Evaluation of a novel, low-cost, 3D printed video laryngoscope with borescope in anesthetized Beagle dogs.

OBJECTIVE: To develop and evaluate a low-cost three-dimensional (3D)-printed video laryngoscope (VLVET) for use with a commercial borescope. STUDY DESIGN: Instrument development and pilot study. ANIMALS: A total of six adult male Beagle dogs. METHODS: The VLVET consisted of a laryngoscope handle and a Miller-type blade, and a detachable camera holder that attached to various locations along the blade. The laryngoscope and camera holder were 3D-printed using black polylactic acid filament. Dogs were premedicated with intravenous (IV) medetomidine (15 µg kg-1) and anesthesia induced with IV alfaxalone (1.5 mg kg-1). The VLVET, combined with a borescope, was used for laryngeal visualization and intubation. Performance was evaluated by comparing direct and video-assisted views in sternal recumbency. The borescope camera was sequentially positioned at 2, 4, 6, 8 and 10 cm from the blade tip (distanceLARYNX-CAM), which was placed on the epiglottis during intubation or laryngoscopy. At the 10 cm distanceLARYNX-CAM, laryngeal visualization was sequentially scored at inter-incisor gaps of 10, 8, 6, 4 and 2 cm. Laryngeal visualization scores (0-3 range, with 0 = obstructed and 3 = unobstructed views) were statistically analyzed using the Friedman's test. RESULTS: Under direct visualization, the 2 cm distanceLARYNX-CAM had a significantly lower score compared with all other distanceLARYNX-CAM (all p = 0.014) because the view was obstructed by the camera holder and borescope camera. With both direct and camera-assisted views, visualization scores were higher at inter-incisor gaps ≥ 4 cm compared with 2 cm (all p < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: During laryngoscopy and intubation, the VLVET and borescope facilitated both direct and video laryngoscopy at distanceLARYNX-CAM in Beagle dogs when inter-incisor gaps were ≥ 4 cm.

Sex Disparities in Applied Force on Maxillary Incisors Among Novices During Laryngoscopy Using a High-Fidelity Simulator: A Prospective Observational Study.

Endotracheal intubation (ETI) is a common and crucial intervention. Whether the performance of ETI differs according to the sex of the laryngoscopist remains unclear. The aim of this study was to assess sex disparities in markers of ETI performance among novices using a high-fidelity simulator. This prospective observational study was conducted from April 2017 to March 2019 in a public medical university. In total, 209 medical students (4th and 5th grade) without clinical ETI experience were recruited. Of the 209 students, 64 (30.6%) were female. The participants used either a Macintosh direct laryngoscope or C-MAC video laryngoscope in combination with a stylet or gum-elastic bougie to perform ETI on a high-fidelity simulator. The primary endpoint was the maximum force applied on the maxillary incisors during laryngoscopy. The secondary endpoint was the time to ETI. The implanted sensors in the simulator automatically quantified the force and time to ETI. The maximum force applied on the maxillary incisors was approximately 30% lower in the male than female group for all laryngoscopes and intubation aids examined (all P < 0.001). Similarly, the time to ETI was approximately 10% faster in the male than female group regardless of the types of laryngoscopes and intubation aids used (all P < 0.05). In this study, male sex was associated with a lower maximum force applied on the maxillary incisors during both direct and indirect laryngoscopy performed by novices. A clinical study focusing on sex differences in ETI performance is needed to validate our findings.

Design and Usability of an Open-Source, Low-Cost Flexible Laryngoscope for Resource-Limited Settings.

