Simulated Difficult Airway Research Articles

56 Combined laryngo-bronchoscopy intubation approach in a simulated difficult airway scenario

56 Combined laryngo-bronchoscopy intubation approach in a simulated difficult airway scenario

Evaluation of a 12-hole clock model for improving bronchoscopic skills in simulated normal and difficult airways among anesthesia residents: A randomized controlled study.

Simulation-based training is used to improve fiberoptic bronchoscopic skills for novices. We developed a nonanatomical task trainer (named 12-hole clock model) that focused on training manipulation of bronchoscopes. The aim of this study was to evaluate the training effect of this model on bronchoscopic skills and learning interests in simulated normal and difficult airways among anesthesia residents. Forty-three anesthesia residents without experience in bronchoscopic intubation were randomly divided into control (n = 22) and intervention groups (n = 21). All participants received standard multimedia learning and a baseline test using a normal airway manikin. Then, the control and intervention groups engaged in 60 minutes of training via a traditional airway manikin or the clock model, respectively. After training, the participants completed bronchoscopic performance assessments in simulated normal and difficult airways, as well as an electronic questionnaire related to the course. During training, the total hands-on time of bronchoscopic practice recorded by trainees' themselves was longer in the intervention group than in the control group (1568 ± 478 seconds vs 497 ± 172 s, P < .0001). Posttraining, the time required to visualize the carina in simulated normal airways was longer in the intervention group than in the control group (22.0 [18.0, 29.0] vs 14.0 [10.8, 18.3], P < .0001), while it was shorter for simulated difficult airways (24.0 [16.0, 32.0] s vs 27.0 [21.0, 35.5] s, P = .0425). The survey results indicated that confidence in bronchoscopic intubation increased in both groups, without significant differences in satisfaction, acceptance, or perceived difficulty between the groups. However, the interest ratings were higher in the intervention group than in the control group. The 12-hole clock model is a simple and feasible method for improving bronchoscopic skills and promoting interest among trainees. NCT05327842 at Clinicaltrials.gov.

Comparison of Efficacy of Intubation with HugeMed Non-channelled Video Laryngoscope, McCoy and Macintosh Laryngoscope in Simulated Difficult Laryngoscopy Using Rigid Cervical Collar: A Prospective Randomized Trial.

In cervical spine injuries, there is an impairment in positioning of the patient to maintain the airway axis during endotracheal intubation (ETI). Literature shows video laryngoscope (VLS) facilitating the intubation in these patients with cervical immobilization. VL3 VLS (HugeMed Medical Technical Development, Shenzhen, China) is a newer VLS with limited studies. The primary aim of this study is to compare the efficacy of ETI using VL3 VLS with Macintosh and McCoy (MC) blades for simulated difficult airway with rigid cervical collar (RCC). The secondary aim was to compare the oral insertion of laryngoscope and intraoral bleeding. One hundred and fifty patients were randomly divided into three groups depending on laryngoscope used for ETI. Group M, Group V, and Group MC used Macintosh, VL3, and MC laryngoscopic blades, respectively, for ETI. During ETI, the Intubation Difficulty Scale (IDS), intubation time (IT), ease of laryngoscope insertion, and any bleeding intraorally were noted. The data collected were further analyzed. IDS was statistically significantly least (0.9 ± 1.5) with VL3 VLS compared to direct laryngoscopy with Macintosh and MC blades. There was significantly no difference in IT among the three groups. Insertion of blade of VL3 was significantly more difficult than Macintosh or MC. Intraoral bleeding was present in 8% of patients with VL3. VL3 VLS can be used for ETI during cervical immobilization using RCC. More studies are needed to define its efficacy in different difficult airway situations compared with different VLS.

The Impact of Implementing the Vortex Approach on Airway Management Performance in Stressed Medical Students: A Randomized Controlled Simulation Study.

