Video-assisted Laryngoscopy Research Articles

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

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

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

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

How to Build a Low-Cost Video-Assisted Laryngoscopy Suite for Airway Management Training

How to Build a Low-Cost Video-Assisted Laryngoscopy Suite for Airway Management Training

Conventional versus video-assisted laryngoscopy for perioperative endotracheal intubation (COVALENT) - a randomized, controlled multicenter trial

BackgroundData on the routine use of video-assisted laryngoscopy in peri-operative intubations are rather inconsistent and ambiguous, in part due to small populations and non-uniform outcome measures in past trials. Failed or prolonged intubation procedures are a reason for relevant morbidity and mortality. This study aims to determine whether video-assisted laryngoscopy (with both Macintosh-shaped and hyperangulated blades) is at least equal to the standard method of direct laryngoscopy with respect to the first-pass success rate. Furthermore, validated tools from the field of human factors will be applied to examine within-team communication and task load during this critical medical procedure.MethodsIn this randomized, controlled, three-armed parallel group design, multi-centre trial, a total of more than 2500 adult patients scheduled for perioperative endotracheal intubation will be randomized. In equally large arms, video-assisted laryngoscopy with a Macintosh-shaped or a hyperangulated blade will be compared to the standard of care (direct laryngoscopy with Macintosh blade). In a pre-defined hierarchical analysis, we will test the primary outcome for non-inferiority first. If this goal should be met, the design and projected statistical power also allow for subsequent testing for superiority of one of the interventions.Various secondary outcomes will account for patient safety considerations as well as human factors interactions within the provider team and will allow for further exploratory data analysis and hypothesis generation.DiscussionThis randomized controlled trial will provide a solid base of data in a field where reliable evidence is of major clinical importance. With thousands of endotracheal intubations performed every day in operating rooms around the world, every bit of performance improvement translates into increased patient safety and comfort and may eventually prevent significant burden of disease. Therefore, we feel confident that a large trial has the potential to considerably benefit patients and anaesthetists alike.Trial registrationClincalTrials.gov NCT05228288.Protocol version1.1, November 15, 2021.

How to Build a Low-Cost Video-Assisted Laryngoscopy Suite for Airway Management Training.

This suite of borescope laryngoscopes is designed to instruct emergency medicine residents and sub-interns in video-assisted airway management. Skillful and confident airway management is one of the markers of a strong emergency medicine physician.1 Video-assisted airway management is a necessary skill, particularly in the setting of difficult airways and cervical spine immobilization.2,3 However, the idea of learning airway management "by doing" is high-risk and mistakes can have devastating implications on patient outcomes. Fortunately, high-fidelity medical simulation tools have been developed to address this dilemma, allowing a safe environment for providers to practice their airway management skills.4,5 These tools, while undeniably useful, are limited in their scope; they are often designed for clinical rather than educational use, and are proprietary and expensive.6,7Video laryngoscopes approved for patient use are difficult to implement widely in educational settings due to cost or because they cannot be removed from a designated area. Clinical video laryngoscopy suites typically cost 2,000 - 6,000 US dollars. Additionally, the video images can only be viewed on a local small screen rather than a television or projector. This means that the number of learners is limited by space around the small laryngoscope screen. These cost and space barriers may be especially pronounced in low resource or non-traditional learning environments. Using an anatomically accurate airway simulator, by the end of a 20-30-minute instructional session, learners should be able to: 1) Understand proper positioning and use the video laryngoscope with dexterity, 2) identify airway landmarks via the video screen, and 3) demonstrate ability to intubate a simulated airway. We developed a low-cost borescope laryngoscope for airway simulation training. Using this device, learners should be able to identify airway landmarks and successfully intubate a simulated airway. The borescope laryngoscope, a novel device which employs the camera-end of a video borescope and a single-use VL blade, was used by learners during high-fidelity airway simulation. Learners were residents or medical students undergoing airway training in case-based simulation, or in airway-management procedure stations. The borescope laryngoscopes were used during dedicated airway training in place of their medical device counterparts. During case-based simulation sessions involving airway management, 32 residents and 20 medical students used the borescope laryngoscope. During dedicated airway management procedure stations, 12 medical students used the borescope laryngoscope. Learners were instructed to perform endotracheal intubation and fully visualize critical structures before passing the tube. Successful intubation was defined as the ability to pass the tube independently or with the help of the instructor. The borescope laryngoscope proved effective at video visualization of critical structures. Compared to official medical equipment, the VL borescope similarly allowed for visualization of a Cormack-Lehane Grade 1 view. Learners were able to visualize the airway anatomy and successfully pass the ET tube on each pass either independently or with the help of the instructor. The development of this airway-training tool was effective and less expensive than medical grade versions. Our group of learners successfully visualized essential anatomy and passed an endotracheal tube (ED tube) through the vocal cords. The borescope laryngoscope offers a comparable user experience at a much lower cost. The devices also allowed instructors to teach video laryngoscopy without depending on clinical equipment. Widespread use may allow for expansion of airway simulation training while maintaining a high-fidelity learner experience. Video laryngoscopy, borescope, improvised equipment, airway training.

Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: AMulticenter Study of Clinical Outcomes.

To explore the association between video-assisted laryngoscopy (use of a videolaryngoscope regardless of where laryngoscopists direct their gaze), first-attempt success, and adverse airway outcomes. We conducted an observational study using data from 2 airway consortiums that perform prospective surveillance: the National Emergency Airway Registry for Children (NEAR4KIDS) and a pediatric emergency medicine airway education collaborative. Data collected included patient and procedural characteristics and procedural outcomes. We performed multivariable analyses of the association of video-assisted laryngoscopy with individual patient outcomes and evaluated the association between site-level video-assisted laryngoscopy use and tracheal intubation outcomes. The study cohort included 1,412 tracheal intubation encounters performed from January 2017 to March 2021 across 11 participating sites. Overall, the first-attempt success was 70.0%. Video-assisted laryngoscopy was associated with increased odds of first-attempt success (odds ratio [OR] 2.01; 95% confidence interval [CI], 1.48 to 2.73) and decreased odds of severe adverse airway outcomes (OR 0.70; 95% CI, 0.58 to 0.85) including decreased severe hypoxia (OR 0.69; 95% CI, 0.55 to 0.87). Sites varied substantially in the use of video-assisted laryngoscopy (range from 12.9% to 97.8%), and sites with high use of video-assisted laryngoscopy (> 80%) experienced increased first-attempt success even after adjusting for individual patient laryngoscope use (OR 2.30; 95% CI, 1.79 to 2.95). Video-assisted laryngoscopy is associated with increased first-attempt success and fewer adverse airway outcomes for patients intubated in the pediatric emergency department. There is wide variability in the use of video-assisted laryngoscopy, and the high use is associated with increased odds of first-attempt success.

Algorithm (Vado) and (Via) Mnemoic in the Airway Approach in Patients with Head and Neck Tumors: A Case Report

Head and neck tumors are considered potential and important malignancies. Airway management is a challenge for the surgical medical team, but for the anesthesiologist implies a challenge when choosing the approach and insurance method of the airway for each specific case. This is a case review of a 27-year-old female patient with a diagnosis of papillary thyroid tumor 9 months. We emphasize the importance and effectiveness of the VADO algorithm and the V.I.A mnemonic in patients with head and neck tumors as a tool when planning and performing a difficult airway approach. The importance of having an anesthetic plan prior to the surgical procedure in order to avoid complications in order to reduce the morbidity and mortality of patients with head and neck tumors when undergoing general anesthesia, always considering other precautions such as Video-Assisted Laryngoscopy or Awake Intubation in this patients

Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies.

Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet. Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared. From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups. The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.

Video-assisted versus macintosh direct laryngoscopy for intubation of obese patients: a meta-analysis of randomized controlled trials

INTRODUCTION: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the usefulness of video-assisted (VL) approaches with the Macintosh direct laryngoscope for endotracheal intubation of obese patients. MATERIAL AND METHODS: Studies were obtained via a systematic search of SCOPUS, Medline, Web of Science, CINAHL, and the Cochrane Central databases. The polled relative risks (RRs) odds ratios (ODs) or standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated with a random–effects model. Subgroup analyses were performed to evaluate the influence of VL types on the association. RESULTS: First intubation attempt success rate in VL and DL group varied and amounted to 94.7% vs 89.5% respectively (OR = 2.04; 95% CI: 1.21–3.42; p = 0.007) and overall intubation success rate was 99.0% vs 97.5% respectively (OR = 2.20; 95% CI: 0.45–10.67; p = 0.33). Intubation time which was 48.0 ± 37.7 for VL and 48.4 ± 37.5 seconds for DL (SMD = 0.14; 95% CI: –0.33–0.61; p = 0.56). Cormack-Lehane 1 or 2 grade during intubation using VL was observed in 95.9% of cases and was statistically significantly higher than in the case of direct laryngoscopy (79.6%; OR = 6.68; 95% CI: 3.32–13.42; p &lt; 0.001). CONCLUSIONS: Our meta-analysis suggests that video-assisted intubation may be superior to conventional intubation in an obese patient population due to a higher first–attempt success rate, better glottis visibility, and a lower rate of intubation-related injuries.

