Intubation Attempts Research Articles

Nasal Intermittent Positive Pressure Ventilation During Neonatal Endotracheal Intubation: A Randomized Controlled Trial.

This prospective, multicenter, randomized controlled trial aimed to determine whether the use of nasal intermittent positive pressure ventilation (NIPPV) during neonatal endotracheal intubation increased the rate of successful intubation without physiological instability during all intubation attempts. In total, 150 infants were randomly assigned to either an NIPPV or standard care group (n = 75 each). The primary outcome was successful intubation without physiological instability (defined as ≥ 20% decline in the peripheral oxygen saturation [SpO2] from preintubation value or bradycardia with a heart rate < 100 beats/min) during all intubation attempts. The mean postmenstrual age of the infants was 32.5 weeks, with a median weight of 1552 g at the time of intubation. The incidence of successful intubation without physiological instability during all intubation attempts was significantly higher in the NIPPV group (64%) than that in the standard care group (42.7%) (p = 0.009). This difference was particularly significant when inexperienced practitioners were involved. In the NIPPV group, the rates of bradycardia (18.7% vs. 41.3%) and severe desaturation (30.7% vs. 49.3%) were significantly lower, whereas the lowest SpO2 (85% vs. 76%) and lowest heart rate (118 vs. 105 beats/min) were significantly higher. NIPPV during endotracheal intubation increased the incidence of successful intubation without physiological instability during intubation attempts in neonates while reducing the rate of hypoxia and bradycardia.

Multidisciplinary Management of Acute Tetraparesis in an Infant with Achondroplasia, with a Focus on Anesthetic Strategies: A Case Report

Background/Objectives: This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. Case presentation: A 1-year-old boy with achondroplasia presented with acute tetraparesis after a whiplash injury. Initial craniocervical computed tomography demonstrated a reduced volume of the posterior fossa, foramen magnum stenosis, and ventriculomegaly, without any fractures or dislocations. Moreover, magnetic resonance imaging (MRI) revealed pathological signal changes in the medulla oblongata, cervical spinal cord in segments C1 and C2, and the posterior atlantoaxial ligament. After initial conservative therapy and head immobilization using a soft cervical collar, partial remission of the tetraparesis was achieved. Two weeks post-injury, microsurgical posterior fossa decompression extending to the foramen magnum and C1 laminectomy was performed under general anesthesia with intraoperative neuromonitoring. Following an unsuccessful intubation attempt using a fiberoptic bronchoscope, successful airway management was achieved using a combined technique incorporating video laryngoscopy. Venous access was secured under ultrasound guidance. The patient exhibited complete remission of neurological symptoms by the third postoperative month during follow-up. Conclusions: This case report underscores the crucial need for a multidisciplinary approach in managing children with achondroplasia, especially with foramen magnum stenosis and complex cervical spine injuries. Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks. It also highlights the importance of conservative therapy paired with timely neurosurgical intervention, resulting in the patient’s full recovery.

Associations of time to the operating room on outcomes in odontogenic infection

The purpose of this study was to determine if there were correlations between the length of time from hospital admission to surgical intervention and the frequency of complications in patients with odontogenic infections. While odontogenic infection is well studied in terms of interventions and outcomes, less is known about hospital utilization and resource burden of odontogenic infection with respect to timeliness to intervention. A retrospective cohort analysis was used to examine correlations between time from admission to surgical intervention and clinical outcomes. Patients included in this study were divided into three categories of length of time to the operating room: 0–12 h, 12.1–24 h, and greater than 24 h. Time of admission, time of surgical intervention, patient demographics, admission lab values, and space involvement were measured and compared to the primary outcome variables including complications of intubation attempts and type, ICU admission, length of hospitalization, number of changes in antibiotic therapy, and frequency of return to the operating room. We found that the length of time to the OR had a statistically significant association with length of hospital stay (p = 0.003) and number of changes in antibiotic therapy (p = 0.033). While overall length of hospital stay is inherently dependent on length of time to the OR, this relationship highlights the importance of timeliness to definitive intervention in order to reduce hospital burden. This study provides evidence on how to prioritize odontogenic infections in a hospital setting. We recommend treating odontogenic infection in less than 24 h from the time of admission in order to reduce costs and improve outcomes for patients.