BACKGROUND The ability to manage airways in emergencies is paramount, especially for less experienced medical students. Although the Vortex Approach, a useful scheme to support decision-making during airway management, promises structured guidance, there's limited research on its benefits among students. Our study aimed to evaluate student proficiency in a simulated difficult airway scenario and assess the advantages of the Vortex Approach. MATERIAL AND METHODS Medical students initially practiced on low-fidelity mannequins. Subsequently, they were divided into Vortex (n=48) and control groups (n=48). The Vortex group received specialized training. Both groups encountered a simulated scenario focusing on proper ventilation and supraglottic device insertion when traditional intubation failed. Performance was assessed using the airway management outcome score (AMOS). RESULTS The Vortex-trained group demonstrated superior capabilities. Fewer participants exceeded 3 lifeline interventions (4.2% vs 16.7%, P=0.046). The Vortex group consistently optimized subsequent attempts (31.3% vs 10.4%, P=0.01) and reduced prolonged apnea episodes (47.9% vs 81.3%, P=0.0009). Their AMOS scores were notably higher (56.3% vs 27.1%, AMOS=2, P=0.002), reflecting better patient outcomes (41.7% vs 10.4%, P=0.0005). CONCLUSIONS There is a marked need to enhance airway management skills among senior medical students. The Vortex Approach, even after brief exposure, yields significant skill improvements, underscoring its potential as a pivotal component in medical training. Integrating it into the curriculum could bridge the evident skill gap, optimizing future patient care.

Evaluation of Flexible Tip bougie in simulated difficult intubation: a randomized cross-over manikin study

Introduction: Both video laryngoscopes and bougies play major role in difficult airway management. Even when a video laryngoscope is available to improve intubation view, there are instances when the vocal cords are visible, but intubation cannot be achieved. In these cases, bougies have a role in assisting intubation. This study aimed to compare the efficacy of the Flexible Tip Bougie with others in simulated difficult intubation. Methods: This study was designed as a randomized, cross-over, simulation manikin study. It involved 42 medical officers from the Department of Anaesthesiology. In the study, participants performed intubation under simulated difficult airway conditions. Three types of bougie were used by each participant in random order: (1) Flexible Tip Bougie, (2) Portex Single-Use Introducer, and (3) Frova Intubating Introducer. Results: The intubation success rate was 100% for the Flexible Tip Bougie, 78.6% for the Frova Intubating Introducer, and only 50% for the Portex Single-Use Introducer (p &lt; 0.001). The median intubation time was shortest with the Flexible Tip Bougie, at 16.08 s (interquartile range [IQR]: 6.13); 18.25 s (IQR: 18.07) with Frova, and 19.39 s (IQR: 37.60) with Portex (p = 0.449). The ease of use was lowest with Portex (69.64, standard deviation [SD]: 32.45), average with Frova (50.59, SD: 29.98), and highest with Flexible Tip (16.67, SD: 21.86; [p &lt; 0.001]). Conclusion: In this manikin study, the Flexible Tip Bougie was more efficient in achieving successful intubation and easier to use than the Portex and Frova introducers in a difficult intubation scenario.

Comparison of silicone double-lumen tube and polyvinyl chloride single-lumen tube in fiberoptic tracheal intubation on a difficult airway model: a randomized controlled non-inferiority trial

The management of patients with history or suspicion of difficult intubation can be challenging, especially in surgical procedures requiring one-lung ventilation. The ease of insertion of silicone double lumen tube (DLT) have previously been shown to be comparable to polyvinyl single lumen tube (SLT) in fiberoptic bronchoscope (FOB) tracheal intubation. Hence, in difficult airway situation, we hypothesized that the performance of insertion of silicone DLT would also be non-inferior to polyvinyl SLT in FOB intubation. We used a neck collar to mimic patients with difficult airway. 80 patients who required one-lung ventilation were enrolled in a prospective, randomized, non-inferiority trial. Patients were randomly allocated to the DLT or SLT groups (SLT with bronchial blocker). Neck collar was supplied to all patients before FOB intubation. The time of insertion for FOB, railroading, tracheal intubation, and total procedure were measured. The difficulty of railroading was evaluated in 4 grades. In the DLT group, the railroading was significantly shorter and easier comparing to the SLT group. The total procedure was also simpler and faster in the DLT group. While simulated difficult airways may not fully replicate actual difficult airways, we suggest that fiberoptic intubation with silicone DLT could be a feasible first-line option for patients with expected difficult airways requiring lung separation, unless the size of the DLT relative to the patient’s airway is problematic.Trial registration: NCT03392766.

Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Introduction: The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilitate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60˚ angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective: To compare the ease of oral intubation with the use of the C-MAC stylet (60˚ angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Methods: Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60˚ angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results: The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions: The 60˚ angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

Comparison of the McGRATHTM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial

Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients' morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway.

