Number Of Intubation Attempts Research Articles

INCIDENCE OF BRADYCARDIA IN INFANTS UNDERGOING INTUBATION WITH OR WITHOUT ATROPINE

Bradycardia is a life-threatening arrhythmia that endangers life by compromising blood flow to the brain. During intubation, its prevention is life-saving—the benefit of atropine in preventing bradycardia before intubation is controversial in the literature. Objective: The objective of the study was to find and compare the incidence of bradycardia with and without atropine. Methods: This single-centre randomised controlled trial was conducted at a tertiary care pediatric emergency department for six months. After applying inclusion and exclusion criteria, children were divided into two groups. Group 1 was given atropine before intubation, and group 2 was not. The overall incidence of bradycardia in subgroups was noted, along with the number of attempts and intubation time. Data was analysed using SPSS 26.0. Results: 86 patents were included in the study, with 43 in both groups. The mean age of the participants was 69.02+109.10 days. 48 (55.8%) were males and 38 (44.2%) were females. The incidence of bradycardia was 7% (6 Patients), with no statistically significant difference in both the groups (p-value was greater than 0.05). The number of attempts for intubation and intubation duration was also neither associated with bradycardia nor with atropine use. (p-value> 0.05).Conclusion: There is a higher incidence of bradycardia during intubation in children, with no significant difference in its occurrence with the use of atropine.

Comparison of channelled with non-channelled blade of King Vision videolaryngoscope for orotracheal intubation in patients undergoing emergency surgery: A randomised double blind study

BackgroundPatients undergoing emergency surgery can have both anatomical and physiological difficult airways. There being no consensus on the best strategy to secure such airways, hence the present study evaluated the clinical performance of the two blades of King Vision™ Videolaryngoscope (KVVL). MethodsThis prospective double blind study was done on fifty two patients of 18–80 years aged posted for emergency surgery under general anaesthesia (GA). Patients were randomly assigned to channelled (CH) and non-channelled (NC) group for intubation. The primary outcome was time to tracheal intubation with CH and NC blades. The secondary outcomes among the two groups noted were ease of videolaryngoscope (VL) blade insertion, time to optimal laryngeal view, fremantle score, number of intubation attempts, any manoeuver required to intubate and complications. Haemodynamic parameters were noted before induction, during preoxygenation before laryngoscopy and 5 min after endotracheal intubation. ResultsSignificant shorter time to intubation was noted in NC group (18s) compared with CH group (25s). The NC blade was easier to insert and the time to optimal laryngeal view was also shorter with NC group (7s) as compared to CH group (10s). Fremantle score was comparable among the two groups. Endotracheal tube (ETT) impingment on arytenoids was more common with NC blade. For intubation with CH blade, anticlockwise rotation of ETT was frequently required. ConclusionThe NC blade of KVVL was easier to introduce and resulted in faster intubation, thus favouring its use in patients undergoing emergency surgery under GA. The CH blade of KVVL required anticlockwise rotation to facilitate intubation.

Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial

Abstract Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility. Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance. Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups. Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.

Assessment of Different Indices as Predictors of Difficult Airway in Obese Patients.

