Total Intubation Time Research Articles

USB-endoscope laryngoscope is as effective as video laryngoscope in difficult intubation

BACKGROUND: Video laryngoscopy (VL) has recently been put into clinical use to minimize the limitations of direct laryngoscopy and assist physicians interested in airway management. However, the high cost is the biggest constraint especially in countries with limited resources. To lower the cost, a custom-made VL obtained by attaching a USB-endoscope camera ($8.5) to the Macintosh laryngoscope (USB-L) can be used. MATERIAL AND METHODS: All intubations were performed in a difficult intubation model. Intubations were carried out by two emergency physicians. A Glidescope as a VL and a custom-made USB-L were used. In addition to these devices, one bougie to facilitate the advancement of the tube was used. The total intubation time was evaluated. RESULTS: Correct tube placement for both operators was 100% for both devices. A difference between the operators in the duration of intubations could not be found. Also, there is no difference in the duration of intubations between the devices for both operators. CONCLUSION: It was concluded that the USB-L and VL are not statistically different in terms of intubation time in the difficult intubation model using bougie. For countries with limited resources, the low-cost USB-L has come to the forefront due to the high cost of VL and difficulty of access.

Effects of tip-manipulated stylet angle on intubation using the GlideScope® videolaryngoscope in children: A prospective randomized controlled trial.

An optimal endotracheal tube curve can be a key factor in successful intubation using the GlideScope videolaryngoscope. This study aimed to evaluate the effects of tube tip-modified stylet curve on the intubation time in children. Children aged 1-5years were randomly assigned to either the standard curve (group S, n=60) or tip-modified curve (group T, n=60) groups. In group S, the endotracheal tube curve was similar to that in the GlideScope. In group T, a point approximately 1.5cm from the tube tip was additionally angled to the left by 15°-20°. The primary outcome was the total intubation time, and the secondary outcomes were incidence of successful intubation in the first attempt, number of additional manipulations of the stylet curve, and visual analog scale (VAS) score for the easiness of intubation. The mean total intubation time was significantly longer in group S than that in group T (13.9 [10.8] vs. 9.0 [3.4] sec, mean difference, 4.9s; 95% confidence interval [CI], 2.0-7.8; p=.001). All patients in group T were successfully intubated in the first attempt, whereas those in group S were not (100% vs. 93.3%, relative risk [RR], 0.11; 95% CI, 0.01-2.02; p=.1376). Three patients in group S could be intubated after modifying the ETT curve similar to that in group T. Operators reported that tracheal intubation was easier in group T than in group S (median [interquartile range] for VAS; 1 [1-2] vs. 2 [1-3]; p<.001). Having additional angle of the endotracheal tube tip to the left could be a useful technique to facilitate directing and advancing endotracheal tube into the vocal cords.

Comparison of direct and video laryngoscope endotracheal intubations by pediatric residents: A study of a child model with normal airway.

This study aimed to compare the efficacy of direct and videolaryngoscopy procedures performed by pediatric residents who had limited experience of direct endotracheal intubation and had not previously used video laryngoscopes in a normal airway child manikin. The endotracheal intubations performed by pediatric residents with a direct laryngoscope and Storz C-MAC videolaryngoscope on a pediatric manikin with a normal airway were compared. Theoretical and practical training was given before the study. In the first attempt, the success of the intubation procedure, glottis visual duration, and endotracheal tube insertion time were determined. Practitioners grouped the glottis image between 1-4 according to the Cormack-Lehane Staging (Stage 1 ideal image). After the intervention, the participants scored one to ten points on direct and videolaryngoscopy (1 not useful, 10 very useful). The success of direct and videolaryngoscopy of 51 pediatric residents on the same manikin was 48 out of 51 (94%) for each method (P> 0.05). Glottis visual duration was similar in both methods (P>0.05); tube insertion and total intubation time were shorter in the video laryngoscope group (P<0.05); glottis image was better in the video laryngoscope group according to Cormack-Lehane Classification (P<0.05). Participants' rating was higher on videolaryngoscope (P<0.05). Users with limited endotracheal intubation experience use Video laryncoscope more effectively than direct laryngoscope in children with normal airway model after training.

