 119 subjects, tongue dimensions, particularly the sagittal tongue area, showed a robust association with increased intubation difficulty using videolaryngoscopy. A multiparametric model combining the following three ultrasound variables in awake patients: (a) the distance from skin to epiglottis, (b) the distance from skin to the deepest part of the palate, and (c) the sagittal tongue area, yielded a sensitivity of 92.3%, specificity of 94.5%, positive predictive value of 82.8%, and negative predictive value of 97.8% (p < 0.001). Conclusion Point-of-care airway ultrasound emerges as a more useful tool compared to traditional clinical scales to anticipate possible challenges during videolaryngoscopic intubation.
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Affiliation(s)
- Miguel A. Fernández-Vaquero
- Department of Anesthesiology, Clínica Universidad de Navarra, Madrid, Spain
- School of Medicine, Navarra University, Navarra, Spain
| | | | - Miguel A. García-Aroca
- Department of Anesthesiology, Clínica Universidad de Navarra, Madrid, Spain
- School of Medicine, Navarra University, Navarra, Spain
| | - Jose M. Álvarez-Avello
- Department of Anesthesiology, Clínica Universidad de Navarra, Madrid, Spain
- School of Medicine, Navarra University, Navarra, Spain
| | | | - Robert Greif
- School of Medicine, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | | | - Diana Ly-Liu
- Department of Anesthesiology, Basurto University Hospital, Bilbao, Spain
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3
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van Zundert AAJ, Gatt SP. Videolaryngoscopy: The Way Forward in Airway Management. Anesth Analg 2023; 137:e55-e56. [PMID: 37973143 DOI: 10.1213/ane.0000000000006726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- André A J van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital & The University of Queensland, Brisbane, Queensland, Australia, Udayana University, Denpasar, Bali, Indonesia
| | - Stephen P Gatt
- Department of Anaesthesia, The University of New South Wales, Sydney, New South Wales, Australia, Udayana University, Bali, Indonesia,
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Kumar R, Bihani P, Mohammed S, Syal R, Bhatia P, Jaju R. Comparison of Clinical Performance of C-MAC Video Laryngoscope Guided vs Blind Placement of I-Gel® in Paediatric Patients: A Randomized Controlled Open-Label Trial. Turk J Anaesthesiol Reanim 2023; 51:347-353. [PMID: 37587678 PMCID: PMC10440480 DOI: 10.4274/tjar.2023.221010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/09/2023] [Indexed: 08/18/2023] Open
Abstract
Objective Placement of the supraglottic airway devices under direct vision has been shown to decrease the incidence of malposition in adults. This study was designed to compare the clinical performance of C-MAC guided and blind placement of i-gel® in paediatric patients. Methods The present prospective, randomized controlled study was conducted on 102 paediatric patients scheduled to undergo elective infraumbilical surgeries under general anaesthesia. Patients were randomly divided into group "B" (blind) and group "C" (C-MAC) based on the technique used for placement of i-gel®. The primary objective of the study was to compare the incidence of malposition based on the fiberoptic bronchoscope (FOB) score of the glottic view. Oropharyngeal leak pressure (OPLP), hemodynamic parameters, and insertion characteristics (time taken to insert and the number of attempts) were secondary objectives. Categorical data were presented as ratio or percentage and continuous data were presented as mean ± standard deviation or median [95% confidence interval (CI)]. Results The incidence of malposition (Brimacombe score 1 or 2) was significantly lower in group C compared to group B (7.8% vs 49% respectively) (P < 0.001); implying a relative risk reduction of 2.42 (95% CI 1.72 to 3.40) with C-MAC. On FOB assessment, the median (interquartile range) Brimacombe score was significantly better in group C [4 (4-4)] compared to group B [3 (2-3)] (P < 0.001). The OPLP was significantly higher in group C compared to group B. Other insertion characteristics were comparable in both the study groups. Conclusion Compared to blind placement, C-MAC guided placement ensures proper alignment of i-gel® with periglottic structures and proper functioning of i-gel®.
