C-MAC© videolaryngoscopy: The anaesthetic assistant's view

Although videolaryngoscopy plays a major role in the 2015 Difficult Airway Society guidelines, the impact on anaesthetic assistant working practices and training has not previously been reported. We surveyed anaesthetic assistants in our hospital to document their experience with using the C-MAC^© videolaryngoscope (48 practitioners, 100% response rate). Improvements in the following were reported: patient safety 100%; ability to see whether laryngoscopy is difficult 98%; ability to anticipate the 'next step' 98%; team-working and human factors 96%; ability to call a senior anaesthetist more quickly 94%; assessment or adjustment of cricoid force application 92%, understanding of laryngeal anatomy 92%; training in intubation 98%; training in cricoid force application 87%. Concerns were primarily about local issues such as decontamination and blade availability. Ninety percent reported that the clinical benefit outweighed any additional workload. In conclusion, the C-MAC^© videolaryngoscope is judged by anaesthetic assistants to confer numerous advantages for their working practice and training.

Device and Medication Preferences of Canadian Physicians for Emergent Endotracheal Intubation in Critically Ill Patients

OBJECTIVES

Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.

METHODS

A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from "always" to "never" to capture usual practice.

RESULTS

The survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would "always/often" be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would "always/often" administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00).

CONCLUSIONS

Most EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.