Introduction Difficulties with tracheal intubation contribute to the morbidity and mortality associated with anesthesia. Suggested predictors for difficult airwayinclude, history of obstructive sleep apnea, high Mallampati score, elderly, male, short neck, and high Wilson score.However, none of these has high diagnostic accuracy particularly in obese population. Parameters used to quantify obesity such as Body Mass Index(BMI), mid arm circumference, skin fold thickness,etc. have not been used as independent predictors of difficult airway. This study has been designed to evaluate the accuracy of commonly used tools to assess difficult airway and to test other obesity markers as scale for assessing difficult airway i.e. Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3. Aim To assess BMI, Mallampati grading, Neck circumference and Thyromental distance as predictors of difficult airway in obese patients and to validate neck circumference to thyromental distance ratio and skin fold thickness as a tool for assessment of difficult airway (Bag mask ventilation grade ≥3 or Cormack-Lehane Grade≥3 on Direct Laryngoscopy or number of intubation attempts ≥3.) in obese patients. Methods This prospective observational study was carried out on 51 obese patients (as per BMI) of ASA gradeII, either sex, aged 23 to 57 years posted for elective surgery under general anesthesia with endotracheal intubation. After subjective assessment of difficult airway following data sets and variables were obtained - sex, weight, height, body mass index (BMI),Modified Mallampati class (MPG), Cormack-Lehane (CL) grade, adequacy of bag mask ventilation (BMV), number of endotracheal intubation attempts, patient's neck circumference (NC), thyromental distance (TMD), waist-hip ratio (WHR) and Skin fold thickness. The observations made during the study were statistically analyzed and correlated as predictors for difficult airway. Result Correlation of MPG to CL-grade (r-0.41, p-0.003), BMV (r-0.31, p-0.028) & No. of intubationattempts (r-0.37, p-0.007) was mild & statistically significant. Correlation of Neck Circumference with CL-grade (r-0.57, p-0.000), & No. of intubation attempts (r-0.62, p-0.000), found moderate & statistically significant, & with BMV was mild and statistically significant (r-0.48, p-0.000). Correlation of Thyromental Distance to CL-grade (r-0.65, p-0.000), BMV (r-0.70, p-0.000) & No. of intubationattempts (r-0.61, p-0.000) was moderate & statistically significant. Correlation of BMI to CL-grade (r-0.11, p-0.428), BMV (r-0.04, p-0.757) & No. of intubation attempts (r-0.16, p-0.257) was weak & not significant. Skin Fold Thickness showed no significant association with Difficult airway i.e., CL Grade (p-0.478), BMV (p-0.101), and No. of intubation attempts (p-0.143). Correlation of NC/TMD ratio with BMV (r-0.74, p-0.000), CL-grade (r-0.76, p-0.000), & No. of intubation attempts (r-0.77, p-0.000) wasmoderate & statistically significant. Conclusion NC, TMDand NC/TMD Ratio depicted a close association with airway difficulty in obese patients. Obesity grade is a risk factor for difficult airway but predictors of obesity including Skin Fold Thickness, individually did not showassociation with difficult airway (small sample size may be a limiting factor). None of the commonly performed tests alone has proven to be adequate in predicting difficult intubation in the obese population.

Prehospital Use of Waveform Capnography in Intubated Neonates

Introduction Routine continuous monitoring of endotracheal tube placement with waveform capnography is considered standard of care in the prehospital setting. However, maintaining this standard in neonatal patients remains a challenge due to low tidal volumes that do not tolerate the additional dead space ETCO2 attachments add. Additionally, continuous ETCO2 can increase the risk of ETT dislodgement or kinking because of the weight and size of the capnography attachments relative to the patient and tube size. We hypothesize that there is a gap in care of intubated neonates when compared to adults in the prehospital setting in terms of continuous monitoring of ETT placement. Methods Data were obtained from a single air medical agency. Through a retrospective chart review, records of intubated neonates (<28 days), children (≥28 days–12 years), adolescents (13–18 years), and adults (aged ≥18 years) were analyzed. Records were available from 11/21/13–1/21/22. The number of intubation attempts, whether an intubation was successful, and the use of capnography were recorded in RedCap. Statistical analysis was performed in Microsoft Excel via Chi Square Goodness of Fit Tests. Results During the study period, 674 intubation attempts were identified, and 28 charts were excluded due to missing patient age. Continuous waveform ETCO2 monitoring was used on 62%, 94%, 95%, and 97% of successfully intubated neonates, children, adolescents, and adults, respectively. There was a statistically significant difference between use of continuous waveform capnography in adults and neonates (p-value = 0.013). There was also a statistically significant difference between use of continuous waveform capnography in intubated neonates, children, and adolescents (p-value = 0.049). Conclusion Continuous ETCO2 monitoring is underutilized in intubated neonates compared to children, adolescents, and adults in the prehospital setting in this study population. This suggests a gap in the standard of care provided to neonates. Additional studies are needed to determine if these results are consistent around the industry and if there is a higher rate of undetected tube displacement in neonates who are transported without waveform capnography.

Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children.

We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first-attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first-attempt success rate. In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings. Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185). Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy.

Comparative Evaluation of Direct Laryngoscopy Versus GlideScope for the Purpose of Laryngoscopy Management and Intubation in Candidates of Cesarean Delivery with General Anesthesia.