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Affiliation(s)
- Rakesh Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Pooja Bihani
- Department of Anaesthesiology, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Sadik Mohammed
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Rashmi Syal
- Department of Anaesthesiology, Dr. Sampurnanand Medical College, Jodhpur, India
| | - Pradeep Bhatia
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Rishabh Jaju
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Deoghar, India
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5
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Maguire S, Schmitt PR, Sternlicht E, Kofron CM. Endotracheal Intubation of Difficult Airways in Emergency Settings: A Guide for Innovators. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:183-199. [PMID: 37483393 PMCID: PMC10362894 DOI: 10.2147/mder.s419715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Over 400,000 Americans are intubated in emergency settings annually, with indications ranging from respiratory failure to airway obstructions to anaphylaxis. About 12.7% of emergency intubations are unsuccessful on the first attempt. Failure to intubate on the first attempt is associated with a higher likelihood of adverse events, including oxygen desaturation, aspiration, trauma to soft tissue, dysrhythmia, hypotension, and cardiac arrest. Difficult airways, as classified on an established clinical scale, are found in up to 30% of emergency department (ED) patients and are a significant contributor to failure to intubate. Difficult intubations have been associated with longer lengths of stay and significantly greater costs than standard intubations. There exists a wide range of airway management devices, both invasive and noninvasive, which are available in the emergency setting to accommodate difficult airways. Yet, first-pass success rates remain variable and leave room for improvement. In this article, we review the disease states most correlated with intubation, the current landscape of emergency airway management technologies, and the market potential for innovation. The aim of this review is to inspire new technologies to assist difficult airway management, given the substantial opportunity for translation due to two key-value signposts of medical innovation: the potential to decrease cost and the potential to improve clinical outcomes.
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Affiliation(s)
- Samantha Maguire
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Phillip R Schmitt
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Eliza Sternlicht
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
| | - Celinda M Kofron
- Center for Biomedical Engineering, School of Engineering, Brown University, Providence, RI, USA
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Ratajczyk P, Kluj P, Dolder P, Szmyd B, Gaszyński T. Assessment of the Possibility of Using the Laryngoscopes Macintosh, McCoy, Miller, Intubrite, VieScope and I-View for Intubation in Simulated Out-of-Hospital Conditions by People without Clinical Experience: A Randomized Crossover Manikin Study. Healthcare (Basel) 2023; 11:healthcare11050661. [PMID: 36900666 PMCID: PMC10000538 DOI: 10.3390/healthcare11050661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
The aim of the study was to evaluate the laryngoscopes Macintosh, Miller, McCoy, Intubrite, VieScope and I-View in simulated out-of-hospital conditions when used by people without clinical experience, and to choose the one that, in the case of failure of the first intubation (FI), gives the highest probability of successful second (SI) or third (TI). For FI, the highest success rate (HSR) was observed for I-View and the lowest (LSR) for Macintosh (90% vs. 60%; p < 0.001); for SI, HSR was observed for I-View and LSR for Miller (95% vs. 66,7%; p < 0001); and for TI, HSR was observed for I-View and LSR for Miller, McCoy and VieScope (98.33% vs. 70%; p < 0.001). A significant shortening of intubation time between FI and TI was observed for Macintosh (38.95 (IQR: 30.1-47.025) vs. 32.4 (IQR: 29-39.175), p = 0.0132), McCoy (39.3 (IQR: 31.1-48.15) vs. 28.75 (IQR: 26.475-35.7), p < 0.001), Intubrite (26.4 (IQR: 21.4-32.3) vs. 20.7 (IQR: 18.3-24.45), p < 0.001), and I-View (21 (IQR: 17.375-25.1) vs. 18 (IQR: 15.95-20.5), p < 0.001). According to the respondents, the easiest laryngo- scopes to use were I-View and Intubrite, while the most difficult was Miller. The study shows that I-View and Intubrite are the most useful devices, combining high efficiency with a statistically significant reduction in time between successive attempts.
