Success Rate Of Tracheal Intubation Research Articles

Remifentanil for tracheal intubation without neuromuscular blocking drugs in adult patients: a systematic review and meta-analysis.

There is increasing interest in the use of short-acting opioids such as remifentanil to facilitate tracheal intubation. The aim of this systematic review was to determine the efficacy and safety of remifentanil for tracheal intubation compared with neuromuscular blocking drugs in adult patients. We conducted a systematic search for randomised controlled trials evaluating remifentanil for tracheal intubation. Primary outcomes included tracheal intubation conditions and adverse events. Twenty-one studies evaluating 1945 participants were included in the analysis. Use of remifentanil (1.5-4.0 μg.kg-1 ) showed no evidence of a difference in tracheal intubation success rate compared with neuromuscular blocking drugs (risk ratio (95%CI) 0.97 (0.94-1.01); six studies; 1232 participants; I2 28%; p = 0.16; moderate-certainty evidence). Compared with neuromuscular blocking drugs, the use of remifentanil (2.0-4.0 μg.kg-1 ) makes little to no difference in terms of producing excellent tracheal intubation conditions (risk ratio (95%CI) 1.16 (0.72-1.87); two studies; 121 participants; I2 31%, p = 0.54; moderate-certainty of evidence). There was no evidence of an effect between remifentanil (2.0-4.0 μg.kg-1 ) and neuromuscular blocking drugs for bradycardia (risk ratio (95%CI) 0.44 (0.01-13.90); two studies; 997 participants; I2 81%; p = 0.64) and hypotension (risk ratio (95%CI) 1.05 (0.44-2.49); three studies; 1071 participants; I2 92%; p = 0.92). However, the evidence for these two outcomes was judged to be of very low-certainty. We conclude that remifentanil may be used as an alternative drug for tracheal intubation in cases where neuromuscular blocking drugs are best avoided, but more studies are required to evaluate the haemodynamic adverse events of remifentanil at different doses.

A comparison of the McGrath videolaryngoscope with direct laryngoscopy for rapid sequence intubation in the operating theatre: a multicentre randomised controlled trial.

Aspiration of gastric contents is a recognised complication during all phases of anaesthesia. The risk of this event becomes more likely with repeated attempts at tracheal intubation. There is a lack of clinical data on the effectiveness of videolaryngoscopy relative to direct laryngoscopy rapid sequence intubation in the operating theatre. We hypothesised that the use of a videolaryngoscope during rapid sequence intubation would be associated with a higher first pass tracheal intubation success rate than conventional direct laryngoscopy. In this multicentre randomised controlled trial, 1000 adult patients requiring tracheal intubation for elective, urgent or emergency surgery were allocated randomly to airway management using a McGrath™ MAC videolaryngoscope (Medtronic, Minneapolis, MN, USA) or direct laryngoscopy. Both techniques used a Macintosh blade. First-pass tracheal intubation success was higher in patients allocated to the McGrath group (470/500, 94%) compared with those allocated to the direct laryngoscopy group (358/500, 71.6%), odds ratio (95%CI) 1.31 (1.23-1.39); p < 0.001. This advantage was observed in both trainees and consultants. Cormack and Lehane grade ≥ 3 view occurred less frequently in patients allocated to the McGrath group compared with those allocated to the direct laryngoscopy group (5/500, 1% vs. 94/500, 19%, respectively; p < 0.001). Tracheal intubation with a McGrath videolaryngoscope was associated with a lower rate of adverse events compared with direct laryngoscopy (13/500, 2.6% vs. 61/500, 12.2%, respectively; p < 0.001). These findings suggest that the McGrath videolaryngoscope is superior to a conventional direct laryngoscope for rapid sequence intubation in the operating theatre.

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.

A randomised controlled trial to compare blind intubation success through LMA Blockbuster® and I-Gel® LMA.

