Success Rate Of Intubation Research Articles

Facilitated Intubation: Time to Re-examine an Old Technique With Its Associated Risks Mitigated by New Technology.

Facilitated intubation (FI) refers to intubation performed using a sedative or anesthetic drug as an induction agent, without the use of a paralytic (neuromuscular blocking agent). In comparison, rapid sequence intubation (RSI) employs both an induction agent and a paralytic drug. RSI has been seen to outperform FI in terms of first-pass success when performing direct laryngoscopy and was quickly adopted as the gold standard in all situations. Recently, ketamine-only intubation has been used in situations where there is distorted anatomy or apnea intolerance (physically and physiologically difficult airways) resulting in an increased risk of a can't intubate/can't oxygenate scenario or significant hypoxemia. Frequent and recurring national ketamine shortages have resulted in renewed interest in whether or not other forms of FI are feasible in an era where other factors that mitigate complictions in achieving first-pass success (video laryngoscopy, bougie use, semi-Fowler positioning) are commonly used. We present a case series with outcomes for profoundly hypoxic patients with coronavirus disease 2019 (COVID-19) (physiologically difficult airways) undergoing FI during a time of national ketamine shortage, using modern techniques and technology to maximize first-pass success and minimize peri-intubation complication. We included patients with COVID-19 pneumonia with pre-intubation oxygen saturations of less than 80% (significant hypoxemia) requiring intubation who presented to a tertiary care center in southern United States between August 25, 2021, and October 22, 2021.In this specific cohort, patients underwent endotracheal intubation with midazolam for induction without the use of paralytic agents.We used video-assisted laryngoscopy to increase the success of the first-pass attempt as well as placing the patients in a semi-Fowler position (head of bed elevation 30-45°) and bilevel positive pressure pre-oxygenation to minimize peri-intubation complications. Our case series included 29 consecutive patients that met the inclusion criteria.The mean ± standard deviation (SD) age of the patients was 49.5±15.0 years. The mean±SD pre-intubation oxygenation of our cohort was 73.1±5.9%.All 29 intubations were successful on the first-pass attempt.Only one patient (3.4%) required a rescue paralytic to facilitate oral opening. Of note, 27/29 (93%) of the patients did not receive any immunizations (including partial) for COVID-19.There were no incidents of peri-intubation arrest (cardiac arrest within 30 minutes of induction) or aspiration. In 29 physiologically difficult patients with acute respiratory failure, in whom the physician determined that RSI posed a higher than normal risk, FI assisted by VL, semi-Fowler positioning, and bilevel positive pressure pre-oxygenation resulted in excellent successful first-pass intubation rates without any incidencesof peri-intubation arrestor aspiration.While this cohort was small, our study reveals that FI with midazolam does not likely pose a higher risk than ketamine-only intubationand warrants further study.

Comparing Intubation Success Between Flight Nurses and Flight Paramedics in Helicopter Emergency Medical Services

ObjectiveIntubation is a vital skill performed by flight nurses and paramedics. Before flight training, nurses do not routinely intubate and must be trained in proper techniques. Flight paramedics universally train in intubation before flight training and are the primary managers of in-flight airways. The aim of this study was to determine if a difference exists in intubation attempts and success rates between flight nurses and flight paramedics. MethodsA 5-year retrospective chart review was performed from a regional helicopter emergency medical service. Intubation attempts and the success of flight nurses compared with flight paramedics were the primary outcomes. ResultsThree hundred three of 322 cases in which intubation was attempted were successful. Three hundred forty-four total intubation attempts were made. Two hundred seventy-one (88.9%) patients were intubated by paramedics, and 32 (10.5%) were intubated by nurses. Of the 19 unsuccessfully intubated patients, 14 (73.7%) were attempted by a paramedic and 5 (26.3%) by a nurse. Two hundred seventy-seven intubations were successful on the first attempt, 250 (90.3%) of which were performed by a paramedic and 27 (9.7%) by a nurse. ConclusionFlight paramedics performed more intubations with greater success than flight nurses.