The present study aimed at comparing the hemodynamic responses to laryngoscopy and initiation of intubation with either direct or video-assisted laryngoscopy. This double-blind clinical trial was performed on 90 pregnant women candidates for cesarean section under general anesthesia. The participants were divided into two groups. In the first group, intubation was performed using direct Macintosh laryngoscope (MCL group). The second group underwent intubation using the GlideScope video laryngoscope (GSL group). Then, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), the percentage of the saturation of peripheral oxygen (SpO2), the time-to-intubation (TTI), and the number of intubation attempts were recorded. SBP, DBP, and MAP in the MCL group were significantly higher than GSL group 1, 3, and 5 min after laryngoscopy (P < 0.05). HR in the MCL group with the mean of 118.44 ± 15.53 bpm was significantly higher than that the GSL group with the mean of 110.11 ± 16.68 bpm only 3 min after laryngoscopy (P = 0.016). The TTI in the MCL group was significantly longer than that of the GSL group (12.80 ± 1.86 vs. 10.15 ± 2.61; P = 0.001). The frequency of the first intubation attempt in the GSL group with 91.1% was significantly higher than that the MCL group with 84.4% (P = 0.003). It seems that the GSL technique is a better choice to conduct laryngoscopy with more success in intubation and a higher stability of the patients' hemodynamic status.

A Comparative Exploration of Video Laryngoscopes (King Vision and Airtraq) as the Future of Intubation during General Anesthesia

Abstract Background: In the dynamic medical landscape, anesthesiology plays a pivotal role in ensuring patient safety and comfort during surgeries. Central to this is endotracheal intubation, a critical procedure for securing the airway under anesthesia. Innovations such as King Vision and Airtraq video laryngoscopes offer enhanced glottis visualization and Cormack Lehane scores compared to direct laryngoscopy, with a shorter learning curve. This study aims to assess King Vision and Airtraq’s efficiency in terms of laryngoscopy time, Cormack and Lehane grading, and single-attempt success rate, the number of intubation attempts and endotracheal intubation duration. Methodology: We conducted a study involving 90 patients, aged 20–40 years, undergoing elective surgeries in Departments of General Surgery, ENT, and Gynecology under General Anesthesia. They were divided into two groups, Group K (King Vision) and Group A (Airtraq). Anesthesiologists with at least 40 prior intubations using both devices performed intubations. Preoperative assessments included Alprazolam and Ranitidine, fasting for 8 h, and vital sign monitoring. Anesthesia induction comprised fentanyl, propofol, and succinylcholine, with Macintosh laryngoscopy as a backup. Anesthesia maintenance included nitrous oxide, oxygen, isoflurane, and rocuronium, while parameters were diligently recorded. Results: Our results indicate comparable age and gender distributions between Airtraq and King Vision groups, as well as no differences in Mallampati grading. Kings Vision showed significantly faster laryngoscopy and quicker intubation. Most patients required only one intubation attempt in both groups. Cormack and Lehane grading was unaffected by device choice. Conclusion: Our study shows that both Airtraq and King Vision perform similarly across patient characteristics, but King Vision offers faster laryngoscopy and intubation times, ideal for urgent airway management.

Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study

Objectivesprimary objective: to improve the FPS rates after an educational intervention. Secondary objective: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts. Designit was a prospective quasi-experimental study. Settingdone in an ED in a public Hospital in Argentina. Patientsthere were patients of all ages with intubation in ED. Interventionsin the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented. Main variables of interestthe operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL). Resultsdata from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89–77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20–90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training. Conclusionsa low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries.

Comparison of intubating conditions in supine (sniffing) and 25° back-up position using channelled and non-channelled video laryngoscopes - A randomised controlled study.

