Intubation Research Articles

A Cross-Sectional Survey of Anesthesiologists' Awareness Toward Traumatic Dental Injuries During General Anesthesia in Syrian Arab Republic.

Traumatic dental injuries with tracheal intubation during general anesthesia are considered one of the most common complications. It is also the primary reason for malpractice legal claims against anesthesiologists according to insurance companies. There is much information regarding the incidence, consequences, and risk factors of traumatic dental injuries during general anesthesia. This study aimed to assess the awareness (knowledge, practice, and attitude) of anesthetists regarding peri-anesthetic traumatic dental injuries and discuss measures to reduce the risk regarding peri-anesthetic traumatic dental injuries. Sixty seven anesthetists participated in this cross-sectional survey between January 2023 and July 2023, which was carried out in the Syrian Arab Republic. The questionnaire was generated using Google Forms and sent individually, as the researcher (MNA) was accompanied by all included anesthesiologists while filling out all the questionnaire paragraphs to answer any questions. The Fisher exact test and Pearson's Chi-squared test were used to analyze the results. The dental trauma caused by the anesthetists during their professional careers was 38.8%, and none of them were exposed to any legal claim. 77.6% of the anesthetists thought that avulsed permanent teeth could be replanted, 46.2% believed that the procedure must be done in < 30 min, and 84.6% thought they could not do it themselves and would send the patient to a dentist after the procedure. More than half of respondents (63.5%) indicated that the sterile saline solution was the best storage medium for avulsed teeth. Furthermore, 74.6% of anesthetists stated that emergency intubations are related to more traumatic dental injuries in comparison with elective intubation and about 62% were aware of the importance of mouthguard. However, nearly 57% complained about the shortage of knowledge related to the oral cavity and its special structure. Syrian anesthetists have limited awareness (knowledge, practice, and attitude) of traumatic dental injury classification, prevention, and management. More information and training are still needed about factors used within clinical dentistry.

Novice Learners’ Perspectives on Obstetric Airway Crisis Decision-Making Training Using Virtual Reality Simulation

(Int J Obstet Anesth. 2024;57:103926. https://doi.org/10.1016/j.ijoa.2023.103926) The incidence of failed tracheal intubation during cesarean sections ranges from 1:238 to 1:808 and has not improved in 40 years despite advances in airway equipment and training. Most failures occur after hours with trainee anesthetists, leading to a mortality rate of 1 in 90. Over the past 3 decades, the preference for neuraxial over general anesthesia has increased due to better postoperative analgesia and fewer airway complications. Managing difficult airways in obstetrics is crucial but less common, reducing practice opportunities for trainees. Our curriculum includes didactic teaching and simulations, but current training may be insufficient. Virtual reality (VR) offers a potential solution by providing safe, immersive simulation training and enhancing technical and decision-making skills in managing difficult obstetric airways. The study aims to assess junior residents’ learning needs and perceptions of VR as a training tool.

Outcome of video laryngoscopy versus direct laryngoscopy for emergency tracheal intubation in emergency department: a propensity score matching analysis

BackgroundThe high incidence of airway management failure in the emergency department (ED) necessitates a comparative analysis of laryngoscopy methods. This study aims to compare the success and complications associated with video-assisted laryngoscopy (VL) and direct laryngoscopy (DL) in emergency tracheal intubation in ED.MethodsThis retrospective cohort study was conducted at the ED of Thammasat University Hospital. It involved adult patients undergoing emergency tracheal intubation using either VL (GlideScope®) or DL (Macintosh®). The outcomes assessed were success rates of intubation and occurrence of peri-intubation adverse events. Propensity score matching and multivariable risk regression analysis were employed for statistical evaluation.ResultsThe study included 3,424 patients, with 342 in the VL group and 3,082 in the DL group. The initial analysis revealed no significant differences in the intubation success rates between the two methods. However, the VL group experienced fewer peri-intubation adverse events (33% compared to 40%). After propensity score matching, a higher first-attempt success rate was observed in the DL group (88.9% vs. 81.3%, risk difference: 7.6, 95% CI: 1.9 to 13.2, p=0.009), but there was no statistically significant difference in peri-intubation adverse events. VL had a lower first-attempt success rate among low-experience intubators. Subgroup analyses of intubators with moderate and high experience, as well as patients who received both induction agents and neuromuscular blocking agents, show results consistent with the analysis of the entire cohort.ConclusionBoth VL and DL have comparable first-attempt success rates and peri-intubation adverse events. VL is particularly beneficial when used by moderately or highly experienced intubator. The choice of intubation method, combined with clinical experience and technique plays a critical role in the success and safety of emergency intubations.