Video analysis of neonatal intubations using video laryngoscopy: a prospective comparison of clinical practice with resuscitation guidelines

BackgroundThe Neonatal Resuscitation Program recommends direct laryngoscopy (DL) as the primary method for neonatal intubation. Video laryngoscopy (VL) is suggested as an option, particularly for training novice operators or for...

Comparison of video laryngoscopy and direct laryngoscopy for urgent intubation in newborn infants: A meta-analysis.

Securing a stable airway is a critical component in neonatal resuscitation. Compared to direct laryngoscopy, video laryngoscopy provides improved visualization of the glottis, potentially enhancing the success rate of intubation. This systematic review and meta-analysis were conducted to assess and compare the efficacy and safety of video laryngoscopy versus direct laryngoscopy in neonatal intubation. A thorough search was performed across CENTRAL, Embase, and PubMed databases to identify relevant randomized controlled trials (RCTs) that evaluated the use of video laryngoscopy in comparison with direct laryngoscopy for neonatal intubation. The data extraction and analysis were conducted in alignment with Cochrane guidelines. The primary outcome of interest was the time required for intubation, while secondary outcomes included the number of intubation attempts and the success rate on the first attempt. The meta-analysis included nine RCTs, encompassing a total of 719 neonates. The findings revealed that video laryngoscopy was associated with a longer intubation time (mean difference [MD] 3.23s, 95% confidence interval [CI] 2.42 to 4.04; I2=96%). However, it also significantly improved the first-attempt success rate (risk ratio [RR] 1.31, 95% CI 1.20 to 1.44; I2=76%) and borderline reduced the total number of intubation attempts (MD -0.08, 95% CI -0.15 to 0.00; I2=53%). While video laryngoscopy is associated with a modest increase in intubation time, it provides clear benefits by enhancing the success rate of first-attempt intubations and reducing the need for multiple attempts in neonatal intubation procedures.

Association between video laryngoscopy characteristics and successful neonatal tracheal intubation: a prospective study

ObjectiveTo identify associations between procedural characteristics and success of neonatal tracheal intubation (NTI) using video laryngoscopy (VL).DesignProspective single-centre observational study.SettingQuaternary neonatal intensive care unit.PatientsInfants requiring NTI at the Children’s Hospital...

Clinical Decision-Making and Process Complications During Anticipated Difficult Airway Management for Elective Surgery.

Difficult airway management (DAM) is a challenging aspect of anesthetic care. Although nearly all DAM episodes result in successful intubation, complications are common and clinical decision-making may be complex. In adults with anticipated DAM scheduled for nonemergent surgery, we prospectively observed clinical decisions made during DAM such as awake/sedated versus anesthetized, choice of initial and subsequent devices, case cancellation/postponement, conversions between awake and anesthetized approaches, and process complications such as multiple intubation/supraglottic airway (SGA) insertion attempts, difficult bag-mask ventilation (BMV), hypoxemia, and cardiovascular destabilization. From 2009 to 2014, we prospectively observed 1295 episodes of anticipated DAM in a convenience sample of 1245 adults scheduled for nonemergent surgery. Trained observers recorded airway management decisions and process complications during DAM. We described clinical decisions made during DAM and outcomes including number of attempts, need for BMV, hypoxemia, and cardiovascular destabilization. No cases were canceled/postponed for airway management failure and all intubations were eventually successful. Of the 1295 episodes of airway management in our study cohort, 166 (13%) were intubated awake. Patients intubated awake had more difficult airway indicators than those intubated anesthetized, their first-pass success rate was 49%, 30% required ≥3 attempts, 4% required a device change, 50% experienced hypoxemia, and 29% experienced cardiovascular destabilization. Among the 1129 patients intubated while anesthetized, first-pass success rate was 64% and 20% required ≥3 attempts, 11% required a device change, hypoxemia occurred in 30%, and cardiovascular destabilization in 20%. One patient (0.08%) was converted from an anesthetized to an awake approach. Patients with a failed anesthetized intubation attempt and difficult BMV between attempts were at high risk for multiple attempts (67%) and hypoxemia (100%). Airway management was successful in all patients and the incidence of process complications was higher than in routine airway management. Despite a high risk of DAM, 87% of patients were intubated anesthetized and conversions between awake and anesthetized approaches were rare. That patients intubated awake had more difficult airway indicators implies that clinicians reserve awake intubation for particularly difficult airways. The high incidence of multiple attempts, hypoxemia, and cardiovascular destabilization in patients intubated awake suggests that awake airway management remains challenging. We found no clear pattern in device choices after a first failed attempt. Patients with a first failed anesthetized intubation attempt and difficult BMV were at particularly high risk for hypoxemia.

