Investigating the influence of experiential training on the ability to anticipate risks of caught-in accidents.

Caught-in accidents are the most common type of occupational accidents in Taiwan's manufacturing industry. Although the law stipulates that, as a control measure, specific machinery and equipment must comply with safety standards before leaving the factory, caught-in accidents are still reported. Therefore, education and training are important. We referred to Kirkpatrick's four-level model for analysis and chose a film manufacturer as the study subject. Workers were divided into three groups to evaluate the effectiveness of different training methods: (a) without safety/health education and training (control group); (b) with traditional lecture teaching; (c) with practical experiential training. Although statistically significant overall, only the group with practical experiential training showed statistically significant differences in graph selection and occupational accident videos compared to the group without safety/health education and training. Therefore, we suggest using traditional indoor lectures and practical experiential training for risk anticipation in enterprises to improve their performance.

An alternative technique for accurate placement of central venous catheter tips.

For intravenous electrocardiography (IVECG), a wire stylet is usually utilized as the exploring probe to correctly position the central venous catheter. We present an alternative technique using the transduction probe connected to the original right arm lead of the ECG monitor to accurately position the central venous catheter. We compared the efficacy and quality of the IVECG signals of the two techniques. Sixty patients were randomly enrolled into two groups. In group G, the IVECG signal was conducted from the guide wire to identify the correct catheter tip position. In group T, the IVECG signal was conducted from the transduction probe to ascertain the tip position. The quality of IVECG signals, which included baseline drift, P-wave pattern, and QRS wave pattern, were assessed for 10 seconds. There was no obvious difference between the groups for catheter tip placement time or measured optimal catheter length. During manipulation, the incidence of cardiac dysrhythmia was higher in group G than in group T, but the difference was not significantly different (p = 0.09). Satisfactory IVECG signal quality was observed in 26 of the 30 patients in group G and in 27 of the 30 patients in group T. We conclude that the transduction probe can effectively conduct IVECG signals with no specific additional equipment required. It is an alternative technique for accurate placement of central venous catheter tips during IVECG.

Application of a double-lumen tube for one-lung ventilation in patients with anticipated difficult airway.

One-lung ventilation (OLV) is essential in some surgical situations. The use of double- lumen tubes (DLTs) can achieve OLV more quickly and more easily than bronchial blockers. The management of a difficult airway is a challenge for anesthesiologists when, at the same time, OLV is needed for a surgical procedure. This report describes the successful application of DLTs in two patients with difficult airways, and who were scheduled for pulmonary decortication. Case 1 already had a permanent tracheostomy, while Case 2 had oral cancer with an extremely limited mouth opening and needed elective tracheostomy for anesthesia. Nasal intubation of Case 2 was done with fiberoptic-guided intubation with the patient awake. OLV was achieved uneventfully after inserting the DLT directly through the tracheostomy in both cases. We also describe the appropriate use of airway devices for OLV, focusing on patients with an anticipated difficult airway.

Perioperative airway management in a child with Treacher Collins syndrome.

We report the perioperative airway management in a 12-year-old boy suffering from Treacher Collins syndrome (TCS) and severe mental retardation who was scheduled for elective dental treatment under general anesthesia. TSC is also known as mandibulofacial dysostosis or Franceschetti syndrome, usually with a potentially difficult airway presentation. It is a major challenge for the anesthesiologist to manage an uncooperative child with such a congenital airway anomaly. A difficult airway was encountered during induction of general anesthesia, and both oral intubation by direct laryngoscopy and classic laryngeal mask airway (LMA) insertion were unsuccessful. In an expedient critical trial, with the cooperation of two anesthesiologists, one performing nasal fiberoptic intubation and the other maintaining oral mask ventilation, a nasal endotracheal tube was successfully placed at the first attempt, although at the expense of prolonged respiratory depression in the patient. Therefore, fiberoptic nasal intubation simultaneously with mask ventilation for placement of the endotracheal tube is a practical substitute for a difficult airway usually managed by LMA with inadequate ventilation. After extubation, tracheostomy may be indicated if the TCS patient suffers from persistent difficult upper airway in consequence of a traumatic intubation.

Lightwand-assisted intubation of patients in the lateral decubitus position.

In some situations, patients need endotracheal intubation to maintain airway patency while they are constrained in the lateral position. In this study we compared lightwand-guided intubation of 120 randomly enrolled patients placed in the supine, right, or left lateral position. Group S patients were initially placed in the supine position, and subsequent to the artificial airway having been established they were turned to the lateral decubitus position. Group R patients were initially placed in a right decubitus position during induction and intubation. Group L patients were initially placed in a left decubitus position during induction and intubation. The duration of each intubation attempt, the total time to successful intubation, and the incidence of intubation-related intraoral injury, hemodynamic changes, and postoperative sore throat and hoarseness were recorded. Intubation took a similar length of time in the supine (14.5 +/- 13.4 s), left lateral (13.3 +/- 10.2 s), and right lateral positions (15.5 +/- 13.0 s) and resulted in a similar trend in hemodynamic changes. Patients in the lateral and supine positions revealed a comparable incidence of successful first-attempt intubation, sore throat, hoarseness, oral mucosal injury, and dysrhythmia. Insignificantly more esophageal intubations were performed in the lateral position in the first attempt at intubation; however, all patients were correctly intubated shortly after reattempting intubation. We concluded that lightwand-assisted intubation is easily performed and a similar technique may be used whether the patient is in a lateral, recumbent, or a supine position. This alternative technique should be practiced and is recommended for patients who must remain in a lateral position during intubation and surgery.