Intubation Technique Research Articles

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

BackgroundWe aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery.MethodsA total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value.ResultsTen variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%).ConclusionsFour radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

Respiratory management of adult patients with acute respiratory distress syndrome due to COVID-19.

Respiratory management of adult patients with acute respiratory distress syndrome due to COVID-19.

Comparison of blind intubation and a smartphone-based endoscope-assisted intubation in rabbits

ObjectiveTo compare between blind and smartphone-based endoscope-assisted techniques for endotracheal intubation in rabbits. Study designProspective clinical study. AnimalsA total of 34 rabbits. MethodsRabbits were assigned to four groups: intubation by a veterinary anesthesiologist (VA) or an exotic pet medicine specialist (EPS) using blind or endoscope-assisted techniques. Propofol dose, number of attempts until successful intubation, total time for intubation, duration of the successful attempt and occurrence of lingual cyanosis/laryngeal lesions were recorded. Data were analyzed by t test, Wilcoxon–Mann–Whitney U test or chi-square test. Pearson correlation for body weight was performed. ResultsThe success rate of blind intubation was 88.9% and 77.8% for VA and EPS, respectively. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 3.1 (0–6.2) mg kg–1, 19, 2 (1–5), 79 ± 65 and 30 ± 20 seconds for VA and 1.5 (0–4.5) mg kg–1, 24, 3 (1–5), 136 ± 92 and 38 ± 16 seconds for EPS. The success rate of endoscope-assisted intubation was 87.5% for both operators. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 2.5 (1.3–7.4) mg kg–1, 22, 3 (1–5), 170 (65–368) and 46 (22–150) seconds for VA and 3.2 (0–6) mg kg–1, 11, 1 (1–4), 56 (27–432) and 55 (26–79) seconds for EPS. VA performed blind intubation more quickly, propofol dose was lower and cyanosis was less frequent than in the endoscope-assisted group. Conclusions and clinical relevanceBoth techniques were reliable for rabbit endotracheal intubation. Best results were achieved when the operator was experienced in the technique. The smartphone-based endoscope is a useful aid for rabbit intubation.

Enhanced Experiential Learning in Airway Management: Surgical Modification of Cadavers.

Failure of airway management remains a significant source of morbidity and mortality. Advanced airway management has been addressed effectively by simulation-based training. However, simulation of difficult airways in manikins is limited by the pre-set conditions provided by the manufacturer. Life-like conditions in the form of the softness of the tissue and true anatomy as seen in cadaver models are needed to create simulated models with a closer resemblance to real patients. The goal of this study was to determine the feasibility of simulating difficult airway from submandibular abscess in cadaver models by surgical modification of the cadaver heads for use in enhanced experiential learning of the management of difficult airways. The cadaver heads were modified surgically to simulate a submandibular abscess. The models were used in an airway course where participants provided feedback on the realistic nature of the model and its benefits for difficult airway training. The ease of tracheal intubation of the models with the assistance of video laryngoscopy was assessed. The modified cadavers were acceptable in simulating difficult airway as demonstrated by the feedback from the participants. All participants (100% [95% confidence interval = 89.1%-100%]) found the models to be realistic and beneficial for difficult airway training. A good proportion (56.3%) felt that the intubation technique was made easier with the video laryngoscopy. Cadavers can be modified to simulate pathologies associated with difficult airways. These models can be used to enhance experiential learning and the management of difficult airways.