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Affiliation(s)
- Paweł Ratajczyk
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
- Correspondence:
| | - Przemysław Kluj
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Przemysław Dolder
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Bartosz Szmyd
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 90-549 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
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Kim HJ, Kim HR, Kim SY, Kim HY, Park WK, Lee MH, Kim HJ. Predictors of difficult intubation when using a videolaryngoscope with an intermediate-angled blade during the first attempt: a prospective observational study. J Clin Monit Comput 2022; 36:1121-1130. [PMID: 34251587 DOI: 10.1007/s10877-021-00742-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
The curvature of a videolaryngoscope blade has been diversified from the standard macintosh-type to the hyperacute-angle-type, resulting in different performances. We aimed to determine the intubation success rate and identify predictors of difficult intubation when using an intermediate-angled videolaryngoscope in the first attempt of intubation under routine anaesthesia settings. We enrolled 808 patients between 19 and 79 years of age, scheduled for elective surgeries under general anaesthesia with orotracheal intubation from July 2017 to November 2018; patients who were candidates for awake intubation were excluded. We obtained patient demographic data and performed airway evaluation before induction of anaesthesia for elective surgeries. We used the UEScope for tracheal intubation with a hockey stick-shaped malleable stylet. The intubation time was defined as the total duration from the entry of the blade into the oropharynx to the detection of first end-tidal carbon dioxide capnogram; this duration was recorded along with the number of intubation attempts. Difficult intubation was defined as either > 60 s duration for tracheal intubation, or > 1 intubation attempt. The use of the UEScope demonstrated a 99.4% success rate for intubation; however, increased difficulties were observed in patients who were male, obese, had a short thyromental distance, limited mouth opening, and high upper-lip-bite test class. Despite the high intubation success rate using an intermediate-angled videolaryngoscope, we recommend preparing backup plans, considering the increased difficulty in patients with certain preoperative features.Clinical trial number and registry URL: Clinical Trials.gov Identifier: NCT03215823 (Date of registration: 12 July).
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Affiliation(s)
- Hye Jin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye Rim Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wyun Kon Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Ho Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Anesthesia and Pain Research Institute, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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8
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Rogers AM, Hansel J, Cook TM. Videolaryngoscopy, oesophageal intubation and uncertainty: lessons from Cochrane. Anaesthesia 2022; 77:1448-1450. [PMID: 35897123 DOI: 10.1111/anae.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- A M Rogers
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Hansel
- University of Manchester, Manchester, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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9
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Gupta A, Trikha A, Ayub A, Bhattacharjee S, Aravindan A, Gupta N, Prakash K, Aggarwal R, Ganesh V, Soni KD, Malhotra RK. Comparison of KingVision videolaryngoscope channelled blade with Tuoren videolaryngoscope non-channelled blade in a simulated COVID-19 intubation scenario by non-anaesthesiologists and experienced anaesthesiologists: A prospective randomised crossover mannequin study. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 38:42-48. [PMID: 38620715 PMCID: PMC7997946 DOI: 10.1016/j.tacc.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/08/2023]
Abstract
Purpose A videolaryngoscope has been recommended for intubation in the COVID-19 scenario but the videolaryngoscope providing optimal intubation conditions is not ascertained. We compared KingVision channelled blade with a non-Channelled videolaryngoscope for intubation times in a simulated COVID-19 intubation scenario by both anaesthesiologists and non-anaesthesiologists. Methods This prospective randomised cross over mannequin study was conducted in a skill training lab. 25 anaesthesiologists and 25 non-anaesthesiologists donned in standard personal protective equipment performed 100 intubations with KingVision and Tuoren videolaryngoscopes in a mannequin covered with a transparent plastic sheet. The total intubation time, percentage of glottic opening scores, first attempt success rates were assessed. Results The mean difference in intubation times in anaesthesiologists and non-anaesthesiologist less with KingVision videolaryngoscope (21.1s; 95% CI 9.6-32.6s vs. 35.9s; 95% CI 24.4-47.4 s; P = 0.001). Percentage of glottic opening score was significantly better with KingVision by non-anaesthesiologists (60; IQR 42.5 to 75 vs. 70; IQR 50 to 100; P = 0.019). KingVision provided superior first attempt success rate in non-anaesthesiologists (84% vs. 61.9%; P = 0.02) and anaesthesiologists (96% vs. 76%; P = 0.12). Conclusion KingVision channelled videolaryngoscope provided faster intubation times, glottic views and first attempt success rates in a simulated COVID-19 scenario in manikins and might be preferred over videolaryngoscopes with non-channelled blade. The findings need to be further verified in humans. Trial registration ctri.nic.in identifier: REF/2020/05/033338.