Using a Bougie With C-MAC Video Laryngoscopy Did Not Improve First-Attempt Intubation Success Rates in Critical Care Air Transport

ObjectiveStudies have shown a bougie improves first-attempt success rates when used in combination with direct laryngoscopy during the initial attempt. The purpose of this study was to determine whether the use of a bougie in combination with C-MAC (Karl Storz, Tuttlingen, Germany) improves first-attempt success rates of endotracheal intubation (ETI) compared with C-MAC with a traditional stylet. MethodsThis study is a retrospective chart review using data collected on 371 intubations completed by a single air medical service using the C-MAC laryngoscope and either a bougie or a stylet. ResultsThe overall success rate using C-MAC for ETI with either a bougie or a stylet was 83%. There was no statistically significant difference between first-attempt successful intubations using C-MAC and a bougie (82%) or a stylet (86%) (χ1 = 0.871, P = .351). There was no statistically significant difference between laryngoscopy grade and the number of attempts that resulted in a successful intubation (χ1 = 0.743, P = .7). ConclusionThere was no difference between first-attempt success rates using video laryngoscopy with a bougie, overall intubation success rates, or difficult intubation success rates compared with video laryngoscopy with a stylet, indicating that the purpose of a bougie as a rescue device did not hold true in the prehospital setting of our critical care air medical service.

Left Head Rotation as Alternative to Difficult Tracheal Intubation: Randomized Open Label Clinical Trial.

Tracheal intubation is a life-saving intervention not only for physicians but also for allied health workers. Optimizing the patient's head and neck position for the best glottic view is a crucial step that accelerates tracheal intubation. The left head rotation maneuver has been recently described as an innovative approach to tracheal intubation with marked improvement in glottic visualization and can be an alternative before proceeding to a surgical airway. This study compared the glottic view and intubating conditions in the sniffing position versus left head rotation during direct laryngoscopy. This randomized, open-label clinical trial enrolled fifty-two adult patients admitted to the Baguio General Hospital & Medical Center from September 2020 to January 2021 for an elective surgical procedure requiring tracheal intubation under general anesthesia. Intubation was done using a 45-degree left head rotation in the experimental group (n=26), while the control group (n=26) was intubated using the conventional sniffing position. Glottic visualization and intubation difficulty with left head rotation and sniffing position were assessed using Cormack-Lehane Grade and Intubation Difficulty Scale, respectively. Successful intubation is measured by observing a capnographic waveform in the end-tidal CO2 monitor after placement of the endotracheal tube. There was no significant statistical difference in the clinicodemographic characteristics between the left head rotation and sniffing position groups. There was no statistically significant difference in the Cormack-Lehane Grade, with 85% of patients classified under Grades 1 and 2 in both groups. Also, there were no statistically significant differences in the Intubation Difficulty Scale scores of patients intubated with left head rotation or sniffing position; 30.7% of patients in both groups were easily intubated, while 53.8% in left head rotation and 57.6% in sniffing position groups were intubated with slight difficulty. Similarly, there were no significant differences between the two techniques in any of the seven parameters of the Intubation Difficulty Scale, although numerically fewer patients required the application of additional lifting force [7 (26.9%) vs. 11 (42.3%)] or laryngeal pressure [3 (11.5%) vs. 7 (26.9%)] when intubated with left head rotation. The intubation success rate with left head rotation was 92.3% vs. 100% in the sniffing position, but this difference was not statistically significant. Left head rotation produces comparable laryngeal exposure and intubation ease to the conventional sniffing position. Therefore, left head rotation may be an alternative for patients who cannot be intubated in the sniffing position, especially in hospitals where advanced techniques such as video laryngoscopes and flexible bronchoscopes are unavailable, as is the case in this study. However, since our sample size was small, studies with a larger study population are warranted to establish the generalizability of our findings. In addition, we observed inadequate familiarity among anesthesiologists with the left head rotation technique, and the intubation success rate may improve as practitioners attain greater technical familiarization. This trial was registered in the International Traditional Medicine Clinical Trial Registry (ISRCTN23442026).

An approach to difficult airway in infants: Comparison of GlideScope® Spectrum LoPro, GlideScope® Spectrum Miller and conventional Macintosh and Miller blades in a simulated Pierre Robin sequence performed by 90 anesthesiologists.