Airway management for patients who underwent appendectomy for the indication of acute appendicitis at a Texas tertiary care center: a single center retrospective study

Background The primary aim of our study was to determine the frequency of video laryngoscopy (VL) use on the first intubation attempt for patients who underwent appendectomy for acute appendicitis at our hospital. Methods Patients who had an appendectomy for the indication of acute appendicitis at Baylor Scott & White Medical Center – Temple between January 1, 2021, and December 31, 2023, were included in our study. Study investigators extracted demographic, physical, and clinical data from our electronic medical record. Results A total of 533 and 70 patients had direct laryngoscopy (DL) and VL for their first intubation attempts, respectively. Among these, 518 (97.2%) and 53 (75.7%) performed with DL and VL, respectively, were successful on the first attempt (P < 0.001). Patients who had VL for the first intubation attempt were more likely to be male, older, have a higher body mass index, and have a higher incidence of previous airway management with VL, appendiceal perforation, nasopharyngeal tube placement, and SARS-CoV-2 infection compared to patients who had DL. Conclusion Approximately 12% of our patients who underwent appendectomy for acute appendicitis had VL on the first intubation attempt, and these patients were more complex than those who had DL.

Comparison of jaw thrust and backward-upward-rightward pressure (BURP) manoeuvre with conventional technique on glottic visualization and intubation characteristics using C-MAC video-laryngoscope

Abstract Background and Aims: Traditionally various methods have been employed to improve glottic visualization during laryngoscopy, namely backward-upward-rightward pressure (BURP) and jaw trust with promising results. The current study aims to compare these maneuvers for the enhancement of glottic visualization during video laryngoscopy. Material and Methods: In this prospective randomized study in 120 adult patients with normal airways, C-MAC® laryngoscopy was performed under general anesthesia (GA). Images of the glottis with conventional laryngoscopic technique, using BURP maneuver and jaw thrust were acquired, and Cormack–Lehane (CL) grading, percentage of glottic opening (POGO) score, and approximate glottic area were recorded from the images. Subsequently, patients were divided into three equal groups–in group C, the trachea was intubated using conventional laryngoscopic technique, in group B, BURP was used, and in group J, jaw thrust was used. Intubation time, ease of intubation, number of intubation attempts, incidence of airway trauma, and postoperative sore throat were noted. Results: Both jaw thrust and BURP maneuvers improved CL grading, POGO score, and glottic area significantly as compared to the conventional laryngoscopic technique. CL grading and POGO score were better with BURP than with jaw thrust; however, the glottic area improved more with jaw thrust. Jaw thrust also resulted in statistically significant lower intubation time and better ease of insertion score. Intubation was successful in the first attempt in all patients and there was no airway trauma and postoperative sore throat. Conclusion: Both BURP and jaw thrust maneuvers result in better glottic visualization. Jaw thrust provides lower intubation times, better ease of intubation scores, as well as a higher visualized glottic area than BURP.