Importance: Endoscopes are paramount to the practice of otolaryngology. To provide physicians in low-middle-income countries with adequate tools to treat otolaryngologic problems, it is necessary to create a low-cost sustainable option. Objective: To describe the design and usability of an open-source, low-cost flexible laryngoscope that addresses the lack of affordable and accessible methods for otolaryngologic visualization in resource-limited settings. Design, Setting, and Participants: This quality improvement study used a mixed-methods approach, including a technical description of device design as well as quantitative and qualitative survey evaluation of device usability. Engineering involved device design, sourcing or manufacturing individual components, fabricating a prototype, and iterative testing. Key assumptions and needs for the device were identified in collaboration with otolaryngologists in Zimbabwe, and designed and simulated by biomedical engineers in a US university laboratory. Board-certified otolaryngologists at a single US university hospital trialed a completed prototype on simulated airways between May 2023 and June 2023. Main Outcomes and Measures: Technical details on the design of the device are provided. Otolaryngologist gave feedback on device characteristics, maneuverability, and visualization using the System Usability Scale, a customized Likert-scale questionnaire (5-point scale), and semistructured interviews. Results: A functional prototype meeting requirements was completed consisting of a distal-chip camera, spring bending tip, handle housing the control mechanism and electronics, and flexible polyether block amide-coated silicone sheath housing the camera and control wires; an external monitor provided real-time visualization and ability to store data. A total of 14 otolaryngologists participated in the device review. The mean (SD) System Usability Scale score was 88.93 (10.08), suggesting excellent usability. The device was rated highly for ease of set up, physical attributes, image quality, and functionality. Conclusions and Relevance: This quality improvement study described the design of a novel open-source low-cost flexible laryngoscope that external review with otolaryngologists suggests was usable and feasible in various resource-limited environments. Future work is needed to translate the model into a clinical setting.

Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative.

INTRODUCTION: Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch. METHODS: The ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management. RESULTS: In 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of CO2eq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m2 per year and water savings of 221.6 m3 per year. The average cost per intubation varies from 3.16 [3.15-3.16] for SUB to 2.81 [2.77-2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00-6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively. CONCLUSION: In a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of CO2eq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.

Implementation of video laryngoscopes and the development in airway management strategy and prevalence of difficult tracheal intubation: A national cohort study.

BACKGROUND: We aimed to determine the development in the use of video laryngoscopy over a 9-year period, and its possible impact on airway planning and management. METHODS: We retrieved 822,259 records of tracheal intubations recorded from 2008 to 2016 in the Danish Anaesthesia Database. The circumstances regarding pre-operative airway assessment, the scheduled airway management plan and the actual airway management concerning video laryngoscopy were reported for each year of observation. Further, the association between year of observation and various airway management related outcomes was evaluated by multivariate logistic regression. RESULTS: There was a significant increase in airway management with 'advanced technique successfully used within two attempts' from 2.7% in 2008 to 15.5% in 2016 (p < .0001). This predominantly reflects use of video laryngoscopy. The prevalence of tracheal intubations 'scheduled for video laryngoscopy' increased from 3.5% in 2008 to 10.6% in 2016 (p < .0001). We found a significant increase in the prevalence of anticipated difficulties with intubations by direct laryngoscopy from 1.8% in 2008 to 5.2% in 2016 (p < .0001). The prevalence of failed tracheal intubations decreased from 0.14% in 2008 to 0.05% in 2016 (p < .0001). CONCLUSION: From 2008 to 2016, a period of massive implementation of video laryngoscopes, a significant change in airway management behaviour was recorded. Increasingly, video laryngoscopy is becoming a first-choice device for both acute and routine airway management. Most importantly, the data showed a noticeable reduction in failed intubation over the time of observation.

A Novel Low-Cost Technique to Allow for Jet Ventilation.