LOCALANAESTESIA FOR AWAKE FIBEROPTIC INTUBATION: A COMPARISON OF TWO TECHNIQUES- AIRWAY NERVE BLOCKS VS 'SPRAY AS YOU GO' TECHNIQUE

Background- Awake fiberoptic intubation is the recommended technique for anticipated difficult airway management which requires effective local anesthesia for patient's comfort and co-operation. In this study, we compared airway nerve blocks and “Spray as you go” technique for awake fiberoptic intubation in difficult airway patients. Method- Sixty adult patients with an anticipated difficult airway with Mallampati Class III and IV were selected and randomized into two groups for awake fiberoptic intubation. Each group receiving lignocaine as a local anesthetic with either of two different methods. Group A (n=30) via airway nerve blocks using transtracheal and superior laryngeal nerve block; and group B (n=30) via intubating fiberscope using ‘spray as you go’ technique. We compared two groups using the Number of attempts for intubation, Intubation time, Intubating conditions, Cough count, Hemodynamic response, Severity scale [patients comfort], and the additional required dose of lignocaine used. Descriptive statistics were done for all data. p-value&lt;0.05 was considered statistically significant. The result- we found that airway nerve blocks provide better local anesthesia by providing good intubating conditions with less cough count, less intubation time, and better hemodynamic stability as compare to spray as you go group. None of the patients showed any evidence of lignocaine toxicity. But an additional dose of lignocaine used was significantly more number of patients in the spray as you go, group. However patient comfort and acceptance is equal in both groups as patient severity score was the same in both groups and all patients got successfully intubated in both the groups Conclusion- airway nerve block technique of local anesthesia is better than spray as you go method however spray as you go technique can be used in cases where airway blocks are not possible.

Preoperative retrograde reintubation during partial tracheal resection and anastomosis in a cat with severe tracheal stenosis

A seven-month-old European shorthair cat was presented with dyspnoea and expiratory stridor due to a severe obstructive tracheal stenosis. Surgical resection of the stenotic area and anastomosis of the remaining parts of the trachea were performed. The anaesthetic management of a patient during tracheal resection is an anaesthetic challenge. Total intravenous anaesthesia with propofol and a continuous rate infusion of fentanyl were chosen to maintain a surgical anaesthetic depth and to ensure pain control. Endotracheal extubation was necessary at a specific time during the surgical procedure. However, subsequent oral reintubation was complicated, due to patient positioning and the presence of laryngeal spasms. Reintubation was only successful by means of a modified retrograde intubation technique. Recovery was satisfactory and uneventful.

Practical Guidance for Tracheal Intubation of Patients With COVID-19

The novel coronavirus (COVID-19) pandemic has created an urgent need for pragmatic best-practice approaches that maximize safety for both patients and care providers during the tracheal intubation of patients who are suspected or confirmed to be infected. Literature reporting experiences during the severe acute respiratory syndrome (SARS) epidemic revealed that providers who engaged in tracheal intubation had a substantial increase in risk of viral transmission.1-3 Longstanding principles of emergency airway management, including excellent preoxygenation and rapid sequence intubation techniques, apply to patients with suspected or confirmed COVID-19 infection.

Simultaneous en bloc endotracheal tube insertion with GlideScope® Titanium™ video laryngoscope use: a randomized-controlled trial

Intubation-associated trauma with the GlideScope is rare, but when it occurs, it is likely due to advancing the endotracheal tube (ETT) blindly between the direct view of the oropharynx and the video view of the glottis. It is also occasionally difficult to advance the ETT to the glottic aperture despite a good view of the glottis on the monitor. One technique to potentially address both issues is to introduce the ETT en bloc with the GlideScope, thus visualizing the ETT tip throughout its entire path. We hypothesized that this en bloc technique could be faster and potentially easier than the standard technique. Fifty patients with normal-appearing airways who required orotracheal intubation for elective surgery were randomly allocated to intubation with either the en bloc or the standard (GlideScope-first-then-ETT) technique. A three-dimensional printed clip was utilized to secure the ETT to the GlideScope during en bloc insertion. The primary outcome was time to intubation, defined from mask removal to first end-tidal carbon dioxide detection, recorded by a blinded observer. Secondary outcomes were subjective ease of intubation (100-mm visual analogue scale [VAS], 0 = easy; 100 = difficult), number of intubation attempts/failures, and incidence of oropharyngeal trauma (bleeding). The median [interquartile range (IQR)] intubation time was 36 [31-42] sec with the en bloc technique vs 41 [37-50] sec with the standard technique (difference in medians, 5 sec; 95% confidence interval [CI], 2 to 11; P = 0.008). The median [IQR] ease of intubation VAS was 11 [9-21] mm with the en bloc technique, and 15 [11-24] mm with the standard technique (difference in medians, 4 mm; 95% CI, -2 to 8; P = 0.19). Laryngoscopic grade and number of intubation attempts were similar between the groups; there was no oropharyngeal trauma noted. In this study of video laryngoscopy, intubation was slightly faster with the en bloc technique than with the standard GlideScope intubation technique, although the clinical importance of this difference is unknown. www.clinicaltrials.gov (NCT02787629); registered 1 June 2016.

Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients.

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.

Suitability and realism of the novel Fix for Life cadaver model for videolaryngoscopy and fibreoptic tracheoscopy in airway management training

BackgroundVideolaryngoscopy is increasingly advocated as the standard intubation technique, while fibreoptic intubation is broadly regarded as the ‘gold standard’ for difficult airways. Traditionally, the training of these techniques is on patients, though manikins, simulators and cadavers are also used, with their respective limitations. In this study, we investigated whether the novel ‘Fix for Life’ (F4L) cadaver model is a suitable and realistic model for the teaching of these two intubation techniques to novices in airway management.MethodsForty consultant anaesthetists and senior trainees were instructed to perform tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy in four F4L cadaver models. The primary outcome measure was the verbal rating scores (scale 1–10, higher scores indicate a better rating) for suitability and for realism of the F4L cadavers as training model for these techniques. Secondary outcomes included success rates of the procedures and the time to successful completion of the procedures.ResultsThe mean verbal rating scores for suitability and realism for videolaryngoscopy was 8.3 (95% CI, 7.9–8.6) and 7.2 (95% CI, 6.7–7.6), respectively. For fibreoptic tracheoscopy, suitability was 8.2 (95% CI, 7.9–8.5) and realism 7.5 (95% CI, 7.1–7.8). In videolaryngoscopy, 100% of the procedures were successful. The mean (SD) time until successful tracheal intubation was 34.8 (30.9) s. For fibreoptic tracheoscopy, the success rate was 96.3%, with a mean time of 89.4 (80.1) s.ConclusionsWe conclude that the F4L cadaver model is a suitable and realistic model to train and teach tracheal intubation with videolaryngoscopy and fibreoptic tracheoscopy to novices in airway management training.

Airway Abnormalities in Patients With Congenital Heart Disease: Incidence and Associated Factors

Airway abnormalities complicate the perioperative course of patients with congenital heart disease (CHD), leading to significant morbidity and mortality. The literature describing airway abnormalities in those patients is scarce. This study aimed to determine the incidence of airway abnormalities in CHD patients and identify associated factors, genetic syndromes, and cardiac diagnoses. Retrospective study conducted after institutional review board approval. Tertiary children's hospital. Patients presenting for cardiac diagnostic, interventional, or surgical procedures from 2012 to 2018. A total of 9,495 encounters were reviewed. age >18 years. Methods/Interventions: Age, weight, sex, intubation technique, number of intubation attempts, and difficult intubation (DI) were recorded. Using the International Classification of Diseases, Ninth and Tenth Revisions codes, genetic syndromes, acquired and congenital airway abnormalities, and cardiac diagnoses were identified. Multivariate generalized estimating equations modeling was used to identify independent predictors of airway abnormalities. A total of 4,797 patients, with 8,657 encounters were included. The median age was 1.3 years (interquartile range [IQR]: 0.2-6.0) and weight was 9.2 kg (IQR: 4.3-19.2), and 55% were male. A total of 16.7% had at least 1 genetic syndrome; 8.5% had congenital airway abnormalities and 9.7% acquired. Incidence of DI was 1.1%. The most common syndromes were Down, 22q11.2 microdeletion, and CHARGE. The most frequent congenital airway abnormalities were laryngomalacia and bronchomalacia, and the most frequent acquired were partial and total vocal cord paralysis. The likelihood of a coexistent airway abnormality should be considered in premature CHD patients, weight <10 kg, and in those with specific cardiac lesions and a concomitant genetic syndrome. Preoperative identification of patients at high risk of airway abnormalities is useful in planning their perioperative airway management.