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Affiliation(s)
- Anju Gupta
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arshad Ayub
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajisha Aravindan
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi, India
| | - Kelika Prakash
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical Care, JPN Apex Trauma Centre, New Delhi, India
| | - Venkata Ganesh
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Department of Critical Care, JPN Apex Trauma Centre, New Delhi, India
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10
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Vaishnavi BD, Syal R, Vyas R, Bihani P. Awake intubation with C-MAC videolaryngoscope in a patient with difficult airway. Indian J Anaesth 2021; 65:253-254. [PMID: 33776118 PMCID: PMC7989476 DOI: 10.4103/ija.ija_631_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- B D Vaishnavi
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rashmi Syal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raksha Vyas
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pooja Bihani
- Department of Anaesthesiology and Critical Care, Dr S. N. Medical College, Jodhpur, Rajasthan, India
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11
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Jiang J, Kang N, Li B, Wu AS, Xue FS. Comparison of adverse events between video and direct laryngoscopes for tracheal intubations in emergency department and ICU patients-a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2020; 28:10. [PMID: 32033568 PMCID: PMC7006069 DOI: 10.1186/s13049-020-0702-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis was designed to determine whether video laryngoscope (VL) compared with direct laryngoscope (DL) could reduce the occurrence of adverse events associated with tracheal intubation in the emergency and ICU patients. METHODS The current issue of Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science (from database inception to October 30, 2018) were searched. The RCTs, quasi-RCTs, observational studies comparing VL and DL for tracheal intubation in emergency or ICU patients and reporting the rates of adverse events were included. The primary outcome was the rate of esophageal intubation (EI). Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. The ACROBAT-NRSi Cochrane Risk of Bias Tool was applied to assess the risk of bias for each eligible observational study. RESULTS Twenty-three studies (13,117 patients) were included in the review for data extraction. Pooled analysis showed a lower rate of EI by using VL (relative risk [RR], 0.24; P < 0.01; high-quality evidence for RCTs and very low-quality evidence for observational studies). Subgroup analyses based on the type of studies, whether a cardiopulmonary resuscitation study, or operators' expertise showed a similar lower rate of EI by using VL compared with DL in all subgroups (P < 0.01) except for experienced operators (RR, 0.44; P = 0.09). There were no significant differences between devices for other adverse events (P > 0.05), except for a lower incidence of hypoxemia when intubation was performed with VL by inexperienced operators (P = 0.03). CONCLUSIONS Based on the results of this analysis, we conclude that compared with DL, VL can reduce the risk of EI during tracheal intubation in the emergency and ICU patients, but does not provide significant benefits on other adverse events associated with tracheal intubation.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Na Kang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Shahsavari S, Walker DT, Patel C, Kapoor K, Davies-Husband CR. The use of video-laryngoscopy in head and neck surgery. Clin Otolaryngol 2018; 44:493-495. [PMID: 30408345 DOI: 10.1111/coa.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Somayyeh Shahsavari
- Department of Head and Neck surgery, Queen Victoria Hospital, East Grinstead, UK
| | - David T Walker
- Department of Head and Neck surgery, Queen Victoria Hospital, East Grinstead, UK
| | - Chetan Patel
- Department of Anaesthesiology, Queen Victoria Hospital, East Grinstead, UK
| | - Karan Kapoor
- Department of Head and Neck surgery, Queen Victoria Hospital, East Grinstead, UK
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Booth AWG, Wyssusek KH, Lee PK, Pelecanos AM, Sturgess D, van Zundert AAJ. Evaluation of the D-FLECT® deflectable-tip bougie in a manikin with a simulated difficult airway. Br J Anaesth 2018; 121:1180-1182. [PMID: 30336865 DOI: 10.1016/j.bja.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022] Open
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Russell TM, Hormis A. Should the Glidescope video laryngoscope be used first line for all oral intubations or only in those with a difficult airway? A review of current literature. J Perioper Pract 2018; 28:322-333. [PMID: 30035689 DOI: 10.1177/1750458918788985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question 'Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?' A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.
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Affiliation(s)
| | - Anil Hormis
- 2 Consultant in Anaesthesia & Critical Medicine, Honorary Professor, Sheffield Hallam University
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15
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Ji SM, Lee JG, Kim S, Seo H, Lee BJ. The effect of low-dose rocuronium on rapid tracheal intubation using a video laryngoscope: A randomized double blind controlled study. Medicine (Baltimore) 2018; 97:e10921. [PMID: 29851824 PMCID: PMC6392944 DOI: 10.1097/md.0000000000010921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [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 The aim of this study was to investigate the clinical effectiveness of rocuronium in low doses on conditions during rapid tracheal intubation using video laryngoscope. METHODS Ninety-eight patients undergoing otolaryngologic surgery were randomly divided into 2 groups: group L using 0.3 mg/kg of rocuronium intravenously (n = 49) and group C using 0.6 mg/kg of rocuronium (n = 49). Sixty seconds after rocuronium administration, tracheal intubation was performed using a video laryngoscope. The overall intubation condition was evaluated along with specific conditions, including laryngoscopy condition, vocal cord position, and intubation response. Intubation profiles, including Cormack-Lehane grade, 1st attempt success rate, and intubation time, were also evaluated. RESULTS Overall intubation conditions showed a significant difference between group L and group C (P = .003). Although the incidence of vigorous response after tracheal intubation was higher in group L than in group C (P = .022), laryngoscopy condition and vocal cord position were similar between the 2 groups (P = .145 and .070, respectively). Intubation profiles showed no differences between the 2 groups. The frequency and amount of additional rocuronium administration during surgery were also similar. CONCLUSIONS Low-dose rocuronium provided significantly worse overall intubation conditions compared to the conventional dose of rocuronium for rapid tracheal intubation. However, when using a video laryngoscope, it may provide clinically acceptable laryngeal muscle relaxation.