Laryngeal mask airway-blockbuster (LMA-BT) is a relatively new supraglottic airway device (SGAD). In this study, we compared LMA-BT with I-Gel LMA for efficacy of blind tracheal intubation. We conducted a single-blind prospective study after ethical approval. One hundred American Society of Anesthesiology (ASA) Grade I-III (age 18-60 years) patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were included and randomly divided into 2 groups. Blind tracheal intubation was performed through LMA-BT ( n = 50) and I-Gel ( n = 50) in groups 1 and 2, respectively. The primary aim was to evaluate the first pass success rate of blind tracheal intubation through the LMAs. The secondary objectives noted were attempts and ease of LMA insertion, total time taken for LMA insertion, airway seal pressure of LMA, ease of NGT insertion through LMA, fibre-optic grading of laryngeal view through LMA, overall success rate and time of intubation through LMA, time for LMA removal, and complications, if any. In the LMA-BT group, the first pass success rate ( P < 0.019) and the overall success rate of intubation ( P < 0.005) were significantly higher than in the I-Gel group. Using LMA-BT also resulted in statistically significant shorter intubation time ( P < 0.0001) with higher airway seal pressure as compared to I-Gel ( P < 0.001). The difference in the first attempt insertion, number of insertion attempts, ease and time of LMA insertion and removal after intubation, and postoperative complications were comparable among the groups. LMA-BT is a superior device as compared to I-Gel LMA as a conduit for blind tracheal intubation.

Feasibility of ultrasound measurement of tracheal diameter in patients undergoing severe scoliosis orthopedic surgery: A randomized trial

Objective To explore the feasibility of ultrasound measurement of the transverse diameter of the cervical trachea at its narrowest point in patients undergoing severe scoliosis orthopedic surgery. Methods A total of 110 patients, aged 18-65, who scheduled for elective orthopedic surgery for severe scoliosis were included. Prior to surgery, all patients underwent two types of tracheal inner diameter measurements: (1) CT measurement of the anteroposterior diameter (Dmin,AP) and transverse diameter (Dmin,T) of the cervical trachea at its narrowest point; and (2) ultrasound measurement of Dmin,T. Based on the measurement results, the patients were randomly divided into two groups, the CT group ( n = 55) and the ultrasound group ( n = 55). We compared the Dmin,AP and Dmin,T measured by CT for all patients. Then, we compared CT and ultrasound measurements of Dmin,T. Furthermore, we conducted an analysis to determine the correlation and consistency between the two methods. Additionally, we examined the success rate of first-attempt tracheal intubation and the occurrence rate of tracheal tube being too wide or too narrow between the two groups, and assessed the occurrence of postoperative 24-h pharyngeal pain and hoarseness. Results When comparing the Dmin,AP and Dmin,T measured by CT in all patients, a statistically significant difference was observed ( p &lt; .001). When comparing the measurements of Dmin,T between CT and ultrasound in all patients, no statistically significant differences were found ( p &gt; .05). The correlation coefficient (r) between CT and ultrasound measurements of Dmin,T was 0.849 ( p &lt; .001). The mean difference in Dmin,T was 0.19 mm, and the limits of agreement (LoA) were −2.24 mm to 2.62 mm. Conclusions Ultrasound measurement of Dmin,T in severe scoliosis patients is feasible and provides valuable guidance for the selection of endotracheal tube sizes. It serves as a non-invasive and bedside auxiliary examination method for perioperative airway assessment.

Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial.

Hyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre-anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.

Deep learning-based facial analysis for predicting difficult videolaryngoscopy: a feasibility study.

While videolaryngoscopy has resulted in better overall success rates of tracheal intubation, airway assessment is still an important prerequisite for safe airway management. This study aimed to create an artificial intelligence model to identify difficult videolaryngoscopy using a neural network. Baseline characteristics, medical history, bedside examination and seven facial images were included as predictor variables. ResNet-18 was introduced to recognise images and extract features. Different machine learning algorithms were utilised to develop predictive models. A videolaryngoscopy view of Cormack-Lehane grade of 1 or 2 was classified as 'non-difficult', while grade 3 or 4 was classified as 'difficult'. A total of 5849 patients were included, of whom 5335 had non-difficult and 514 had difficult videolaryngoscopy. The facial model (only including facial images) using the Light Gradient Boosting Machine algorithm showed the highest area under the curve (95%CI) of 0.779 (0.733-0.825) with a sensitivity (95%CI) of 0.757 (0.650-0.845) and specificity (95%CI) of 0.721 (0.626-0.794) in the test set. Compared with bedside examination and multivariate scores (El-Ganzouri and Wilson), the facial model had significantly higher predictive performance (p < 0.001). Artificial intelligence-based facial analysis is a feasible technique for predicting difficulty during videolaryngoscopy, and the model developed using neural networks has higher predictive performance than traditional methods.