BACKGROUND/OBJECTIVE: Traditional jet ventilation requires the use of a catheter that is inserted either through an endotracheal tube or laryngoscope. Specially designed laryngoscopes with a built-in luer lock adapter to which the high-pressure tubing may be attached exist but are not always available. We present our experience with an adapter which allows connection of the high-pressure tubing to the suction side port of suitable laryngoscopes that is easily assembled using readily available materials in the operating room. METHOD: We designed a jet ventilator adapter using a high-pressure jet ventilation tubing assembly and a 3-way stopcock extension set which we have used for the past 13 years. A retrospective case series of all adult patients who underwent direct laryngoscopy and/or bronchoscopy using this jet ventilation adapter between January 2017 and August 2021 was performed. RESULT: A total of 100 consecutive patients underwent laryngoscopy and bronchoscopy using jet ventilation between January 2017 and August 2021 was identified. The mean age was 56.3 years, and the mean BMI was 31.2. The most common diagnoses were idiopathic subglottic/tracheal stenosis (46.4%), acquired tracheal stenosis (34.1%), and acquired subglottic stenosis (14.8%). The median duration of the surgical procedure was 53 minutes with an interquartile range of 23. The CO2 laser was used in all cases. There was no disconnection of the adapter, episodes of postoperative respiratory compromise, or extraluminal air on chest radiography for any of our cases. Oxygen saturations remained above 90% intraoperatively for all cases. CONCLUSION: Our simple jet ventilator adapter connects the jet ventilator to the suction side port of suitable laryngoscopes and eliminates the need for a jet ventilation catheter or specialized laryngoscope at a minimal cost.

Simulation-Based Assessment of the Novel, Disposable i-view Video Laryngoscope by Emergency Medicine Physicians.

INTRODUCTION: Airway obstruction is the second leading cause of potentially preventable death on the battlefield. Previous studies demonstrate the most frequent airway intervention is intubation. Currently, the US Army has advanced video laryngoscopy (VL) in its sets, kits, and outfits (SKOs) at a cost of approximately $12,000 and generally only deploys them to the forward resuscitative surgical detachments and field hospitals. The i-view is a disposable video laryngoscope that costs approximately $120. The purpose of this study was to assess operator performance with this device and survey user opinions. METHODS: We conducted a prospective, observational study with emergency medicine residents and attending physicians using a synthetic cadaver model. Placement success, time-to-cannulation, number of attempts, and number and type of complications were recorded, followed by surveys. RESULTS: We enrolled 31 participants. One was missing data and was excluded, leaving 30 for analysis. The median age was 29, most (66%) were male, most were Air Force (57%), in-training residents (77%) with few reporting previous deployment experience (13%). Almost all had real patient experience with both direct (93%) and video laryngoscopy (90%). Most (90%) were able to get a grade 1 view with all achieving airway cannulation on first-pass attempt. The median time to cannulation was 11.6 seconds. On the post-procedure survey, most strongly agreed they would use this in the deployed setting (77%). Most reported they found it easy to use (77%). CONCLUSION: Our simulation-based study demonstrates the device has strong potential use for the clinical setting with all achieving rapid first-pass success for intubation. This study lays the foundation for validation of this device in the clinical setting.

A Prospective Assessment of a Novel, Disposable Video Laryngoscope With Physician Assistant Trainees Using a Synthetic Cadaver Model.

BACKGROUND: Airway obstruction is the second leading cause of preventable death on the battlefield. Video laryngoscopy has improved airway management in the emergency setting for several decades, and technology continues to improve. Current technology in the supply chain is cost-prohibitive to incorporate at Role 1 facilities, which is where many intubations occur by novice intubators. The i-view is a novel video laryngoscopy device that is handheld, inexpensive, and disposable. The aim of this study was to determine if the i-view is suitable based on performance assessments by physician assistant trainees and survey feedback. MATERIALS AND METHODS: We prospectively enrolled physician assistant students at the Interservice Physician Assistant Program at Joint Base San Antonio-Fort Sam Houston. We provided them structured training on how to use the device, and then, a board-certified emergency medicine physician or certified registered nurse anesthetist assessed their intubations performed on a SynDaver mannequin model. We surveyed the participants afterward. RESULTS: We enrolled 60 Interservice Physician Assistant Program students. Most participants were male (75%) with a median age of 32 years. Service affiliations included Army (50%), Navy (23%), Air Force (18%), and Coast Guard (8%). Most (70%) had previous deployment experience. All the participants successfully cannulated the mannequins and 98% achieved first-attempt success. Most participants (78%) reported a grade 1 view. On postprocedure survey, 91% strongly agreed with using this device in the deployed setting and 89% strongly agreed with finding it easy to use. CONCLUSIONS: All physician assistant trainees successfully and rapidly performed endotracheal intubation using the disposable i-view video laryngoscope. Study participants rated the device as easy to use and desirable for deployment. Further research is necessary to validate this novel device in the clinical setting before recommending dissemination to the deployed military medical force sets, kits, and outfits.