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Affiliation(s)
- Sung-Mi Ji
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University, Cheonan
| | - Jeong-Gug Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University, Cheonan
| | - Seokkon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University, Cheonan
| | - Hyungseok Seo
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bong-Jae Lee
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Van Zundert AAJ, Wyssusek KH, Greenland KB. Benefits of recording images during video laryngoscopy for early detection of oropharyngeal and laryngeal lesions: implications for “inattentional blindness”. Can J Anaesth 2018; 65:1156-1157. [DOI: 10.1007/s12630-018-1116-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
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Van Zundert AAJ, Wyssusek KH, Greenland KB. In reference to Is multidisciplinary team care for head and neck cancer worth it? and Does a multidisciplinary approach to voice and swallowing disorders improve therapy adherence and outcome? Laryngoscope 2018. [PMID: 29537079 DOI: 10.1002/lary.27177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- André A J Van Zundert
- Department of Anaesthesia and Perioperative Medicine Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Kerstin H Wyssusek
- Department of Anaesthesia and Perioperative Medicine Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Keith B Greenland
- Wesley Anaesthesia and Pain Management, Brisbane, Queensland, Australia
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Cook T, Boniface N, Seller C, Hughes J, Damen C, MacDonald L, Kelly F. Universal videolaryngoscopy: a structured approach to conversion to videolaryngoscopy for all intubations in an anaesthetic and intensive care department. Br J Anaesth 2018; 120:173-180. [DOI: 10.1016/j.bja.2017.11.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/20/2022] Open
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Jiang J, Ma D, Li B, Yue Y, Xue F. Video laryngoscopy does not improve the intubation outcomes in emergency and critical patients - a systematic review and meta-analysis of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:288. [PMID: 29178953 PMCID: PMC5702235 DOI: 10.1186/s13054-017-1885-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/06/2017] [Indexed: 01/12/2023]
Abstract
Background There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients. Methods We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017. Only randomized controlled trials comparing video and direct laryngoscopy for tracheal intubation in emergency department, intensive care unit, and prehospital settings were selected. The primary outcome was the first-attempt success rate. Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of evidence for all outcomes. Results Twelve studies (2583 patients) were included in the review for data extraction. Pooled analysis did not show an improved first-attempt success rate using video laryngoscopy (relative risk [RR], 0.93; P = 0.28; low-quality evidence). There was significant heterogeneity among studies (I2 = 91%). Subgroup analyses showed that, in the prehospital setting, video laryngoscopy decreased the first-attempt success rate (RR, 0.57; P < 0.01; high-quality evidence) and overall success rate (RR, 0.58; 95% CI, 0.48–0.69; moderate-quality evidence) by experienced operators, whereas in the in-hospital setting, no significant difference between two devices was identified for the first-attempt success rate (RR, 1.06; P = 0.14; moderate-quality evidence), regardless of the experience of the operators or the types of video laryngoscopes used (P > 0.05), although a slightly higher overall success rate was shown (RR, 1.11; P = 0.03; moderate-quality evidence). There were no differences between devices for other outcomes (P > 0.05), except for a lower rate of esophageal intubation (P = 0.01) and a higher rate of Cormack and Lehane grade 1 (P < 0.01) when using video laryngoscopy. Conclusions On the basis of the results of this study, we conclude that, compared with direct laryngoscopy, video laryngoscopy does not improve intubation outcomes in emergency and critical patients. Prehospital intubation is even worsened by use of video laryngoscopy when performed by experienced operators. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1885-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Danxu Ma
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, affiliated with Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Yun Yue
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Fushan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