Use of combined laryngo-bronchoscopy intubation approach in a simulated difficult airway scenario with cervical stabilization

The occurrence of unexpected difficult airway management (DAM) during endotracheal intubation (ETI) attempts represents a life-threatening scenario. The management of such challenges may improve with training in simulated DAM scenarios. Moreover, simulation allows investigation at the potential value of new devices and techniques for DAM. The combined use of laryngoscopy with fiberoptic bronchoscope (CLBI) has been proposed in this regard, but its performance by novices facing DAM remain unexplored. We performed a randomized crossover simulation study evaluating the performance of ninety-six anesthesiology residents during ETI with four approaches: direct laryngoscopy (DL), Glidescope®, McGrath® and CLBI. Increased difficulty was produced by placement of a cervical collar. Residents had maximum of 3 attempts per device/technique (up to 60 seconds per attempt). The main outcomes were success rate (SR) and corrected time-to-intubation (cTTI, with 60 seconds added for each failed attempt). Subgroup analyses were performed separating residents according to their experience (junior, n = 60; senior, n = 36).The CLBI had significantly lower SR at both 1st and 3rd attempt (31% and 64%, respectively) as compared to DL (93% and 98%), Glidescope® (70% and 86%) and McGrath® (58% and 84%), with all p &lt; 0.001. Moreover, CLBI had significantly longer cTTI (158.5 seconds; (54.3; 180)) than other devices: Glidescope® (37.6 seconds; (24.7; 88.2)), McGrath® (39.3 seconds; (20.6; 105.1)), and DL (19 seconds; (15.4; 27.2)), all p &lt; 0.002. CLBI and McGrath® were the only approaches performing better in senior as compared to junior residents. In a DAM simulated setting, anesthesiology residents had lower SR and longer cTTI with the CLBI as compared to direct and video-laryngoscopy.

A Comparative Evaluation of 2 Videolaryngoscopes as an Intubation Aid in a Simulated Difficult Airway: A Prospective Randomised Study.

Several videolaryngoscopes have been developed for using in difficult airway. We conducted this study to evaluate the performance of McGrath® MAC and King Vision® videolaryngoscopes in a simulated difficult airway. This prospective, randomised, comparative study was conducted in 140 surgical patients. Anaesthesia was administered as per standard protocol. A cervical collar was applied to simulate a difficult airway. Patients were randomised into 2 groups. In group M (n=70), laryngoscopy was performed first with King Vision® videolaryngoscope and second time with McGrath® MAC videolaryngoscope and trachea was intubated using the second device, while in group K (n=70), laryngoscopy was performed first with McGrath® MAC videolaryngoscope and second time with King Vision® videolaryngoscope and trachea was intubated using the second device. The laryngeal view, time taken for optimal laryngeal view, number of intubation attempts, ease of intubation, first attempt intubation success, time to tracheal intubation, haemodynamic parameters, and complications such as airway trauma, if any, were noted. Tracheal intubation was faster with McGrath® MAC (34.89 ± 3.7 seconds) compared to King Vision® videolaryngoscope (43.43 ± 4.3 seconds, P <.001) with comparable first attempt intubation success by 100% vs 97.1%, P =.496, respectively. The laryngeal view obtained with both the devices was comparable but the mean time taken for optimal laryngeal view was significantly longer with King Vision® videolaryngoscope, both in group M (P <.001) and group K (P <.001). Ease of intubation and complications were comparable in the 2 groups. McGrath® MAC videolaryngoscope in comparison to King Vision® videolaryngoscope resulted in a shorter time taken for optimal laryngeal view and time to tracheal intubation with comparable first attempt intubation success.

Comparing the Ease of Intubation between C-MAC, McGrath, and Conventional Macintosh Laryngoscope in a Simulated Difficult Airway of a Laerdal Mannequin

Tracheal intubation is an essential skill for doctors. Tracheal intubation is done in patients with questionable airway patency, poor respiratory drive, hypercarbia, or hypoxia. The objective of this study was to compare the ease of tracheal intubation using MacintoshLaryngoscopes, C-MAC, and McGrath on a simulated difficult airway mannequin. The rationale of the study was to identify the easiest device to use for tracheal intubation. This randomized clinical trial was done at the Teluk Intan Hospital, Perak, Malaysia, from March 2020 to February 2021. Sixty-five medical officers participated in this study. The results showed that the mean time for tracheal intubation was significantly shorter when the participants were using the C-MAC than the conventional direct laryngoscope and McGrath. (C-MAC: 20.8 seconds, Direct Laryngoscope: 27.7 seconds, McGrath: 34.6 seconds) The results showed that C-MAC andMcGrath had a better first-attempt success rate than conventional direct laryngoscopes. C-MAC scored the highest first-attempt success rate, followed by McGrath. (95% compared to 83%) Regarding Cormack-Lehane grading, the C-MAC device showed a better view than McGrath and Direct Laryngoscope. The preferred device by medical officers for tracheal intubation was the C-MAC. (45% compared to other devices) In conclusion, the C-MAC device was superior in first attempt success rate and was the most preferred device compared to McGrath and direct laryngoscope. However, using the C-MAC device must be accompanied by adequate training and practice.

