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Pap R, van Loggerenberg C. A comparison of airway management devices in simulated entrapment-trauma: a prospective manikin study. Int J Emerg Med 2019; 12:15. [PMID: 31286862 PMCID: PMC6615147 DOI: 10.1186/s12245-019-0233-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/25/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In the patient entrapped after a motor vehicle collision (MVC), advanced airway management may need to be performed before extrication. The aim of this study was to compare four airway management devices utilized by paramedics in a simulated entrapped patient. METHODS Twenty-six paramedics performed advanced airway management on a manikin seated in the driver's seat (right side) of a car. Access was through the opened door only. The airway devices were the Macintosh laryngoscope and the Airtraq optical laryngoscope to facilitate the endotracheal intubation (ETI), the laryngeal mask airway (LMA) Supreme and the laryngeal tube (LT). Time to first successful ventilation and number of attempts required for successful placement were measured. Following each placement, participants rated the degree of difficulty. For ETI, participants ranked the achieved glottic view using Cormack-Lehane grades (CLG). Finally, participants were asked which airway management device they preferred. RESULTS The LMA Supreme had the shortest mean time to first successful ventilation (16.7 s, CI [0.95] 14.9-18.6). Insertion of the LMA Supreme and ETI with the Macintosh laryngoscope had 100% first-attempt success. The LMA Supreme was rated least difficult to insert (mean score 1.7/10 (CI [0.95] 1.2-2.1)). Compared to the Macintosh, the Airtraq laryngoscope facilitated superior laryngoscopy (CLG I view 46.2% and 80.8%, respectively). Most participants (10/26; 38%) chose the Macintosh laryngoscope as their preferred technique, followed closely by the LMA Supreme (9/26; 35%). CONCLUSION The LMA Supreme took the least amount of time and was the easiest to be inserted. Extraglottic airway devices may be beneficial alternative airway management devices to be considered by paramedics in the entrapped patient. Endotracheal intubation using the Macintosh laryngoscope was performed competently by participating paramedics. The Airtraq enabled superior laryngoscopy but resulted in poorer first-pass success rate.
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Affiliation(s)
- Robin Pap
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia.
| | - Charl van Loggerenberg
- ER Consulting Inc., Johannesburg, South Africa.,School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Lee S, Kang H, Oh J, Lim TH, Lee Y, Kim C. Comparison of Pentax-AWS®, Glidescope®, and King Vision® for difficult-airway intubation in manikins model by paramedics. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917724727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Prehospital tracheal intubation of a difficult airway is challenging for paramedics. Thus far, the potential role of video laryngoscopes for this purpose has not been confirmed. Therefore, this study aimed to determine the impact of different types of video laryngoscopes on the success rate and time to intubation by paramedics. Methods: This is a prospective, randomized, crossover manikin study involving 18 paramedics. Participants performed intubation on a difficult airway in a high-fidelity manikin using Pentax-AWS®, Glidescope®, and King Vision® (with two blade types). Time to intubation and success rate of intubation were determined. Participants also rated the best glottic view and reported their preferences of devices. Results: In a difficult-airway scenario, the median time to intubation with Pentax-AWS® was 22.9 s (interquartile range, 19.5–24.9 s), which was significantly shorter than using other devices. There were no significant differences in the time to maximal exposure of the vocal cords between four devices ( p = 0.156). The time to insert the endotracheal tube with Pentax-AWS® and King Vision® with a guide-channel blade was significantly shorter than that with the other two devices (all, p < 0.05). Pentax-AWS® and King Vision® with a guide-channel blade showed higher success rates than the other two devices ( p = 0.04). With regard to device preference, 14 participants preferred Pentax-AWS® among all devices analyzed. Conclusion: Pentax-AWS® could be an appropriate device for paramedics in cases of difficult airways, with high success rate.
