1
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Nelson A, Baur JW, Lew A, Pettit NN, Nguyen CT. Rethinking Perioperative Antibiotic Prophylaxis for Low-Risk Head and Neck Procedures. Ann Otol Rhinol Laryngol 2024; 133:458-461. [PMID: 38183237 DOI: 10.1177/00034894231222690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
OBJECTIVE For true clean-contaminated head and neck procedures, the literature supports ≤24 hours of perioperative antibiotics. However, there are certain otolaryngology procedures with low surgical site infection (SSI) risk for which there is negligible benefit from antibiotic prophylaxis. The objective of this evaluation was to describe antibiotic use and adherence to evidence-based institutional guidelines in low-risk head and neck procedures. METHODS This was a single-center, retrospective cohort study of patients undergoing low-risk clean-contaminated head and neck procedures wherein antibiotic prophylaxis was not indicated, based on evidence-based institutional guidelines. RESULTS Among the 291 included patients, perioperative antibiotics were unnecessarily administered in 29% of patients. Among patients who received antibiotics, 76% received preoperative antibiotics and 41% received postoperative antibiotics, for a median duration of 7 days. There were no significant differences in SSIs, mortality, and length of stay for those receiving perioperative antibiotics versus those not receiving perioperative antibiotics. CONCLUSION These data highlight the need for antibiotic stewardship interventions and partnerships between antibiotic stewardship teams and surgical services.
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Affiliation(s)
- Avery Nelson
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Jordan W Baur
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Alison Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
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2
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Messina S, Merola F, Santonocito C, Sanfilippo M, Sanfilippo G, Lombardo F, Bruni A, Garofalo E, Murabito P, Sanfilippo F. Articulating Video Stylet Compared to Other Techniques for Endotracheal Intubation in Normal Airways: A Simulation Study in Consultants with No Prior Experience. J Clin Med 2024; 13:728. [PMID: 38337422 PMCID: PMC10856441 DOI: 10.3390/jcm13030728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Simulation for airway management allows for acquaintance with new devices and techniques. Endotracheal intubation (ETI), most commonly performed with direct laryngoscopy (DL) or video laryngoscopy (VLS), can be achieved also with combined laryngo-bronchoscopy intubation (CLBI). Finally, an articulating video stylet (ProVu) has been recently introduced. A single-center observational cross-sectional study was performed in a normal simulated airway scenario comparing DL, VLS-Glidescope, VLS-McGrath, CLBI and ProVu regarding the success rate (SR) and corrected time-to-intubation (cTTI, which accounts for the SR). Up to three attempts/device were allowed (maximum of 60 s each). Forty-two consultants with no experience with ProVu participated (15 ± 9 years after training completion). The DL was significantly faster (cTTI) than all other devices (p = 0.033 vs. VLSs, and p < 0.001 for CLBI and Provu), no differences were seen between the two VLSs (p = 0.775), and the VLSs were faster than CLBI and ProVu. Provu had a faster cTTI than CLBI (p = 0.004). The DL and VLSs showed similar SRs, and all the laryngoscopes had a higher SR than CLBI and ProVu at the first attempt. However, by the third attempt, the SR was not different between the DL/VLSs and ProVu (p = 0.241/p = 0.616); ProVu was superior to CLBI (p = 0.038). In consultants with no prior experience, ProVu shows encouraging results compared to DL/VLSs under simulated normal airway circumstances and further studies are warranted.
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Affiliation(s)
- Simone Messina
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Federica Merola
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Marco Sanfilippo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Giulia Sanfilippo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Federica Lombardo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Andrea Bruni
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Eugenio Garofalo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (M.S.); (G.S.); (A.B.); (E.G.)
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, Policlinico-San Marco University Hospital, Via S. Sofia n 78, 95123 Catania, Italy; (S.M.); (F.M.); (C.S.); (F.L.); (P.M.)
- Section of Anesthesia, Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy
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Azam S, Khan ZZ, Shahbaz H, Siddiqui A, Masood N, Anum, Arif Y, Memon ZU, Khawar MH, Siddiqui FF, Azam F, Goyal A. Video Versus Direct Laryngoscopy for Intubation: Updated Systematic Review and Meta-Analysis. Cureus 2024; 16:e51720. [PMID: 38322075 PMCID: PMC10846758 DOI: 10.7759/cureus.51720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/08/2024] Open
Abstract
Direct laryngoscopy (DL) is a modality commonly used in endotracheal intubation (EI). Video laryngoscopy (VL) was introduced to further facilitate the procedure with enhancement in glottic views, which captures the video image of the vocal cords to be projected onto a screen, providing enhanced visualization. This real-time video projection aids in accurately placing the endotracheal tube (ETT) through the vocal cords. In emergency and critical care settings, both laryngoscopes are used for intubations. This study assesses the efficacy of both modalities by comparing success rates in first-attempt tracheal intubation in critically ill patients. PubMed, EMBASE, and Scopus were searched and all randomized controlled trials (RCTs) and observational studies until 2023 were included. Studies included patients in critical care settings undergoing EI under the guidance of either DL or VL. The primary outcome was the first attempt at successful tracheal intubation. The secondary outcomes assessed the comparative safety of DL and VL by comparing the rates of severe hypoxemia, severe hypotension, and cardiac arrest occurring during each modality. P-values were considered of statistical significance if below 0.05. Statistical analysis was performed using RevMan v5.4 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). The results were displayed in the form of forest plots. A total of eight studies were included with a total of 5348 patients, with 1780 in the DL group and 3568 in the VL group. Analysis revealed that in emergency situations, the success rate of intubation on the first attempt was significantly higher for VL than DL [81.5% vs 68%; RR= 1.19; 95% CI: 1.10, 1.29; p <0.00001; I2=70%]. There was no significant correlation between VL and severe hypoxemia [13.4% vs 11.6%; RR= 0.99; 95% CI: 0.74, 1.33; p =0.97; I2=46%], severe hypotension [6.09% vs 4.78%; RR:1.19; 95% CI: 0.83, 1.72; p =0.35, I2-15%], and cardiac arrest, [0.8% vs 0.4%; RR= 1.17; 95% CI: 0.37, 3.70]; p =0.79; I2=0%]. Our meta-analysis confirmed that VL has a higher success rate for first-pass intubation than DL. Furthermore, our analysis has shown no significant evidence linking VL to any adverse events.
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Affiliation(s)
- Saad Azam
- Medical School, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, PAK
| | - Zainab Z Khan
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Rawalpindi, PAK
| | - Haania Shahbaz
- Psychiatry, Dow University of Health Sciences, Karachi, PAK
| | - Aisha Siddiqui
- Medical School, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Anum
- Medical School, Faisalabad Medical University, Faisalabad, PAK
| | - Yumna Arif
- Medical School, Dow University of Health Sciences, Karachi, PAK
| | - Zeenat U Memon
- Medical School, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | | | - Farina F Siddiqui
- Medical School, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fiza Azam
- Orthopaedics and Trauma, Dorset County Hospital, Dorchester, Dorchester, GBR
| | - Aman Goyal
- Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
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4
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Merola R, Mancino D, Vargas M. Videolaryngoscopy versus direct laryngoscopy: a bibliometric analysis. Br J Anaesth 2024; 132:166-168. [PMID: 37925267 DOI: 10.1016/j.bja.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Dalila Mancino
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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5
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Küçükosman G, Bollucuoğlu K, Ava M, Ayoğlu H. Comparison of the Effectiveness of the Miller Laryngoscope and the McGrath-MAC Video Laryngoscope in Direct Visualization of the Glottic Opening. Medicina (Kaunas) 2023; 60:62. [PMID: 38256323 PMCID: PMC10818884 DOI: 10.3390/medicina60010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.
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Affiliation(s)
- Gamze Küçükosman
- Department of Anesthesiology and Reanimation, Trabzon Faculty of Medicine, University of Health Sciences, Trabzon 61080, Turkey
| | - Keziban Bollucuoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University, Zonguldak 67100, Turkey; (K.B.); (M.A.)
| | - Mahmut Ava
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University, Zonguldak 67100, Turkey; (K.B.); (M.A.)
| | - Hilal Ayoğlu
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University, Zonguldak 67100, Turkey; (K.B.); (M.A.)
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6
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Pintarič TS. Videolaryngoscopy as a primary intubation modality in obstetrics: A narrative review of current evidence. Biomol Biomed 2023; 23:949-955. [PMID: 37021834 PMCID: PMC10655883 DOI: 10.17305/bb.2023.9154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/07/2023]
Abstract
Pregnancy-related physiologic and anatomic changes affect oxygenation and airway management, and it is widely believed that airway difficulty may be more common in obstetric patients as a result. In addition, most obstetric intubations are performed under emergency conditions, and preoperative airway assessment poorly predicts airway management outcomes. These considerations necessitate special protocols for airway care in the obstetric population, and the evolution of the videolaryngoscope represents one of the most important milestones in recent decades. However, recommendations for the use of videolaryngoscopy in obstetrics remain unclear. A considerable body of evidence affirms that videolaryngoscopy improves laryngeal visualisation, increases first-attempt and overall intubation success rates, shortens intubation time, and facilitates team communication and education. In contrast, a significant number of studies have also reported conflicting results regarding comparative clinical outcomes and have highlighted other limitations regarding the adoption of videolaryngoscopy in routine obstetric care. Nevertheless, considering the peculiarities of obstetric intubation, the Macintosh-style videolaryngoscope can be suggested as the primary intubation device as it offers the benefits of both videolaryngoscopy and direct laryngoscopy. However, more rigorous evidence is needed to clarify the current blind spots and controversies regarding the role of videolaryngoscopy in obstetrics.