Complete percutaneous angio-guided implantation and explantation of VA-ECMO using preclosing for cardiogenic shock or cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: None. Background. The approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Angio-guided percutaneous implantation and explantation could decrease vascular complications. Purpose We sought to describe the feasibility and safety of complete percutaneous angio-guided ECMO implantation and explantation using preclosing. Methods. All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-09/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under fluoroscopic guidance. The occurrence of vascular complication was recorded. Results. Forty-nine patients underwent percutaneous VA-ECMO implantation for cardiogenic shock (n = 36) or refractory cardiac arrest (n = 13). Femoral vessel cannulations were successful in all patients and total cannulation time was 21± 8 min. Weaning from ECMO was possible in 23 patients (47%) and 11 (22%) patients were alive at 30-day. Significant vascular complications occurred in 3 patients (6%); all were related to distal perfusion line. One patient experienced major bleeding, and 2 experienced lower limb ischemia requiring vascular intervention (one failure of distal perfusion sheath implantation and one self-uprooting of the reperfusion cannula). Percutaneous decannulation was performed in 17 patients with 16/17 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. Among these patients, none required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO. Conclusion. Emergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.

Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study.

BackgroundIn the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier.MethodsA randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants’ performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively.ResultsThere were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015).ConclusionsThe findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.

Comparison of KingVision videolaryngoscope channelled blade with Tuoren videolaryngoscope non-channelled blade in a simulated COVID-19 intubation scenario by non-anaesthesiologists and experienced anaesthesiologists: A prospective randomised crossover mannequin study

PurposeA videolaryngoscope has been recommended for intubation in the COVID-19 scenario but the videolaryngoscope providing optimal intubation conditions is not ascertained. We compared KingVision channelled blade with a non-Channelled videolaryngoscope for intubation times in a simulated COVID-19 intubation scenario by both anaesthesiologists and non-anaesthesiologists. MethodsThis prospective randomised cross over mannequin study was conducted in a skill training lab. 25 anaesthesiologists and 25 non-anaesthesiologists donned in standard personal protective equipment performed 100 intubations with KingVision and Tuoren videolaryngoscopes in a mannequin covered with a transparent plastic sheet. The total intubation time, percentage of glottic opening scores, first attempt success rates were assessed. ResultsThe mean difference in intubation times in anaesthesiologists and non-anaesthesiologist less with KingVision videolaryngoscope (21.1s; 95% CI 9.6–32.6s vs. 35.9s; 95% CI 24.4–47.4 s; P = 0.001). Percentage of glottic opening score was significantly better with KingVision by non-anaesthesiologists (60; IQR 42.5 to 75 vs. 70; IQR 50 to 100; P = 0.019). KingVision provided superior first attempt success rate in non-anaesthesiologists (84% vs. 61.9%; P = 0.02) and anaesthesiologists (96% vs. 76%; P = 0.12). ConclusionKingVision channelled videolaryngoscope provided faster intubation times, glottic views and first attempt success rates in a simulated COVID-19 scenario in manikins and might be preferred over videolaryngoscopes with non-channelled blade. The findings need to be further verified in humans. Trial registrationctri.nic.in identifier: REF/2020/05/033338.

Complete percutaneous angio-guided approach using preclosing for venoarterial extracorporeal membrane oxygenation implantation and explantation in patients with refractory cardiogenic shock or cardiac arrest