Finding a way for airway: a retrospective study.

Maxillofacial trauma is complex kind of injury that requires complex treatment, hence it is difficult in selecting the type of intubation technique depending on trauma. With the advent of various technologies and devices, surgeon and anesthetist should select right method of intubation that will benefit patient. In a retrospective study, patients of either sex, admitted in Lata Mangeshkar Hospital under Oral and Maxillofacial Surgery unit for treating maxillofacial trauma operated during year 2018 to year 2019 as elective basis were studied. Of 78 patients, the majority (37, 47.4%) were in the 21-30 age group, followed by the young adults 31-40 years age group (19, 24.3%). Mandible fracture was found to be the most common injury in 35 patients (44.3%) followed by fracture zygoma in 26(33.3%) patients and panfacial in eight patients (10.2%). There was frontal bone fracture in three patients (3.8%). Fiberoptic intubation under sedation was carried out in 34 (43.5%) and submental intubation in 20 (25.6%) and nasal intubation with direct visualization of vocal cords in 14 (17.9%) and blind nasal intubation was performed in eight (10.2%). The results of this study suggest that the old concept of securing the airway in difficult situation by tracheostomy should be revised.

Finding a way for airway: a retrospective study

Background Maxillofacial trauma is complex kind of injury that requires complex treatment, hence it is difficult in selecting the type of intubation technique depending on trauma. With the advent of various technologies and devices ,surgeon and anesthetist should select right method of intubation that will benefit patient. Methods In a retrospective study, patients of either sex , admitted in Lata Mangeshkar Hospital under Oral and Maxillofacial Surgery unit for treating Maxillofacial trauma operated during year 2018 to year 2019 as elective basis were studied. In total 78 patients [Table 1], majority of patients were in the age group of 21-30 years 37(47.4),followed by age group of young adults 31-40 years-19(24.3)Fracture mandible [Table 2] was found to be the most common injury in 35 patients (44.3%) followed by fracture zygoma in 26(33.3%) patients and panfacial in 8 patients (10.2%) There was frontal bone fracture in 3 patients (3.8%). Fiberoptic intubation under sedation was carried out in 34(43.5%) and submental intubation in 20(25.6%) and nasal intubation with direct visualization of vocal cords in 14(17.9%) and blind nasal intubation was done in 8(10.2%). Conclusions The results of this study suggest that the old concept of securing the airway in difficult situation by tracheostomy should be revised.

Radiographic Predictors of Difficult McGrath MAC Videolaryngoscopy in Patient Undergoing Cervical Spine Surgery.

McGrath MAC videolaryngoscopy is a useful technique for successful intubation in cervical spine-injured patients with manual in-line stabilization of the neck during intubation. We aimed to identify radiographic predictors of difficult McGrath MAC videolaryngoscopy in patient undergoing cervical spine surgery. Patients undergoing cervical spine surgery who were intubated with a McGrath MAC videolaryngoscope under manual in-line stabilization of the neck between June 2016 and August 2018 were included in this study. Data on airway-related variables and radiographic indices obtained from preoperative lateral cervical spine x-ray, magnetic resonance imaging, and computed tomography (CT) scans were retrospectively collected. Patients were divided into difficult and easy McGrath MAC videolaryngoscopic intubation groups on the basis of intubation time and the number of intubation attempts. In total, 183 patients were included in the study of which 33 (18%) showed difficult videolaryngoscopic intubation. In multivariate logistic regression analysis, atlanto-occipital distance (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.62-0.89; P=0.001) on lateral cervical spine x-ray, incisor-C1-C6 angle in neck extension on lateral cervical spine x-ray (OR, 1.12; 95% CI, 1.02-1.22; P=0.015), tongue area/oral cavity area ratio in the mid-sagittal plane of cervical magnetic resonance imaging or computed tomography (OR, 1.12; 95% CI, 1.05-1.19; P<0.001), and interincisor gap (OR, 0.92; 95% CI, 0.86-0.98; P=0.015) were independent risk factors for difficult videolaryngoscopic intubation. Radiographic variables indicating enlarged tongue relative to the oral cavity and limited neck extension were associated with difficult McGrath MAC videolaryngoscopy in patients undergoing cervical spine surgery with manual in-line cervical stabilization during intubation.