Comparison of direct laryngoscopy and video-assisted laryngoscopy in pediatric intensive care unit

Our objective was to compare video-assisted laryngoscopy (VAL) with direct laryngoscopy (DL) for glottic visualization in a pediatric intensive care unit in terms of the success rate in first attempts. Our study included patients aged from 1 month to 18 years who were admitted to the pediatric intensive care unit. We excluded patients with limited neck extension (C-spine immobilization, congenital abnormality), congenital anomalies (e.g., Pierre Robin syndrome, micrognathia, macroglossia), and recent airway surgery. Patients were premedicated before intubation. The time to intubation was defined as the time between the start of anesthesia and completion of intubation. The start of anesthetic induction was defined as the time the sedative was first administered. Completion of intubation was defined as the time that the end-tidal carbon dioxide tension was detected. We evaluated 120 of 135 intubations that met our inclusion criteria; 15 were excluded because in eight cases (53%) non-pediatric intensive care physicians made the initial attempts, and in seven cases (47%) the recorded intubation times were erroneous. We detected significantly higher POGO scores in the VAL group (p<0.001). VAL provided a fuller view of the glottis (Cormack and Lehane grade 1) than DL (p<0.001). Although the intubation attempts in the DL group were significantly higher (two or more attempts), no intubation failures occurred in either group.

Maintenance of basic endotracheal intubation skills with direct or video-assisted laryngoscopy: A randomized crossover follow-up study in inexperienced operators.

BackgroundLaryngoscopy is a difficult skill to acquire and maintain and even more so by less frequent users. Numerous studies have compared limitations of direct laryngoscopic (DL) and video‐assisted laryngoscopic (VL) techniques for endotracheal intubation in different scenarios, but individual retention over time of intubation skills with either technique has, to our knowledge, never been reported. The primary aim of this study was to evaluate to what extent recently acquired basic skills of endotracheal intubation, based on DL or VL, are being maintained over time by inexperienced operators.MethodsThis randomized crossover follow‐up study was designed to compare endotracheal intubation with direct (McIntosh blade) versus video‐assisted (hyperangulated blade) laryngoscopy by 20 undergraduate medical students in identical manikins three months after brief basic intubation training with no further intubation practice.ResultsNo significant differences in skills retention were found between DL and VL regarding the time for successful intubation or number of adverse events. However, the first intubation was significantly slower regardless of the technique compared with the last one three months earlier. Furthermore, DL was slower and associated with more incidents of esophageal intubation and dental manipulation than was VL.ConclusionsAlthough basic intubation skills seem to be similarly well maintained over time regardless of the laryngoscopic technique, endotracheal intubation with VL by inexperienced operators is faster and associated with fewer adverse events than is DL after a three‐month period with no further intubation training.

Technical factors associated with first-pass success during endotracheal intubation in children: analysis of videolaryngoscopy recordings

BackgroundFirst-pass success (FPS) during intubation is associated with lower morbidity for paediatric patients. Using videolaryngoscopy (VL) recordings, we reviewed technical aspects of intubation, including factors associated with FPS in children.MethodsWe...

Maintenance of Skill Proficiency for Emergency Skills With and Without Adjuncts Despite the Use of Level C Personal Protective Equipment.

ObjectiveTo determine the impact of Level C personal protective equipment (PPE) on the time to perform intravenous (IV) cannulation and endotracheal intubation, both with and without the use of adjuncts.MethodsThis prospective, case-control study of emergency medicine resident physicians was designed to assess the time taken by each subject to perform endotracheal intubation using both direct laryngoscopy (DL) and video laryngoscopy (VL), as well as peripheral IV cannulation both with and without ultrasound guidance and with and without PPE.ResultsWhile median times were higher using VL as compared to DL, there was no significant difference between intubation with either DL or VL in subjects with and without Level C PPE. Similarly, no significant difference in time was found for intravenous cannulation in the PPE and no-PPE groups, both with and without ultrasound guidance.ConclusionsExisting skill proficiency was maintained despite wearing PPE and there was no advantage with the addition of adjuncts such as video-assisted laryngoscopy and ultrasound-guided intravenous cannulation. A safe and cost-effective strategy might be to conduct basic, just-in-time PPE training to enhance familiarity with donning, doffing, and mobility, and couple this with the use of personnel who have maximal proficiency in the relevant emergency skill, instead of more expensive, continuous, skills-focused PPE training.