Comparaison of effectiveness of flexible intubation fibersocope versus bonfils fiberoscope in tracheal intubation of paediatrics with midfacial hypoplasia

ABSTRACT Background Airway management is one of the fundamental skills of an anesthesiologist. When compared to adult patients, the pediatric patients have notable anatomical and physiological variations. These variations affect the methods and equipment the anesthesiologist will select to provide safe airway management. Purpose The purpose of the study aimed to compare the effectiveness of first intubation attempt while utilizing flexible intubation fiberoscope versus Bonfils fiberoscope in tracheal intubation of pediatrics with midfacial hypoplasia. Also, to estimate time to first intubation attempt, time to endotracheal insertion and to assess the occurrence of complications. Methods This randomized controlled trial was conducted over 30 children (aged 6 month up to 5 years) with midfacial hypoplasia planned to undergo elective surgery while under general anesthesia. The children were categorized in random to two equal groups: group I intubation was with Karl Storz flexible intubation fiberoscope 3.7 mm via AirQ-ILA, while group II intubation was with Storz Bonfils fiberoscope 3.5 mm. Success of first attempt of intubation, time to first attempt of intubation, time to endotracheal insertion, number of intubation attempt, complications were recorded. Results No notable variations were observed in the success of first attempt of intubation between the two groups. The time to first attempt of intubation and the time to endotracheal tube insertion were significantly less in group II than in group I where p > 0.001. Regarding the number of intubation attempt and the occurrence of complications, the two groups did not significantly differ from one another where p = 1.000. Conclusion The Bonfils fiberoscope and the flexible intubation fiberoscope are both appropriate tools for intubating pediatrics with midfacial hypoplasia. However, Bonfils fiberoscope was superior with regard to the time to first attempt of intubation and the time to endotracheal tube insertion.

Oral Endotracheal Intubation with Restricted Glottis View using C-MAC D Blade®: A Randomised Controlled Trial

Introduction: The perspective of airway management has undergone a considerable transformation since the advent of Video Laryngoscopes (VL). VL has rapidly been accepted as an intubation tool in a variety of clinical scenarios. This heralds a wide array of VL models with their own strengths and weaknesses. The C-MAC D blade® is one such VL with an angulated blade that provides an excellent glottis view, but negotiating the Endotracheal Tube (ETT) past the glottis opening and into the trachea might be difficult. No study till date was done on the C-MAC D blade® with different glottis views for intubation. Aim: To compare the Total Time of Intubation (TTI) with restricted glottis view and full glottis view with C-MAC D blade® as the primary aim, along with the first attempt intubation rate and complications during intubation. Materials and Methods: The present prospective single-centre randomised controlled trial was conducted in the Department of Anaesthesiology, Shree Krishna Hospital, PSMC, Karamsad, Gujarat, India, from September 2021 to August 2022. A total of 42 patients were randomly divided into two groups: group-F (n=21), which had a full glottis view, and group-R (n=21), which had a restricted glottis view. Randomised glottis views were achieved with the C-MAC D blade® VL during oral endotracheal intubation in both groups. Video recordings of the intubations were made, and TTI, first attempt success rate and complications during intubation were noted. Statistical analysis was done with an independent sample t-test to compare the two groups of continuous variables using STATA version 14.2. Results: The mean age in group-F was 45.86±10.83 years and in group-R was 47.76±9.14 years. The male-to-female ratio in group-F was 10:11 and in group-R was 9:12. Overall, the firstattempt successful intubation rate with the C-MAC D blade® in both groups was 90.48%. However, it was higher in group-R (95.24%) compared to group-F (85.71%). TTI was less in group-R compared to group-F (36.19±11.11 vs 45±15.89 seconds, p-value=0.0438). Group-R had lower incidence of postoperative sore throat (14.29% vs 57.14%, p-value=0.004) compared to group-F. Conclusion: Total time of intubation was less with a restricted glottis view compared to a full glottis view with C-MAC D blade® VL. Additionally, the restricted view had a higher first attempt intubation rate. Postoperative sore throat was significantly lower in the restricted view, with a lesser incidence of oropharyngeal trauma compared to the full glottis view.