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Van Zundert A, Gatt S, Kumar C, van Zundert T, Pandit J. Reply to Tobin and colleagues. Br J Anaesth 2017; 119:844. [DOI: 10.1093/bja/aex311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Pieters BMA, Maas EHA, Knape JTA, van Zundert AAJ. Videolaryngoscopy vs. direct laryngoscopy use by experienced anaesthetists in patients with known difficult airways: a systematic review and meta-analysis. Anaesthesia 2017; 72:1532-1541. [DOI: 10.1111/anae.14057] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- B. M. A. Pieters
- Department of Anaesthesia; University Medical Centre Utrecht; Utrecht the Netherlands
| | - E. H. A. Maas
- Department of Anesthesia; Erasmus University Medical Center; Rotterdam the Netherlands
| | - J. T. A. Knape
- Department of Anaesthesia; University Medical Centre Utrecht; Utrecht the Netherlands
| | - A. A. J. van Zundert
- Department of Anaesthesia and Perioperative Medicine; Royal Brisbane and Women's Hospital; University of Queensland; Brisbane Qld Australia
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Use of the GlideScope Ranger Video Laryngoscope for Emergency Intubation in the Prehospital Setting: A Randomized Control Trial. Crit Care Med 2017; 44:e470-6. [PMID: 27002277 DOI: 10.1097/ccm.0000000000001669] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. DESIGN Multicenter, prospective, randomized, control trial with patient recruitment over 18 months. SETTING Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway. PATIENTS Adult emergency patients requiring endotracheal intubation. INTERVENTIONS Airway management strictly following a prehospital algorithm. First and second intubation attempt employing GlideScope or direct laryngoscopy as randomized; third attempt crossover. After three failed intubation attempts, immediate use of an extraglottic airway device. MEASUREMENTS AND MAIN RESULTS A total of 326 patients were enrolled. Success rate with the GlideScope (n = 168) versus direct laryngoscopy (n = 158) group was 61.9% (104/168) versus 96.2% (152/158), respectively (p < 0.001). The main reasons for failed GlideScope intubation were failure to advance the tube into the larynx or trachea (26/168 vs 0/158; p < 0.001) and/or impaired sight due to blood or fluids (21/168 vs 3/158; p < 0.001). When GlideScope intubation failed, direct laryngoscopy was successful in 61 of 64 patients (95.3%), whereas GlideScope enabled intubation in four of six cases (66.7%) where direct laryngoscopy failed (p = 0.055). In addition, GlideScope was prone to impaired visualization of the monitor because of ambient light (29/168; 17.3%). There was no correlation between success rates and body mass index, age, indication for airway management, or experience of the physicians, respectively. CONCLUSIONS Video laryngoscopy is an established tool in difficult airway management, but our results shed light on the specific problems in the emergency medical service setting. Prehospital use of the GlideScope was associated with some major problems, thus resulting in a lower intubation success rate when compared with direct laryngoscopy.
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Rendeki S, Keresztes D, Woth G, Mérei Á, Rozanovic M, Rendeki M, Farkas J, Mühl D, Nagy B. Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices. BMC Anesthesiol 2017; 17:68. [PMID: 28549421 PMCID: PMC5446697 DOI: 10.1186/s12871-017-0362-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Direct laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators. However, an increasing number of reports currently support videolaryngoscopy, particularly for novice users. The widespread use of videolaryngoscopy may be limited due to financial limitations, especially in low-income countries. Therefore, affordable single-use scopes are now becoming increasingly popular. We sought to compare these new scopes with direct laryngoscopes and the previously tested videolaryngoscopes in mannequins by novices. METHODS Fifty medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the Airtraq®, a custom-made videolaryngoscope, the King Vision®, the Macintosh laryngoscope and the VividTrac®, on an airway trainer (Laerdal Airway Management Trainer®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. RESULTS We observed no differences in esophageal intubation. However, intubation-related times, the view of the glottis and operator satisfaction were significantly better throughout the study with the commercial videolaryngoscopes. In comparison, the custom-made videolaryngoscope performance proved to be similar to that of the Macintosh laryngoscope. The VividTrac® performance was similar (P > 0.05) or significantly better than that of the King Vision® in both scenarios. CONCLUSIONS Based upon our results, the Airtraq®, King Vision® and VividTrac® were superior to the Macintosh laryngscope in both normal and difficult airway scencarios for novice users. In particular, our study is the first to report that the VividTrac® shows promise for further clinical evaluation.