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.

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.

Airway management during ongoing chest compressions-direct vs. video laryngoscopy. A randomised manikin study.

Tracheal intubation is used for advanced airway management during cardiac arrest, particularly when basic airway techniques cannot ensure adequate ventilation. However, minimizing interruptions of chest compressions is of high priority. Video laryngoscopy has been shown to improve the first-pass success rate for tracheal intubation in emergency airway management. We aimed to compare first-pass success rate and time to successful intubation during uninterrupted chest compression using video laryngoscopy and direct laryngoscopy. A total of 28 anaesthetists and 28 anaesthesia nurses with varied clinical and anaesthesiological experience were recruited for the study. All participants performed a tracheal intubation on a manikin simulator during ongoing chest compressions by a mechanical resuscitation device. Stratified randomisation (physicians/nurses) was performed, with one group using direct laryngoscopy and the other using video laryngoscopy. First-pass success rate was 100% (95% CI: 87.9% - 100.0%) in the video laryngoscopy group and 67.8% (95% CI: 49.3% - 82.1%) in the direct laryngoscopy group [difference: 32.2% (95% CI: 17.8% - 50.8%), p<0.001]. The median time for intubation was 27.5 seconds (IQR: 21.8-31.0 seconds) in the video laryngoscopy group and 30.0 seconds (IQR: 26.5-36.5 seconds) in the direct laryngoscopy group (p = 0.019). This manikin study on tracheal intubation during ongoing chest compressions demonstrates that video laryngoscopy had a higher first-pass success rate and shorter time to successful intubation compared to direct laryngoscopy. Experience in airway management and professional group were not significant predictors. A clinical randomized controlled trial appears worthwhile.

Demographic disparities in tracheal intubation success rates during infant out-of-hospital cardiac arrest

ObjectivesTracheal intubation is a skill performed by qualified emergency medical services (EMS) providers during out-of-hospital cardiac arrest (OHCA) in adult and pediatric patients. Unsuccessful intubation can negatively impact a patient's likelihood of survival. Thus, intubation success rates are an important quality improvement benchmark. Given other demographic disparities that have been reported in adults and children, we hypothesize there might be disparities in intubation success across infant race/ethnicity and/or sex. MethodsWe examined a national-level registry of EMS activations in the United States (NEMSIS). Inclusion criteria were OHCA calls involving infant patients (under 1 years of age) between January 2017 and May 2022 where EMS attempted tracheal intubation, documented whether the procedure was successful, and documented information about the patient's demographics (eg. race/ethnicity and sex). Intubation success rates across patient sex and racial/ethnic categories with more than one-hundred cardiac arrests with intubation attempts were compared. ResultsA total of 3663 infant cardiac arrests where tracheal intubation was attempted met inclusion criteria. White infants were associated with significantly higher rates of intubation success (62.2%) when compared with Black or African American infants (58.1%) and Hispanic/Latino infants (56.2%) (p < .01). Female infants were associated with slightly higher rates of intubation success than male infants, but this difference was not significant (p > .2). ConclusionSignificant demographic disparities in endotracheal intubation success rates exist among infants who experience OHCA. Future studies should continue to examine these disparities with the goal of identifying why these differences occur and concrete mechanisms for eliminating such disparities.

A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan

BackgroundIn Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope. ObjectiveThe purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients. MethodThis study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2. ResultsA total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01–1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03–1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups. ConclusionOur data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.

