Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath).

Objective. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. Design. A crossover manikin study. Settings. University-affiliated hospital. Participants. Forty-two novice medical students unfamiliar with DLT intubation. Interventions. Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). Measurements and Main Results. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (P < 0.044 and P < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (P < 0.011 and P < 0.002, respectively) in the simulated "easy" and "difficult" over most of the intubation attempts. In the simulated "easy" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], P = 0.012). Conclusion. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated "easy" and "difficult" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.

Quality of Life among Hemodialysis Patients: Role of the Dialysis Shift.

This study examined the effects of the time of hemodialysis (HD) on patients' quality of life (QOL). This study included 175 HD patients (116 males, 59 females), aged 18-80 years (mean = 58.1 ± 11.3 years). Shift 1 was 7:00-11:00 AM, Shift 2 was 12:00-4:00 PM, Shift 3 was 5:00-9:00 PM, and Shift 4 was 10:00-2:00 AM (38, 38, 43, and 56 patients, respectively). Those on Shift 4 had a higher mean age compared with the other shifts, with a higher number of widowed people (8.6%). The proportions of males and females showed no significant differences among the shifts. The mean duration on dialysis was 42.1 ± 39.3 months, with a shorter duration for Shift 4. We observed the highest QOL score for the psychological and spiritual subscale, followed by the family subscale. Half the patients were dissatisfied with their jobs and had less satisfaction with their sexual life, their education, and getting a kidney transplant. We found a significant difference in overall QOL among shifts, with the greatest difference between Shifts 3 and 4. Health and functioning, psychological and spiritual, and social and economic scores were lowest in Shift 4, which was significantly different from Shift 1 and Shift 3. We found significant associations between overall QOL and general health, and the scores from different domains. Satisfaction was moderate in all groups. The study revealed poor QOL among Shift 4 patients; hence, they need more support in clinical practice guidelines.

Anesthetic management of a parturient with Kearns-Sayre syndrome, dual-chamber and VVI implantable defibrillator pacemaker/defibrillator, and preeclampsia for cesarean delivery: A case report and review of the literature.

Kearns-Sayre syndrome (KSS), a rare form of mitochondrial myopathy, is a triad of chronic progressive external ophthalmoplegia, bilateral pigmentary retinopathy, and cardiac conduction abnormalities. In this report, we show how a combined spinal epidural anesthesia can be useful for cesarean delivery, as we illustrate in a dual-chamber and VVI implantable defibrillator pacemaker/defibrillator parturient with a KSS and preeclampsia.

A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study.

OBJECTIVES: To test the hypothesis that laryngoscopy using the Airtraq (Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu A/S, Ballerup, Denmark) would result in a shorter time for successful double-lumen endobronchial tube (DLT) intubation by users with mixed experience than the time required using the Macintosh or GlideScope (Verathon Inc., Bothell, WA) laryngoscopes. DESIGN: A randomized, prospective, blind study. SETTING: A single university hospital. PARTICIPANTS: The study comprised 133 patients undergoing elective thoracic surgery. INTERVENTIONS: Patients were randomly allocated into the following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34), Airtraq (n = 35), or KVL (n = 32). MEASUREMENTS AND MAIN RESULTS: The following data were recorded: time required for achieving successful DLT intubation; glottis visualization; optimization maneuvers; first-pass success rate; intubation difficulty; failure to intubate, defined as an attempt taking >150 seconds to perform or if peripheral oxygen saturation <92% was noted; and postoperative sore throat and hoarseness were recorded. Compared with GlideScope, the Airtraq resulted in shorter times for achieving successful DLT intubation (median times: 21 s [95% confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval 46.2-89.1 s], respectively; p = 0.021); a lower score for difficult intubations (p = 0.023); and fewer optimization maneuvers. The 4 laryngoscopes were associated with comparable glottis visualization; first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p = 0.522); incidence of oropharyngeal trauma; postoperative sore throat; and hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures using the Airtraq due to the inability to advance the DLT through the glottis opening. The experience of the anesthesiologists in using the 4 devices had a statistically significant negative correlation with the time to confirmation of endobronchial intubation (Spearman r -0.392; p < 0.001). CONCLUSION: When used by operators with mixed experience, the channeled Airtraq required less time for DLT intubation and was easier to use than the GlideScope, although failures did occur with the Airtraq, whereas they did not occur with the other systems.