Direct laryngoscopy assisted fiberoptic intubation: A novel technique for the pediatric airway

ObjectiveTo introduce a novel intubation technique for difficult pediatric airways. MethodsThis two-provider technique requires a direct laryngoscope and a flexible fiberoptic laryngoscope. One provider performs direct laryngoscopy which allows for introduction of the flexible laryngoscope. The second provider inserts the flexible laryngoscope with the endotracheal tube loaded, through the oropharynx in to the subglottis. ResultsWe report three pediatric patients that were initially unable to be intubated by conventional methods. We were ultimately able to successfully intubate these patients with difficult airways using our novel technique. ConclusionsWe found that this technique of direct laryngoscopy assisted flexible fiberoptic intubation is a useful adjunct in select pediatric difficult airway patients.

Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy

ABSTRACT&#x0D; Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity.&#x0D; Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable.Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Difficult airway management practice changes after introduction of the GlideScope videolaryngoscope: A retrospective cohort study.

Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management. The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques. Retrospective cohort study. Tertiary care referral centre. Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems. Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P < 0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [before 149/8306 (1.8%); after 85/8517 (1.0%), P < 0.0001]. The GlideScope replaced flexible fibreoptic bronchoscopy in most cases with expected and unexpected difficult intubation. In patients with limited mouth opening, flexible fibreoptic bronchoscopy was still mostly the first choice after the introduction of the GlideScope. There was a 70% reduction in the use of other difficult intubation techniques after the introduction of the GlideScope [before 84/8306 (1.0%); after 22/8517 (0.3%), P < 0.0001)]. The GlideScope videolaryngoscope replaced flexible fibreoptic bronchoscopy for most patients with expected and unexpected difficult intubation. In the case of limited mouth opening, flexible fibreoptic bronchoscopy was still the first choice after the introduction of the GlideScope. The reduced use of flexible fibreoptic bronchoscopy raises concerns that residents may not be adequately trained in this essential airway management technique. GlideScope use was disproportionately greater than the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.

Short-Term Clinical Outcomes after Using Novel Deeper Intubation Technique (DIT) of Ileus Tube for Acute Bowel Obstruction Patients.

Background The ileus tube has been widely used for the treatment of acute small bowel obstruction. However, it is difficult to get the tube sufficiently adjacent to the obstruction site due to various reasons. Methods We developed a novel intubation technique, named Deeper Intubation Technique (DIT), by using the Zebra Urological Guidewire and digital gastrointestinal fluoroscopy, where we deepened the catheter intubation, and further compared the effects of DIT with the Traditional Intubation Technique (TIT) on the short-term clinical outcomes of 183 patients. Results The average intubation depth of DIT apparently exceeds that of TIT (213.89 ± 31.11 vs. 134.67 ± 18.22 cm, P < 0.001). Compared with patients in the TIT group, patients in the DIT group got a lower pain score (P < 0.001), shorter recovery time for anal exhaust defecation (2.87 ± 1.50 vs. 3.37 ± 1.52 d, P = 0.040), higher recovery rate in anal exhaust defecation (24 h, 16.8% vs. 5.7%, P = 0.021; 48 h, 46.3% vs. 27.3%, P = 0.009), better symptomatic remission rate and imaging relief rate (P < 0.05), and increased drainage volume (1006.88 ± 583.45 vs. 821.02 ± 358.73 ml, P = 0.009). Importantly, the emergency surgery rate in the DIT group was lower than that in the TIT group (3.2% vs. 13.6%, P = 0.014). In addition, the DIT procedure was effective for patients with adhesive obstruction but not for cancerous and stercoral bowel obstruction. Conclusion Compared to TIT, DIT produced better short-term clinical outcomes, indicating that DIT is a safe and feasible technique for the treatment of adhesive intestinal obstruction.