Direct versus video laryngoscopy with standard blades for neonatal and infant tracheal intubation with supplemental oxygen: a multicentre, non-inferiority, randomised controlled trial

Tracheal intubation in neonates and infants is a potentially life-saving procedure. Video laryngoscopy has been found to improve first-attempt tracheal intubation success and reduce complications compared with direct laryngoscopy in children younger than 12 months. Supplemental periprocedural oxygen might increase the likelihood of successful first-attempt intubation because of an increase in safe apnoea time. We tested the hypothesis that direct laryngoscopy is not inferior to video laryngoscopy when using standard blades and supplemental oxygen is provided. We did a non-inferiority, international, multicentre, single-blinded, randomised controlled trial, in which we randomly assigned neonates and infants aged up to 52 weeks postmenstrual age scheduled for elective tracheal intubation to either direct laryngoscopy or video laryngoscopy (1:1 ratio, randomly assigned using a secure online service) at seven tertiary paediatric hospitals across Australia, Canada, Italy, Switzerland, and the USA. An expected difficult intubation was the main exclusion criteria. Parents and patients were masked to the assigned group of treatment. All infants received supplemental oxygen (1 L/Kg per min) during laryngoscopy until the correct tracheal tube position was confirmed. The primary outcome was the proportion of first-attempt tracheal intubation success, defined as appearance of end-tidal CO2 curve at the anaesthesia monitor, between the two groups in the modified intention-to-treat analysis. A 10% non-inferiority margin between direct laryngoscopy or video laryngoscopy was applied. The trial is registered with ClinicalTrials.gov (NCT04295902) and is now concluded. Of 599 patients assessed, 250 patients were included between Oct 26, 2020, and March 11, 2022. 244 patients were included in the final modified intention-to-treat analysis. The median postmenstrual age on the day of intubation was 44·0 weeks (IQR 41·0-48·0) in the direct laryngoscopy group and 46·0 weeks (42·0-49·0) in the video laryngoscopy group, 34 (28%) were female in the direct laryngoscopy group and 38 (31%) were female in the video laryngoscopy group. First-attempt tracheal intubation success rate with no desaturation was higher with video laryngoscopy (89·3% [95% CI 83·7 to 94·8]; n=108/121) compared with direct laryngoscopy (78·9% [71·6 to 86·1]; n=97/123), with an adjusted absolute risk difference of 9·5% (0·8 to 18·1; p=0·033). The incidence of adverse events between the two groups was similar (-2·5% [95% CI -9·6 to 4·6]; p=0·490). Post-anaesthesia complications occurred seven times in six patients with no difference between the groups. Video laryngoscopy with standard blades in combination with supplemental oxygen in neonates and infants might increase the success rate of first-attempt tracheal intubation, when compared with direct laryngoscopy with supplemental oxygen. The incidence of hypoxaemia increased with the number of attempts, but was similar between video laryngoscopy and direct laryngoscopy. Video laryngoscopy with oxygen should be considered as the technique of choice when neonates and infants are intubated. Swiss Pediatric Anaesthesia Society, Swiss Society for Anaesthesia and Perioperative Medicine, Foundation for Research in Anaesthesiology and Intensive Care Medicine, Channel 7 Telethon Trust, Stan Perron Charitable Foundation, National Health and Medical Research Council.

A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial.

This study aimed to compare the intubation effectiveness of the bébé Vie Scope™ (VieScope) and direct laryngoscopy for emergency intubation in a pediatric manikin model performed by paramedics with and without personal protective equipment for aerosol generating procedures (PPE-AGP). Participants performed endotracheal intubation using VieScope and standard Macintosh laryngoscope (MAC) in two research scenarios: (1) without PPE-AGP, and (2) with PPE-AGP. Fifty-one paramedics without any previous experience with the VieScope participated in this study. In the PPE-AGP scenario, in the VieScope group, the percentage of successful tracheal intubation on the first attempt was higher compared to the MAC group (94.1 vs. 78.4%, p = 0.031), intubation time was shorter (29.8 vs. 33.9 s, p &lt; 0.001), and percentage of glottic opening (POGO) score was higher 91.0 vs 77.8 (p &lt; 0.001). On the Cormack-Lehane scale, intubation with VieScope intubation was associated with higher scores rated at 1 (64.7 vs. 29.4%) than in the MAC group (p = 0.001). For intubation in the non-PPE scenario, there were no statistically significant differences between VieScope and MAC in relation to above parameters. Summarize, the bébé VieScope™ under PPE-AGP wearing conditions has proven to be a useful device for airway management in children providing better visualization of the larynx, better intubation conditions, and a higher success rate of tracheal intubation on the first attempt and reduced intubation time compared to the standard Macintosh laryngoscope.