Effectiveness of different pharmacological or non-pharmacological interventions on preventing coughing during extubation: a protocol for a systematic review and network meta-analysis

IntroductionCoughing during extubation can lead to several postoperative complications, including surgical site bleeding, intracranial hypertension and high intraocular pressure. Currently, various pharmacological and non-pharmacological interventions are employed in clinical practice...

Atrial Fibrillation Impacts Inpatient Mortality, Length of Stay, Resource Utilization, Blood Transfusion, and Endotracheal Intubation in Cesarean Sections, Natural Spontaneous Deliveries, and Instrumental Deliveries: A Nationwide Analysis (2016-2020)

Atrial Fibrillation Impacts Inpatient Mortality, Length of Stay, Resource Utilization, Blood Transfusion, and Endotracheal Intubation in Cesarean Sections, Natural Spontaneous Deliveries, and Instrumental Deliveries: A Nationwide Analysis (2016-2020)

Obstructive shock and cardiac arrest due to diaphragmatic hernia after esophageal surgery: a case report.

We report the exceedingly rare case of diaphragmatic hernia after esophageal surgery resulting in obstructive shock and cardiac arrest. An 82-year-old man, who had undergone a robotic-assisted thoracoscopic esophagectomy and gastric tube reconstruction via a subcutaneously route with three-field lymphadenectomy for esophagogastric junction cancer at another hospital 3months prior, complaining of persistent epigastric pain and nausea. Computed tomography revealed that the proximal jejunum had herniated through the esophageal hiatus into the left thoracic cavity, with dilation of the subcutaneous gastric tube and duodenum. He was urgently admitted, and a nasogastric tube was inserted. His respiratory and circulatory parameters were normal upon admission, however, nine hours after admission, there was a rapid increase in oxygen demand, and he subsequently developed shock. His blood pressure was 106/65 mmHg, pulse rate of 150bpm, respiratory rate of 30/min with an O2 saturation of 97% on High-flow nasal cannula FiO2:0.4, cyanosis and peripheral coldness appeared. Chest X-ray showed a severe mediastinal shift to the right, suggesting obstructive shock due to intestinal hernia into the thoracic cavity. Emergency surgery was planned, but shortly after endotracheal intubation, the patient experienced cardiac arrest. It was found that approximately 220 cm of small intestine had herniated into the thoracic cavity through the esophageal hiatus, and it was being strangulated by the diaphragmatic crura. A portion of the diaphragmatic crura was incised to manually reduce the herniated small intestine back into the abdominal cavity. The strangulated intestine was congested, but improvement in coloration was observed and it had not become necrotic. The procedure finished with closure of the esophageal hiatus. Intensive care was continued, but he died on postoperative day 29 because of complications including perforation of the descending colon and aspiration pneumonia. Rapid progression of small intestine hernia into the thoracic cavity, leading to obstructive shock, was suspected. While this case was rare, early recognition of the condition and prompt reduction could have potentially led to life-saving outcomes.

Evaluation and Treatment of Acute Laryngeal Injury at Time of Tracheostomy for Prolonged Intubation.