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Affiliation(s)
- Sanghyun Lee
- Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon, South Korea
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yoonjae Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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Comparison of airway management techniques for different access in a simulated motor vehicle entrapment scenario. Eur J Emerg Med 2017; 23:279-285. [PMID: 25715022 DOI: 10.1097/mej.0000000000000254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency airway management can be particularly challenging in patients entrapped in crashed cars because of limited access. The aim of this study was to analyse the feasibility of four different airway devices in various standardized settings utilized by paramedics and emergency physicians. METHODS Twenty-five paramedics and 25 emergency physicians were asked to perform advanced airway management in a manikin entrapped in a car's left front seat, with access to the patient through the opened driver's door or access from the back seat. Available airway devices included Macintosh and Airtraq laryngoscopes, as well as laryngeal mask airway (LMA) Supreme and the Laryngeal Tube. The primary endpoints were successful placement, along with attempts needed to do so, and time for successful placement. The secondary endpoints included Cormack-Lehane grades and rating of the difficulty of the technique with the different devices. RESULTS The overall intubation and placement success rates were equal for the Macintosh and Airtraq laryngoscopes as well as the LMA Supreme and Laryngeal Tube, with access from the back seat being superior in terms of placement time and ease of use. Supraglottic airway devices required half of the placement time and were easier to use compared with endotracheal tubes (with placement times almost >30 s). Paramedics and emergency physicians achieved equal overall successful placement rates for all devices. CONCLUSION Both scenarios of securing the airway seem suitable in this manikin study, with access from the back seat being superior. Although all airway devices were applicable by both groups, paramedics and emergency physicians, supraglottic device placement was faster and always possible at the first attempt. Therefore, the LMA Supreme and the Laryngeal Tube are attractive alternatives for airway management in this context if endotracheal tube placement fails. Furthermore, supraglottic device placement, while the patient is still in the vehicle, followed by a definitive airway once the patient is extricated would be a worthwhile alternative course of action.
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Declercq PL, Bubenheim M, Gelinotte S, Guernon K, Michot JB, Royon V, Carpentier D, Béduneau G, Tamion F, Girault C. Usefulness of video-laryngoscopy with the Airway Scope for intubation performance and learning: an experimental manikin controlled study. Ann Intensive Care 2016; 6:83. [PMID: 27566712 PMCID: PMC5001963 DOI: 10.1186/s13613-016-0182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/10/2016] [Indexed: 12/03/2022] Open
Abstract
Background Different video-laryngoscopes (VDLs) for endotracheal intubation (ETI) have recently been developed. We compared the performance of the VDL Airway Scope (AWS) with the direct laryngoscopy by Macintosh (DLM) for ETI success, time and learning. Methods We performed an experimental manikin controlled study. Twenty experienced (experts) and 40 inexperienced operators (novices) for DLM-ETI were enrolled. None of them had experience with the use of AWS-VDL. Novices were assigned to start learning with DLM or AWS, and two sub-groups of 20 novices were formed. Experts group constituted the control group. Each participant performed 10 ETI attempts with each device on the same standard manikin. The primary endpoint was the ETI success probability. Secondary endpoints were ETI time, technical validity and qualitative evaluation for each technique. We also assessed the learning order and the successive attempts effects for these parameters. Results Overall, 1200 ETI attempts were performed. ETI success probability was higher with the AWS than with the DLM for all operators (98 vs. 81 %; p < 0.0001) and for experts compared to novices using devices in the same order (97 vs. 83 %; p = 0.0002). Overall ETI time was shorter with the AWS than with the DLM (13 vs. 20 s; p < 0.0001) and for experts compared to novices using devices in the same order (11 vs. 21 s; p < 0.0001). Among novices, those starting learning with AWS had higher ETI success probability (89 vs. 83 %; p = 0.03) and shorter ETI time (18 vs. 21 s; p = 0.02). Technical validity was found better with the AWS than DLM for all operators. Novices expressed global satisfaction and device preference for the AWS, whereas experts were indifferent. Conclusions AWS-VDL permits faster, easier and more reliable ETI compared to the DLM whatever the previous airway ETI experience and could be a useful device for DLM-ETI learning.