Comparative study of intubating LMA and I-gel for ease of insertion and as a conduit for endotracheal intubation

Background: A recently introduced supraglottic airway device (SAD) has been claimed to be an efficient supraglottic airway. It can also be used as a conduit for endotracheal intubation. However, LMA frequently used for this purpose; hence in this randomized study, success rate of blind tracheal intubation through two different SADs i-gel and LMA was evaluated. Methods: This is a prospective study was conducted in the Department of Anesthesia at Sapthagiri Institute of Medical Sciences &amp; Research Centre among 140 patients fulfilling the criteria. Fasting patients with ages 20-50 years undergoing elective procedures under general anesthesia with ASA physical status 1 and 2 and Mallampatti class I and II were included in the study. Whereas patients with ASA physical status 3 or 4, and having contraindications to insertion of LMA or i-gel™ such as; mouth opening less than 2 cm, increased risk of aspiration, anticipated difficult intubation and facemask ventilation, with Mallampatti class III to IV were excluded. Results: One of the groups was administered the I-gel (Group G) and the other group was given I-LMA (Group L). Two groups were statistically similar in terms of distribution of ASA physical status grading (p&lt;0.05). Two groups were statistically similar in terms of mallampati score distribution. Distribution of duration of surgery was not statistically significant in both the groups (p&gt;0.05). It was observed that insertion I-gel was easy in 50 out of 70 patients. Difficulin 56 out of 70 patients. Difficult to insertion took place in 14 patients. The comparison of ease of insertion between the two groups did not reveal any statistical significance (p&gt;0.05). Conclusion: We concluded I-gel aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

Standard and flexible tip bougie for tracheal intubation using a non‐channelled hyperangulated videolaryngoscope: a randomised comparison#

Bougie impingement during tracheal intubation can increases the likelihood of prolonged intubation time, failed intubation and airway trauma. A flexible tip bougie may overcome this problem, which can occur when using a non-channelled, hyperangulated videolaryngoscope with a standard bougie. This randomised controlled study compared standard and flexible tip bougies using a non-channelled videolaryngoscope (C-MAC® D-blade) in 160 patients. The primary outcome measure was the modified intubation difficulty scale score. Secondary outcome measures were: laryngoscopy time; total tracheal intubation time; first attempt success rate; and postoperative sore throat verbal rating score. The median (IQR [range]) modified intubation difficulty scale scores for standard bougie and flexible tip bougie were 1 (0-2[0-5]) and 0 (0-1[0-3]), respectively (p = 0.001). There was no significant differences in laryngoscopy time, total tracheal intubation time, first attempt success rate and postoperative sore throat between the two groups. Both the flexible tip and standard bougies can be used with a high first attempt success rate for tracheal intubation using a C-MAC D-blade videolaryngoscope. The flexible tip bougie demonstrated a significantly better modified intubation difficulty scale score and lower incidence of bougie impingement.

Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry.

Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia. This study used data from an international observational registry, the Pediatric Difficult Intubation Registry, which prospectively collects data about tracheal intubation in children with difficult airways. The use of sedation versus general anesthesia for tracheal intubation were compared. The primary outcome was the first-attempt success of tracheal intubation. Secondary outcomes included the number of intubation attempts and nonsevere and severe complications. Propensity score matching was used with a matching ratio up to 1:15 to reduce bias due to measured confounders. Between 2017 and 2020, 34 hospitals submitted 1,839 anticipated difficult airway cases that met inclusion criteria for the study. Of these, 75 patients received sedation, and 1,764 patients received general anesthesia. Propensity score matching resulted in 58 patients in the sedation group and 522 patients in the general anesthesia group. The rate of first-attempt success of tracheal intubation was 28 of 58 (48.3%) in the sedation group and 250 of 522 (47.9%) in the general anesthesia group (odds ratio, 1.06; 95% CI, 0.60 to 1.87; P = 0.846). The median number of intubations attempts was 2 (interquartile range, 1 to 3) in the sedation group and 2 (interquartile range, 1, 2) in the general anesthesia group. The general anesthesia group had 6 of 522 (1.1%) intubation failures versus 0 of 58 in the sedation group. However, 16 of 58 (27.6%) sedation cases had to be converted to general anesthesia for successful tracheal intubation. Complications were similar between the groups, and the rate of severe complications was low. Sedation and general anesthesia had a similar rate of first-attempt success of tracheal intubation in children with difficult airways; however, 27.6% of the sedation cases needed to be converted to general anesthesia to complete tracheal intubation. Complications overall were similar between the groups, and the rate of severe complications was low.

Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study.

SummaryRespiratory adverse events in adults with COVID‐19 undergoing general anaesthesia can be life‐threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID‐19. We created an international observational registry to collect airway management outcomes in children with COVID‐19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID‐19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test‐confirmed or suspected COVID‐19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first‐pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID‐19 negative and 329 confirmed or presumed COVID‐19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID‐19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70–4.10)). Children who had symptoms of COVID‐19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5–9.1)). Children with confirmed or presumed COVID‐19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.

Articles That May Change Your Practice: Bougie and First-Attempt Intubation

The inability to maintain airway patency or inadequate oxygenation and ventilation is an emergency situation and an indication for an advanced airway. The quickest and most effective means of establishing a definitive airway is through rapid sequence intubation (RSI). RSI is a requisite skill for practitioners in the air medical and land critical care transport setting. Although these providers have been shown to have a higher first-attempt success rate for tracheal intubation in the prehospital setting compared with other prehospital providers, their rates of first-attempt success are lower than intubations performed in the emergency department by physicians.

Abstract No.: ABS2070: Comparative evaluation of intubating Laryngeal Mask Airway (Fastrach) and Blockbuster Laryngeal Mask Airway for blind tracheal intubation in general surgical operations

Background & Aims:Supraglottic devices fill a niche between the facemask and tracheal tube. The aim of this study was to compare the insertion characteristics (ease of insertion), insertion time, number of attempts, haemodynamic changes and complications (if any)following blind tracheal intubation.Methods:The comparative study was conducted by dividing 70 patients of age 18-60 years, ASA grade I and II into two groups of 35 patients each who were scheduled for general surgical operations. Group F underwent blind tracheal intubation usingFastrach LMA whereas Group B underwent blind tracheal intubation using Blockbuster LMA. The two groups were thencompared for the efficacy and overall success rate of blind tracheal intubation in patients undergoing surgeries under general anaesthesia.Association of cough, vocal cord movement and patient’s reaction with groups Group D (DEXEM)Group P (PROPOFOL)Totalχ2, P No.%No.%No.%Cough None2893.32893.35693.3χ2=0.000, P=1.000 Slight26.726.746.7Vocal Cord Movement Open2583.32893.35388.3χ2=1.456, P=0.228 Moving516.726.7711.7Patient Reaction No reaction826.72066.72846.7χ2=10.410, P=0.015 Slight grimacing1033.36201626.7 Severe grimacing1136.7413.31525 Defensive movement of head, hands or feet13.30011.7 Total301003010060100 Comparison of Intubation Score among both Groups Group D Group P P Mean SD Mean SD Intubation Score4.41.33.61.00.007Results:Both devices were inserted in first attempt only. The first time successful ETT insertion following Blockbuster LMA was in 33/35 patients (94.29%) as compared to 26/35 patients (74.29%) of FT LMA. The mean time taken by Group B was13.57±3.48 seconds as compared to 18.82±5.09 seconds of Group F. The complications (sore throat, dysphagia, dysphonia) were significant for Group F as compared to Group B. The haemodynamic parameters were insignificant for both the groups.Group FGroup B No.% ageNo.% ageFirst time successYes2674.293394.29No925.7125.71Total35100.0035100.00Χ2: 5.285; P=0.002Conclusion:Although both supraglottic devices are feasible for blind tracheal intubation, Blockbuster LMA is a better option as it provides higher first pass success rate with less complications like sore throat, dysphagia and dysphonia.