The primary objective was to assess incidence and severity of acute laryngeal injury (ALgI) following intubation at time of tracheostomy using a proposed grading scale. The secondary objective was to evaluate what factors influence the rate of decannulation. Single institution cohort study with review of prospectively maintained database including patients from October 2021 to October 2022 who underwent tracheostomy for prolonged intubation/critical illness. Severity of ALgI was graded as mild, moderate, or severe based on intraoperative endoscopic findings (laryngeal mucosal ulceration and/or granulation tissue). Rates of tracheostomy decannulation were collected as the secondary outcome measure. Twenty-eight patients met criteria for inclusion. About 60.7% (n = 17) patients were female. Average age was 59.0 ± 13.2 years old. Average body mass index was 32.3 ± 14.0 kg/m2. The most common endotracheal tube size was 7.5 (range = 6.0-8.0) inner diameter (ID) for men and 7.0 (range = 5.5-8.0) ID for women. Average Charlson Comorbidity Index (CCI) was 4.8 ± 2.4. Length of intubation was 15.7 ± 6.5 days (range = 5-30). Direct laryngoscopy at the time of tracheostomy demonstrated ALgI in 92.8% (n = 26) of patients. This was graded as mild (25.0%, n = 7), moderate (42.9%, n = 12), or severe (25.0%, n = 7). Severe ALgI was correlated with a reduced rate of tracheostomy decannulation compared to no/mild/moderate ALgI (28.5% vs 81.2%, P = .04). ALgI is highly prevalent in patients undergoing tracheostomy for prolonged intubation. Severe injury is associated with reduced rates of decannulation. Direct laryngoscopy at time of tracheostomy is warranted to diagnose ALgI and guide interventions. Determining the extent of laryngeal injury is prognostic and could help tailor follow-up and management strategies. 4.

Performance of a hybrid capture-based target enrichment next-generation sequencing for the identification of respiratory pathogens and resistance-associated genes in patients with severe pneumonia.

Severe pneumonia remains the leading infectious cause of death worldwide. The time-consuming nature and suboptimal sensitivity of sputum cultures hamper prompt pathogen detection for tailored treatments. Advanced techniques such as polymerase chain reaction (PCR) and next-generation sequencing (NGS) offer rapid genetic pathogen detection and identification of antimicrobial resistance (AMR) genes. However, the performance of hybrid capture-based target enrichment NGS, e.g., Respiratory Pathogen ID/AMR Enrichment Panel (RPIP), for pathogen detection in patients with severe pneumonia remains uncertain. A prospective study involving adults with severe pneumonia was conducted. Respiratory samples from the lower respiratory tract were collected via bronchoalveolar lavage, bronchial washing, or endotracheal tube suction. The performance of RPIP in pathogen and AMR-associated gene detection was compared to that of conventional culture methods and the multiplex PCR-based FilmArray Pneumonia Panel (FilmArray-PN). A total of 83 subjects were enrolled. The most prevalent pathogens detected by RPIP were Rothia mucilaginosa, Stenotrophomonas maltophilia, Pseudomonas aeruginosa; herpes simplex virus-1, cytomegalovirus, and Epstein-Barr virus, and Pneumocystis jirovecii. Overall, the positive and negative agreement rates for bacterial detection were 63.6% and 97.5% between RPIP and culture methods, respectively, and 55.8% and 99.4% between FilmArray-PN and culture methods, respectively. Compared to FilmArray-PN, RPIP exhibited significantly better detection rates for bacteria (P = 0.029), viruses (P < 0.001), and fungi (P < 0.001) and identified additional blaOXA, blaCMY as extended-spectrum β-lactamase genes and blaOXA, blaSHV as carbapenemase genes. In conclusion, RPIP can sensitively profile respiratory pathogens and is a promising tool for detecting multiple microorganisms and AMR-associated genes in patients with severe pneumonia.IMPORTANCESensitive pathogen detection is pivotal for timely treatment by tailoring adequate antimicrobial agents. Unlike conventional phenotypic approach, novel measures using molecular interrogation appear promising. This study aimed to elucidate the efficacy of a hybrid capture-based target enrichment next-generation sequencing technique (Respiratory Pathogen ID/AMR Enrichment Panel, RPIP) as exemplified in a cohort with severe pneumonia. Pathogen landscape in the population was illustrated by these three methodologies. As compared with multiplex polymerase chain reaction-based FilmArray Pneumonia Panel and conventional culture, RPIP demonstrated significantly improved sensitivity in identifying bacteria, viruses, and fungi. The RPIP also exhibited better performance in identifying different pathogens in patients co-infected with multiple microorganisms. Additionally, the genotypes contributing to antimicrobial resistance were determined by RPIP. The study facilitated the implementation of molecular diagnosis by presenting real-world data, whereas future studies are mandated to generalize such an approach toward different clinical settings.