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Affiliation(s)
- Tatjana Stopar Pintarič
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Institute of Anatomy, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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7
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Pass M, Di Rollo N, McNarry AF. Videolaryngoscopy in critical care and emergency locations: moving from debating benefit to implementation. Br J Anaesth 2023; 131:434-438. [PMID: 37507261 DOI: 10.1016/j.bja.2023.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
The recently published INTUBE study subanalysis and DEVICE trial findings both demonstrate a clear benefit of videolaryngoscopy over direct laryngoscopy in facilitating tracheal intubation of patients in the emergency department and ICU. We consider the increasing evidence supporting the use of videolaryngoscopy, the possible reasons behind its relatively slow adoption into clinical practice, and the potential role of the hyperangulated videolaryngoscope blade. We discuss the significance of improved first-pass tracheal intubation success in reducing the overall risk of complications in critically ill patients. Additionally, we address the need for specific training in videolaryngoscopy in order to maximise patient benefit, and propose that adequate training and rehearsal opportunities in videolaryngoscopy can only be realised by widespread and regular use wherever the clinical setting.
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Affiliation(s)
- Marc Pass
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Nicola Di Rollo
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Alistair F McNarry
- Departments of Anaesthesia Western General and St John's Hospitals, NHS Lothian, Edinburgh, UK.
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8
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Evrin T, Dabkowski M, Pruc M, Hernik J, Wieczorek W, Chabowski L, Wieczorek P, Chmielewski J, Feduniw S, Szarpak L. ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study. J Clin Med 2023; 12:5074. [PMID: 37568476 PMCID: PMC10419956 DOI: 10.3390/jcm12155074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.
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Affiliation(s)
- Togay Evrin
- Department of Emergency Medicine, Medical Faculty, Ufuk University, 06510 Ankara, Turkey
| | - Miroslaw Dabkowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, International Academy of Ecology and Medicine, 02000 Kyiv, Ukraine
| | - Jacek Hernik
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
| | - Wojciech Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Warsaw, 02-013 Warsaw, Poland
| | - Lukasz Chabowski
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, Odessa International Medical University, 12042 Odessa, Ukraine
| | - Pawel Wieczorek
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Pediatric Intensive Care Unit (PICU), John Paul II Upper Silesian Health Centre in Katowice, 40-752 Katowice, Poland
| | - Jaroslaw Chmielewski
- Institute of Environmental Protection—National Research Institute (IEP-NRI), 02-170 Warsaw, Poland
- Department of Public Health, International European University, 03187 Kyiv, Ukraine
| | - Stepan Feduniw
- Department of Obstetrics, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
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Silwal S, Shrestha D, Neupane G, Rana R, Bhurtel S, Adhikari P, Khadka N. Awake tracheal intubation in a patient with a post-burn contracture performed via direct laryngoscopy in a resource-limited setting. Anaesth Rep 2023; 11:e12265. [PMID: 38058474 PMCID: PMC10696405 DOI: 10.1002/anr3.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- S. Silwal
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - D. Shrestha
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - G. Neupane
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - R. Rana
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - S. Bhurtel
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - P. Adhikari
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - N. Khadka
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
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10
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Davis G, Malka RE, Moore A, Cook SL, Blackburn M, Dion GR. Quantifying Intubation Forces on Incisors and Tongue Base Across Exposure Difficulty and Experience in a Simulator. Cureus 2023; 15:e41611. [PMID: 37575794 PMCID: PMC10412742 DOI: 10.7759/cureus.41611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE Laryngoscopy simulators quantifying forces on critical structures in progressively challenging airways and operator expertise are lacking. We aimed to quantify laryngoscopy forces across expertise and exposure difficulty. STUDY DESIGN Prospective observational study Setting: Tertiary care medical center Methods: Force gauges were affixed to a difficult airway mannequin to quantify teeth and tongue forces across increasingly challenging airway exposure. Medical students (n=10), residents (n=11), and otolaryngology staff (n=10) performed direct laryngoscopy using a Miller size 3 laryngoscope with 1) normal neck/jaw mobility, 2) restricted neck extension, 3) restricted jaw opening, and 4) restricted neck/jaw mobility. Incisor and tongue pounds of force (lbf) were continuously measured. RESULTS As the difficulty setting increased, forces exerted by the students, residents, and staff on the incisors and tongue base increased (p=0.01). Between normal and maximally restricted settings, force delivered to the incisors increased by 6.95 lbf (standard error (SE) 1.29), 5.93 lbf (SE 0.98), and 5.94 lbf (SE 0.70) for the students, residents, and staff, respectively. At the tongue base, force increased by 0.37 lbf (SE 0.18), 0.46 lbf (SE 0.14), and 0.73 lbf (SE 0.15) for the students, residents, and staff, respectively. Esophageal intubations occurred in 50% of the students, 23% of the residents, and 45% of the otolaryngology staff at maximal difficulty, with none at the easiest setting (p=0.33). Compared to the residents, the staff applied significantly increased pressure on the tongue base during laryngoscopy (p=0.02). CONCLUSION Forces exerted on the incisors and tongue base varied across exposure difficulty and expertise levels, suggesting that they may be useful markers for training and competence assessment.
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Affiliation(s)
- Gavin Davis
- Ophthalmology, Brooke Army Medical Center, San Antonio, USA
| | - Ronit E Malka
- Otolaryngology - Head and Neck Surgery, Brooke Army Medical Center, San Antonio, USA
| | - Austin Moore
- Hemorrhage and Edema Control, United States Army Institute of Surgical Research, San Antonio, USA
| | - Stacy L Cook
- Otolaryngology - Head and Neck Surgery, Brooke Army Medical Center, San Antonio, USA
| | - Megan Blackburn
- Hemorrhage and Edema Control, United States Army Institute of Surgical Research, San Antonio, USA
| | - Gregory R Dion
- Otolaryngology, University of Cincinnati Medical Center, Cincinnati, USA
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11
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Gaszynski T, Michalek P, Ratajczyk P. A Prospective Comparative Study of Laryngeal Glottic View Using the Vie Scope ® versus Standard Macintosh Laryngoscope in Morbidly Obese Patients. Ther Clin Risk Manag 2023; 19:405-411. [PMID: 37214351 PMCID: PMC10199711 DOI: 10.2147/tcrm.s377585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Background The visualization of the glottis may be inadequate in morbidly obese patients when a standard Macintosh blade laryngoscope (MCL) is used. The Vie Scope® (VS) is a novel type laryngoscope consisting of a straight, enclosed, illuminated tube that offers intubation via a bougie using the paraglossal technique. In this prospective, nonrandomized comparative study, we tested the research hypothesis that the VS may improve visualization of the glottic larynx in comparison to the MCL. Materials and Methods After obtaining institutional ethics committee approval, 60 morbidly obese patients (BMI >40 kg/m2) undergoing elective non-head and neck surgery were included in the study. After induction of general anesthesia (GA), the glottic visualization was performed using the two laryngoscopes in succession, first MCL size 3 or 4 followed by the VS and was assessed using the modified Cormack-Lehane scale. Tracheal intubation was performed using the VS The first pass intubation success and the total success rate was recorded only for the VS Intubation time was not measured because of the paired study design. Results and Discussion Mean demographic data included: age 41.9±8.2 years, height 171.2±10.2 cm, weight 129.9±21.6 kg, BMI 44.95±3.85 kg/m2. Using MCL, Cormack-Lehane grade 1 was observed in 36 (60%) cases; grade 2 in 7/60 (11.6%); grade 3 in 13/60 (21.7%); and grade 4 in 4/60 (6.7%). Poor laryngeal views represented by grades 3 and 4 were observed in 28.4% of patients with the MCL. Grades obtained with the VS were all grade 1 (100%). The first attempt intubation success was in 58/60 (96.7%) with the VS. No complications were observed. Conclusion The Vie Scope® laryngoscope, using the paraglossal technique of tracheal intubation, significantly improves visualization of the vocal cords in morbidly obese patients compared to the standard Macintosh laryngoscope.