A manikin study comparing the performance of traditional Macintosh laryngoscope, GlideScope®, Airtraq®, and video-optical intubation stylet in endotracheal intubation used by emergency doctors in simulated difficult airway intubation: A pilot study

Background: The video-optical intubation stylet (VS) is a slim, rigid but flexible intubating device that aids physicians to intubate patients, particularly with difficult airways. Objectives: The objective of this study was to compare the performance of emergency department doctors in using different intubating devices for intubation in an airway manikin simulating different difficult airway scenarios. Methods: Thirty emergency department doctors were recruited in a pilot study. Their performance of using traditional Macintosh laryngoscope, GlideScope®, Airtraq® and C-MAC® Video Stylet were compared in three situations: normal, restricted cervical motion and limited oral aperture. The time for intubation, first attempt success rate, failure rate, dental injury and the subjective ease of different devices by the participants were compared. Result: The mean intubation time by VS in each scenario was significantly shorter compared with other devices (Normal: 19.77s vs 24.67–28.19s, p = 0.014; Cervical restriction: 20.85 vs 26.17–31.26s, p = 0.008; Limited oral aperture:19.03 vs 29.35, p = 0.001). However, there was no significant difference in failure rate or first attempt success rate. The incidence of dental injury was significantly lower with VS than other laryngoscopes (p = 0.001, p &lt; 0.05 and p &lt; 0.05 in normal, cervical restriction and limited oral aperture scenarios, respectively). Moreover, participants appreciated that VS was the easiest device to intubate in each scenario. (p &lt; 0.05 in all scenarios) Conclusion: The performance of VS was comparable to or even better than the commonly used laryngoscopes in the emergency department in airway management. When adequate training is provided, VS can be a potentially good alternative for tracheal intubation in different situations.

A learning curve of a novel multimodal endotracheal intubation assistant device for novices in a simulated airway: a prospective manikin trial with cumulative sum method.

BackgroundAwake fiberoptic intubation is conventionally performed in anticipated difficult airways. However, obstruction by secretions and sputum makes it challenging for novices. A prototype of a novel multimodal endotracheal intubation assistant device (MEIAD) was developed for an indication of airway according to end-tidal carbon dioxide (ETCO2) and image. At the tip, 4 sampling tubes collected ETCO2 concentration. The airway direction is located according to an advanced algorithm based on 4 directions’ concentrations. It assists awake intubation, especially with unclear view field. The objective was to analyze the learning curve of MEIAD for novices on a manikin by cumulative sum method (CUSUM) and evaluate the utility.MethodsA total of 16 novice residents with less than 2-year clinical experience were enrolled. After instruction, each individual exercised 40 insertions with MEIAD on a difficult airway simulation. Insertion success (defined as a visualization of the carina within 120 seconds), insertion time (the time from when the guiding scope entered the nasal cavity to the carina was visible), and self-confidence score (subjective score with a numerical rating scale from 0 to 10) were recorded. The acceptable and unacceptable failure rates of CUSUM were set as 15% and 30%, respectively. The exercises were divided into 2 phases (phase 1: 1–20, phase 2: 21–40) for further evaluation. All continuous data were expressed by median (IQR, interquartile ranges) and analyzed using Mann-Whitney test. All categorical variables were expressed as percentages and compared by the χ2 test.ResultsAmong the 16 residents, 15 were able to cross the lower decision boundary in an average of 21.27±9.51 attempts using the novel device. The insertion time [24.0 (17.0–42.0) vs. 17.5 (14.0–28.0) seconds, P<0.001] and success rate (88.4% vs. 97.5%, P<0.001) were improved with increased experience. The confidence score was significantly improved from 2.5 (1.3–4.0) to 7.0 (7.0–8.0).ConclusionsMEIAD showed a satisfactory learning curve and efficacy on the manikin for novices. However, as a small exploratory manikin trial, the results cannot be replicated in clinical practice. MEIAD is expected to be further improved and potential to be an alternative device for difficult airways.