Does intubation while observing the glottis with a fiberoptic scope reduce postoperative sore throat?

IntroductionIn oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11–55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube. However, the extent to which this technique causes postoperative complications is unknown compared to traditional technique. The aim of this study was retrospectively to determine the effect of postoperative sore throat following nasotracheal intubation by tip of the tube is visualized by fiberoptic scope.MethodAnesthesia records of the adult patients with nasotracheal intubation were checked. Patients underwent oral maxillofacial surgery from January 2021 until March 2023. Facilitated with rocuronium, nasotracheal intubation was performed using the traditional or observative method by fiberoptic scope with a 4.8 mm outer diameter. Intubation was performed with a cuffed 6.5–8.0 mm ID nasotracheal tube. The following variables were recorded: gender, age, height, weight, ASA classification, anesthesia time, duration of intubation, tube size, intubation attempts, fentanyl and remifentanil. The postoperative sore throat and the incidence of hoarseness were recorded at operative day and at the day after operative day, and the time to recovery.ResultA total of 104 cases (traditional fiberoptic intubation n = 51, observative fiberoptic intubation n = 53) were enrolled in this retrospective study. There were no significant differences in clinical characteristics and anesthetic data. There was not significant difference in incidence of postoperative sore throat, hoarseness and recovery between the two groups (P = 0.61, 0.44, 0.90). For subjects reporting postoperative sore throat (n = 30), there was not a significant difference in VAS means at operative day and at the day after operative day between the two groups (P = 0.81, 0.91).ConclusionWe found that postoperative sore throat and recovery were not influenced by observative fiberoptic scope for nasotracheal intubation.

Comparison Between I-Gel And Endotracheal Tube For Peak Airway Pressure During General Anesthesia In Pediatric Inguinal Hernia Surgeries

Objective: To compare I-gel and Endotracheal tube for peak airway pressure during general anesthesia in pediatric inguinal hernia surgeries Study Design: Quasi experimental study. Place and Duration of Study: Anesthesia/surgical department, Pak Emirates Military Hospital Rawalpindi, Pakistan Jun to Nov 2021. Methodology: A Quasi experimental study was conducted on 250 children. Patients were randomly assigned into two groups. Group-A received the I-gel after induction with sedative agents while Group-B received the Endotracheal tube with routine induction and muscle paralysis. Peak airway pressure was monitored by the consultant anesthetist on anesthesia workstation throughout the surgery. Results: Out of 250 pediatric patients undergoing hernia repair randomized into two groups, 136(54.4%) were categorized into Group-A and 114(45.6%) were categorized into Group-B. Mean age of patients in our study was 3.35±2.454 years. 159(63.6%) children included in the study were male while 91(36.4%) were female. Out of 250, 202(80.8%) patients had normal peak airway pressure during the surgery while 48(19.2%) had raised pressure during the surgery. Use of Endotracheal tube was found statistically significantly associated with raised peak airway pressure during the surgery (p-value&lt;0.05). Conclusion: Use of I-gel was found better in relation to maintenance of peak airways pressure as compared to Endotracheal tube in pediatric patients undergoing hernia repair under general anesthesia.