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Affiliation(s)
- Tomasz Gaszynski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pawel Ratajczyk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
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12
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Warshavsky A, Holan A, Muhanna N, Oestraicher Y, Nachalon Y, Kampel L, Nard-Carmel N, Chaushu H, Shapira U, Ungar O, Gutfeld O, Ospovat I, Oz YN, Even-Sapir E, Horowitz G. Diagnostic efficacy of positron emission computerized tomography scans in suspicious laryngeal findings postorgan preservation treatment. Head Neck 2023; 45:207-211. [PMID: 36301004 DOI: 10.1002/hed.27227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Larynx preservation protocols (LPP) for glottic primary squamous cell carcinoma has gained popularity worldwide. Direct laryngoscopy (DL) with biopsy is mandated when recurrence is suspected. The efficacy of 18Fluoro-deoxy-glucose positron emission computerized tomography (PET-CT) as alternative first-line diagnostic investigation in suspected recurrence was evaluated. METHODS A retrospective study of patients with suspicious fiber-optic findings at more than 12 weeks after LPP. Sensitivity, specificity, and the negative predictive value (NPV) of DL and PET-CT were compared. RESULTS Seventy-two patients presenting 105 cases of suspicious events were included in this study. Fifty-two events were initially investigated by DL and 53 events by PET-CT. The sensitivity of DL and PET-CT was 56.25% and 100%, respectively. The NPV was 84% for DL and 100% for PET-CT (p = 0.015). CONCLUSION Negative PET scans after LPP are highly accurate in ruling out recurrent/persistent disease and may spare the patient from negative biopsies.
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Affiliation(s)
- Anton Warshavsky
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Holan
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Oestraicher
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuval Nachalon
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liyona Kampel
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Narin Nard-Carmel
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hen Chaushu
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Udi Shapira
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Ungar
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Gutfeld
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Inna Ospovat
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Natan Oz
- Institute of Radiotherapy, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Even-Sapir
- Institute of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology - Head & Neck Surgery and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Mirrakhimov AE, Torgeson E. Use of videolaryngoscopy as the first option for all tracheal intubations: not so fast. Comment on Br J Anaesth 2022; 129: 624-634. Br J Anaesth 2023; 130:e12-e13. [PMID: 36307273 DOI: 10.1016/j.bja.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Eli Torgeson
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, NM, USA
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14
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Pourmand A, Terrebonne E, Gerber S, Shipley J, Tran QK. Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis. Prehosp Disaster Med 2022; 38:1-11. [PMID: 36515070 DOI: 10.1017/s1049023x22002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Placing an endotracheal tube is a life-saving measure. Direct laryngoscopy (DL) is traditionally the default method. Video laryngoscopy (VL) has been shown to improve efficiency, but there is insufficient evidence comparing VL versus DL in the prehospital settings. This study, comprising a systematic review and random-effects meta-analysis, assesses current literature for the efficacy of VL in prehospital settings. METHODS PubMed and Scopus databases were searched from their beginnings through March 1, 2022 for eligible studies. Outcomes were the first successful intubation, overall success rate, and number of total DL versus VL attempts in real-life clinical situations. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess heterogeneity. RESULTS The search yielded seven studies involving 23,953 patients, 6,674 (28%) of whom underwent intubation via VL. Compared to DL, VL was associated with a statistically higher risk ratio for first-pass success (Risk Ratio [RR] = 1.116; 95% CI, 1.005-1.239; P = .041; I2 = 87%). The I2 value for the subgroup of prospective studies was 0% compared to 89% for retrospective studies. In addition, VL was associated with higher likelihood of overall success rate (RR = 1.097; 95% CI, 1.01-1.18; P = .021; I2 = 85%) and lower mean number of attempts (Mean Difference = -0.529; 95% CI, -0.922 to -0.137; P = .008). CONCLUSION The meta-analysis suggested that VL was associated with higher likelihood of achieving first-pass success, greater overall success rate, and lower number of intubation attempts for adults in the prehospital settings. This study had high heterogeneity, likely presenced by the inclusion of retrospective observational studies. Further studies with more rigorous methodology are needed to confirm these results.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Emily Terrebonne
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Stephen Gerber
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Jeffrey Shipley
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DCUSA
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MarylandUSA
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15
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Wieczorek P, Szarpak L, Dabrowska A, Pruc M, Navolokina A, Raczynski A, Smereka J. A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial. Children (Basel) 2022; 9. [PMID: 36421223 DOI: 10.3390/children9111774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p < 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p < 0.001). On the Cormack−Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.
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16
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Amar PS, Syed KA, Michael RC. The Role of Modified Killian's Method in the Evaluation of Hypopharyngeal and Supraglottic Cancers. South Asian J Cancer 2022; 11:332-335. [PMID: 36756096 PMCID: PMC9902103 DOI: 10.1055/s-0042-1754375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Priyanka Schilling AmarObjectives Hypopharyngeal cancer is one of the upper aerodigestive tract malignancies with the poorest prognosis. The aim of this study was to assess the role of modified Killian's (MK) method in routine, outpatient-based flexible laryngoscopy to improve visualization and assess the extent of supraglottic and hypopharyngeal cancers. Materials and Methods An observational study was conducted in a tertiary hospital in India where fifty consecutive patients who presented to the outpatient clinic with suspected hypopharyngeal and supraglottic malignancy underwent a conventional laryngoscopy as well as MK method. The site and extent of the tumor on endoscopy were recorded and the videos were graded independently by two investigators on Murono's scale from 1 to 5. A subset of these patients who underwent direct laryngoscopy under general anesthesia was also scored with the above scale. The scores were compared to check the accuracy of flexible laryngoscopy with the MK method in staging cancer. Statistical Analysis Descriptive statistics were given using mean (standard deviation [SD]) for continuous variables and frequency (percentage) for categorical variables. The difference between the mean scores was analyzed using the paired-t test. The agreement between the scales and the observer, that is, the inter- and intraobserver agreement, was presented with concordance rate and Kappa weighted analysis. Results In this study, the mean scores of the Murono's scale grading of the conventional method, MK method, and direct laryngoscopy were 1.42 (SD: 0.64), 2.94 (SD: 0.95), and 4.30 (SD: 1.49), respectively, which showed significant improvement in scores with MK method. In addition, the subset analysis demonstrated a significant agreement between direct laryngoscopy and MK method. Conclusion The MK method is a good diagnostic test and a valuable adjunct to diagnostic flexible laryngoscopy in the evaluation and staging of hypopharyngeal and supraglottic cancers.
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Affiliation(s)
- Priyanka Schilling Amar
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India,Address for correspondence Priyanka Schilling Amar MS Department of Otorhinolaryngology and Head & Neck Surgery, Christian Medical CollegeVellore – 632004, Tamil NaduIndia
| | - Kamran Asif Syed
- Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C. Michael
- Department of Head & Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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17
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Nichols M, Fouche PF, Bendall JC. Video versus direct laryngoscopy by specialist paramedics in New South Wales: Preliminary results from a new airway registry. Emerg Med Australas 2022; 34:984-988. [PMID: 35717028 DOI: 10.1111/1742-6723.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Video laryngoscopy (VL) is increasingly used as an alternative to direct laryngoscopy (DL) to improve airway visualisation and endotracheal intubation (ETI) success. Intensive Care Paramedics in New South Wales Ambulance, Australia started using VL in 2020, and recorded success in a new advanced airway registry. We used this registry to compare VL to DL. METHODS The present study was a retrospective analysis of out-of-hospital data for ETI by specialist paramedics using an airway registry. We calculated overall and first-pass success for VL versus DL, and compared success using a Χ2 test. RESULTS The DL overall success was 61 out of 78 (78.2%) and VL was 233 out of 246 (94.7%); difference of 16.5% (P < 0.001). First-pass for DL was successful for 49 out of 78 (62.8%) and for VL in 195 out of 246 (79.3%); difference of 16.5% (P = 0.003). There were five (1.6%) patients where both VL and DL were used and in all instances, DL was used first. CONCLUSIONS This analysis of a new airway registry used by specialist paramedics in New South Wales shows a substantial increase in overall and first-pass intubation success with the use of VL when compared to DL.
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Affiliation(s)
- Martin Nichols
- Clinical Systems, New South Wales Ambulance, Sydney, New South Wales, Australia
| | - Pieter F Fouche
- Clinical Systems, New South Wales Ambulance, Sydney, New South Wales, Australia
| | - Jason C Bendall
- Clinical Systems, New South Wales Ambulance, Sydney, New South Wales, Australia
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18
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Wilson CP, Romano E, Vasan NR. Comparison of Dental Injury Rates in Perioperative Intubation and Suspension Laryngoscopy for Otolaryngology Procedures. OTO Open 2021; 5:2473974X211065021. [PMID: 34926975 PMCID: PMC8671680 DOI: 10.1177/2473974x211065021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Direct laryngoscopy is an essential skill during perioperative intubation and otolaryngology procedures. Dental injury is a common complication of direct laryngoscopy. However, the technique and tools used by anesthesiologists, nurse anesthetists, and others during perioperative intubation and by ear, nose, and throat surgeons for their procedures are different. The purpose of this review is to explore the literature for all studies detailing rates of dental injury in each of these settings and to compare them to see if the approaches have a significant difference in rate of dental injury. Data Sources PubMed. Review Methods A comprehensive search of PubMed was performed through February 2021 with search terms “dental” and “intubation” or “laryngoscopy.” PRISMA guidelines were followed. Studies documenting rates of dental injuries during intubation or during laryngologic procedures were included, and the 2 groups were compared. Results Twenty-three studies met inclusion criteria: 17 in the perioperative intubation group and 6 in the suspension laryngoscopy group. There was an increased incidence of dental injury in the perioperative intubation group (4.86%) as compared with the suspension laryngoscopy group (1.70%). Conclusions The difference in dental injury rate between the groups could be due to the differences in direct laryngoscopy technique or tools used, the presence vs absence of a dental guard, or a combination of these factors. More studies need to be performed to develop definitive and specific conclusions to recommend changes that prevent dental injury.