A cost comparison between reusable flexible and disposable laryngoscopes.

OBJECTIVES: To compare the costs of disposable laryngoscopes to reusable scopes in outpatient and inpatient settings. METHODS: The total variable and fixed costs involved in flexible scope reprocessing were collected from two general otolaryngology clinics, a pediatric otolaryngology clinic, and a children's hospital. Variable costs of disposable materials and labor were collected from 65 scope reprocessing events to identify the cost of reprocessing. Fixed costs of scope maintenance, monitors, video towers, and storage equipment were collected from financial records. Fixed and variable costs were analyzed to identify the cost per scope event. The costs were then compared to a theoretical model where disposable scopes were used to meet the volume demands of each clinic and children's hospital setting. The model of disposable scopes was generated after obtaining volume costs specific to each setting from a disposable scope company. RESULTS: The average cost of a reusable scope model per scope event was $66.02 ± 4.49 at the three clinics and $130.66 at the children's hospital. The average cost of the disposable scope model per scope event was $152.55 ± 0.55 in the three clinics and $172.61 in the children's hospital. The cost differences were $86.53 ± 3.96 and $41.95 respectively. CONCLUSIONS: In an outpatient clinic, reusable scopes are less expensive than a disposable scope model. In children's hospital inpatient setting, the difference in costs between disposable and reusable scopes is lower. When considering other non-economic factors, disposable scopes may be a feasible option, especially in the children's hospital setting.

A Prospective, Feasibility Assessment of a Novel, Disposable Video Laryngoscope With Special Operations Medical Personnel in a Mobile Helicopter Simulation Setting.

BACKGROUND: Video laryngoscopy (VL) is shown to improve first-pass success rates and decrease complications in intubations, especially in novice proceduralists. However, the currently fielded VL devices are cost-prohibitive for dispersion across the battlespace. The novel i-view VL is a low-cost, disposable VL device that may serve as a potential solution. We sought to perform end-user performance testing and solicit feedback. METHODS: We prospectively enrolled Special Operations flight medics with the 160th Special Operations Aviation Regiment at Hunter Army Airfield, Savannah, Georgia. We asked them to perform an intubation using a synthetic cadaver model while in a mobile helicopter simulation setting. We surveyed their feedback afterward. RESULTS: The median age of participants was 30 and all were male. Of those, 60% reported previous combat deployments, with a median of 20 months of deployment time. Of the 10, 90% were successful with intubation, with 60% on first-pass success with an average of 83 seconds time to intubation. Most had a grade 1 view. Most agreed or strongly agreed that it was easy to use (70%), with half (50%) reporting they would use it in the deployed setting. Several made comments about the screen not being bright enough and would prefer one with a rotating display. CONCLUSIONS: We found a high proportion of success for intubation in the mobile simulator and a high satisfaction rate for this device by Special Operations Forces medics.

An in vitro assessment of light intensity provided during direct laryngeal visualization by videolaryngoscopes with Macintosh geometry blades.