Application of Submandibular Intubation as Alternative to Elective Short-Term Tracheotomy for Particular Cases of Oral and Maxillofacial Tumors Resection and Defects Reconstruction

Objective: To describe the cases of oral and maxillofacial tumors (OMFT) resection and defects reconstruction under submandibular intubation (SMI) performed in our institution; secondly, to systematically review and analyze the characteristics of studies about SMI in oral and maxillofacial surgery to estimate the incidence rate of complication. Method: Data related to all 6 patients included in this study were prospectively collected from November 2016 to November 2023. The tract for endotracheal tube was created by bluntly dissection from the submandibular area to the floor of mouth. We performed an exhaustive search for studies about SMI using Pubmed, Embase, Proquest, and Chinese Biomedical Literature Database. Meta-analysis of the incidence rate of complication and infection was performed using STATA 14.1. Results: There was a male predominance (87.3%); the mean age was 47.8±16.8 years; squamous cell carcinoma (SCC) was the most frequent diagnosis (33.3%); the mean time of the operation was 237.0±65.2 minutes; the SMI procedure mean time was 5.5±0.9 minutes; and the mean time to extubation 133.3±12.5 minutes. No accident or complication was observed intraoperatively and postoperatively. The systematic review included 22 out of 234 studies screened. The meta-analysis showed an overall complication rate and superficial infection rate of 5.7% and 3.7% in the last 15 years versus 20.2% and 10.6% in over 15 years ago. Conclusion: Submandibular intubation was found technically easy, safe, and effective alternative of elective short-term tracheotomy, orotracheal and nasotracheal intubations in our series of OMFT resection and defects reconstruction.

Improvement of the Endotracheal Intubation Skill of Nurse Anesthesia Students Using Visual Self-evaluation in Iran: A Randomized Controlled Study

Background: One of the feedback methods is visual self-evaluation, which is a type of immediate feedback provided after a task. It is at the level of self-regulation. Mastery in learning requires accurate evaluation of clinical skills, and visual self-evaluation can help learners to master the stages of skill implementation. Objectives: The present study investigated the effect of visual self-evaluation on the endotracheal intubation skill of nurse anesthesia students of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Methods: This randomized controlled study was conducted in April and May of 2023. 63 second- and third-year nurse anesthesia students were allocated to the intervention (visual self-evaluation) and control (conventional methods) groups according to the academic year, using stratified random sampling. The skill of endotracheal intubation was taught using visual self-evaluation method in the intervention group while the same skill was taught in the control group based on the conventional methods, i.e. lecture, practical training, and practice on the mannequin under the supervision of the instructor. Visual self-evaluation and conventional teaching methods were compared in terms of learning outcomes. The endotracheal intubation skill evaluation checklist developed by hart was used to evaluate endotracheal intubation skill. The students of the intervention group also completed a questionnaire to measure their satisfaction with the visual self-evaluation method. Results: The students with a mean age of 21.53 ± 3.65 years, participated in this study. About 73% of the participants were women. The mean scores of students in the post-test compared to the pre-test in both intervention (23.56 ± 2.68 at baseline and increased to 28.87 ± 4.80) and control (24.03 ± 2.22 at baseline and increased to 25.19 ± 2.46) groups increased significantly (P &lt; 0.001), but the mean post-test scores of the intervention group were significantly higher than those of the control group (P &lt; 0.001). Also, the mean satisfaction score in the intervention group was 40.79 ± 1.22 out of a maximum of 50, which indicates a very high satisfaction with the adoption of visual self-evaluation method in clinical education. Conclusions: The use of visual self-evaluation not only had a significant effect on improving the clinical skill of nurse anesthesia students but also was effective in helping them learn self-regulation and achieve mastery and independence. This method is recommended as a low-cost and effective method to be used along with other educational methods.

Post-esophagectomy patients presenting for general anesthesia induction: a survey of practice among US anesthesiologists (PESO-GAIN-S).