Airway management can be challenging in neonates and infants. The Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis and airway obstruction. The airway management of these patients poses great challenges for anesthesiologists and pediatricians alike. To date, there has been no direct comparison of the hyperangulated GlideScope® Spectrum LoPro (GLP), the straight GlideScope® Spectrum Miller (GSM), a conventional Macintosh (MC) and a conventional Miller blade (ML) in patients with PRS. For this purpose, 90 anesthesiologists (43 with limited experience, 47 with extensive experience) performed orotracheal intubation on an Air-Sim® Pierre Robin X manikin using GLP, GSM, MC and ML in randomized order. 'Time-to-vocal-cords', 'time-to-intubate', 'time-to-ventilate', the severity of oral-soft-tissue-trauma and the subjective evaluation of each device were recorded. A significantly faster and better view of the vocal cords and lower oral-soft-tissue-trauma was achieved using the GLP (p<0.001). Though, there were no significant differences in the 'time-to-intubate' or 'time-to-ventilate'. The highest intubation success rate was found with GSM and the lowest with GLP (GSM 100%, ML 97.8%, MC 96.7%, GLP 93.3%). When using the videolaryngoscopes, there were no undetected esophageal intubations but in six cases prolonged attempts of intubation (>120s) with the GLP. In the sub-group with extensive experience, we found significantly shorter intubation times for the GSM and ML. The GLP was the tool of choice for most participants, while the conventional MC received the lowest rating. Videolaryngoscopy leads to increased safety for the prevention of undetected esophageal intubation in the airway management in a PRS manikin. Hyperangulated blades may ensure a good and fast view of the vocal cords and low oral-soft-tissue-trauma but pose a challenge during the placement of the tube. Specific skills and handling seem to be necessary to ensure a safe tube placement with this sort of blades.

ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study.

Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.

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.

Effects of right stellate ganglion block combined with topical anesthesia on heart rate variability in awake patients receiving tracheal intubation.

General anesthesia is commonly performed with tracheal intubation. We aimed to evaluate the effects of right stellate ganglion block combined with topical anesthesia on the heart rate variability in awake patients receiving tracheal intubation. A total of 120 eligible patients were equally divided into observation and control groups using a random number table. The observation group underwent right stellate ganglion block combined with topical anesthesia. The excellent and good rate of anesthesia, indicators of vital signs and heart rate variability, incidence rate of adverse reactions, success rate and time consumption of tracheal intubation, postoperative resuscitation and cognitive function score of the two groups were compared. The systolic pressure, diastolic pressure and heart rate significantly increased in both groups during tracheal intubation compared with those before tracheal intubation, which they were lower in the observation group than those in the control group during tracheal intubation (P<0.05). Low-frequency power, ratio of low-frequency power to high-frequency power and heart rate variability index significantly decreased in both groups during tracheal intubation compared with those before tracheal intubation (P<0.05). Right stellate ganglion block combined with topical anesthesia can work well for awake patients during tracheal intubation.

Ease of Intubation with McGrath Videolaryngoscope and Incidence of Adverse Events During Tracheal Intubation in COVID-19 Patients: A Prospective Observational Study.

Tracheal intubation in critically ill patients remains high-risk despite advances in equipment, technique, and clinical guidelines. Many patients with COVID-19 were in respiratory distress and required intubation that is considered an aerosol-generating procedure (AGP). The transition to videolaryngoscopy as a routine first line option throughout anesthetic and ICU practice has been reported. We evaluated the ease of intubation, success rate, use of accessory maneuvers and adverse outcomes during and 24 hours after intubation with the McGrath videolaryngoscope. This was a prospective, observational single center study conducted at non-operating room locations that included all adults (>18 years old) with suspected or confirmed COVID-19 infection and were intubated by McGrath videolaryngoscope. The anesthesiologist performed tracheal intubation were requested to fill online data collection form. A co-investigator was responsible to coordinate daily with assigned consultants for COVID intubation and follow up of patients at 24 hours after intubation. A total of 105 patients were included in our study. Patients were predominantly male (n=78; 74.3%), their COVID status was either confirmed (n=97, 92.4%) or suspected (n=8, 7.6%). Most were intubated in the COVID ward (n=59, 56.2%) or COVID ICU (n=23, 21.9%). The overall success rate of intubation with McGrath in the first attempt was 82.9%. The glottic view was either full (n=85, 80.95%), partial (n=16, 15.24%) or none (n=4, 3.81%). During intubation, hypoxemia occurred in 18.1% and hypotension in 16.2% patients. Within 24 hours of intubation, pneumothorax occurred in 1.9%, cardiac arrest and return of spontaneous circulation in 6.7% and mortality in 13.3% of patients. These results illustrate the ease and utility of the McGrath videolaryngoscope for tracheal intubation in COVID-19 patients. Its disposable blade is of significant value in protectin during tracheal intubation.