Simulation-based Randomized Paired Cross-over Comparison of Direct versus Video-assisted Laryngoscopy for Endotracheal Intubation by Inexperienced Operators

PurposeDirect laryngoscopy (DL) is the standard technique for endotracheal intubation. Video-assisted laryngoscopy (VL) has emerged as an alternative, particularly for difficult airway management. Nevertheless, DL and VL have not been systematically compared for simulation-based endotracheal intubation by inexperienced operators. MethodA prospective, randomized cross-over study was carried out at Lund University Faculty of Medicine, Malmö, Sweden, in 50 medical undergraduate students with no previous experience of endotracheal intubation in manikins or patients. Identical manikins (Rescue AnneTM, Laerdal AS, Stavanger, Norway) were consecutively intubated using DL with the Macintosh-type blade, and VL with the hyper-curved GlidescopeTM blade. Similarly designed and extensive instructional films on DL and VL techniques were shown to each study participant immediately before each training session, comprising ten consecutive individual intubation attempts with that specific device. No further instructions or feedback were provided by the study investigators. ResultsThe VL technique was found to be overall faster than DL, and also associated with fewer intubation failures (P = 0.0209), dental manipulations (P < 0.001), and oesophageal intubations (P < 0.0001). DiscussionSince VL for endotracheal intubation by inexperienced operators was more successful and associated with fewer adverse events than was DL, we propose that VL might be preferable to DL for endotracheal intubation by less experienced users. Further research is however strongly encouraged to validate these findings.

Determining correct tracheal tube insertion depth by measuring distance between endotracheal tube cuff and vocal cords by ultrasound in Chinese adults: a prospective case-control study

ObjectivesUnrecognised malposition of the endotracheal tube can lead to severe complications in patients under general anaesthesia. The purpose of this study was to verify the feasibility of using ultrasound to...

Use of the McGRATH™ MAC: To view or not to view?

BackgroundDue to the life-threatening consequences that a failed tracheal intubation entails, many efforts have been made to identify specific patient features, which may predict difficulty during tracheal intubation. In addition, debate exists as to whether or not video-assisted laryngoscopy (VAL) should replace direct laryngoscopy and if airway practitioners will lose their skills associated with direct laryngoscopy, now that VAL use has increased in clinical practice. AimThis study was designed to determine the first attempt success rate of tracheal intubation with the McGRATH™ MAC laryngoscope using direct visualization in patients with known difficult airways, as well as exploring the possibility of identifying a particular direct Cormack-Lehane (C-L) grade view where indirect (video) visualization can be most beneficial during laryngoscopy and intubation. MethodsFollowing IRB/ethical board approval and written informed consent, 100 adult patients (age > 18 years) with an ASA status I-III and a BMI < 50 kg/m2 who met ≥ 2 of the following inclusion criteria: Mallampatti class: III-IV, reduced mouth opening < 4 cm, neck circumference (>40 cm for females, > 43 cm for males), thyromental distance < 6 cm, ratio of the patient's height to thyromental distance ≥ 23.5 cm, sternomental distance < 12 cm, requiring general anesthesia for an elective surgery, were enrolled into this study. Patient demographic characteristics and intervening outcomes, such as initial modified C-L grade view for both direct and indirect laryngoscopy, first-attempt success rate, and the time required for a successful intubation with the McGRATH™ MAC, were recorded. ResultsOut of the 94 patients that were included in the data analysis, 72 (76.6%) were successfully intubated via direct laryngoscopy and 16 (17%) were successfully intubated via indirect (video) laryngoscopy on the first attempt with the McGRATH™ MAC (P = 0.59). This translates to an overall first-attempt success rate of 96.15% (n = 88). Six patients required a second attempt for tracheal intubation, in which indirect (video) laryngoscopy was then performed, representing an 83% second attempt success rate (n = 5; 5.3%). One patient (1.1%) required a third intubation attempt and an alternative device was used to secure the airway (n = 1; Table 1). The most common initial C-L grade view during the first attempt was a 2b (28.7%), which accounted for 36.1% of the 72 patients that were successfully intubated via direct laryngoscopy (n = 26). A noticeable C-L grade view improvement was observed with the use of the McGRATH™ MAC using the indirect view. Thus, the most common initial indirect C-L grade view during the first attempt was a 1 (54.3%), which accounted for 65.3% of the 72 patients that were successfully intubated via direct laryngoscopy (n = 47). ConclusionThe McGRATH™ MAC is a versatile laryngoscope that allows both direct and indirect (video) laryngoscopy to be performed, simultaneously if needed, with a favorable chance of successful intubation during the first attempt. VAL with the McGRATH™ MAC exhibited an enhanced glottic view and served as a successful rescue airway device during inadequate glottic visualization and/or unsuccessful tracheal intubation, after failing with the same device when direct laryngoscopy was performed.