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Affiliation(s)
- Pierre-Louis Declercq
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Michael Bubenheim
- Department of Clinical Research Support, Biostatistics Unit, Rouen University Hospital, Rouen Cedex, France
| | - Stéphanie Gelinotte
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Kévin Guernon
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Jean-Baptiste Michot
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Vincent Royon
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Dorothée Carpentier
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Gaëtan Béduneau
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France.,UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen Cedex, France
| | - Fabienne Tamion
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France
| | - Christophe Girault
- Department of Medical Intensive Care, Rouen University Hospital, Rouen Cedex, France. .,UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen Cedex, France. .,Service de Réanimation Médicale, Hôpital Charles Nicolle, Centre Hospitalier Universitaire-Hôpitaux de Rouen, 1, Rue de Germont, 76031, Rouen Cedex, France.
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Yallapragada SV, Parasa M, Vemuri NN, Shaik MS. Comparison of the ease of tracheal intubation by postgraduate residents of anesthesiology using Airtraq™ and Macintosh laryngoscopes: An observational study. Anesth Essays Res 2016; 10:233-7. [PMID: 27212753 PMCID: PMC4864674 DOI: 10.4103/0259-1162.171444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Airtraq™ (Prodol Meditec, Vizcaya, Spain) is a recently developed laryngoscope, which facilitates easy visualization of glottis through a matrix of sequentially arranged lenses and mirrors. In this observatory study, we sought to compare the ease of tracheal intubation with Airtraq™ and Macintosh laryngoscope when performed by 2(nd) year postgraduate residents of Anesthesiology in NRI Medical College, Mangalagiri. AIMS To compare the ease of tracheal intubation by Airtraq™ laryngoscope with that by Macintosh laryngoscope among the 2(nd) year postgraduate residents of anesthesiology in terms of time taken for intubation and the rise of rate-pressure product (RPP) with intubation. SETTINGS AND DESIGN Prospective randomized observational study. SUBJECTS AND METHODS Eighty adult and healthy patients with an easy airway, scheduled for general anesthesia were allocated into two groups A, and M. Patients in Group A were intubated with Airtraq™ laryngoscope and those in Group M were intubated with Macintosh laryngoscope by the 2(nd) year postgraduate residents of anesthesiology. The time taken for intubation, the RPPs at baseline, after induction of general anesthesia, postintubation, at 3 and 5 min after intubation, the rise of RPP to intubation and the occurrence of a sore throat were compared between the two groups. STATISTICAL ANALYSIS USED Descriptive and inferential statistical methods were used to analyze the data. RESULTS The mean time for intubation in Macintosh group was 28.18 s and was 40.98 s in Airtraq group. The mean rise of RPP to intubation was 4644.83 in Airtraq group and 2829.27 in Macintosh group. The incidence of a sore throat was equal in both the groups. CONCLUSIONS The time for intubation and the sympathetic response to airway instrumentation were more with Airtraq™ laryngoscope than with Macintosh laryngoscope.
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Affiliation(s)
| | - Mrunalini Parasa
- Department of Anaesthesiology, NRI Medical College, Guntur, Andhra Pradesh, India
| | - Nagendra Nath Vemuri
- Department of Anaesthesiology, NRI Medical College, Guntur, Andhra Pradesh, India
| | - Mastan Saheb Shaik
- Department of Anaesthesiology, NRI Medical College, Guntur, Andhra Pradesh, India
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Murphy LD, Kovacs GJ, Reardon PM, Law JA. Comparison of the King Vision Video Laryngoscope with the Macintosh Laryngoscope. J Emerg Med 2014; 47:239-46. [DOI: 10.1016/j.jemermed.2014.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/30/2013] [Accepted: 02/09/2014] [Indexed: 02/07/2023]
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Hoshijima H, Kuratani N, Hirabayashi Y, Takeuchi R, Shiga T, Masaki E. Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia 2014; 69:911-8. [PMID: 24820205 DOI: 10.1111/anae.12705] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 12/01/2022]
Abstract
The Pentax Airway Scope(®) is a single-use optical videolaryngoscope designed to assist with difficult tracheal intubation. We systematically reviewed the efficacy of the Pentax Airway Scope with that of a conventional laryngoscope for tracheal intubation in adults with 'normal' and 'difficult' airways. We included 17 randomised controlled trials with a total of 1801 participants. We used the DerSimonian and Laird random-effects model to calculate pooled relative risk or weighted mean differences. The relative risk (95% CI) of a Cormack-Lehane grade-1 laryngeal view was 2.40 (1.76-2.49) with the Pentax Airway Scope compared with the Macintosh laryngoscope, p < 0.00001. We found no other differences between the two laryngoscopes. Despite a superior laryngeal view, the Pentax Airway Scope provides little clinical benefit over the conventional laryngoscope.