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Affiliation(s)
- Caleb P Wilson
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Erica Romano
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Nilesh R Vasan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Gadek L, Szarpak L, Konge L, Dabrowski M, Telecka-Gadek D, Maslanka M, Drela WL, Jachowicz M, Iskrzycki L, Bialka S, Peacock FW, Smereka J. Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial. J Clin Med 2021; 10:5740. [PMID: 34945036 DOI: 10.3390/jcm10245740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.
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20
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Maughan EF, Rotman A, Rouhani MJ, Thong G, Poncia J, Myatt J, Al Yaghchi C, Sandhu G. Suspension laryngoscopy experiences in a tertiary airway service: A prospective study of 150 procedures. Clin Otolaryngol 2021; 47:52-60. [PMID: 34570956 DOI: 10.1111/coa.13867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/12/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In most cases, suspension laryngoscopy (SL) is efficient, bloodless and with minimal post-procedure discomfort. We aimed to identify predictive patient factors for acceptable surgical views at SL as well as quantify our tertiary airway unit's complication rates. DESIGN Prospective cohort study of 150 consecutive microlaryngoscopy procedures involving SL over an 8-month period between November 2019 and July 2020. Patients were assessed preoperatively for pre-existing oral, temporomandibular, dental, pharyngeal or laryngeal pathology, interincisor distance and qualitative gross limitations to neck extension and forward head posture. Intraoperatively, the laryngoscopic view was graded by anaesthetic and surgical teams, and complications were recorded on patient interview in recovery. SETTING Tertiary adult airway service for predominantly benign pathology. RESULTS Adequate surgical views were obtained in 149/150 procedures. BMI had a weak positive correlation with a more difficult view (r = .22, p = .008) but did not correlate with a statistically significant increase in any complication. There was a weak negative correlation between age and interincisor gap (r = -.20, p = .014), and wider mouth opening correlated very weakly with a lower incidence of sore throat (r = -.19, p = .023). Gross macroglossia showed a significant moderate positive correlation with tongue symptoms (r = .45, p = 1.611 × 10-8 ). CONCLUSION In the context of an experienced airway unit with a high caseload of predominantly benign pathology, SL is very effective and safe with low associated morbidity and no mortality. The most common complication of SL is temporary sore throat and there remain recognised risks of temporary tongue and dental symptoms.
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Affiliation(s)
- Elizabeth F Maughan
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Anthony Rotman
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Maral J Rouhani
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Gerard Thong
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - James Poncia
- Anaesthetics Department, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - John Myatt
- Anaesthetics Department, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Gurpreet Sandhu
- Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
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21
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Urdaneta F, Zhang J, Jiang W. Letter in reply. J Comp Eff Res 2021; 10:1105. [PMID: 34486890 DOI: 10.2217/cer-2021-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Felipe Urdaneta
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Jianying Zhang
- Health Economic Outcome Research, Medtronic Inc., Mansfield, MA 02048, USA
| | - Wei Jiang
- Health Economic Outcome Research, Medtronic Inc., Mansfield, MA 02048, USA
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22
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Ghotbaldinian E, Dehdari N, Åkeson J. Maintenance of basic endotracheal intubation skills with direct or video-assisted laryngoscopy: A randomized crossover follow-up study in inexperienced operators. AEM Educ Train 2021; 5:e10655. [PMID: 34522831 PMCID: PMC8427182 DOI: 10.1002/aet2.10655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Laryngoscopy is a difficult skill to acquire and maintain and even more so by less frequent users. Numerous studies have compared limitations of direct laryngoscopic (DL) and video-assisted laryngoscopic (VL) techniques for endotracheal intubation in different scenarios, but individual retention over time of intubation skills with either technique has, to our knowledge, never been reported. The primary aim of this study was to evaluate to what extent recently acquired basic skills of endotracheal intubation, based on DL or VL, are being maintained over time by inexperienced operators. METHODS This randomized crossover follow-up study was designed to compare endotracheal intubation with direct (McIntosh blade) versus video-assisted (hyperangulated blade) laryngoscopy by 20 undergraduate medical students in identical manikins three months after brief basic intubation training with no further intubation practice. RESULTS No significant differences in skills retention were found between DL and VL regarding the time for successful intubation or number of adverse events. However, the first intubation was significantly slower regardless of the technique compared with the last one three months earlier. Furthermore, DL was slower and associated with more incidents of esophageal intubation and dental manipulation than was VL. CONCLUSIONS Although basic intubation skills seem to be similarly well maintained over time regardless of the laryngoscopic technique, endotracheal intubation with VL by inexperienced operators is faster and associated with fewer adverse events than is DL after a three-month period with no further intubation training.
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Affiliation(s)
- Ehsan Ghotbaldinian
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care MedicineLund UniversityMalmöSweden
| | - Navid Dehdari
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care MedicineLund UniversityMalmöSweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Anaesthesiology and Intensive Care MedicineLund UniversityMalmöSweden
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Lui B, Walsh S, White RS, Samuels JD. Letter to the Editor: video laryngoscopy - the new de facto standard in intubation. J Comp Eff Res 2021; 10:1103-1104. [PMID: 34328020 DOI: 10.2217/cer-2021-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Briana Lui
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Spencer Walsh
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Jon D Samuels
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Zheng M, Lui C, O'Dell K, M Johns M, Ference EH, Hur K. Aerosol Generation During Laryngology Procedures in the Operating Room. Laryngoscope 2021; 131:2759-2765. [PMID: 34213770 DOI: 10.1002/lary.29729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/21/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases. STUDY DESIGN Prospective quantification of aerosol generation. METHODS Airborne particles (0.3-25 μm in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO2 ) laser use with or without jet ventilation, all utilizing intermittent suction. RESULTS Greater than 99% of measured particles were 0.3 to 1.0 μm in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 μm particles (P < .0001). 1.0 to 25 μm particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 μm particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO2 laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 μm particles. Overall, there was no difference when comparing CO2 laser use during jet ventilation versus GETA. CONCLUSIONS CO2 laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization. LEVEL OF EVIDENCE III Laryngoscope, 2021.
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Affiliation(s)
- Melissa Zheng
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Christopher Lui
- University of Southern California, Keck School of Medicine, Los Angeles, California, U.S.A
| | - Karla O'Dell
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Michael M Johns
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Elisabeth H Ference
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Kevin Hur
- Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Mahli N, Md Zain J, Mahdi SNM, Chih Nie Y, Chian Yong L, Shokri AFA, Maaya M. The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model. Front Med (Lausanne) 2021; 8:677626. [PMID: 34026801 PMCID: PMC8137891 DOI: 10.3389/fmed.2021.677626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8–41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8–69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.
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Affiliation(s)
- Nurfadilah Mahli
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jaafar Md Zain
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Siti Nidzwani Mohamad Mahdi
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yeoh Chih Nie
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Liu Chian Yong
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Fairuz Abdul Shokri
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Maaya
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Downey AW, Duggan LV, Adam Law J. A systematic review of meta-analyses comparing direct laryngoscopy with videolaryngoscopy. Can J Anaesth 2021; 68:706-714. [PMID: 33512660 PMCID: PMC7845281 DOI: 10.1007/s12630-021-01921-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022] Open
Abstract
PURPOSE In the preceding 20 years, many randomized-controlled trials and meta-analyses have compared direct Macintosh laryngoscopy with videolaryngoscopy. The videolaryngoscope blades have included both traditional Macintosh blades and hyperangulated blades. Macintosh and hyperangulated blades differ in their geometry and technique for tracheal intubation; certain patient populations may benefit from one blade type over another. The primary objective of this systematic review was to assess whether published meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy have accounted for the videolaryngoscope blade type. Secondary objectives evaluated heterogeneity among practitioner experience and specialty, clinical context, patient population, and original primary study outcomes. SOURCE A search was performed across Ovid Medline, Ovid Embase, ClinicalKey, PubMed, TRIP, AccessAnesthesiology, Google Scholar, and ANZCA discovery. A systematic review identified meta-analyses which compared direct Macintosh laryngoscopy to videolaryngoscopy. There were no patient age or clinical specialty restrictions. Exclusion criteria included non-English language, studies comparing non-Macintosh blade to videolaryngoscopy, and studies in awake patients. PRINCIPAL FINDINGS Twenty-one meta-analyses were identified that were published between 1 January 2000 and 7 May 2020. Macintosh and hyperangulated videolaryngoscope blades were combined in most studies (16/21; 76%). Heterogeneity was also present among practitioner experience (20/21; 95%), clinician specialty (15/21; 71%), and clinical locations (10/21; 48%). Adult and pediatric patients were combined or not defined in 5/21 studies (24%). The primary outcomes of the meta-analyses varied, with the most common (7/21; 33%) being first-pass tracheal intubation success. CONCLUSIONS Heterogeneity across important clinical variables is common in meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy. To better inform patient care, future videolaryngoscopy research should differentiate blade type, clinical context, and patient-related primary outcomes.