Difficult Airway Response Team Outcomes in an Academic Emergency Department: A Prospective, Multidisciplinary Airway Management Cohort Study

Background Successful first-attempt intubation minimizes the risk of hypoxemia, hypoventilation, and hypoperfusion. However, few data exist on outcomes of team-based difficult airway management in the Emergency Department (ED) for patients with deteriorating respiratory status. Objective To investigate the outcomes of an ED Difficult Airway Response Team (DART) program. Methods A prospective observational cohort study of DART implementation was conducted in the ED of an academic, tertiary care institution over a five-year period. An activation protocol was established, and the DART team included emergency physicians, other physicians (anesthesiologists, otolaryngologists, and trauma surgeons), respiratory therapists, nurses, and staff. Patients 18 years or older managed by the DART in the ED were included. Outcome measures included first-attempt intubation success, intubation techniques, and need for surgical airway. Results Across 98 DART activations, 73 patients were managed in ED, nine patients were transported directly to the operating room, and 16 were transported to the operating room after an unsuccessful attempt at airway securement. Advanced airway techniques (fiberoptic bronchoscopy or videolaryngoscopy) accounted for 76% of first-attempt success with airway securement versus 24% for direct laryngoscopy (p&lt;.01). Difficulty with bag-mask ventilation, need for cardiopulmonary resuscitation, and underlying illness predicted lower first attempt success rates (all p &lt;.01). Surgical interventions were required in 17 patients, and 6 patients underwent cricothyroidotomy. There were no airway-related mortalities. Airway anatomy, difficult airway history, and context were associated with equipment selection, transport to operating room, and need for surgical airway. Conclusion In this DART implementation, the first attempt intubation success was associated with use of advanced airway techniques and favorable patient characteristics.

Learning tracheal intubation with a hyperangulated videolaryngoscopy blade: sub-analysis of a randomised controlled trial.

The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs. direct laryngoscopy to determine the number of tracheal intubations with a hyperangulated videolaryngoscope blade needed to provide an acceptable first-attempt success rate. We included clinicians from a randomised controlled trial who were familiar with direct laryngoscopy and Macintosh-blade videolaryngoscopy but inexperienced with hyperangulated videolaryngoscopy. Cumulative sum statistics were used to generate learning curves with acceptable success rates of 85% and unacceptable success rates of 70% for the primary outcome of first-attempt tracheal intubation success. We included 223 clinicians (25 consultants; 35 certified registered nurse anaesthetists; 36 student registered nurse anaesthetists; 46 fellows; and 81 residents) who attempted tracheal intubation in 4312 procedures. The median (IQR [range]) number of tracheal intubations per clinician was 15 (8-25 [1-77]). First-attempt failure was low, with only 72 failed first attempts overall, and was comparable across clinician groups. In total, 133 (60%) clinicians crossed the acceptable success rate boundary while the remaining 90 (40%) clinicians crossed neither the acceptable nor unacceptable success rate boundaries. Among clinicians who crossed the acceptance boundary, the median (IQR [range]) number of attempts for learning was 12 (12-12 [12-26]). Clinicians experienced in tracheal intubation with direct laryngoscopy but unfamiliar with hyperangulated-blade videolaryngoscopy can achieve proficiency after approximately 12 attempts.

