Duration Of Successful Intubation Research Articles

Intubation difficulty scale contributors and time delay in clinical practice.

The intubation difficulty scale (IDS) includes 7 contributors that provide a comprehensive assessment of difficult intubation. However, the effect of each contributor is unclear, and the scale has not been revalidated recently and has not been validated in orient. This study determined the duration of successful intubation (DSI) for each of these 7 contributors.The patients were intubated by attending anesthesiologists. The duration and other data were recorded by 2 research assistants. Anaesthesiologists reported the IDS and their perceptions. A linear mixed-effects model with a DSI was constructed using IDS factors.In total, 1095 patients were enrolled. The average DSI was 23.9 ± 21.8 seconds (37.1% IDS = 0). All 7 factors were independently associated with duration, with the exception of vocal cord adduction. The best model was as follows: DSI (in seconds) = 15.2 + 31.1 (number of additional attempts) + 26.2 (number of additional operators) + 11.4 (number of alternative techniques) + 7.9 (increased lift force) + 4.9 (external laryngeal pressure) + 3.5 (Cormack grade 1). The mixed models were similar except for the regression coefficient for the number of alternative techniques that decreased from 11.4 to 6.9 seconds.We confirmed that each IDS contributor affects the DSI and validated a prediction model with 6 IDS contributors. This prediction model may facilitate the development of strategic plans for critical airway management. Furthermore, it could improve simulations and monitor learning progress and help provide valuable feedback.

Comparison of channelled vs unchannelled video laryngoscope- A prospective randomised trial

Introduction: Conventional laryngoscopy using the traditional Macintosh blade remains the commonest method of tracheal intubation in the routine clinical scenario. Video laryngoscopes have taken over this position in many scenarios as they have been proved successful over conventional laryngoscope. There are several types of video laryngoscopes available with multiple advantages over one another. We aimed to compare the performance of the Airtraq and McGrath when performing tracheal intubation in routine anaesthesia practice. Materials and Methods: Sixty patients posted for surgery requiring endotracheal intubation were randomized to undergo intubation using an Airtraq (n=30) or McGrath (n=30) video laryngoscope. Primary end points were total duration of intubation, overall success rate of tracheal intubation, number of optimization manoeuvres used and ease of intubation between the two groups. Results: We observed that the duration of successful intubation was shorter in Airtraq 19.18 (±2.86) secs) than in the McGrath laryngoscope.27 (±5.09) secs)* P A significantly better Cormack lehane view was obtained with the Airtraq. Grade I in 73.3% with the Airtraq group versus 50% in the McGrath group, p Conclusion: We conclude that the Airtraq laryngoscope facilitates a more rapid and successful intubation as compared to McGrath in routine clinical practice. Keywords: Airtraq, McGrath, Intubation.

EXPERIENCE OF VIDEO LARYNGOSCOPY DURING TRACHEAL INTUBATION FOR EMERGENCY INDICATIONS IN THE PRACTICE OF AN ANESTHESIOLOGIST AND RESUSCITATOR

Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.

Ultrasound-guided versus Shikani optical stylet-aided tracheal intubation: a prospective randomized study

BackgroundTo compare ultrasound-guided tracheal intubation (UGTI) versus Shikani optical stylet (SOS)-aided tracheal intubation in patients with anticipated normal airway.MethodsSixty patients aged 18–65 years old who presented for elective surgery under general anesthesia were recruited in this prospective randomized study. They were assigned into two equal groups, either an ultrasound-guided group (Group UG, n = 30) or an SOS-aided group (Group SOS, n = 30). After the induction of anesthesia, the tracheal intubation was performed by a specified skilled anesthesiologist. The number of tracheal intubation attempt and the duration of successful intubation on the first attempt were recorded. Complications relative to tracheal intubation including desaturation, hoarseness and sore throat were also recorded.ResultsThe first-attempt success rate is 93.3% (28/30) in Group UG and 90% (27/30) in Group SOS (P = 0.640). The second-attempt was all successful for the 2 and 3 patients left in the two groups, and the overall success rate of both groups was 100%. The duration of successful intubation on the first attempt of Group UG was not significantly different from that of Group SOS (34.0 ± 20.8 s vs 35.5 ± 23.2 s, P = 0.784). One patient in Group SOS had desaturation (P = 0.313), and there was none hoarseness in the two groups. Sore throat was detected in both group (4 in Group UG, 5 in Group SOS, P = 0.718).ConclusionUltrasound-guided tracheal intubation was as effective as Shikani optical stylet-aided tracheal intubation in adult patients with anticipated normal airway.Trial registrationChinese Clinical Trial Registry, ChiCTR-IIC-17010875. Date of Registration: 15 March 2017.