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Affiliation(s)
- Andrew W Downey
- Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Australia.
| | - Laura V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - J Adam Law
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Zhang J, Jiang W, Urdaneta F. Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting. J Comp Eff Res 2021; 10:831-844. [PMID: 33904779 DOI: 10.2217/cer-2021-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. Materials & methods: This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Results: Patients with VL had decreased inpatient cost (US$1144-5891 across eight major diagnostic categories [MDC]); >1-day LOS reduction in five MDC; reduced odds for postoperative ICU admission (0.04-0.68) and reduced odds of respiratory complications in three MDC (0.43-0.90). Conclusion: Video laryngoscopy may lower total costs, reduce LOS and decrease the likelihood of postoperative ICU admission.
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Affiliation(s)
- Jianying Zhang
- Health Economic Outcome Research, Medtronic Inc, Mansfield, MA, USA
| | - Wei Jiang
- Health Economic Outcome Research, Medtronic Inc, Mansfield, MA, USA
| | - Felipe Urdaneta
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA
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28
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Malik A, Abdullah M, Chaudhry M, Murtaza A, Kanwal A. Unilateral Vocal Cord Paralysis in a Patient With Acute Viral Hepatitis. Cureus 2021; 13:e13399. [PMID: 33754115 PMCID: PMC7971698 DOI: 10.7759/cureus.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hepatitis A virus is a leading cause of acute infectious hepatitis worldwide. The infection is characterized by a self-limiting course, and rarely has there been any occurrence of chronic sequelae or extra-hepatic manifestations. We report a case of unilateral vocal cord paralysis in a patient with acute hepatitis A.
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Affiliation(s)
| | - Mohammad Abdullah
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | - Amna Murtaza
- Otolaryngology, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Ayesha Kanwal
- Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
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Li T, Jafari D, Meyer C, Voroba A, Haddad G, Abecassis S, Bank M, Dym A, Naqvi A, Gujral R, Rolston D. Video laryngoscopy is associated with improved first-pass intubation success compared with direct laryngoscopy in emergency department trauma patients. J Am Coll Emerg Physicians Open 2021; 2:e12373. [PMID: 33532760 PMCID: PMC7821955 DOI: 10.1002/emp2.12373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to assess differences in (1) first-pass intubation success, (2) frequency of a hypoxic event, and (3) time from decision to intubate to successful intubation among direct laryngoscopy (DL) versus video laryngoscopy (VL) intubations in emergency department (ED) patients with traumatic injuries. METHODS This retrospective cohort study was performed at a Level I trauma center ED where trauma activations are video recorded. All patients requiring a Level I trauma activation and intubation from 2016 through 2019 were included. Multivariable logistic regression was used to assess the association between initial method of intubation and first-pass success. Differences in frequency of a hypoxic event and time to successful intubation were assessed using bivariate tests. RESULTS Of 164 patients, 68 (41.5%) were initially intubated via DL and 96 (58.5%) were initially intubated via VL. First-pass success for DL and VL were 63.2% and 79.2%, respectively. In multivariable regression analysis, VL was associated with higher odds of first-pass intubation success compared with DL (odds ratio: 2.28; 95% confidence interval: 1.04, 4.98), independent of mechanism of injury, presence of airway hemorrhage or obstruction, and experience of intubator. Frequency of a hypoxic event during intubation was not significantly different (13.2% for DL and 7.3% VL; P = 0.1720). Median time from decision to intubate to successful intubation was 7 minutes for both methods. CONCLUSIONS Video laryngoscopy, compared with direct laryngoscopy, was associated with higher odds of first-pass intubation success among a sample of ED trauma patients. Frequency of a hypoxic event during intubation and time to successful intubation was not significantly different between the 2 intubation methods.
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Affiliation(s)
- Timmy Li
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Daniel Jafari
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of SurgeryDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of SurgeryNorth Shore University HospitalManhassetNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Cristy Meyer
- Department of SurgeryNorth Shore University HospitalManhassetNew YorkUSA
| | - Ashley Voroba
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Ghania Haddad
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Samuel Abecassis
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
| | - Matthew Bank
- Department of SurgeryDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of SurgeryNorth Shore University HospitalManhassetNew YorkUSA
| | - Akiva Dym
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Ali Naqvi
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Rashmeet Gujral
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Daniel Rolston
- Department of Emergency MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of SurgeryDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
- Department of SurgeryNorth Shore University HospitalManhassetNew YorkUSA
- Department of Emergency MedicineNorth Shore University HospitalManhassetNew YorkUSA
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30
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Gok PG, Ozakin E, Acar N, Karakilic E, Kaya FB, Tekin N, Yazlamaz NO. Comparison of Endotracheal Intubation Skills With Video Laryngoscopy and Direct Laryngoscopy in Providing Airway Patency in a Moving Ambulance. J Emerg Med 2021; 60:752-759. [PMID: 33518375 DOI: 10.1016/j.jemermed.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early and successful management of the airway in the prehospital and hospital settings is critical in life-threatening situations. OBJECTIVE We aimed to perform endotracheal intubation (ETI) by direct laryngoscopy (DL) and video laryngoscopy (VL) on airway manikins on a moving track and to compare the properties of intubation attempts. METHODS Overall, 79 participants with no previous VL experience were given 4 h of ETI training with DL and VL using a standard airway manikin. ETI skill was tested inside a moving ambulance. The number of attempts until successful ETI, ETI attempt times, time needed to see the vocal cords, and the degree of convenience of both ETI methods were recorded. RESULTS Overall, 22 of 79 individuals were men; mean age was 30.3 ± 4.5 years. No difference was found in the comparison of the two methods (p = 0.708). Time needed to see the vocal cords for those who were successful in their first attempt were between 1 and 8 s in both methods. In the VL method, time needed to see the vocal cords (p = 0.001) and the intubation time (p < 0.001) in the first attempt were shorter than in the DL method. The VL method was easier (p < 0.001). The success rate was 97.5% in DL and 93.7% in VL. CONCLUSIONS The VL method is rapid and easier to see the vocal cords and perform successful ETI. Therefore, it might be preferred in out-of-hospital ETI applications.
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Affiliation(s)
- Pakize Gozde Gok
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Engin Ozakin
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nurdan Acar
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Evvah Karakilic
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Filiz B Kaya
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Nurettin Tekin
- Ministry of Health, Provincial Ambulance Service, Eskisehir, Turkey
| | - Nazlı Ozcan Yazlamaz
- Department of Emergency Medicine, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Ohri R, Malhotra K. Different 2D ultrasound calculation methods to evaluate tongue volume for prediction of difficult laryngoscopy. Indian J Anaesth 2020; 64:S193-S197. [PMID: 33162601 PMCID: PMC7641053 DOI: 10.4103/ija.ija_843_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/19/2020] [Accepted: 01/05/2020] [Indexed: 11/06/2022] Open
Abstract
Background and Aims: The aim of the study was to evaluate and compare three different ultrasonographic calculation methods for tongue volume in a real time 2D ultrasonography and correlate with Modified Cormack–Lehane grading observed under direct laryngoscopy. Methods: This prospective observational study was conducted in a tertiary care institute. Tongue volume was assessed ultrasonically in 50 adult patients using three techniques in all the patients undergoing surgery under general anesthesia and correlated with Modified Cormack–Lehane grading. In METHOD A, the tongue volume was calculated as multiplication of mid sagittal cross-sectional area and width in transverse plane; METHOD B, Cross-sectional area obtained in vertical plane was multiplied with the maximum width of tongue in transverse plane; METHOD C. the volume was calculated by multiplying length, width, and height in vertical, transverse, and mid-sagittal/oblique plane, respectively. The analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Receiver operating characteristic (ROC) curve was used to find out cutoff point of different methods for predicting difficult laryngoscopy. Results: The specificity and sensitivity of three different methods were statistically compared and area under the receiver operating characteristic (ROC) curve for method A, B, and C was 0.562, 0.502, and 0.548, respectively. Conclusion: In our study, we found all three methods to calculate tongue volume to be equally good to assess difficult laryngoscopy.