BackgroundThe approach for veno-arterial extracorporeal membrane oxygenation implantation (VA-ECMO) in patients with cardiogenic shock can be either surgical or percutaneous. Complete angio-guided percutaneous implantation and explantation could decrease vascular complications. We sought to describe the initial results of complete percutaneous angio-guided ECMO implantation and explantation using preclosing.MethodsAll consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020). Percutaneous preclosing using two closing devices (Perclose ProGlide, Abbott) inserted before cannulation was used in both femoral artery and vein. Explantation was performed using a crossover technique under angiographic guidance. The occurrence of vascular complication was recorded.ResultsAmong the 56 patients who underwent percutaneous VA-ECMO implantation for cardiogenic shock or refractory cardiac arrest, 41 underwent preclosing. Femoral vessel cannulation was successful in all patients and total cannulation time was 20 (10–40) min. Weaning from ECMO was possible in 22/41 patients (54%) and 12 (29%) patients were alive at day 30. Significant vascular complications occurred in 2/41 patients. Percutaneous decannulation was performed in 20 patients with 19/20 technical success rate. All femoral arteries and veins were properly closed using the pre-closing devices without bleeding on the angiographic control except for one patient in whom surgical closure of the artery was required. No patient required transfusion for access related significant bleeding and no other vascular complication occurred. Furthermore, no groin infection was observed after full percutaneous implantation and removal of ECMO.ConclusionEmergent complete percutaneous angio-guided VA-ECMO implantation and explantation using pre-closing technique can be an attractive strategy in patients referred for refractory cardiogenic shock.

For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis.

Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear. When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia. A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time. PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020. The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia. Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference -7.28 (-14.40 to -0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference -0.59 (-1.95 to 0.77) s, P = 0.40. On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time. The study protocol has been registered in PROSPERO (CRD42020169949).

Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal Intubation in Anaesthetised Spontaneously Breathing Paediatric Patients.

ObjectiveFlexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route.MethodsSixty children aged 6–12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded.ResultsThe time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting.ConclusionIntubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6–12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.

A prospective observational study on predicting the risk of obstructive sleep apnea and difficult intubation in patients posted for elective surgery

Introduction: The present study compared video laryngoscope with Macintosh laryngoscope in terms of laryngoscopic time, total intubation time, Cormack and lehane scale and stress response while intubating. Materials and methods: After a standardized technique of induction of anesthesia, Group MCL (53 cases) intubated with Macintosh laryngoscope and Group VVL (53cases) intubated with Vividtrac Video laryngoscope. We compared laryngoscopic time, total intubation time, Cormack and lehane scale and stress response while intubating in these two groups. Results: The heart rate and blood pressure was above immediately after post intubation and started declining to reach post induction value at about three to five minutes in both groups (p values > 0.05).The mean tracheal intubation time was 11.05 seconds in MCL group and 18.05 seconds in VVL group (p-0.001). All cases in VVL group were intubated in first attempt, but one patient in MCL group required two attempts for success (p->0.05). Visualisation of glottis and non-alignment of the airway axis was better with VVL (p-0.001). There is no desaturation noted in all of the 106 cases. Conclusion: Vivid trac Laryngoscope has a comparable similar safety profile with Macintosh laryngoscope with respect to deleterious haemodynamic response produced by rigid manipulation of airway. Vivid trac Video Laryngoscope, a rigid channeled indirect laryngoscope provides always the better view of the laryngeal inlet than the Macintosh direct laryngoscope. Intubation time in Vividtrac video laryngoscopy was more than conventional laryngoscopy.