The 25°back-up position is proposed to increase the efficacy of preoxygenation and provide better tracheal intubating conditions when using a direct laryngoscope. This study aimed to compare the ease of tracheal intubation between supine and 25° back-up positions when using two video laryngoscopes (VLS). One hundred adults with normal airways and belonging to the American Society of Anesthesiologists physical status classes I and II, requiring general anaesthesia, were randomised in groups K and M. The trachea was intubated using King Vision and McGrath VLS in either supine (groups K1 and M1) or 25° back-up (groups K2 and M2) positions. The 25° backup position was given by raising the operating table from the horizontal position by flexing the torso at the hips so that an imaginary line connected the patient's external auditory meatus to the sternal notch. Modified Intubation Difficulty Scale (mIDS) was the primary outcome, and intubation time, the number of intubation attempts, vital parameters, and complications were compared secondarily. Statistical analysis was done using MedCalc software by applying an independent t-test for parametric data and a Chi-square test for categorical data and finding the risk ratio. Mean (Standard deviation) mIDS was significantly reduced using both VLS in the 25° back-up position [0.92 (0.75) versus 0.48 (0.58), P = 0.025, degree of freedom (DF): 48, mean difference (95% confidence interval [CI]):-0.44 (-0.821 to - 0.059) in group K1 versus group K2 and 0.76 (0.59) versus 0.36 (0.48), P = 0.012, DF: 48, mean difference (95% CI): -0.40(-0.706 to - 0.094) in group M1 versus group M2, respectively]. The risk ratio comparing both the positions for the total number of patients requiring manoeuvres during intubation using both the VLS was 0.48 with P = 0.0004 and 95% CI = 0.305 - 0.765. Intubation time was shorter in the 25° backup position by using King Vision (P = 0.005) and McGrath (P = 0.042) VLS. The 25° backup position helps provide ease of intubation using both the channelled (King Vision) and non-channelled (McGrath) VLS.

Incidence and Risk Factors of Post-Thyroidectomy Stridor

Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications.&#x0D; Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence.&#x0D; Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively.&#x0D; Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor.&#x0D; Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor.

The sniffing position facilitated easier light wand guided endotracheal intubation compared with the neutral position with chin-lift.

Traditionally, the patient's head is placed in a neutral position with a chin-lift to facilitate light wand guided endotracheal intubation. However, our study found that the sniffing position was more effective. In this study, we aimed to compare the two positions of light wand guided endotracheal intubation. Sixty adult patients were included in the study, after obtaining informed consent, and were randomly assigned to one of two groups: a control group in a neutral position with a chin-lift (group C, n = 30) and a sniffing position group (group S, n = 30). In group C, the anesthesiologist inserted a light wand after lifting the patient's mandible using the thumb of their non-dominant hand inside the patient's mouth. In group S, a light wand was inserted after the patient's head was flexed with the neck extended. We assessed variables such as light-search time, number of intubation attempts, time to achieve intubation, and side effects including blood tinge on the endotracheal tube, hoarseness, sore throat, and anesthesiologist satisfaction. The light-search and intubation times were shorter in group S than in group C. The incidence of blood tinge on the endotracheal tube was higher in group C than in group S. Anesthesiologist satisfaction was higher in group S than in group C. The sniffing position was more effective in facilitating light wand guided endotracheal intubation than the neutral position with a chin-lift.

Incidence and Risk Factors of Post-Thyroidectomy Stridor

Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice. Background: Thyroidectomy is a common procedure performed by the general surgeons. Stridor is an airway sign caused by a variety of post-thyroidectomy complications. Objective: To determine the incidence of post-thyroidectomy stridor and the risk factors associated with its occurrence. Patients and Methods: The study included 280 adult patients who had total or partial thyroidectomy performed by various surgeons. Patients were followed up for 6 months after they were discharged from the hospital. Data collected included demographic information, type of thyroid disease, duration of illness before surgery, type of surgery, number of intubation attempts, and the presence of hoarseness and hematoma post-operatively. Results: Only eighteen patients (6.43%) who underwent thyroidectomy developed stridor during the follow-up period. They were compared to 25 other patients who were chosen from the original sample based regular visit of patients during the follow up. Higher body mass index (BMI), bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and more than one attempt at intubation were all associated with an increased risk of post-thyroidectomy stridor. Conclusion: Stridor affects only a small percentage of patients undergoing thyroidectomy. Increased BMI, bilateral thyroidectomy, presence of concomitant hoarseness and hematoma, and frequent tracheal intubation are the most common risk factors for post-thyroidectomy stridor. Keywords: Thyroidectomy, stridor, hoarseness of voice.