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Affiliation(s)
- Ruchi Ohri
- Department of Anaesthesiology, PGIMER and Dr. RML Hospital, New Delhi, India
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Tsui BCH, Pan S. Distanced-based dynamic behaviour of aerosol particles during aerosol-generating medical procedures. Br J Anaesth 2020; 125:e426-e428. [PMID: 32828494 PMCID: PMC7836680 DOI: 10.1016/j.bja.2020.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital at Stanford, Stanford, CA, USA.
| | - Stephanie Pan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital at Stanford, Stanford, CA, USA
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Gupta R, Sahni A. Is video laryngoscopy easier than direct laryngoscopy for intubation in patients with contracture neck? Saudi J Anaesth 2020; 14:206-211. [PMID: 32317876 PMCID: PMC7164456 DOI: 10.4103/sja.sja_808_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: Postburn contracture (PBC) of the neck is commonly seen after acute burn in the face and neck region. Managing the airway is a challenge due to functional and anatomical deformities. We compared the ease of intubation using video and direct laryngoscopes. Material and Methods: Eighty patients, 18–60 years of age with ASA physical status I/II with Onah's types 1 and 2 contracture of the neck were randomized in this study. Group DL were intubated by direct laryngoscopy (DL) using Macintosh blade and Group VL by video laryngoscopy (VL) using King Vision. The outcome measures were ease of intubation (EOI), Cormack-Lehane (CL) grading, and associated complications if any. Results: EOI score was significantly lower in group VL (0.42 ± 0.84) as compared to group DL (0.85 ± 1.21) (P = 0.048) as was the use of external maneuvers (group VL: 17.5%; group DL: 42.5%; P = 0.015), and the use of stylet (group VL: 0%; group DL: 20%, P = 0.005). CL grading improved significantly in group VL (P < 0.001). Occurrence of complications was negligible in both the groups. A single failure in group DL needed rescue intubation. Conclusion: Intubation with a video laryngoscope was easier than with DL in patients with mild-to-moderate contracture neck with mouth opening >3 cm and MPG I/II.
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Affiliation(s)
- Roopali Gupta
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ameeta Sahni
- Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Abstract
Laryngeal diseases in young children are much less common than diseases of other ENT organs, which allows them to be attributed to the poorly studied section of pediatric otorhinolaryngology. This article presents the results of the examination and treatment of 37 children from different regions of the Russian Federation (aged 11 months to 3 years) with laryngeal cysts. The purpose of the study was to improve the results of surgical treatment for young children with laryngeal cysts.
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Affiliation(s)
- M R Bogomil'skij
- FGBOU VO Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - E O Vyaz'menov
- FGBOU VO Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - V Yu Oborkin
- FGBOU VO Pirogov Russian National Research Medical University, Moscow, Russia, 117997
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Čaušević S, Rizvanović N, Pojskić B. Comparison of intubation condition and the quality of muscle relaxation between rocuronium and vecuronium using "timing principle". Med Glas (Zenica) 2020; 17:7-14. [PMID: 31402637 DOI: 10.17392/1045-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 11/18/2022]
Abstract
Aim To compare the quality of the conditions for endotracheal intubation and muscle relaxation between rocuronium bromide and vecuronium bromide using the ''timing principle'' method for induction in anaesthesia. The "timing principle" includes the administration of muscle relaxants before the hypnotic agent during induction in anaesthesia. Method Sixty patients who had undergone elective surgery were randomly allocated into two equal groups using muscle relaxants: rocuronium (group R) and vecuronium (group V). The intubation conditions were assessed using Cooper's scoring system, based on jaw relaxation, vocal cords position and response to intubation. The quality of muscle relaxation was evaluated by recording the time of clinical weakness, a count of ''train of four'' (TOF) twitches at intubation, the time of loss TOF response and duration of direct laryngoscopy. Results The intubation conditions were excellent in 100% of patients in the group R versus excellent in 80% and good in 20% of patients in the group V (p<0.05). The time of clinical weakness was statistically significantly shorter in the group R than in the group V (p<0.000). The time of loss of TOF response was statistically significantly shorter in the group R (p<0.000). The absence of TOF twitches (the level of muscle relaxation of 100%) at intubation recorded in 25 (83.3%) patients in the group R versus five (16.7%) patients in the group V (p<0.000). Duration of direct laryngoscopy did not significantly differ between the groups. Conclusion Rocuronium bromide provides better intubation conditions and greater quality of muscle relaxation than vecuronium bromide using ''timing principle'' technique.
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Musharaf I, Daspal S, Shatzer J. Is Video Laryngoscopy the Optimal Tool for Successful Intubation in a Neonatal Simulation Setting? A Single-Center Experience. AJP Rep 2020; 10:e5-e10. [PMID: 31993245 PMCID: PMC6984956 DOI: 10.1055/s-0039-3400970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/13/2019] [Indexed: 10/29/2022] Open
Abstract
Background Endotracheal intubation is a skill required for resuscitation. Due to various reasons, intubation opportunities are decreasing for health care providers. Objective To compare the success rate of video laryngoscopy (VL) and direct laryngoscopy (DL) for interprofessional neonatal intubation skills in a simulated setting. Methods This was a prospective nonrandomized simulation crossover trial. Twenty-six participants were divided into three groups based on their frequency of intubation. Group 1 included pediatric residents; group 2 respiratory therapists and transport nurses; and group 3 neonatal nurse practitioners and physicians working in neonatology. We compared intubation success rate, intubation time, and laryngoscope preference. Results Success rates were 100% for both DL and VL in groups 1 and 2, and 88.9% for DL and 100% for VL in group 3. Median intubation times for DL and VL were 22 seconds (interquartile range [IQR] 14.3-22.8 seconds) and 12.5 seconds (IQR 10.3-38.8 seconds) in group 1 ( p = 0.779); 17 seconds (IQR 8-21 seconds) and 12 seconds (IQR 9-16.5 seconds) in group 2 ( p = 0.476); and 11 seconds (IQR 7.5-15.5 seconds) and 15 seconds (IQR 11.5-36 seconds) in group 3 ( p = 0.024). Conclusion We conclude that novice providers tend to perform better with VL, while more experienced providers perform better with DL. In this era of decreased clinical training opportunities, VL may serve as a useful tool to teach residents and other novice health care providers.
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Affiliation(s)
- Iram Musharaf
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sibasis Daspal
- Division of Neonatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Shatzer
- Johns Hopkins University School of Education, Baltimore, Maryland
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Kim H, Chang JE, Won D, Lee JM, Jung JY, Choi S, Min SW, Hwang JY. The effect of cricoid and paralaryngeal force on upper oesophageal occlusion during induction of anaesthesia: a randomised, crossover study. Anaesthesia 2019; 75:179-186. [PMID: 31631314 DOI: 10.1111/anae.14873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 01/07/2023]
Abstract
The aim of this study was to evaluate the effectiveness of cricoid and paralaryngeal force for oesophageal entrance occlusion during induction of anaesthesia. Seventy-four patients were included in this randomised, crossover study. The relative position of the glottis and outer anteroposterior diameter of the upper oesophageal entrance were assessed at baseline, after the application of 30 N cricoid and paralaryngeal force, and after induction of anaesthesia. The occlusion rate of the oesophageal entrance with cricoid and paralaryngeal force was assessed during direct laryngoscopy. The relative position of the upper oesophageal entrance to the glottis changed in 45 out of 74 patients after induction of anaesthesia and during direct laryngoscopy compared with the awake state. The application of cricoid and paralaryngeal force decreased the mean (SD) diameter of the upper oesophageal entrance to a similar degree in awake (8.5 (2.1) mm to 6.4 (1.7) mm and 6.5 (1.6) mm, respectively; p < 0.001) and anaesthetised (8.7 (2.2) mm to 6.5 (1.7) mm and (6.7 (1.9) mm, respectively; p < 0.001) states. During direct laryngoscopy, the occlusion rate of the oesophageal entrance was greater with cricoid compared with paralaryngeal force (46/74 vs. 26/74, respectively; p = 0.002). The relative position of the upper oesophageal entrance to the glottis may change after induction of anaesthesia and during direct laryngoscopy. Cricoid and paralaryngeal force both decrease the diameter of the upper oesophageal entrance in awake and anaesthetised states. Occlusion of the oesophageal entrance is achieved more frequently with cricoid force compared with paralaryngeal force during direct laryngoscopy.