Comparison of Airtraq DL™ and Macintosh laryngoscope for double-lumen tube placement in simulated difficult airway: A randomised study.

ABSTRACTBackground and Aims:The Airtraq DL ™ is a prototype channeled video laryngoscope, designed specifically for endobronchial intubation with a double-lumen tube (DLT). Evidence on its superiority over Macintosh laryngoscope for DLT placement in the difficult airway is limited. This study compared the efficacy of both these laryngoscopes in the simulated difficult airway.Methods:A prospective randomised controlled study was conducted on 52 patients undergoing elective thoracic surgery with lung isolation using a left-sided DLT. The patients were randomised into Airtraq DL ™ group (group A) and Macintosh group (group M). The primary objective was to compare the time required for intubation, and the secondary objectives were to evaluate time to best glottic view, Cormack–Lehane (CL) grading, intubation difficulty score (IDS), manoeuvres, attempts at intubation, haemodynamic response and complications. Operating anaesthesiologists were also asked to grade the ease of laryngoscopy and intubation for both devices on a 4-point Likert scale.Results:The mean time to intubation was found to be lesser in group A than in group M (18 ± 6.91 s vs 25.48 ± 9.47 s, P = 0.003). Group A showed better CL grading (P ≤ 0.001), lesser requirement of manoeuvres (P = 0.02) and lower IDS (P = 0.003). Also, group A had significantly better Likert scale results as compared to group M.Conclusion:The Airtraq DL ™ is superior to Macintosh laryngoscope as it requires lesser time for intubation and provides favourable intubating conditions (better CL grading, lesser manoeuvres, lower IDS and improved Likert scales) for double-lumen placement in the simulated difficult airway.

Effects of head-elevated position on tracheal intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway: a prospective randomized crossover study

BackgroundThe head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway.MethodsSixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation.ResultsThe mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P < 0.0001). MCL grade 1 or 2a was achieved in 56 (85.9%) and 28 (43.7%) of patients in the head-elevated and head-flat positions, respectively (P < 0.0001). Optimization maneuvers for intubation were required in 7 (21.9%) and 17 (53.1%) patients in the head-elevated and head-flat positions, respectively (P < 0.0001). The IDS scores and time to intubation did not differ significantly between the two positions.ConclusionIn the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers.Trial registrationThis trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021.

Comparing S-Guide® and Gliderite® Times to Assist Video laryngoscopic Intubation in Patients with Simulated Difficult Airways: A Single-Blinded Randomized Prospective Study.

Objective:Gliderite®, one of the first stylets designed specifically to assist tracheal intubation with non-channeled curved blades video laryngoscopes, can cause injury. The S-Guide® is a new, malleable, intubating guide allowing oxygenation. Its soft tip is designed to prevent trauma. We aimed to compare the duration of tracheal intubation with S-Guide compared to Gliderite using a C-MAC® D-Blade® video laryngoscope in patients with simulated difficult airways. Methods:We performed a single-blinded prospective randomized study, with 50 adult patients requiring orotracheal intubation under general anaestheesia in Lausanne University Hospital. A cervical collar was fitted around the patient’s neck to simulate difficult intubation conditions. Exclusion criteria were American Society of Anesthesiologists (ASA) >3, BMI > 35 kg m2, known or at risk of difficult intubation, and risk of aspiration of gastric content. We recorded T1: time of identification of the glottis; T2: time to inflate the cuff, and T3: total intubation time (capnography curve appearance). Secondary outcomes were the presence of arytenoid contact during intubation and postoperative airway discomfort.Results:There were no significant differences between T1 and T2 (seconds) while using the S-Guide or Gliderite, respectively: 14.6 [9.6-18.6] vs 16.5 [11.0-20.6]; P = .368 and 43.3 [33.2-49.3] vs 46.3 [35.6-61.5], P = .308. T3 was significantly shorter in the S-Guide group: 58.1 [50.2-61.8] vs 65.3 [57.6-78.7], P = .044. Fewer arytenoid contact occurred during intubation using the S-Guide (P = .032), without difference in postoperative airway discomfort.Conclusion:S-Guide-assisted tracheal intubation, with a C-MAC D-Blade in simulated difficult airways, allows successful and faster intubation than with the Gliderite Stylet.