Following esophagectomy, annually several thousand patients in the United States (US) reach a stable post-esophagectomy status. Such patients may require general anesthesia (GA) for elective procedures, but no generally accepted guidelines exist for the induction of GA in post-esophagectomy patients. A national survey describing a post-esophagectomy patient was emailed to 23,524 attending anesthesiologists who were members of the American Society of Anesthesiologists. The survey included 3 demographic and 12 anesthetic management questions. Responses were further stratified by gender, years in practice and frequency of exposure to the patient population of interest. A total of 744 (3.2%) respondents completed the survey. The respondent demographic characteristics closely reflected recent US anesthesiology workforce analyses. Endotracheal tube was the preferred method of airway management for 648 (87.1%), 419 (64.7%) used a rapid sequence induction, and 504 (67.7%) elected a reverse Trendelenburg position, withthe latter two choices being favored among anesthesiologists with routine (vs. rarely/never) exposure to post-esophagectomy patients (76.6% vs. 58.4%; p < 0.001; and 73.6% vs. 63.9%; p = 0.021, respectively). Across survey participants, induction of GA was highly variable with differential effects of gender, years in practice and exposure frequency to post-esophagectomy patients. US attending anesthesiologists' approach to induction of GA in a patient with a history of successful esophagectomy was not uniform. The majority of responses reflected a concern for aspiration in such a patient. Considering surgical and non-surgical upper gastrointestinal changes, establishment of practice guidance to optimize perioperative care is an unmet need.

Airway management in pediatrics: improving safety

AbstractAirway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.

Analysis of YouTube Videos on Endotracheal Tube Aspiration Training in Terms of Content, Reliability, and Quality

This descriptive study aims to investigate the content, quality, and reliability of YouTube videos containing content related to endotracheal tube aspiration. The study was scanned using the keywords “endotracheal aspiration” and “endotracheal tube aspiration,” and 22 videos were included in the study. The contents of the selected videos were measured using the Endotracheal Tube Aspiration Skill Form, their reliability was measured using the DISCERN Survey, and their quality was measured using the Global Quality Scale. Of the 22 videos that met the inclusion criteria, 18 (81.8%) were educational, and four (18.2%) were product promotional videos. When pairwise comparisons were made, the coverage score of open aspiration videos was higher for educational videos than for product promotion videos (P &lt; .005). Useful videos had higher reliability and quality scores than misleading videos (P &lt; .05). In addition, the reliability and quality scores of videos uploaded by official institutions were significantly higher than those of videos uploaded by individual users (P &lt; .05). This study found that the majority of endotracheal tube aspiration training videos reviewed in the study were published by individual users, and a significant proportion of these videos had low levels of reliability and quality.

Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) directed therapy of patients with malignant pleural effusion and pleural metastasis

Abstract Objectives Pressurized IntraThoracic Aerosol Chemotherapy (PITAC) has been suggested as a new therapy for patients with malignant pleural effusion (MPE) and/or pleural metastasis (PLM). The patients have a poor prognosis with a median survival of 3 to 12 months. We present feasibility, patient safety, and cytological/histological response assessment in PITAC-treated patients with MPE and/or PLM. Methods Patients eligible for PITAC and treated at Odense PIPAC Center were included. PITAC was performed in lateral decubitus or prone position under double-lumen endotracheal tube ventilation to allow exclusion of the lung if necessary. After positioning of the ultrasound-guided trocar, the second trocar is inserted by video-assisted thoracoscopy. MPE was evacuated and measured. Pleural lavage was performed if no or small amounts of MPE were present. MPE or pleural lavage fluid was analyzed cytologically. Visible PLM was biopsied and sent for histology assessment using a four-tiered Thoracic Regression Grading Score (TRGS). After a walkthrough of the safety checklist, the chemotherapy was nebulized followed by 30 min of passive diffusion. The chemotherapy and chemotherapy-saturated air was evacuated through a closed bag and ventilation system. Results We report data on 11 intended PITACs in five patients. Nine PITACs were completed and two PITACs were discontinued due to intraoperative complications or technical reasons. Response evaluation was available in three patients: one showed complete response (TRGS 1) and another stable disease (TRGS 2). Cytology was available from two patients: one showed conversion from malignant to benign. The 30-day mortality was zero. Conclusions PITAC appears to be safe and feasible.

Development of Competencies in Emergency Nursing: Comparison Between Self-Assessment and Tutor Evaluation Before and After a Training Intervention.