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.

Non-channeled Video Laryngoscopy as an Alternative to Conventional Laryngoscopy for Intubating Adult Patients in the Intensive Care Unit.

Background Endotracheal intubation in the intensive care unit (ICU) is often a risky procedure due to the emergency situation, unstable condition of the patient, and technical problems such as inadequate positioning. Several new techniques, such as video laryngoscopy, have been developed recently to improve the success rate of first-pass intubations and reduce complications. We conducted this study to compare a non-channeled reusable video laryngoscope BPL VL-02 (manufactured by BPL Medical Technologies, Bangalore, India) with a conventional laryngoscope for intubation of adult patients in the ICU. Methodology A total of 72 ICU patients were randomly allocated to be intubated with either conventional direct laryngoscopy via Macintosh blade (group A) or video laryngoscopy with BPL VL-02 (group B). All patients were intubated by the primary investigator and the assistant noted the following parameters: the total number of intubation attempts, total duration of intubation, assistance or alternative technique required, Cormack Lehane grading, and any complications. Results There was no significant difference in the Cormack Lehane grading, number of attempts, or complications between the two groups. On comparing the assistance required during intubation in patients, it was observed that four (11.11%) patients in group A and seven (19.44%) patients in group B needed backward, upward, and rightward pressure on the larynx assistance during intubation. In five (13.89%) patients in group B, Stylet was required during intubation. The difference was statisticallysignificant (p = 0.0308). The video laryngoscopy group (group B) had a longer mean duration of intubation (64.36 ± 6.28 seconds) compared to group A (45.72 ± 11.45 seconds), and the difference was statistically significant (p < 0.0001). Conclusions Non-channeled video laryngoscope (BPL VL-02) is not a suitable alternative to conventional direct laryngoscopy with a Macintosh blade in terms of successful first-pass intubation, total duration of intubation, and assistance required.

Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study.

Aerosols and droplets have put healthcare workers performing airway management at high risk of contracting coronavirus disease 2019 (COVID-19). Experts have developed endotracheal intubation (ETI) guidelines and protocols to protect intubators from infection. We aimed to determine whether changes in the emergency department (ED) intubation protocol to prevent COVID-19 infection were associated with first-pass success (FPS) rates in ETI. We used data from the airway management registries in two academic EDs. The study was divided into pre-pandemic (January 2018 to January 2020) and pandemic (February 2020 to February 2022) periods. We selected 2476 intubation cases, including 1151 and 1325 cases recorded before and during the pandemic, respectively. During the pandemic, the FPS rate was 92.2%, which did not change significantly, and major complications increased slightly but not significantly compared with the pre-pandemic period. The OR for the FPS of applying infection prevention intubation protocols was 0.72 (p = 0.069) in a subgroup analysis, junior emergency physicians (PGY1 residents) had an FPS of less than 80% regardless of pandemic protocol implementation. The FPS rate of senior emergency physicians in physiologically difficult airways decreased significantly during the pandemic (98.0% to 88.5%). In conclusion, the FPS rate and complications for adult ETI performed by emergency physicians using COVID-19 infection prevention intubation protocols were similar to pre-pandemic conditions.

Evaluating the Usability of a 3D-Printed Video Laryngoscope for Tracheal Intubation of a Manikin.