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Affiliation(s)
- Szilárd Rendeki
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary.,Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Department of Operational Medicine, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Dóra Keresztes
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary.,Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Department of Operational Medicine, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Gábor Woth
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary.,Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Department of Operational Medicine, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Ákos Mérei
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary.,Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Martin Rozanovic
- Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Mátyás Rendeki
- Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - József Farkas
- Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Department of Operational Medicine, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.,Department of Anatomy, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary
| | - Diána Mühl
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Therapy, Medical School, University of Pécs, Ifjúság Str. 13, HU-7624, Pécs, Hungary. .,Medical Skills Lab, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary. .,Department of Operational Medicine, Medical School, University of Pécs, Szigeti Str. 12, HU-7624, Pécs, Hungary.
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Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults. Crit Care Med 2017; 44:1980-1987. [PMID: 27355526 DOI: 10.1097/ccm.0000000000001841] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults. DESIGN A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows. SETTING Medical ICU in a tertiary, academic medical center. PATIENTS Critically ill patients 18 years old or older. INTERVENTIONS Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation. MEASUREMENTS AND MAIN RESULTS Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator's previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82-5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy. CONCLUSIONS In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.
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Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8943931. [PMID: 27703983 PMCID: PMC5040779 DOI: 10.1155/2016/8943931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022]
Abstract
We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P < 0.001 and P = 0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.
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Selected abstracts presented at the World Airway Management Meeting, 12–14 November 2015, Dublin, Ireland. Br J Anaesth 2016. [DOI: 10.1093/bja/aew183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Koh W, Kim H, Kim K, Ro YJ, Yang HS. Encountering unexpected difficult airway: relationship with the intubation difficulty scale. Korean J Anesthesiol 2016; 69:244-9. [PMID: 27274369 PMCID: PMC4891536 DOI: 10.4097/kjae.2016.69.3.244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 01/27/2016] [Accepted: 02/21/2016] [Indexed: 01/24/2023] Open
Abstract
Background An unexpected difficult intubation can be very challenging and if it is not managed properly, it may expose the encountered patient to significant risks. The intubation difficulty scale (IDS) has been used as a validated method to evaluate a global degree of intubation difficulty. The aims of this study were to evaluate the prevalence and characteristics of unexpected difficult intubation using the IDS. Methods We retrospectively reviewed 951 patients undergoing elective surgery in a single medical center. Patients expected to have a difficult intubation or who had history of difficult intubation were excluded. Each patient was assessed by the IDS scoring system with seven variables. Total prevalence of difficult intubation and the contributing individual factors were further analyzed. Results For the 951 patients, the difficult intubation cases presenting IDS > 5 was 5.8% of total cases (n = 55). The prevalence of Cormack-Lehane Grade 3 or 4 was 16.2% (n = 154). Most of the difficult intubation cases were managed by simple additional maneuvers and techniques such as stylet application, additional lifting force and laryngeal pressure. Conclusions Unexpected difficult airway was present in 5.8% of patients and most was managed effectively. Among the components of IDS, the Cormack-Lehane grade was most sensitive for predicting difficult intubation.
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Affiliation(s)
- Wonuk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hajung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyongsun Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Jin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Seuk Yang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nekhendzy V. Primus Inter Pares? The Angle of View Varies. Anesth Analg 2016; 122:597-600. [PMID: 26891386 DOI: 10.1213/ane.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vladimir Nekhendzy
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Liu ZJ, Yi J, Guo WJ, Ma C, Huang YG. Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists: A Randomized Study. Medicine (Baltimore) 2016; 95:e2514. [PMID: 26765472 PMCID: PMC4718298 DOI: 10.1097/md.0000000000002514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack-Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack-Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation.
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Affiliation(s)
- Zi-Jia Liu
- From the Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Science, Dongcheng District, Beijing, China (Z-JL, JY, W-JG, Y-GH) and Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China (CM)
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Marshall SD, Pandit JJ. Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation. Anaesthesia 2015; 71:131-7. [PMID: 26670262 DOI: 10.1111/anae.13354] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very 'radical evolution'.Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises.All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption.
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Affiliation(s)
- S D Marshall
- Department of Anaesthesia, Peninsula Health, Melbourne, Australia. .,Department of Anaesthesia, Peri-operative Medicine, Central Clinical School, Monash University, Melbourne, Australia.