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Affiliation(s)
- H Kim
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - J-E Chang
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - D Won
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - J-M Lee
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - J-Y Jung
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - S Choi
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - S-W Min
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - J-Y Hwang
- Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Reena. Comparison of King Vision video laryngoscope (channeled blade) with Macintosh laryngoscope for tracheal intubation using armored endotracheal tubes. J Anaesthesiol Clin Pharmacol 2019; 35:359-362. [PMID: 31543585 PMCID: PMC6748021 DOI: 10.4103/joacp.joacp_43_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims During direct laryngoscopy (DL), intubation using armored endotracheal tubes (ETTs) requires help of bougies, stylets, or Magill's forceps, which leads to unnecessary prolongation in the intubation times. The channeled blade of King Vision (KV) video laryngoscope is likely to obviate the need of these equipments for a successful intubation using armored tubes. Material and Methods After approval from Institutional Ethics Committee and informed consent, 100 patients were randomized to receive endotracheal intubation using armored ETTs either with KV video laryngoscope (VL) channeled blade or with Macintosh laryngoscope. Time to intubation, success rate, time for best glottis view, number of attempts, optimization maneuvers, or complications if any were recorded. Ease of device use was also assessed in terms of insertion, glottis visualization, and intubation. Continuous variables were tested using unpaired t-test and categorical variables with Pearson's Chi-square test. P ≤ 0.05 was considered significant. Result First attempt success rate was 92% in group KV and 74% in group DL (P = 0.017). Time for successful intubation was less in group KV as compared with group DL (P < 0.0001). Optimization maneuvers such as "BURP" was needed in three patients of group KV and 11 patients of group DL (P = 0.0218). Bougie was needed in 13 patients of group DL and none from group KV (P = <0.001). Ease of device use was similar in the two groups. Conclusion KVVL offers faster intubating conditions for tracheal intubation requiring armored ETTs in comparison to DL using Macintosh blade.
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Affiliation(s)
- Reena
- Department of Anesthesiology, Heritage Institute of Medical Sciences, Bhadwar, Varanasi, Uttar Pradesh, India
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Low CM, Price DL, Kasperbauer JL. Mandibular Tori Limiting Treatment of Carcinoma of the Upper Aerodigestive Tract. Clin Med Insights Case Rep 2019; 12:1179547619856599. [PMID: 31320809 PMCID: PMC6610396 DOI: 10.1177/1179547619856599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 11/15/2022]
Abstract
Background: Mandibular tori are a rare cause of difficult direct visualization of the
upper aerodigestive tract. In the setting of aerodigestive tract pathology
necessitating direct visualization, removal of mandibular tori may be
required to facilitate treatment. Methods: In the first case, large bilateral symmetric mandibular tori were removed to
facilitate access to the anterior commissure and removal of a T1 glottic
squamous cell carcinoma (SCC). In the second case, large bilateral
mandibular tori were removed to access a markedly exophytic SCC in the right
vallecula. Subsequently, the tumor was removed with robotic assistance with
excellent exposure. Results: Both patients were free of recurrence at last follow-up. Conclusion: Mandibular tori are an uncommon cause of difficult direct laryngoscopy. In
situations that require direct visualization of the anterior commissure or
base of tongue for diagnosis and management of lesions, surgical removal of
the tori may be required as in the cases presented here.
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Affiliation(s)
- Christopher M Low
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Abstract
Recent advances in technology have made laryngoscopy less dependent upon a direct line of sight to achieve tracheal intubation. Whether these new devices are useful tools capable of increasing patient safety depends upon when and how they are used. We briefly consider the challenges in reviewing the emerging literature given the variety of devices, "experience" of the care providers, the clinical settings, and the definitions of outcome. We examine some of the limitations of conventional direct laryngoscopy, question the definitions we have used to define success, discuss the benefits of indirect (video) techniques, and review evidence pertaining to their use in the patients in the operating room, emergency department, and intensive care unit.
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Affiliation(s)
- Matteo Parotto
- Department of Anesthesia, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Richard Cooper
- Department of Anesthesia, University of Toronto, Toronto, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
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Min BC, Park JE, Lee GT, Kim TR, Yoon H, Cha WC, Shin TG, Song KJ, Park M, Han H, Hwang SY. C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation. ACTA ACUST UNITED AC 2019; 55:E225. [PMID: 31146497 DOI: 10.3390/medicina55060225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 01/06/2023]
Abstract
Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17-2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.
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Gu M, Lian M, Gong C, Chen L, LI S. The teaching order of using direct laryngoscopy first may improve the learning outcome of endotracheal incubation: A preliminary, randomized controlled trial. Medicine (Baltimore) 2019; 98:e15624. [PMID: 31124942 PMCID: PMC6571261 DOI: 10.1097/md.0000000000015624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endotracheal intubation (ETI) is a life-saving procedure taught to medical students. We examined the influence of the order of teaching ETI through direct laryngoscopy (DL) and video laryngoscopy (VL) on learning by measuring the intubation time and learning curve of trainees, in order to explore ways to improve ETI performance. METHODS Twenty trainees were randomly divided into 2 groups. In the DL-first group, trainees used DL to perform ETI 10 times and then used VL 10 times, while the order was reversed in the VL-first group. Intubation time, number of intubation attempts, the Cormack-Lehane (CL) classification, and adverse events were recorded. The primary outcome was the cumulative summation (CUSUM). The CUSUM equation is defined as (Equation is included in full-text article.), where ct is the cumulative sum. RESULTS ETI was attempted on 400 patients. The difference in the mean times for the first 10 intubations between the 2 groups was not significant (P > .05). Mean intubation time for second series in the DL-first group was significantly shorter than that of the first series (P < .05), while there were no differences between the 2 series in the VL-first group (P > .05). The mean intubation time in the second series of the DL-first group was shorter than for the first series of the VL-first group (P < .05), while the mean intubation time of the first series by the DL-first group did not differ from the second series by the VL-first group (P > .05). Eighteen attempts were required to achieve an 80% intubation success rate for the DL-first group, while more than 20 attempts were required for the trainees in the VL-first group. CONCLUSION We consider that teaching trainees DL for tracheal intubation first. CLINICAL TRIAL NUMBER ChiCTR-OOR-16008364.
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Affiliation(s)
- Minglu Gu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Lian
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University
| | - Chao Gong
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University
| | - Shitong LI
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiaotong University
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43
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Mustafaev DM. [The foreign body in the larynx in a year old child]. Vestn Otorinolaringol 2019; 84:82-83. [PMID: 30938350 DOI: 10.17116/otorino20198401182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose is: description of clinical observation - successful removal of a foreign body (diode lamp) from the larynx in a child aged one year. Despite the large size of the aspirated object and its localization at the level of the glottis child is breathing through the natural airway. The foreign body was removed through natural ways, with direct laryngoscopy, avoiding the complications. The given supervision once more emphasizes necessity of opportunely carrying out of the objective tests, for revealing foreign bodies of respiratory ways at children of younger age.
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Affiliation(s)
- D M Mustafaev
- Moscow Regional Research and Clinical Institute, Moscow, Russia, 129110
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44
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Hasnaoui M, Masmoudi M, Chefai J, Hmida NB, Mighri K, Driss N. [Symptomatic vallecular cyst in adults: about 4 cases]. Pan Afr Med J 2018; 31:36. [PMID: 30918562 PMCID: PMC6430857 DOI: 10.11604/pamj.2018.31.36.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/06/2018] [Indexed: 11/11/2022] Open
Abstract
Symptomatic vallecular cyst is a rare benign lesion. These cysts are often asymptomatic in the adult. We here report 4 cases of symptomatic vallecular cyst in the adult. Three patients presented with mixed high dysphagia associated with dysphonia. The fourth patient complained of foreign body sensation in the throat. Laryngoscopy showed a cyst in left vallecular region in all cases. CT scan confirmed vallecular cyst. Treatment was based on marsupialisation of the cyst in two cases and endoscopic resection in two cases. This study suggests to clarify the diagnostic and therapeutic features of this disorder.
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Affiliation(s)
- Mehdi Hasnaoui
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
| | - Mohamed Masmoudi
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
| | - Jamel Chefai
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
| | - Nouha Ben Hmida
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
| | - Khalifa Mighri
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
| | - Nabil Driss
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, CHU Tahar Sfar, Mahdia, Tunisie
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45
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Huang HB, Peng JM, Xu B, Liu GY, Du B. Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis. Chest 2017; 152:510-517. [PMID: 28629915 DOI: 10.1016/j.chest.2017.06.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. METHODS We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95% CIs. RESULTS Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = .003), use of VL did not result in a significant increase in the first-attempt success rate (RR = 1.08; 95% CI, 0.92-1.26; P = .35) compared with DL. In addition, time to intubation (MD = 4.12 s; 95% CI, -15.86-24.09; P = .69), difficult intubation (RR = 0.72; 95% CI, 0.30-1.70; P = .45), mortality (RR = 1.02; 95% CI, 0.84-1.25; P = .83), and most other complications were similar between the VL and DL groups. CONCLUSIONS The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.
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Affiliation(s)
- Hui-Bin Huang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China; Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Biao Xu
- Critical Care Medicine Center, the PLA 302 Hospital, Fengtai District, Beijing, People's Republic of China
| | - Guang-Yun Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China.