Incidence of traumatic dental injuries associated with orotracheal intubation in general anesthesia in children during mixed dentition in Damascus, Syria: a prospective longitudinal study

ObjectivesEndotracheal tube intubation by laryngoscope during general anesthesia is a safe procedure with a few complications. However, it may cause some damage to the oral cavity structures, which leads to postoperative pain and discomfort. Traumatic dental injuries associated with endotracheal tube intubation are one of the most common complications. The study aimed to determine the incidence of traumatic dental injuries during oral-endotracheal tube intubation in general anesthesia among children receiving surgery at the Children’s Hospital in Damascus City during 2022–2023.MethodsIt was a prospective longitudinal study which investigated the incidence of traumatic dental injuries during oral-endotracheal tube intubation under general anesthesia in 110 children aged 6–12 years old at the University Children’s Hospital in Damascus City in 2022. After ensuring that the child met inclusion criteria and obtained written consent. Each child was examined before, during, and after 12–24 h of entering the operation room. Personal information (gender – age), information related to anesthesia procedures, and some oral cavity characters were collected.ResultsThe incidence of traumatic dental injuries during general anesthesia was 9.1%. Most of them intra-oral soft tissue injuries. The concussion is the most common injury related to teeth damage. In addition, the tongue was the most common-place. There is a correlation between the incidence of traumatic dental injuries and the difficulty of intubation, the number of intubation attempts, Mallampati score (p < 0.05).ConclusionThe anesthesiologist should evaluate the condition of each patient carefully. Document every detail in their record and inform the patient of the possibility of dental damage during the procedures especially in the case that has difficulty intubation.

Does intubation while observing the glottis with a fiberoptic scope reduce postoperative sore throat?

IntroductionIn oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11–55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube. However, the extent to which this technique causes postoperative complications is unknown compared to traditional technique. The aim of this study was retrospectively to determine the effect of postoperative sore throat following nasotracheal intubation by tip of the tube is visualized by fiberoptic scope.MethodAnesthesia records of the adult patients with nasotracheal intubation were checked. Patients underwent oral maxillofacial surgery from January 2021 until March 2023. Facilitated with rocuronium, nasotracheal intubation was performed using the traditional or observative method by fiberoptic scope with a 4.8 mm outer diameter. Intubation was performed with a cuffed 6.5–8.0 mm ID nasotracheal tube. The following variables were recorded: gender, age, height, weight, ASA classification, anesthesia time, duration of intubation, tube size, intubation attempts, fentanyl and remifentanil. The postoperative sore throat and the incidence of hoarseness were recorded at operative day and at the day after operative day, and the time to recovery.ResultA total of 104 cases (traditional fiberoptic intubation n = 51, observative fiberoptic intubation n = 53) were enrolled in this retrospective study. There were no significant differences in clinical characteristics and anesthetic data. There was not significant difference in incidence of postoperative sore throat, hoarseness and recovery between the two groups (P = 0.61, 0.44, 0.90). For subjects reporting postoperative sore throat (n = 30), there was not a significant difference in VAS means at operative day and at the day after operative day between the two groups (P = 0.81, 0.91).ConclusionWe found that postoperative sore throat and recovery were not influenced by observative fiberoptic scope for nasotracheal intubation.

Expert opinion on factors associated with severe laryngeal injury after intubation in the pediatric population: a worldwide survey study.

To minimize post-intubation laryngeal injury it is important to identify the factors that contribute to the development of these lesions. Previous literature has been inconsistent. This survey aims to investigate experts' opinions on the various factors associated with severe laryngeal injury following intubation in the pediatric population and to determine whether these opinions influence the treatment of patients with one or more of these factors. A multiple-choice questionnaire with the possibility to provide open text answers was developed and sent by email, WhatsApp and Siilo to members of the scientific societies of anesthesiology, pediatric intensive care, emergency medicine and ear nose throat surgeons worldwide. Responses were analyzed thematically. A total of 363 physicians worldwide responded to the survey, mainly anesthesiologists (31%), intensivists (35%) and ENT surgeons (29%). The majority of the respondents (69%) had over 10years of experience in pediatric airway management. Overall, factors with the highest agreement (> 80% of respondents) were 'traumatic intubation', 'multiple intubation attempts', 'the use of oversized tubes', 'skill level of the intubator', 'repeated intubations' and 'period of intubation', specifically in small (weight < 2kg, age < 1year) children. The factors 'use of muscle relaxants' and 'biological sex' were not considered relevant. In accordance with their daily practice, physicians from different specialties reported varying factors as being relevant. These assumptions influence their routine decisions regarding intubation and extubation procedures. Although not extensively supported by literature, the majority of the experts indicate that factors such as 'traumatic intubation', 'multiple intubation attempts', 'oversized tubes', 'skill level of the intubator', 'repeated intubations' and 'period of intubation' are the most relevant factors in the development of post-intubation severe laryngeal injury in the pediatric population. Physicians from different specialisms also highlight specialism specific factors they consider most significant which influence their day-to-day clinical practice.