BACKGROUND: Adequate illumination of the larynx is needed during laryngoscopy to facilitate tracheal intubation. The International Organization for Standardization (ISO) has established a minimum light intensity for direct laryngoscopy (DL) of over 500 lux for at least ten minutes, but no such standard exists for Macintosh geometry videolaryngoscope (Mac-VL) blades, which allow for both direct or indirect (videoscopic) viewing of the larynx. Using in situ bench and in vitro testing in a human cadaver, we determined illumination and luminance values delivered by various Mac-VLs and compared these with published minimum lighting benchmarks as well as a reference direct laryngoscope. METHODS: We tested six Mac-VLs (i-view™, McGRATH™ MAC, GlideScope® Spectrum™ [single-use] DVM S4, GlideScope® Titanium [reusable] Mac T4, C-MAC® S [single-use] Macintosh #4, C-MAC® [reusable] Macintosh #4) together with one direct laryngoscope (Heine LED). Each laryngoscope was assessed with three measurements, as follows: part 1: illuminance (lux) was measured in situ using a purpose-designed benchtop light intensity measurement apparatus; part 2: luminance (light reflected back to the eye) was measured (in candela m-2 [cd·m-2]) during videolaryngoscopy (VL) and DL in a human cadaver using a spot meter pointed at the interarytenoid notch; part 3: illuminance (lux) was measured during VL and DL in a human cadaver using a light meter surgically implanted just proximal to the vocal cords. RESULTS: Illuminance and luminance varied significantly among the Mac-VLs. Mean (standard devitation) illuminance among the six tested Mac-VLs ranged from 117 (11) to 2,626 (42) lux in the measurement apparatus and from 228 (11) to 2,900 (374) lux by the surgically implanted light meter in the cadaver. All values were less than the reference Heine direct laryngoscope and some fell below the published ISO standard of 500 lux for DL. Luminance testing by spot meter had a similarly wide range, varying from 3.78 (0.60) to 49.1 (10.4) cd·m-2, with some Mac-VLs delivering less luminance than the reference Heine direct laryngoscope. CONCLUSIONS: Our results indicate that illuminance and luminance provided by Mac-VLs used for direct laryngeal viewing varies substantially between devices, with some falling below standards previously suggested as the minimum required for DL. While this may have no implications for the quality of image visible on a device's video monitor, the clinician should be aware that when Mac-VLs are used for direct viewing of the larynx, lighting may not be optimal. This might adversely affect ease or success of tracheal intubation.

RéSUMé: CONTEXTE: L'éclairage adéquat du larynx est nécessaire pendant la laryngoscopie pour faciliter l'intubation trachéale. Pour la laryngoscopie directe (LD), l'Organisation internationale de normalisation (ISO) a établi une intensité lumineuse minimale de plus de 500 lux pendant au moins dix minutes. Toutefois, il n'existe aucune norme de ce type pour les lames de vidéolaryngoscope à géométrie Macintosh (VL-Mac), qui permettent une visualisation directe ou indirecte (vidéoscopique) du larynx. Par des études en laboratoire et in vitro sur un cadavre humain, nous avons déterminé les valeurs d'éclairage et de luminance fournies par divers VL-Mac et les avons comparées aux valeurs repères d'éclairage minimal publiées ainsi qu'aux valeurs obtenues avec un laryngoscope direct de référence. MéTHODE: Nous avons testé six VL-Mac (i-view™, McGRATH™ MAC, GlideScope® Spectrum™ [à usage unique] DVM S4, GlideScope® Titanium [réutilisable] Mac T4, C-MAC® S [à usage unique] Macintosh #4, et C-MAC® [réutilisable] Macintosh #4) ainsi qu'un laryngoscope direct (Heine LED). Chaque laryngoscope a été évalué avec trois mesures, comme suit : partie 1: l'éclairage (lux) a été mesuré in situ à l'aide d'un appareil spécialement conçu de mesure de l'intensité lumineuse en laboratoire; partie 2 : la luminance (lumière réfléchie vers l'œil) a été mesurée (en candela m-2 [cd·m-2]) pendant la vidéolaryngoscopie (VL) et la LD sur un cadavre humain, à l'aide d'un posemètre pointé vers la commissure interaryténoïdienne; partie 3: l'éclairage (lux) a été mesuré pendant la VL et la LD sur un cadavre humain à l'aide d'un photomètre implanté chirurgicalement juste en amont des cordes vocales. RéSULTATS: L'éclairage et la luminance variaient considérablement entre les VL-Mac. L'éclairage moyen (écart type) parmi les six VL-Mac testés variait de 117 (11) à 2626 (42) lux avec l'appareil de mesure, et de 228 (11) à 2900 (374) lux lorsque mesuré par le photomètre implanté chirurgicalement dans le cadavre. Toutes les valeurs étaient inférieures au laryngoscope direct Heine de référence, et certaines étaient inférieures à la norme ISO publiée de 500 lux pour la LD. Les essais de luminance par posemètre ont rapporté une plage tout aussi large, variant de 3,78 (0,60) à 49,1 (10,4) cd·m-2, certains VL-Mac offrant moins de luminance que le laryngoscope direct Heine de référence. CONCLUSION: Nos résultats indiquent que l'éclairage et la luminance fournis par les VL-Mac utilisés pour la visualisation directe du larynx varient considérablement d'un appareil à l'autre, certains tombant en dessous des normes précédemment suggérées comme minimalement requises pour la LD. Bien que cela puisse n'avoir aucune incidence sur la qualité de l'image visible sur le moniteur vidéo d'un appareil, le clinicien doit être conscient que lorsqu'un VL-Mac est utilisé pour la visualisation directe du larynx, l'éclairage pourrait ne pas être optimal. Cela pourrait nuire à la facilité ou au succès de l'intubation trachéale.

Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19 / Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice

Simulation of pediatric intubation using a low-cost videolaryngoscope in the setting of the COVID-19 pandemic. / Simulación de intubación pediátrica con videolaringoscopio de bajo costo en contexto de pandemia por COVID-19.

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope. Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8- 148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001). A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice.

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo. Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica.

Economic analysis of the use of video laryngoscopy versus direct laryngoscopy in the surgical setting.

Aim: Compared with direct laryngoscopy (DL), video laryngoscopy (VL) offers clinical benefits in routine and difficult airways. The health economic benefit of VL versus DL for routine tracheal intubation remains unknown. Materials & methods: This analysis compared VL and DL health economic outcomes, including total inpatient costs, length of hospital stay (LOS), postoperative intensive care unit (ICU) admission and incidence of procedurally associated complications. Results: Patients with VL had decreased inpatient cost (US$1144-5891 across eight major diagnostic categories [MDC]); >1-day LOS reduction in five MDC; reduced odds for postoperative ICU admission (0.04-0.68) and reduced odds of respiratory complications in three MDC (0.43-0.90). Conclusion: Video laryngoscopy may lower total costs, reduce LOS and decrease the likelihood of postoperative ICU admission.

Lay abstract In this study, we compared the difference in hospital cost, length of hospital stay, post-surgery complications and post-surgery intensive care unit (ICU) admission between two groups of patients. Both groups of patients were admitted to the hospital for a surgical procedure and underwent general anesthesia for at least 1 h. Before administering anesthesia for surgery, an anesthesiologist inserts a tube into the patient's airway to ventilate the patient. The anesthesiologist might use different types of laryngoscope to assist with the insertion of the tube. The choice of the laryngoscope type is based on several factors such as the availability of the device, doctor's experience, preference and patient's medical and physical conditions. This study focuses on two different types of laryngoscopes: the video laryngoscope and the direct laryngoscope. Patients who received video laryngoscope or direct laryngoscope were divided into separate groups. We made sure that these two groups of patients were comparable in terms of similar age, gender and disease conditions, stayed in similar types of hospitals and had similar procedures. Compared with the direct laryngoscope group, the video laryngoscope group had lower hospital costs (reduced by US$1144­5891), at least 1-day shorter length of hospital stay, reduced rates of ICU admission and fewer complications. This study indicates that video laryngoscopy offers benefits over direct laryngoscopy for elective surgical procedures.