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Affiliation(s)
- H Hoshijima
- Division of Dento-Oral Anaesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Abelsson A, Rystedt I, Suserud BO, Lindwall L. Mapping the use of simulation in prehospital care - a literature review. Scand J Trauma Resusc Emerg Med 2014; 22:22. [PMID: 24678868 PMCID: PMC3997227 DOI: 10.1186/1757-7241-22-22] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/24/2014] [Indexed: 12/15/2022] Open
Abstract
Background High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. Methods An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. Results The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. Conclusion Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels.
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Affiliation(s)
- Anna Abelsson
- Department of Health Sciences, Karlstad University, Karlstad, Sweden.
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Arima T, Nagata O, Miura T, Ikeda K, Mizushima T, Takahashi A, Sakaida K. Comparative analysis of airway scope and Macintosh laryngoscope for intubation primarily for cardiac arrest in prehospital setting. Am J Emerg Med 2013; 32:40-3. [PMID: 24176585 DOI: 10.1016/j.ajem.2013.09.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/25/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022] Open
Abstract
STUDY OBJECTIVE This study sought to determine and compare the utility of the Airway scope (AWS; Pentax Corporation, Tokyo, Japan) and the conventional Macintosh laryngoscope (MLS) for intubation in the prehospital setting. METHODS In this randomized controlled trial in the prehospital setting, the primary outcome was time required for intubation, and the secondary outcomes were ultimate success, first attempt success, and difficulty of intubation. The intent-to-treat principle was used to analyze time to intubation. Ultimate success was defined as intubation completed within 600 s regardless of the device ultimately used. RESULTS A total of 109 patients, primarily with cardiac arrest, were randomly assigned to the AWS or MLS arms. Median time (interquartile range) to intubation was 155 (71-216) s with the AWS versus 120 (60-170) s with the MLS (P = .095). Ultimate success rate was slightly lower with the AWS (96.4%) than with the MLS (100%) (P = .496), while the first attempt success rate was significantly lower (46% and 75%, respectively; P = .002). There was no significant difference in difficulty of intubation (P = .066). Multivariate logistic regression analysis revealed that cervical immobilization and oral contamination, such as vomit, was associated with first attempt success (odds ratio [95% confidence interval]: 0.11 [0.01-0.87] and 0.43 [0.18-0.99], respectively). CONCLUSION Despite its many advantages seen in other settings, the AWS did not show superior efficacy to the MLS in relation to time required for intubation, ultimate or first attempt success rate, or difficulty level of intubation in the prehospital setting.
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Affiliation(s)
- Takahiro Arima
- Emergency Department, Funabashi Municipal Medical Center.