Nursing competence encompasses the integration of knowledge, skills, and attitudes essential for comprehensive and safe patient care. This study aimed to compare self-assessment and tutor evaluation of nurses' competencies in a hospital emergency department before and after a training intervention. A quasi-experimental design was employed, involving 63 newly hired nurses who participated in a mentorship program. The intervention included theoretical and practical sessions on critical care skills. Data were collected through self-assessment questionnaires and objective evaluations by tutors using validated rubrics. The results indicated significant differences between self-assessment and tutor evaluations in pre- and post-intervention phases, particularly in competencies related to orotracheal intubation and fibrinolytic therapy for ischemic stroke. Post-intervention, discrepancies between self-assessment and tutor evaluations decreased, suggesting improved self-awareness and competence among participants. This study highlights the importance of combining self-assessment and external evaluation to ensure accurate competency assessment and effective educational interventions, ultimately enhancing the quality of patient care.

Anesthetic Challenges in a Patient with Nodular Sclerosing Classical Hodgkin’s Lymphoma complicated by Cervical Metastasis and SVC Syndrome: A Case Report

This case presents the anesthetic complexities involved in managing a patient with nodular sclerosing classical Hodgkin’s Lymphoma, who presented with severe airway compromise, limited neck mobility due to C7 vertebra involvement, and superior vena cava syndrome. The patient, with an extensive anterior neck mass extending into the mediastinum, post-auricular, and axillary areas, exhibited symptoms such as dyspnea, orthopnea, facial swelling, and upper extremity edema, complicating traditional airway management techniques. Faced with these challenges, the team anticipated significant difficulty with ventilation, direct laryngoscopy, and invasive airway access. To address the airway obstruction effectively before initiating radiotherapy, the anesthesiologists employed awake nasotracheal intubation using a fiberoptic scope with minimal sedation using Remifentanil. This approach successfully secured the airway and facilitated an extended tracheostomy. The patient tolerated the procedure well and was eventually discharged. This case underscores the critical role of fiberoptic intubation in managing complex airway scenarios, particularly in patients with complex malignancies and associated complications.

Prevalence of Atypical Bacteria in Patients from Different Paediatric Age Groups Diagnosed with a Respiratory Disease.

Atypical bacterial pathogens present the ability to induce pulmonary damage. At present, there are no available phenotypic diagnosis tests that achieve up to 100% reliability. Therefore, clinicians must utilise molecular techniques for the detection and identification of these pathogens. The main objective of this research was to evaluate the prevalence of atypical bacteria in paediatric patients from different age groups. A total of 609 clinical samples were collected from paediatric patients who presented with an adverse respiratory condition during the period from March 2021 to February 2024. DNA was extracted from the samples, and end-point PCR was performed to detect atypical bacteria. Statistical analyses were performed to evaluate the bacterial prevalence and assess clinical data from newborns and mothers that could be related to RDS. A total of 139 patients exhibited at least one atypical organism (22.82%). Ureaplasma parvum was more prevalent in neonates, while M. pneumoniae and C. pneumoniae were more prevalent in older infants. Atypical bacteria can be present in all seasons of the year, but their prevalence increases during hot weather. Mixed infections due to atypical bacteria may occur. The risk factors related to the development of RDS are prematurity, low weight, and orotracheal intubation.

Practice and outcomes of endotracheal intubation in the emergency department: a retrospective observational study at a single institution in Bhutan

BackgroundAirway management is a critical skill required in the Emergency Department (ED). We conducted an observational airway registry-based study to report the practice and outcome of endotracheal intubations in the ED at the national referral hospital in Thimphu.MethodsAll patients who were intubated in the ED and recorded on the registry data form between May 2020 to November 2022 were studied. Variables such as indications, type of physician performing intubations, success rate, complications, medications, and disposition were captured. Descriptive analysis was presented in frequency and proportions.ResultsThere were a total of 336 intubations during the study period. First pass success rate was 87.80% and complication rate was 19.64%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt. Most intubations were performed by emergency medicine (EM) residents (54.17%), followed by medical officers (37.8%). Emergency Physician (EP) performed the least number of intubations, 27 (8.04%). During preoxygenation, 64.5% (n = 217) patients received positive pressure ventilations and 119 (35.42%) did not.ConclusionPhysicians working in the ED are the primary airway provider. First pass success rate was 87.80%. 40 patients (11.90%) needed a second attempt and only 1 patient required a third attempt.