Prospective Cohort Study Comparing Varying Doses of Cisatracurium and Atracurium on Intubating Conditions in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Cisatracurium and atracurium are non-depolarising muscle relaxants belonging to benzylisoquinolinium group. Intubating dose of cisatracurium is found to be safer than atracurium owing to the histamine release and resultant respiratory and cardiac side-effects associated with the latter. However, intubating conditions of twice the ED95 dose (2xED95) of cisatracurium are not as satisfactory as equipotent dose of atracurium because of its higher potency. Aim: To compare the time of onset, intubating conditions and mean duration of action of three and four times ED95 doses (3 and 4xED95) of cisatracurium with 2xED95 dose of atracurium so as to find out an ideal intubating dose of cisatracurium that is comparable with 2xED95 of atracurium. Materials and Methods: The present study was a prospective cohort study that included 102 patients who underwent elective laparoscopic cholecystectomy. They were divided into three groups of 34 each to receive atracurium 0.5 mg/kg (group A), cisatracurium 0.15 mg/kg (group B) or cisatracurium 0.2 mg/kg (group C) for intubation. Onset and duration of neuromuscular block were assessed using Train Of Four (TOF) stimuli. Total time for intubation and mean intubation scores were also noted. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 18.0. Qualitative data were compared using Chi-square test and quantitative data compared using Analysis of Variance (ANOVA). Results: Onset of neuromuscular blockade in groups A, B and C were 292.06±61.486, 204.71±39.407 and 120.88±37.284 seconds (p-value &lt;0.001), respectively. Mean intubation score was highest in group C along with least intubating time (p-value &lt;0.001). The mean duration of action in groups A, B and C were 40.44±5.275, 48.24±5.888 and 63.38±7.659 minutes, respectively (p-value &lt;0.001). Conclusion: The 3 and 4xED95 doses of cisatracurium are superior to 2xED95 dose of atracurium in providing faster onset of action, better intubating conditions, shorter intubation time and longer duration of action. The 4xED95 dose of cisatracurium may be considered for rapid intubation in two minutes.

A hybrid nasal intubation technique for the head and neck surgical patient: a case series and review of the literature

Purpose The inherent morbidity associated with intubation, especially nasal intubation, is well documented in the literature. Risks include vocal cord trauma, arytenoid dislocation, and trauma throughout the nasopharynx and the larynx. Furthermore, repeated intubation attempts are associated with increased patient morbidity and mortality. The head and neck surgical patient poses a unique challenge to the anesthesiologist, presenting with a difficult airway in addition to often requiring nasal intubation for surgical access. This case report series evaluates a hybrid technique that applies existing difficult airway strategies as a standard combined approach in the head and neck surgical patient without trismus. Nasal intubation is achieved with direct laryngoscopy, with or without the assistance of Magill forceps, fiberoptic scopes, and video laryngoscopes, to minimize nasopharyngeal trauma. Our method combines the standard armamentarium for rescue techniques into a hybrid approach. Methods Once anesthesia is induced and after topicalization with lidocaine and oxymetazoline, a nasal Ring-Adair-Elwyn (RAE) endotracheal tube is passed through the favorable nostril and into the nasopharynx. The video laryngoscope is next used to visualize the glottis. Once the tip of the nasal RAE is advanced and visualized near the glottic opening, a fiberoptic scope is passed through the nasal RAE. Two video screens are used simultaneously to guide the fiberoptic scope and subsequently the endotracheal tube through the glottis. Results The 3 patients described in this article were successfully intubated by using this approach, without the use of Magill forceps. This resulted in minimal trauma, fewer intubation attempts, and comparable intubation time. Conclusions Although neither the constituents nor the techniques are unique, they are usually reserved as mutually exclusive rescue measures for managing the difficult airway. We believe this hybrid technique may become the standard of care for the majority of head and neck surgical patients requiring nasal intubation. This decreases the risk of nasopharyngeal and laryngeal trauma and does not increase cost because the video laryngoscope and the fiberoptic scope are standard equipment available in most hospitals. This approach may decrease patient morbidity and reduce total intubation time.

Improving mucosal anesthesia for awake endotracheal intubation with a novel method: a prospective, assessor-blinded, randomized controlled trial

BackgroundTopical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation.MethodsThis is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed.ResultsSixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study.ConclusionsIn awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.Trial registrationChiCTR1900023151. Date of registration: May 14th, 2019.