Comparison of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients

Background: Development of video laryngoscope has made management of airway easier. 0ur study was aimed to compare the efficacy of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients under general anesthesia. Objectives: The primary objective of the study was to compare the glottic view obtained , the need for external manipulation, endotracheal tube insertion time and attempts taken for successful intubation with Macintosh laryngoscope and King Vision video laryngoscope. The secondary objective was to estimate the changes in hemodynamic parameters and to evaluate the occurrence of complications during intubation. Materials and Methods: The study included 136 patients posted for surgery under general anesthesia. Patients were randomly allocated in group C (N=68) and group V (N=68 ).Endotracheal intubation was done in group C by Macintosh and in group V by King Vision video laryngoscope. Laryngoscopy was assessed by Cormack Lehane grading and the need for any manipulation. The intubation time was calculated with each blade. Hemodynamic parameters were recorded and any complication during laryngoscopy and intubation were noted. The observations were analysed statistically by SPSS Program for windows version 28. Results: In group C, 61.8% of patients had Cormack and Lehane score I while in group V 76.5 % of patients had score I . Mean time of successful intubation was 34.90±8.35 sec in group C while in group V it was 32.82± 5.20 second . There was no statistical difference in distribution of patients according to number of attempts of intubation. In group C, 64.7% of patients needed external laryngeal pressure while in group V 97.1 % patients were intubated without external laryngeal pressure. Both the groups were comparable in relation to changes in hemodynamic parameters and any complications associated with laryngoscopy and intubation. Conclusion: We conclude that glottic view is better obtained with King Vision Video laryngoscope whereas optimisation of position and external laryngeal manipulation is often required with Macintosh laryngoscope to get similar glottic view. Introduction of King Vision video laryngoscope into the oral cavity takes time but intubation is easier with it. Hemodynamic variables and complications during the procedure are equally distributed between the two devices.

Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI).

Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates

ObjectiveTo determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation.DesignRetrospective analysis of prospectively collected data on...

Consequences of NICU Intubations: Incidence, Identifications, and Interventions.

Prolonged intubation often leads to laryngeal injuries such as subglottic stenosis (SGS), especially in neonates with prematurity and congenital defects key for tissue healing. Recognizing at risk patients in the neonatal intensive care unit (NICU) is not well studied. The study's goals were to determine intubation risk factors, characterize laryngeal injuries, and calculate the incidence of intervention. Retrospective case review. Quaternary pediatric referral center. This retrospective study included all intubated patients in the NICU from April 1, 2020 to 2023. Electronic records were reviewed for demographics and intubation details. Patients were categorized to into intubation only or intervention groups, including direct laryngoscopy and bronchoscopy (DLB) and tracheostomy history. A total of 441 patients were identified with 94 (21%) neonates undergoing DLB. Characteristics impacting intervention included older gestational age, genetic syndromes, and congenital heart disease. Significant risk factors were older age at first intubation, recurrent intubation events, longer intubation duration, and larger endotracheal tube (ETT) diameter, but not birth weight or intubation attempts. Otolaryngology was more likely to intubate the intervention cohort. SGS overall incidence was 2.95% with balloon dilation in 6.4%. Two-thirds of neonates with DLB ultimately required tracheostomy, in which all variables remained significant risk factors except for gestational age. Older age at first intubation, more intubation events, longer intubation duration, and larger ETT increased risk for future DLB and tracheostomy but not birth weight or number of intubation attempts. Most NICU patients selected for DLB ultimately required further procedures.