The use of modified bite block to improve the safety and efficacy of oral fiber optic intubation in patients with limited neck mobility: a randomized comparative study

BackgroundOne critical aspect of anesthesia is to provide airway management. Fiber optic intubation is the safest solution but can be difficult in patients with limited neck mobility. Insertion of the fiber optic bronchoscope through a modified bite block might facilitate intubation in such patients. Here, we performed fiber optic intubation without and with a bite block that was modified to compare the safety and efficacy of the two techniques.MethodSixty adult patients with limited neck mobility who were to undergo elective surgery with mandatory tracheal intubation under spontaneous ventilation were assigned to two groups. In group TR, the traditional technique of oral fiber optic intubation was performed without the use of a bite block. In group MB, the fiber optic was inserted through a modified bite block.ResultsBoth groups showed statistically significant increases from baseline in mean arterial pressure and heart rate during the first 3 min after intubation; this increase was marked in the TR group than in the MB group. Hemoglobin oxygen saturation was significantly greater in the MB group than in the TR group. The time to successful intubation was significantly shorter in the MB group than in the TR group. The quality of intubation field shows a significant difference in p value between MB and TR groups with the best result observed in MB.ConclusionOral fiber optic intubation with a modified bite block performed under spontaneous ventilation is safer and more effective than traditional fiber optic intubation for patients with limited neck mobility.

LO02: Direct laryngoscopy: is it becoming a lost art in resident education?

Introduction: Intubation is one of the highest-risk procedures performed in the emergency department (ED) on a regular basis. The British Columbia Airway Registry for Emergencies (BCARE) Network collects data from every ED intubation at two tertiary care centres and one community centre and serves as a valuable quality improvement tool. We compared intubation techniques, success, and complication rates between emergency medicine physicians and trainees. Methods: We completed an observational study of all patients intubated in the ED by resident trainees or attending physicians over a period of 28 months from July 2017 to November 2019. Respiratory therapists (RTs) completed a standardized data collection form after every intubation and the data was used to analyze techniques, success, and complication rates. Form completion compliance was periodically reviewed by cross-referencing patient names in the BCARE network with the radiology database for chest x-rays that were performed after intubation in the hospital. Results: 642 intubations were performed by EM physicians: 66 by PGY1-2 residents,141 by PGY3-5 residents, and 435 by staff physicians. Airway assessment prior to intubation was completed by PGY1-2 in 78.1% of cases, PGY3-5 in 67.9%, and staff in 62.6%. Direct laryngoscopy (DL) was chosen as first-choice technique 24.2% by PGY1-2, 24.8% by PGY3-5, and 30.1% by attending physicians. Bougie was used 2.7% of cases for all groups. First-pass success was 78.8% for PGY1-2, 86.5% for PGY3-5, and 85.7% for staff. Mean number of attempts were similar at 1.24, 1.18, and 1.20 for R1-2, R3-5, and staff, respectively. There were similar complication rates between all groups, on average 16.9%, with the most common being hypoxemia prior to induction, and desaturation following induction. There was a higher rate of staff performing second intubation attempts following junior residents (50.0%) than senior residents (26.3%). Conclusion: Trainees have a stronger preference to use video laryngoscopy (VL) than staff physicians as their first-line technique. Success rates were similar between senior residents and attending physicians, but significantly lower in junior residents, despite number of attempts being similar between the three groups. Complication rates were similar among all 3 groups. This data may suggest that a stronger emphasis for DL use among trainees is important.