Comparison of C-MAC D-Blade with macintosh laryngoscope for endotracheal intubation in patients with cervical spine immobilization: A randomized controlled trial

BackgroundRecently, indirect laryngoscopes have emerged as an important tool in managing a difficult airway but the literature is insufficient on the comparison of C-MAC D-Blade with Macintosh for tracheal intubation during manual-in-line stabilization. We compared the efficacy of C-MAC D-blade with Macintosh laryngoscope for tracheal intubation in patients with manual-in-line stabilization. MethodsEighty adult patients undergoing elective surgery under general anesthesia were intubated after application of MILS using C-MAC D-Blade (n = 40) or Macintosh laryngoscope (n = 40) as per group allocation. Intubation Difficulty Scale was the primary outcome. We also recorded the duration of laryngoscopy, modified Cormack-Lehane grading, time taken for intubation, total intubation time, optimizing maneuvers required, number of attempts, and complications. ResultThe median intubation difficulty score (inter-quartile range) was significantly lower with C-MAC D-Blade[(0, 0–1) vs (3, 2–3)](P < 0.0001). C-MAC D-Blade provided significantly better glottic view in lesser time (10 s[7.5–13]vs9 [7–10]) (P = 0.02) without optimum external laryngeal manipulation(p = 0.0001). Time taken for tracheal intubation was longer in the C-MAC D-Blade, though, the total duration of tracheal intubation was comparable in both the groups (P = 0.069). ConclusionC-MAC D-Blade is superior to the Macintosh laryngoscope in terms of lower Intubation Difficulty Score in patients undergoing tracheal intubation with cervical spine immobilization.

S3105 Colonoscopy Total Withdrawal Time and Cecal Intubation Time in Gastrointestinal Medicine Fellows

S3105 Colonoscopy Total Withdrawal Time and Cecal Intubation Time in Gastrointestinal Medicine Fellows

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

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

Conversion of I-gel to definitive airway in a cervical immobilized manikin: Aintree intubation catheter vs long endotracheal tube

BackgroundAfter prehospital insertion of i-gel, a popular supraglottic airway (SGA), fiberoptic-guided intubation through i-gel is often required to switch the i-gel to a definitive airway for anticipated difficult airway. The Aintree intubation catheter (AIC) was developed for this purpose yet it requires many procedural steps during which maintenance of adequate ventilation is difficult. We custom-made a long endotracheal tube (LET) which may facilitate this procedure and compared the efficacy of the AIC and LET in a cervical immobilized manikin.MethodsIn this 2 × 2 crossover manikin-based trial, 20 anaesthesiologists and residents performed both methods in random order. Total intubation time, fiberoptic time, and procedure time were recorded. The ease of insertion, procedure failure rate, difficulty score, and participants’ preference were recorded.ResultsTotal intubation time was significantly shorter for the LET than the AIC group (70.8 ± 16.4 s vs 94.0 ± 28.4 s, P = 0.001). The procedure time was significantly shorter in the LET group (51.9 ± 13.8 s vs 76.5 ± 25.4 s, P < 0.001). The ease of insertion score was lower, i.e., easier, in the AIC than the LET group (2.0 [1.0–2.75] vs 1.0 [1.0–1.0], P < 0.001). Fiberoptic time (19.0 ± 6.9 s vs 17.5 ± 12.3 s) and subjective difficulty (4.0 [3.0–6.0] vs 4.0 [3.0–5.75]) were similar between groups. Fourteen participants preferred the LET method (70%) due to its fewer procedural steps.ConclusionsLET resulted in a shorter intubation time than the AIC during fiberoptic-guided intubation through the i-gel, possibly due to the less procedural steps compared to AIC.Trial registrationNCT03645174 (ClinicalTrials.gov, Aug 22, 2018).

Video Assisted Laryngoscope Facilitates Intubation Skill Learning in the Emergency Department.