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK.,St John's College, Oxford, UK
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Strøm C, Barnung S, Kristensen MS, Bøttger M, Tvede MF, Rasmussen LS. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope. Acta Anaesthesiol Scand 2015; 59:1154-60. [PMID: 25982220 DOI: 10.1111/aas.12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were assessed for eligibility. Patients were intubated using Boedeker intubation forceps and MVL. The primary endpoint was time to intubation. The secondary endpoints were intubation success rate, number of intubation attempts, intubation conditions and post-operative hoarseness. RESULTS Thirty-three patients were assessed for eligibility, and 25 patients were included in the study with a median SARI score of 3 (IQR 3-4). Twenty-two (88%, 95% confidence interval [74-100%]) of the patients were successfully intubated by the method with a median time to intubation of 115 s (IQR 78-247). Steering and advancement of the tube were reported as acceptable in 21 (84%) and 22 cases (88%), respectively, and excellent in 10 cases (45%) for both measures. Ten cases (40%) were intubated on the first attempt. There were three cases (12%) of failed intubation; in these cases, successful intubation was obtained by using a styletted tube. CONCLUSION(S) Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view.
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Affiliation(s)
- C. Strøm
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - S. Barnung
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. S. Kristensen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Bøttger
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. F. Tvede
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - L. S. Rasmussen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Pieters BM, Eindhoven GB, Acott C, Van Zundert AAJ. Pioneers of Laryngoscopy: Indirect, Direct and Video Laryngoscopy. Anaesth Intensive Care 2015; 43 Suppl:4-11. [DOI: 10.1177/0310057x150430s103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway management is one of the core skills of the anaesthetist and various techniques of airway management have developed over many years. Initially, the only view of the glottis that could be obtained was an indirect view (indirect laryngoscopy). Late in the 19th century, a direct view of the glottis was obtained via various direct laryngoscopes. Currently, in the early 21st century, there has been a return to indirect laryngoscopy via videolaryngoscopy using a videolaryngoscope. The aim of this paper is to give a historical overview of the development of both direct and indirect laryngoscopy.
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Affiliation(s)
- B. M. Pieters
- Department of Anaesthesiology and Pain Medicine, Maastricht University Hospital, Maastricht, The Netherlands
| | - G. B. Eindhoven
- Department of Anaesthesiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - C. Acott
- Department of Anaesthesia, Pain and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, South Australia
| | - A. A. J. Van Zundert
- Faculty of Medicine and Biomedical Sciences, University of Queensland and Royal Brisbane and Women's Hospital, Herston Campus, Brisbane, Queensland
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Management of the anticipated and unanticipated difficult airway in anesthesia outside the operating room. Curr Opin Anaesthesiol 2014; 26:481-8. [PMID: 23820104 DOI: 10.1097/aco.0b013e328362cc69] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The number of diagnostic and interventional procedures outside the operating room has dramatically increased over the last years. However, providing well tolerated anesthesia with the same standard of care in these locations is often challenging to the anesthesiologist. The remote locations include different organizational aspects and hazards. Airway management in general is still confronted with scenarios of difficult intubation and ventilation and often leads to significant morbidity and mortality. Continuous awareness of the potential complications is urged when providing anesthesia for remote procedures. RECENT FINDINGS Recent studies have poorly addressed the issue of airway management by trained anesthesiologists outside the operating room. The majority of evidence is provided in the field of emergency medicine and intensive care settings. However, when dealing with difficult airway management in the remote setting, careful assessment and preparation is even more important than in the operating room. New evidence concerning prediction of ventilation and intubation must be incorporated in algorithms of airway management. Different anesthetic regimens using remifentanil and avoiding the use of neuromuscular blockers have to be carefully considered since they might change the scenario of intubation conditions. The new era of video laryngoscopes offers important potential to increase the tools for airway management. These new devices have the perfect design to be incorporated in remote settings. However, studies mainly focus on the emergency department and ICU. Also, there is currently a lack of consensus among professionals about their use and the large number of different devices seems to avoid careful comparisons. SUMMARY Airway management outside the operating room is challenging and needs the implementation of algorithms including the new airway devices. The recent update of the practice guidelines about difficult airway management of the American Society of Anesthesiologists remains the standard reference guide.
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Randomised controlled trials of videolaryngoscopy vs direct laryngoscopy on intensive care are needed. Intensive Care Med 2014; 40:765. [DOI: 10.1007/s00134-014-3262-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 10/25/2022]
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