| | - Osamu Nagata
- Department of Anesthesiology, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Takeshi Miura
- Emergency Department, Funabashi Municipal Medical Center
| | - Katsuki Ikeda
- Emergency Department, Funabashi Municipal Medical Center
| | | | | | - Koji Sakaida
- Emergency Department, Funabashi Municipal Medical Center
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Wendling AL, Tighe PJ, Conrad BP, Baslanti TO, Horodyski M, Rechtine GR. A comparison of 4 airway devices on cervical spine alignment in cadaver models of global ligamentous instability at c1-2. Anesth Analg 2013; 117:126-32. [PMID: 23354337 DOI: 10.1213/ane.0b013e318279b37a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effects of advanced airway management on cervical spine alignment in patients with upper cervical spine instability are uncertain. METHODS To examine the potential for mechanical disruption during endotracheal intubation in cadavers with unstable cervical spines, we performed a prospective observational cohort study with 3 cadaver subjects. We created an unstable, type II odontoid fracture with global ligamentous instability at C1-2 in lightly embalmed cadavers, followed by repetitive intubations with 4 different airway devices (Airtraq laryngoscope, Lightwand, intubating laryngeal mask airway [LMA], and Macintosh laryngoscope) while manual in-line stabilization was applied. Motion analysis data were collected using an electromagnetic device to assess the degree of angular movement in 3 axes (flexion-extension, axial rotation, and lateral bending) during the intubation trials with each device. Intubation was performed by either an emergency medical technician or attending anesthesiologist. RESULTS Overall, 153 intubations were recorded with the 4 devices. The Lightwand technique resulted in significantly less flexion-extension and axial rotation at C1-2 than with the intubating LMA (mean difference in flexion-extension 3.2° [95% confidence interval {CI}, 0.9°-5.5°], P = 0.003; mean difference in axial rotation 1.6° [95% CI, 0.3°-2.8°], P = 0.01) and Macintosh laryngoscope (mean difference in flexion-extension 3.1° [95% CI, 0.8°-5.4°], P = 0.005; mean difference in axial rotation 1.4° [95% CI 0.1°-2.6°], P = 0.03). CONCLUSIONS In cadavers with instability at C1-2, the Lightwand technique produced less motion than the Macintosh and intubating LMA.
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Affiliation(s)
- Adam L Wendling
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, 1600 S.W. Archer Rd., Gainesville, FL 32610-0254, USA.
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Purugganan RV, Jackson TA, Heir JS, Wang H, Cata JP. Video Laryngoscopy Versus Direct Laryngoscopy for Double-Lumen Endotracheal Tube Intubation: A Retrospective Analysis. J Cardiothorac Vasc Anesth 2012; 26:845-8. [DOI: 10.1053/j.jvca.2012.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Indexed: 01/29/2023]
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Sunder RA, Haile DT, Farrell PT, Sharma A. Pediatric airway management: current practices and future directions. Paediatr Anaesth 2012; 22:1008-15. [PMID: 22967160 DOI: 10.1111/pan.12013] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Management of a pediatric airway can be a challenge, especially for the non-pediatric anesthesiologists. Structured algorithms for an unexpected difficult pediatric airway have been missing so far. A recent step wise algorithm, based on the Difficult Airway society (DAS) adult protocol, is a step in the right direction. There have been some exciting advances in development of pediatric extra-glottic devices for maintaining ventilation, and introduction of pediatric versions of new 'non line of sight' laryngoscopes and optical stylets. The exact role of these devices in routine and emergent situations is still evolving. Recent advances in simulation technology has become a valuable tool in imparting psychomotor and procedural skills to trainees and allied healthcare workers. Moving toward the goal of eliminating serious adverse events during the management of routine and difficult pediatric airway, authors propose that institutions develop a dedicated Difficult Airway Service comprising of a team of experts in advanced airway management.
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Affiliation(s)
- Rani A Sunder
- Division of Pediatric Anesthesiology, Washington University at St Louis, St Louis, MO 63105, USA
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Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia 2011; 66 Suppl 2:45-56. [DOI: 10.1111/j.1365-2044.2011.06934.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rai MR, Popat MT. A reply. Anaesthesia 2011. [DOI: 10.1111/j.1365-2044.2011.06773_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomson S, Timms G, Kessell G. Videolaryngoscopes and pre-hospital intubation. Anaesthesia 2011; 66:314-5; author reply 315. [DOI: 10.1111/j.1365-2044.2011.06669.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Videolaryngoskopie in der präklinischen Notfallmedizin. Notf Rett Med 2011. [DOI: 10.1007/s10049-010-1358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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