Compared to direct laryngoscopy, videolaryngoscopy (VL) can provide improved laryngeal and glottic view, higher intubation success rates in patients with a known or predicted difficult airway and reduced incidence of laryngeal/airway trauma. However, the cost and availability of these devices handicap its use in resource-restricted facilities. The objective was to design and manufacture a novel VL using additive manufacturing (AM) and evaluate its usability on an intubation manikin by comparing it to one of the most common video laryngoscopes used in clinical practice, the CMAC®, by measuring the time to first pass of the endotracheal tube as the main outcome. A randomised cross-over study was performed with 36 anaesthetists attempting tracheal intubation of a manikin. The novel 3D-printed hyperangulated VL blade was compared to a CMAC® VL (D-blade). Participants had no prior experience or training with the novel device. The participants included consultants, registrars/trainees and medical officers in the Department of Anaesthesiology at the University of the Free State (UFS) in South Africa. The CMAC® had a statistically shorter time to first pass (median 13.8 seconds) compared to the 3D-printed model (median 19.0 seconds) (95% confidence interval [CI] 1.0-6.2; P=0.0013). No failed attempts occurred with either device. Intubation times were faster with the CMAC® than with the novel device. However, with a comparable intubation success rate, 3D printing technology potentially can improve access to video laryngoscopy. Further design improvements, validation of materials and manufacturing processes are required before 3D-printed laryngoscope blades can be used in human subjects.

Randomized Clinical Trial Comparing the Success Rate of Blockbuster Intubating Laryngeal Mask Airway Versus Fastrach Intubating Laryngeal Mask Airway During Blind Endotracheal Intubation.

Background A new piece of equipment, the Blockbuster (BB) Intubating Laryngeal Mask Airway (ILMA; Tuoren MedicalIndia, Gurugram, India), was created in 2012. Dr. Chandy created the Fastrach (F) ILMA in 1997, which is another supraglottic airway equipment. The primary purpose of this study was to compare the success rateof intubation with BB-ILMA and F-ILMA. Methods In the chosen age category of >20 to <70 years, undergoing general anesthesia for intubation with ILMAs, 55 patients were in the BB-ILMA(group B), and 55 patients were in the F-ILMA (group F). These ILMAs were put in after the induction and checked to see if adequate ventilation was accomplished with either of these devices. Once ventilation had been attained, weproceeded with fiberoptic scope to visualize the glottis, followed by blind intubation. The primary objective was to compare the first pass successful intubation of BB-ILMA and F-ILMA. The secondary objectives were ease of LMA insertion, time taken for intubation, hemodynamic changes, glottis fiberoptic view, and complications. Results The first pass successful intubation of the BB-ILMA and F-ILMA are 94.5% and87.3%, respectively, whereas thetime taken for intubation in BB-ILMA and F-ILMA are 25.02 seconds (s) and42.77 s with ap-value of 0.0001, indicating a statistically significant relationship. Conclusion When compared to the F-ILMA (group F), the BB-ILMA (group B) has a higher success rate for blind tracheal intubation, with lesser time taken for intubation and fewer complications.

Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study

BackgroundTracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. MethodsThis is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. ResultsOf 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05–1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95–1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60–1.02). ConclusionsIn critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. Clinical trial registrationNCT03616054.

Analysis of the Efficacy and Safety of Coronary Catheterization through Distal Transradial Access: A Single-Center Data.

The distal transradial access (dTRA) is a new puncture site for coronary catheterization. We sought to evaluate the feasibility, safety, and complication rates of using the dTRA for cardiac catheterization in Chinese patients. A total of 263 consecutive patients who underwent catheterization through the dTRA were enrolled. The primary endpoint of the study was the rate of conversion to another access site due to the impossibility of successful artery puncture or intubation. Secondary safety endpoints were the rates of bleeding-related complications and nerve disorders. Among 263 patients, the puncture success rate was 96.2% (253/263). Eleven patients were successfully punctured, but the guide wire was difficult to advance. One patient had intubation failure, and the success rate of intubation was 91.6% (241/263). Two hundred thirty-three patients underwent puncture via the right dTRA, 5 patients underwent puncture via the left dTRA, and 3 patients underwent puncture via the bilateral dTRA. A total of 158 (65.6%) patients underwent coronary angiography, and 83 (34.4%) patients underwent percutaneous coronary intervention. After the procedure, only 2 (0.8%) patients had mild bleeding at the puncture site, 2 (0.8%) had a forearm hematoma, and no patient had a nerve disorder. DTRA has a low incidence of complications, making it a safe and effective technique for cardiac catheterization.