The Comparison of Direct Laryngoscopy and Video Laryngoscopy in Pediatric Airways Management for Congenital Heart Surgery: A Randomized Clinical Trial.

BackgroundAirway management in patients with hereditary heart disease is an important therapeutic intervention.ObjectivesThe purpose of this study was to compare direct laryngoscopy (DL) with video laryngoscopy (VL) in pediatric airways management for congenital heart surgery.MethodsThis study was designed as a prospective randomized clinical trial. Two consecutive groups of 30 patients undergoing elective noncyanotic congenital heart surgery. The patients were divided into direct laryngoscopy versus video laryngoscopy for intubation of the trachea. The main outcomes were the number of success rate in the first attempt, and the secondary outcomes were the duration of successful intubation and complications, such as desaturation and bradycardia.ResultsIntubation procedure time was measured as 51.13 ± 17.88 seconds for the group with direct laryngoscopy and 59.66 ± 45.91 seconds for group with VL that was significant (P = 0.006). In DL group, 22 patients were intubated on the first attempt, 8 patients on the second attempt, and 6 patients on the third attempt, compared to 24, 6, and 2 respectively, in VL group. The differences were significant only in the third attempt between groups (P = 0.033). The important difference established in heart rate (HR) and SpaO2 amounts between the two groups at any time (P < 0.05).ConclusionsVL can produce better visualization for intubation of trachea in congenital heart disease, but this is time-consuming. Indeed, training in the use of the VL should be increased to reduce the time required for performance. Moreover, further studies are recommended to approve these helpful findings.

Comparative Study of Intubation Performance between Macintosh, the Channeled King Vision and the C-MAC D-Blade Videolaryngoscope in Controlled Hypertensive Patients

Background: The common cause of anesthesia related injury is inability to intubate the trachea. Video laryngoscopes present an enlarged video image of glottis while intubating the trachea. The aim of this study is to compare efficacy of intubation by Macintosh with C-MAC D-Blade and King Vision video laryngoscope (VL) in controlled hypertensive patients. Patients and methods: 105 ASA II T2: just before intubation; T3: 2 min after intubation; T4: 5 min after intubation. Primary outcome: time and number of attempts required to successful intubation. Secondary outcomes: ease of laryngoscope insertion, Quality of view, Assist maneuvers, Intubation difficulty, Complications. Results: Differences in heart rate and mean blood pressure between all groups were statistically significant at T3&T4. Differences in duration of successful intubation were statistically significant between group (M) and group(C), also between group (M) and group (K). Statistically significant differences were obtained between all groups regarding quality of view of glottis, ease of insertion of laryngoscope, and use of assist maneuvers for intubation. Conclusion: Video laryngoscopes provide hemodynamic stability and better view of glottis than Macintosh during intubation. King Vision VL has advantages of ease of insertion, less need of assist maneuvers for intubation, with less complication. Thus, it is beneficial to use King Vision for intubation in hypertensive patients.

Airtraq(®) versus Macintosh laryngoscope: A comparative study in tracheal intubation.

Background:The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation.Materials and Methods:Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups.Results:We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001.Conclusion:Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant.

Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation

BackgroundFor patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar.MethodsAnesthesia was induced with propofol, remifentanil, and rocuronium. After a Philadelphia cervical collar applied, patients were randomly assigned to tracheal intubation with an Airtraq (Group A, n = 25) or with conventional laryngoscopy (Group L, n = 25). Measurements included intubation time, success rate of first intubation attempt, number of intubation attempts, and percentage of glottic opening (POGO) score. Mean blood pressure and heart rate were also recorded at baseline, just before and after intubation.ResultsThe success rate of the first attempt in Group A (96%) was significantly greater than with the Group L (40%). POGO score was significantly greater in Group A (84 ± 20%) than in Group L (6 ± 11%). The duration of successful intubation at first tracheal intubation attempt and hemodynamic changes were not significantly different between the two groups.ConclusionsThe Airtraq offers a better laryngeal view and higher success rate at first intubation attempt in patients who are applied with a Philadelphia cervical collar due to suspicion of cervical spine injury.