Emergency cricothyroidotomy in difficult airway simulation \u2013 a national observational study of Air Ambulance crew performance

BackgroundAdvanced prehospital airway management includes complex procedures carried out in challenging environments, necessitating a high level of technical and non-technical skills. We aimed to describe Norwegian Air Ambulance-crews’ performance in a difficult airway scenario simulation, ending with a “cannot intubate, cannot oxygenate”-situation.MethodsThe study describes Air Ambulance crews’ management of a simulated difficult airway scenario. We used video-observation to assess time expenditure according to pre-defined time intervals and technical and non-technical performance was evaluated according to a structured evaluation-form.ResultsThirty-six crews successfully completed the emergency cricothyroidotomy with mean procedural time 118 (SD: ±70) seconds. There was variation among the crews in terms of completed procedural steps, including preparation of equipment, patient- monitoring and management. The participants demonstrated uniform and appropriate situational awareness, and effective communication and resource utilization within the crews was evident.ConclusionsWe found that Norwegian Air Ambulance crews managed a prehospital “cannot intubate, cannot oxygenate”-situation with an emergency cricothyroidotomy under stressful conditions with effective communication and resource utilization, and within a reasonable timeframe. Some discrepancies between standard operating procedures and performance are observed. Further studies to assess the impact of check lists on procedural aspects of airway management in the prehospital environment are warranted.

Split Type Postman videolaryngoscope: The newer device versus the standard Macintosh laryngoscope in simulated difficult airway - A new hope for difficult intubation scenarios.

Background and Aims:Studies on simulated difficult airway provide an opportunity to evaluate the performance of intubation devices for use in limited neck mobility. We did a comparative study between Split Type Postman videolaryngoscope and Macintosh laryngoscope, evaluating their efficacy for tracheal intubation in a simulated difficult airway.Methods:Sixty American Society of Anesthesiologists (ASA) physical status I and II patients aged between 20 and 60 years, having body mass index <30 kg m−2, posted for elective surgery under general anaesthesia were allocated to two groups. Endotracheal intubation was done with either Split Type Postman videolaryngoscope or Macintosh laryngoscope after placing a rigid cervical collar around the neck to simulate a difficult airway. The primary outcome measure was time for tracheal intubation as assessed from the time of introduction of laryngoscope between incisors till visual confirmation of passage of endotracheal tube through the vocal cords by the anaesthesiologist. Success rate of intubation, number of attempts required for successful intubation, haemodynamic alterations and airway complications were measured as secondary outcomes.Results:Time taken for endotracheal intubation was significantly shorter in Postman group (26.23 ± 7.18 vs. 31.43 ± 9.83 s) (P = 0.012) compared to Macintosh group. The groups were comparable in terms of incidence (P = 0.491) of successful intubation, with significantly lesser number of attempts required for intubation in Postman group (P = 0.022). The incidence of airway trauma and postoperative sore throat was comparable between the groups.Conclusion:Split Type Postman videolaryngoscope was superior with respect to intubation characteristics when compared to conventional laryngoscope.

Comparative Efficacy Analysis of Intubation Profile in Airtraq Video Laryngoscope Versus Macintosh Laryngoscope in Simulated Difficult Airway Using Cervical Collar

Aim: Comparative efficacy analysis of laryngoscopes -Airtraq vs macintosh - using Intubation Time and Intubationdifficulty score in simulated difficult airway using cervical collar.Methods: Peculiarity is simulated difficult airway by use of cervical collar. A prospective interventionalrandomizedstudy conducted on 60 adult ASA grade-I&amp;II patients scheduled for surgery in tertiary care center.Tracheal Intubation 1. Group(AVL) Airtraq videolaryngoscope (n=30) 2. Group(ML) Macintoshlaryngoscope(n=30). Parameters observed: 1) Intubation Time- seconds 2) Intubation Difficulty Score (IDS) comprised Numbersof-1. intubation attempts 2.operators 3.alternative intubation techniques, 4. Glottic exposure. 5. paramatriccomparison lifting force required during laryngoscopy, Necessity for external laryngeal pressure, Position of thevocal cords.Results: With airtraq laryngoscope intubation discoursed outcomes intubation time is irrelevant with difficultairway where it is highly associated in case of macintosh laryngoscope. Intubation time &amp; difficulty score iscommentating use of Airtraq laryngoscope.Conclusions: The enhanced visual interiors expedite in such a way that intubation time in Airtraq is not dependenton IDS like Macintosh but on neuromuscular reflexes of performer, commentating the superiority of Airtraq overMacintosh

Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

BackgroundThe GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations.MethodsFifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded.ResultsThere was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different.ConclusionsIn patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.