Up-to-date technology has been increasingly useful for learning resuscitation skills in the emergency and resuscitation settings. It improves the learning curve of the learners and helps them to avoid making mistakes on real patients. This study aimed to evaluate the educational efficiency for tracheal intubation by comparing Macintosh (direct) laryngoscope (DL) and video laryngoscope (VL) learning in novices. This prospective randomized controlled study was conducted in an emergency department between 2013 and 2014. Fifth- and sixth-year medical students were enrolled and assigned to normal airway and difficult airway groups, respectively. They were then further randomized into using a VL or DL for tracheal intubation learning. Participants had three practices before proceeding to the post-course assessment. Our primary outcome was post-course assessment performance, which included intubation success rate, total intubation time and best glottic view. The secondary outcome was the sum of total intubation learning times during the three practices. We recruited 177 undergraduate students. Of these, 97 were assigned to the normal airway group (49 VL and 48 DL) and 80 were placed in the difficult airway group (40 each for VL and DL). VL significantly quickened the intubation learning time in both the normal airway and difficult airway groups (140 s vs. 158 s, 141 s vs. 221.5 s; both p < 0.05). The learning curve was much improved with VL when compared using time-to-event analysis (p < 0.001). VL also improved the glottic view performance during post-course assessments. VL improves the learning curve in acquiring intubation skills compared with traditional DL. It shortens the time undergraduate students take to develop such skills and increased their first attempt success rates.

A study to evaluate and compare intubating laryngeal mask airway and air-Q intubating laryngeal airway for intubation using Parker Flex Tip tube.

Background and Aims:Though manufacturer recommendations suggest use of specific endotracheal tube (ETT) with intubating laryngeal mask airway (ILMA) and air-Q intubating laryngeal airway (ILA), Parker Flex Tip tube introduced by J D Parker has certain advantages and is also cost-effective. This study was conducted to compare ILMA and air-Q ILA for intubation using Parker Flex Tip tube.Methods:Patients of either gender, aged 18–60 years, scheduled for elective surgery requiring endotracheal intubation were included in this study. In group A (n = 55), blind intubation was done through ILMA using Parker Flex Tip tube and in group B (n = 55), blind intubation was done through air-Q ILA using Parker Flex Tip tube. Success rate, number of attempts, ease and a total time of intubation were recorded.Results:Intubation was successful in 54 patients (98.2%) in group A and in 46 patients (85.2%) in group B (P = 0.026). Intubation was significantly easy with ILMA (P = 0.048). Manoeuvres for intubation were used in 10.9% patients in group A while it was used in 27.8% patients in group B. Significantly, more manoeuvres were required with air-Q ILA for intubation (P = 0.026). Number of attempts for ETT placement (P = 0.092), insertion time of ETT (TT) (P = 0.472) and total time taken for successful intubation (P = 0.526) were comparable in both the groups.Conclusion:The intubating laryngeal mask airway was superior to the air-Q intubating laryngeal airway for blind intubation using Parker Flex Tip tube.

Comparison of conventional with Parker flex-tip tracheal tube for intubation through air-Q intubating laryngeal airway

Background and Aims:The problem of difficult and failed intubation led to increased development of equipment for airway management. A number of supraglottic airways have now been developed to facilitate the passage of tracheal tubes. Conventional PVC tracheal tubes are recommended for intubation through the air-Q ILA. No study has compared different PVC tubes for blind intubation through air-Q ILA. Thus, we undertook this prospective, randomised, single blind study to compare two PVC tracheal tubes with different designs viz. conventional PVC tracheal tube (TT) and Parker flex-tip TT with regards to success rate, ease of intubation and total time required for successful intubation through air-Q ILA.Material and Methods:One hundred patients of either sex, aged 18–60 years, belonging to American Society of Anesthesiologists (ASA) physical status class I and II scheduled for elective surgery under general anesthesia requiring endotracheal intubation were included in the study. Blind intubation using conventional PVC TT and Parker flex-tip tube was done in group A (n = 50) and group B (n = 50), respectively.Results:The first attempt success rate in Parker flex-tip TT was significantly more as compared to conventional PVC TT (P = 0.002). Success rate of intubation was significantly more in Parker flex-tip TT as compared to conventional PVC TT (P = 0.004). The intubation was significantly easy in Parker flex-tip tube as compared to conventional PVC TT (P = 0.002). Total time of intubation was less in Parker flex-tip tube as compared to PVC TT (P = 0.043).Conclusion:Unique design of the Parker Flex-tip TT resulted in increase in success rate, first attempt success rate and ease of intubation in group B in present study.