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Kim KN, Jeong MA, Oh YN, Kim SY, Kim JY. Efficacy of Pentax airway scope versus Macintosh laryngoscope when used by novice personnel: A prospective randomized controlled study. J Int Med Res 2017; 46:258-271. [PMID: 28835153 PMCID: PMC6011290 DOI: 10.1177/0300060517726229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine whether intubation education using the Pentax Airway Scope (AWS) in normal airways is more useful than direct laryngoscopy (Macintosh laryngoscope) in novice personnel. Methods Eleven intern doctors without intubation experience performed 60 sequential intubations with each device on a manikin and 10 sequential intubations in adult patients. The time required for successful intubation, percentage of glottic opening (POGO) score, number of intubation attempts, and number of dental injuries were analyzed for each intubation technique. Results The mean (standard deviation) time required for successful intubation decreased as the number of intubations increased and was significantly shorter with the Pentax AWS than direct laryngoscope [22.6 (7.3) vs. 29.6 (10.0) and 33.0 (8.0) vs. 44.7 (5.6) s, respectively] in both the manikin and clinical studies. The Pentax AWS was also associated with higher POGO scores than the direct laryngoscope [81.7 (8.9) vs. 55.1 (13.2) and 80.9 (9.7) vs. 49.6 (16.5), respectively] and fewer intubation attempts. Fewer dental injuries occurred with the Pentax AWS in the manikin study. Conclusions Novices performed intubation more rapidly and easily with an improved laryngeal view using the Pentax AWS. We suggest that intubation education with video laryngoscopy should be mandatory along with direct laryngoscope training.
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Affiliation(s)
- Kyu Nam Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - You Na Oh
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea
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Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Ther Clin Risk Manag 2017; 13:831-841. [PMID: 28740393 PMCID: PMC5505682 DOI: 10.2147/tcrm.s136221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The C-MAC videolaryngoscope is the first Macintosh-typed videolaryngoscope. Since the advent of its original version video Macintosh system in 1999, this device has been modified several times. A unique feature of C-MAC device is its ability to provide the 2 options of direct and video laryngoscopy with the same device. The available evidence shows that in patients with normal airways, C-MAC videolaryngoscope compared with direct laryngoscopy can provide comparable or better laryngeal views and exerts less force on maxillary incisors, but does not offer conclusive benefits with regard to intubation time, intubation success, number of intubation attempts, the use of adjuncts, and hemodynamic responses to intubation. In patients with predicted or known difficult airways, C-MAC videolaryngoscope can achieve a better laryngeal view, a higher intubation success rate and a shorter intubation time than direct laryngoscopy. Furthermore, the option to perform direct and video laryngoscopy with the same device makes C-MAC videolaryngoscope exceptionally useful for emergency intubation. In addition, the C-MAC videolaryngoscope is a very good tool for tracheal intubation teaching. However, tracheal intubation with C-MAC videolaryngoscope may occasionally fail and introduction of C-MAC videolaryngoscope in clinical practice must be accompanied by formal training programs in normal and difficult airway managements.
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Affiliation(s)
- Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hui-Xian Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Ambrosio A, Marvin K, Perez C, Byrnes C, Gaconnet C, Cornelissen C, Brigger M. Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy. OTO Open 2017; 1:2473974X17707916. [PMID: 30480183 PMCID: PMC6239019 DOI: 10.1177/2473974x17707916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 01/21/2023] Open
Abstract
Objective Difficult airway management is a key skill required by all pediatric
physicians, yet training on multiple modalities is lacking. The objective of
this study was to compare the rate of, and time to, successful advanced
infant airway placement with direct laryngoscopy, video-assisted
laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway
simulator. This study is the first to compare the success with 3 methods for
difficult airway management among pediatric trainees. Study Design Randomized crossover pilot study. Setting Tertiary academic medical center. Methods Twenty-two pediatric residents, interns, and medical students were tested.
Participants were provided 1 training session by faculty using a normal
infant manikin. Subjects then performed all 3 of the aforementioned advanced
airway modalities in a randomized order on a difficult airway model of a
Robin sequence. Success was defined as confirmed endotracheal intubation or
correct LMA placement by the testing instructor in ≤120 seconds. Results Direct laryngoscopy demonstrated a significantly higher placement success
rate (77.3%) than video-assisted laryngoscopy (36.4%, P =
.0117) and LMA (31.8%, P = .0039). Video-assisted
laryngoscopy required a significantly longer amount of time during
successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct
laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6
seconds; 95% CI, 24.7-48.4). Conclusions Pediatric trainees demonstrated significantly higher success using direct
laryngoscopy in a difficult airway simulator model. However, given the
potential lifesaving implications of advanced airway adjuncts, including
video-assisted laryngoscopy and LMA placement, more extensive training on
adjunctive airway management techniques may be useful for trainees.
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Affiliation(s)
- Art Ambrosio
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, Oceanside, California, USA
| | - Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Colleen Perez
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Chelsie Byrnes
- Division of Critical Care, Department of Pediatrics, Naval Medical Center San Diego, San Diego, California, USA
| | - Cory Gaconnet
- Division of Pediatric Anesthesia, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Chris Cornelissen
- Division of Cardiac Anesthesia, Department of Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | - Matthew Brigger
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA.,Department of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, California, USA
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49
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Floyd E, Goldstein NA, Joks R, Mascaro M, Liaw C, Dickson B, Varughese D, Silverman J. An Extubation Protocol for Angioedema. OTO Open 2017; 1:2473974X17691230. [PMID: 30480175 PMCID: PMC6239052 DOI: 10.1177/2473974x17691230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/03/2017] [Accepted: 01/10/2017] [Indexed: 11/15/2022] Open
Abstract
Angioedema-nonpitting edema of the mucous membranes and skin-most commonly occurs as a complication from the use of angiotensin-converting enzyme inhibitors. At our institution, the otolaryngology department has incorporated the use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy to aid in timing for extubation of angioedema patients. Prospective data collection of patients presenting to the emergency department with angioedema was performed. Of 76 patients with angioedema, 9 required fiberoptic intubation. Intubation was performed at a median of 73 hours (range, 44-118). An endotracheal tube cuff-leak test was performed in 7 patients prior to extubation, and bedside direct laryngoscopy was also performed in 3 of these 7 patients to document resolution of laryngeal edema. The use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy is an easy and inexpensive method to help determine eligibility for extubation in patients intubated for angioedema.
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Affiliation(s)
- Elizabeth Floyd
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
| | - Nira A. Goldstein
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
| | - Rauno Joks
- Division of Allergy and Immunology,
State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Miguel Mascaro
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
- Tzikas Facial Plastic Surgery Center,
Delray, Florida, USA
| | - Christine Liaw
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
- Department of Urology, Mount Sinai
Medical Center, New York, New York, USA
| | - Bradley Dickson
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
| | - Denny Varughese
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
- Department of Otolaryngology–Head and
Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joshua Silverman
- Department of Otolaryngology, State
University of New York Downstate Medical Center, Brooklyn New York, USA
- Department of Otolaryngology, Long
Island Jewish Medical Center/Northwell Health, New Hyde Park, New York, USA
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50
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Gowd A, Nazemi A, Carmouche J, Albert T, Behrend C. Indications for Direct Laryngoscopic Examination of Vocal Cord Function Prior to Anterior Cervical Surgery. Geriatr Orthop Surg Rehabil 2016; 8:54-63. [PMID: 28255513 PMCID: PMC5315243 DOI: 10.1177/2151458516681144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recurrent laryngeal nerve palsy (RLNP) is among the most common complications in both thyroid surgeries and anterior approaches to the cervical spine, having both a diverse etiology and presentation. Most bilateral paresis, with subsequent devastating impact on patients, are due to failure to recognize unilateral recurrent laryngeal nerve paralysis and, although rare, are entirely preventable with appropriate history and screening. Recurrent laryngeal nerve palsy has been shown to present asymptomatically in as high as 32% of cases, which yields limitations on exclusively screening with physical examination. Based on the available literature, diagnosis of unilateral RLNP is the critical factor in preventing the occurrence of bilateral RLNP as the surgeon may elect to operate on the injured side to prevent bilateral paresis. Analysis of incidence rates shows postoperative development of unilateral RLNP is 13.1 (95% confidence interval [CI]: 6.1-28.1) and 13.90 (95% CI: 6.6-29.3) times more likely in anterior spine and thyroid surgery, respectively, in comparison with intubation. Currently, there is no consensus on when to order a preoperative laryngoscopic examination prior to anterior cervical spine surgery. The importance of patient history should be emphasized, as it is the basis for indications of preoperative laryngoscopy. Efforts to minimize postoperative complications must be made, especially when considering the rising rate of cervical fusion. This study presents a systematic review of the literature defining key causes of RLNP, with a probability-based protocol to indicate direct laryngoscopy prior to anterior cervical surgery as a screening tool in the prevention of bilateral RLNP.
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Affiliation(s)
- Anirudh Gowd
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Anirudh Gowd, Musculoskeletal Education & Research Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Alireza Nazemi
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jonathan Carmouche
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Todd Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Caleb Behrend
- Department of Orthopedic Surgery, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
- Musculoskeletal Education & Research Center (MERC), Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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