Conventional videolaryngoscope versus 3D printed videolaryngoscope

&lt;b&gt;Background and objectives:&lt;/b&gt; In patients with Covid-19, using a video laryngoscope as an alternative to direct laryngoscopy is recommended to protect the intubator from infection and reduce intubation failures due to personal protective equipment. The cost of video laryngoscopes limits their availability in all healthcare institutions. The present study aimed to compare the efficacy and safety of 3D printed video laryngoscope and conventional video laryngoscope on intubation.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; 30 ASA I-II patients who were not considered to have a difficult airway were included in the study after obtaining the ethics committee approval from Adnan Menderes University Clinical Research Ethics Committee. Patients were randomly divided into two groups, group 1 and group 2. After the induction of anesthesia under standard monitoring, the Cormack Lehane score was recorded by direct laryngoscopy in all patients. Patients in group 1 were intubated with a 3D-printed video laryngoscope. In contrast, patients in group 2 were intubated with a conventional video laryngoscope (STORZ C-mac videolaryngoscope). Intubation time, number of attempts, and hemodynamic values of patients with early postoperative complications were recorded. The data were recorded and statistically evaluated.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; There were no significant differences between the groups regarding demographic data, BMI, and hemodynamic data. The Cormack Lehane score was calculated as 1.6±0.51 in group 1 and 1.4±0.51 in group 2 (p=0.38). Intubation times of the groups were 32.6±18 s and 27.06±11.37 s, respectively (p=0.4). The number of intubation attempts was 1.2±0.63 in group 1 and 1±0.01 in group 2 (p=0.31). The image quality of the camera by the intubator, intubation conditions, and intubation satisfaction was similar in the two groups.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt;&lt;b&gt; &lt;/b&gt;Comparing a 3D-printed videolaryngoscope with a conventional videolaryngoscope, no differences were observed in intubation times, number of intubation attempts, hemodynamic changes, and early postoperative complications. Intubation satisfaction values by the practitioner were found to be similar. It was concluded that the 3D-printed videolaryngoscope, which is cost-effective and easy to access, can be used instead of conventional videolaryngoscope in patients with a normal airway.

A randomized comparison of the performance of Airtraq videolaryngoscope versus Macintosh laryngoscope in simulated rapid sequence induction of anaesthesia

Application of cricoid pressure during rapid sequence induction (RSI) of anaesthesia leads to difficult airway. No channeled videolaryngoscope (VL) has been compared with the Macintosh laryngoscope for facilitating intubation in RSI. Thus, we compared Airtraq® VL with Macintosh laryngoscope for simulated RSI in patients scheduled for elective surgeries.Following approval from Institutional Ethics Committee-Human Research, this randomized study was conducted. Patients of either sex, aged 18-65yr, ASA grade I/II, scheduled for elective surgeries under GA were included. 'Group DL' underwent direct laryngoscopy (DL) using Macintosh laryngoscope and Group VL with Airtraq® videolaryngoscope. Time taken for intubation, Cormack-Lehane (CL) grade of laryngeal view, number of intubation attempts, and haemodynamic parameters were noted. Student t-test and chi square test were used for statistical analysis.A total of 140 patients with 70 in each group were included. The mean time taken for intubation was significantly higher in VL group (84.70 ± 28.05s) than DL group (23.90 ± 6.67s). The optimal laryngeal view (i.e. CL grade I or II) was significantly improved in VL group than DL group i.e. 97% vs 94%. In group DL, 99% (n=69) were intubated in first attempt; whereas 60% (n=42) in Group VL (p&amp;#60;0.001). Hemodynamics was better in group VL.Airtraq® VL is better than conventional Macintosh laryngoscope for endotracheal intubation during RSI in terms of optimal glottic view, ease of intubation and haemodynamics. On the contrary, the “time taken to intubation” and the first attempt intubation rate were higher with Airtraq® VL.

The Effect of Endotracheal Tube Cuff Shape on Post-extubation Sore Throat in Critically Ill Patients in a Rural Tertiary Care Hospital.

Patients admitted to the critical care unit often require extended periods of mechanical ventilation. After extubation, patients often report discomfort in their throats, coughing, and hoarseness of voice. These symptoms have been linked to the shape of the cuff on the endotracheal tube and are described in terms of the surface area of the cuff in contact with the trachea. During this pilot study, 160 adults receiving intensive primary care were randomly assigned to one of two groups (Gathering A or Gathering B; 80 patients each). Intubated patients were separated into two groups: Group C consisted of those who wore a looser, barrel-shaped sleeve, and Group T consisted of those who wore a more restrictive sleeve. The severity of post-extubation side effects was assessed, including sore throat, dry voice, and hack, and the occurrence of these symptoms was also documented. Neither the number of intubation attempts nor the experience level of the residents who performed them differed significantly between the two groups (p > 0.05). A smaller percentage of patients in Gathering T experienced sore throats in the first, 12th, and 24th hours after extubation compared to patients in Group C at these same time points (p = 0.05). With time passing, fewer people in Group C and Group T experienced hoarseness of voice after extubation. There is a declining trend in the incidence of cough post-extubation in Group T, as compared to an initial increase in the trend for cough post-extubation with a gradual decline as time progressed in Group C. There is an overall decrease in the incidence of post-extubation emergence phenomena with tapered shape cuffed endotracheal tubes when compared with conventional cylindrical type cuffed endotracheal tubes.

Learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents: A cumulative sum analysis.

Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency. This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation. Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation. Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees. Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.

Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study

Objectivesprimary objective: to improve the FPS rates after an educational intervention. Secondary objective: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts. Designit was a prospective quasi-experimental study. Settingdone in an ED in a public Hospital in Argentina. Patientsthere were patients of all ages with intubation in ED. Interventionsin the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented. Main variables of interestthe operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL). Resultsdata from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89–77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20–90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training. Conclusionsa low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries.

Randomized controlled trial assessing intubation time with and without an aerosol biocontainment device

Introduction: The emergence of the coronavirus disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and methods to reduce risk of airborne respiratory pathogen transmission. This has led to the development of novel aerosol protective devices for which clinical and aerosol protective features have not been fully characterized. The relative efficacy of these devices for use during airway procedures has not been assessed in randomized controlled trials. Materials and Methods: We recruited anesthesiology attendings, residents, and certified registered nurse anesthetists to perform intubations with an aerosol biocontainment device (ABCD). Thirty-seven patients undergoing procedures requiring intubation in the operating room were recruited and randomized (2:1) to intubation with (25) or without (12) the ABCD. Primary endpoints were time to secure the airway and adverse events. Secondary endpoints were a number of intubation attempts, access to the patient and airway equipment through the device ports, user assessment of ABCD function and technical burden, and patient experience in the ABCD. Results: Intubation time with the ABCD (46 s) was not significantly different compared to intubation without the ABCD (37 s; P=0.06). There were 3 adverse events with the ABCD (1 claustrophobia, 2 unanticipated difficult airways) that required device removal for intubation. In general, patients tolerated the device well and ABCD users felt the device functioned as intended but increased the technical burden associated with intubation. Discussion: It is feasible to use an aerosol protective device for intubation. The introduction of novel devices into high acuity airway procedures should be approached with caution and should account for the risk mitigation gained from the device balanced against the increased procedural complexity and potential safety risks associated with restricted access to the airway.

Fiberoptic Intubation vs. Video-Assisted Fiberoptic Intubation in a High-Fidelity Pediatric Simulator: A Randomized Controlled Trial.

Life-threatening hypoxemia during tracheal intubation is more likely to occur in children than adults due to its unique physiological and anatomical nature. Fiberoptic intubation is widely performed in children with difficult airways. However, mastery of fiberoptic intubation requires substantial training, and novice trainees need to attempt fiberoptic intubation in children at high risk of respiratory-related adverse events. Therefore, a safer method than traditional fiberoptic intubation for children with difficult airways is desirable for novice anesthesia trainees. This study aimed to compare the efficacy of video-assisted fiberoptic intubation (VAFI) with that of traditional fiberoptic intubation (FOI) in a high-fidelity pediatric simulator by medical professionals with no experience in tracheal intubation. This randomized, controlled, simulation-based study was conducted in a tertiary-care pediatric hospital. Registered nurses working in the operating room were enrolled in this study and randomly assigned to either the FOI or VAFI groups. Participants in the FOI group performed fiberoptic intubation without the aid of any device, whereas those in the VAFI group used a video laryngoscope to obtain a better glottic view. The primary outcome was the time from the moment the tip of the flexible bronchoscope passed between the upper and lower incisors until the completion of tracheal intubation. A total of 28 participants were enrolled in this study. There was no significant difference in the time until the completion of tracheal intubation between FOI and VAFI, with a median time of 55.0 seconds for FOI and 42.5 seconds for VAFI (P = 0.22). Secondary outcomes, including time until passing the vocal cord, the number of intubation attempts, and the first success rate, did not also illustrate the significant difference between the groups. This study did not demonstrate the superiority of VAFI over conventional FOI in a high-fidelity pediatric simulator by medical providers with no experience in tracheal intubation.