PHOTODYNAMIC THERAPY OF RESIDUAL LARYNGEAL TUMOR AFTER EBRT (CASE REPORT)

A case of successful photodynamic therapy of residual laryngeal tumor after external beam radiotherapy (EBRT) is reported. The female patient with diagnosis of laryngeal cancer T1N0M0 underwent a course of EBRT on larynx, fraction dose = 2 Gy, 5 fractions per week, total radiation dose = 60 Gy. One month after EBRT the continued growth of residual tumor in the left vocal fold was diagnosed. The patient had 4 courses of photodynamic therapy with photosensitizer fotoditazin at a dose of 100 mg combined with electroresection of residual laryngeal tumor. The control video-assisted laryngoscopy 1 month after the 4th course of photodynamic therapy showed that larynx was flexible, vocal function was fully restored, tumor of the left vocal fold wasn’t detected. Non-recurrence follow-up period is 10 month. The patient is under follow-up.

Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy.

ObjectiveDifficult airway management is a key skill required by all pediatric physicians, yet training on multiple modalities is lacking. The objective of this study was to compare the rate of, and time to, successful advanced infant airway placement with direct laryngoscopy, video-assisted laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway simulator. This study is the first to compare the success with 3 methods for difficult airway management among pediatric trainees.Study DesignRandomized crossover pilot study.SettingTertiary academic medical center.MethodsTwenty-two pediatric residents, interns, and medical students were tested. Participants were provided 1 training session by faculty using a normal infant manikin. Subjects then performed all 3 of the aforementioned advanced airway modalities in a randomized order on a difficult airway model of a Robin sequence. Success was defined as confirmed endotracheal intubation or correct LMA placement by the testing instructor in ≤120 seconds.ResultsDirect laryngoscopy demonstrated a significantly higher placement success rate (77.3%) than video-assisted laryngoscopy (36.4%, P = .0117) and LMA (31.8%, P = .0039). Video-assisted laryngoscopy required a significantly longer amount of time during successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6 seconds; 95% CI, 24.7-48.4).ConclusionsPediatric trainees demonstrated significantly higher success using direct laryngoscopy in a difficult airway simulator model. However, given the potential lifesaving implications of advanced airway adjuncts, including video-assisted laryngoscopy and LMA placement, more extensive training on adjunctive airway management techniques may be useful for trainees.

Trachway Intubating Stylet Facilitates the Double-Lumen Endobronchial Tube Placement in Patients with Limited Mouth Opening

Intubation for one lung ventilation in patients with difficult airways can be a challenge. Severely limited mouth opening restricts the use of direct laryngoscopy or video-assisted laryngoscopy. We present two patients with limited mouth opening undergoing video-assisted thoracoscopic decortication, who were successfully intubated with left-sided double-lumen endobronchial tube (DLT) using the Trachway® intubating stylet. This technique provides a safe and reliable method for DLT intubation in patients with limited mouth opening.

Comparison Between Direct and Video-assisted Laryngoscopy for Intubations in a Pediatric Emergency Department.

The objective was to compare video-assisted laryngoscopy (VAL) to direct laryngoscopy (DL) on success rate and complication rate of intubations performed in a pediatric emergency department (ED). This is a retrospective cohort study of attempted intubations of children aged 0-18 years in a pediatric ED between 2004 and 2014 with first attempt by an ED provider. In VAL, the laryngoscopist attempts direct visualization of the glottis with a C-MAC video laryngoscope while the video monitor is used for real-time guidance by a supervisor, back-up visualization for the laryngoscopist should the direct view be inadequate, and confirmation of endotracheal tube passage through the vocal cords. We performed univariate comparisons of intubations using DL to intubations using VAL on rates of first-pass success, complications, and whether the patient was successfully intubated by an ED provider. We then created a logistic regression model to adjust for provider experience level, difficult airway characteristics, and indications for intubation to compare intubations using DL to intubations using VAL for each outcome. We identified 452 endotracheal intubations of 422 unique patients, of which 445 intubations had a first attempt by an ED provider. Six intubations were excluded due to insufficient information available in the record. Of the included intubations, 240 (55%) were attempted with DL and 199 (45%) with VAL. The overall first-pass success rate was 71% in the DL group and 72% in the VAL group. After adjustment for covariates, the first-pass success rate was similar between laryngoscopy approaches (adjusted odds ratio = 1.23, 95% confidence interval = 0.78 to 1.94). We found no difference between DL and VAL with regard to first-pass intubation success rate, complication rate, or rate of successful intubation by ED providers for children undergoing intubation in a pediatric ED.