Perbandingan Keberhasilan Intubasi pada Upaya Pertama antara Video Laryngoscope dengan Direct Laryngoscope

This study aims to determine differences in the success of intubation on the first attempt between video laryngoscopes and direct laryngoscopes. The method used is an experimental quasi-experimental type with a Two Group Post Test Design. The sampling technique was carried out by consecutive sampling with the research instrument, namely the observation sheet. Data were collected in the operating room of Prof. Dr. R. D. Kandou Manado with a sample size of 40 respondents, with 20 respondents intubating with a direct laryngoscope and 20 respondents intubating with a video laryngoscope using an unpaired t-test. The results showed that the probability value obtained was 0.035. In conclusion, the success rate of intubation on the first attempt with a video laryngoscope is higher than that of a direct laryngoscope.&#x0D; &#x0D; Keywords: Direct Laryngoscope, Intubation, Video Laryngoscope

Comparison of clinical performance of Ambu® AuraGain™ and BlockBuster® in anaesthetised preschool children-A randomised controlled trial.

Supraglottic airway (SGA) devices are a boon to paediatric airway management. The clinical performances of the BlockBuster® laryngeal mask airway (LMA) and Ambu® AuraGain™ in preschool children were compared in this study. After ethical approval and trial registration, this randomised controlled study was conducted on 50 children, aged 1-4 years, randomised into two groups. Appropriate sized Ambu® AuraGain™ (group A) and LMA BlockBuster® (group B) were placed as per the manufacturer's recommendation under general anaesthesia. Appropriate size of the endotracheal tube was then chosen and inserted through the device. Primary objective of the study was to compare the oropharyngeal seal pressure (OSP), and secondary objectives were the first attempt intubation success rate, overall intubation success rate, SGA insertion time, intubation time, haemodynamic changes and postoperative pharyngolaryngeal complications. The Chi-square test was used to analyse the categorical variables, while the intragroup comparison of mean changes in outcomes was evaluated by the unpaired t-test. The level of significance was set at P < 0.05. Demographic parameters were uniformly distributed in both the groups. The mean OSP in group A was 26.6 ± 0.95 cm H2O and in group B was 29.08 ± 0.75 cm H2O. Both the devices were successfully inserted in all the patients. The success rate of blind endotracheal intubation through the device in first attempt was 4% in group A and 80% in group B. Postoperative pharyngolaryngeal complications were relatively less in group B. LMA BlockBuster® provides higher OSP and provides a higher success rate of blind endotracheal intubation in paediatric patients.

Comparison of Ease and Success of Intubation through LMA Blockbuster and Ambu Aura-I in Patients Receiving General Anesthesia

Background: Airway gadgetry is expanding at an exponential rate. It is imperative to understand the intubating characteristics of supraglottic devices so that the choice of device in patients is based on evidence rather than just the design. The present study was conducted to compare blind intubation with blockbuster LMA and Ambu Aura-i. Methodology: Sixty patients of either sex, 20 to 60 years of age, ASA I–III, scheduled to undergo elective surgery under general anesthesia, were included in this prospective, randomized, comparative study. Group A (n = 30) patients were intubated with AmbuAura-i, and Group B (n = 30) patients were intubated using BlockBuster LMA. Results: Endotracheal intubation was found easy in 76% of the patients and difficult in 10% of the patients intubated with Ambu Aura −i. A 13.3% failure rate was observed in group A. Intubation success rate of 100% was observed in Group B. 86.6% of patients were easily intubated, and seven patients were intubated with a bit of difficulty (P-value 0.010). The mean time of SGD insertion in Group A was 14.77 ± 5.563 seconds, and in Group B was 21.87 ± 7.186 seconds (P-value 0.000). SGD insertion attempts were significantly higher in Group B when compared to Group A (P-value 0.025). Conclusion: Although AA-i requires less time for the placement of SGD, blockbuster LMA remains the better choice with a 100% success rate of blind orotracheal intubation.

Comparison of C-MACTM Videolaryngoscope with Macintosh Laryngoscope in Anticipated Difficult Airway

Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.