Cervical spine motion during tracheal intubation with King Vision™ video laryngoscopy and conventional laryngoscopy: a crossover randomized study.

BACKGROUND: The King Vision™ (KVL) videolaryngoscope with a wide field of view could potentially reduce cervical spine motion during intubation. We aimed to compare the extent of cervical spine movement during laryngoscopy using the KVL and Macintosh laryngoscopes. METHODS: Following ethical approval, 29 patients with a normal cervical spine requiring general anesthesia and tracheal intubation were randomly subjected to both KVL and Macintosh laryngoscopy in a crossover. Cervical spine motion during each laryngoscopy was radiologically examined by measuring changes in cumulative spine motion and changes from the neutral position in the C0-C5 angles formed by the adjacent vertebrae. Time to tracheal intubation, laryngoscopic view, and ease of intubation were also recorded. RESULTS: Compared with direct laryngoscopy, the KVL resulted in significantly less movement of the C-spine at the C0-C1, and C3-C4, C4-C5 segments (mean differences: C0-C1: 3.01 ° [95% CI: -4.74° to -1.28°]; C3-C4: 1.81° [95% CI: -3.19° to -0.43°]; C4-C5: -0.88° [95% CI: -1.61° to -0.19°], P<0.02) and cumulative C-spine movement (mean 36.1˚[95% CI 32.72 to 39.51] vs. 44.1˚[95%CI: 39.54 to 48.75]; P=0.001). There was significant movement in the C0-C3 segment from baseline using both devices. Tracheal intubation took longer with KVL (mean difference: 12.7 s [95% CI: 9.15 to 16.13 s]; P=0.001) even though laryngeal visualization was improved (Cormack Lehane Grade I was reported in 100% KVL vs. 65.5% Macintosh laryngoscopies; P=0.001). CONCLUSIONS: In patients with normal cervical spine, KVL resulted in less extension of the cervical spine than direct laryngoscopy.

Comparison of three videolaryngoscopes for double-lumen tubes intubation in simulated easy and difficult airways: a randomized trial.

BACKGROUND: The King Vision™ (KVL) and Airtraq® videolaryngoscopes may reduce the time to double lumen tube (DLT) intubation compared to the GlideScope® and MacIntosh in simulated easy and difficult airways. METHODS: Twenty-one staff anesthesiologists with limited prior experience in using videolaryngoscopes for DLT intubation were assigned randomly to insert a DLT using the MacIntosh, GlideScope®, Airtraq® and KVL videolaryngoscopes on easy and difficult airway simulators in a randomized crossover order. Time to DLT intubation, laryngoscopic view, intubation difficulty, optimizing manoeuvers and failure to intubation - defined as an attempt taking longer than 150 s - were recorded. RESULTS: The three videolaryngoscopes had comparable times to intubation and glottis visualization in both scenarios. Compared with the MacIntosh, the KVL had longer intubation times in the simulated easy airway scenario (mean 9.2 vs. 21.1 s, respectively, P<0.001). In both scenarios, the Airtraq® took a longer intubation time than the MacIntosh (P<0.001 and P=0.019, respectively). The GlideScope® was easier to use than the Airtraq® and KVL in the easy airway scenario (P=0.021 and P=0.001, respectively). The KVL had higher intubation difficulty scores than the GlideScope® and Airtraq® (P=0.002 and P=0.008, respectively) in both scenarios and required more frequent optimizing manoeuvers than the GlideScope® (P=0.012) in the simulated easy airway. Two participants failed to intubate the difficult airway simulator; one with the MacIntosh and the other with the KVL. CONCLUSIONS: The Airtraq® and non-channeled KVL required more time over the MacIntosh for DLT intubation, as a primary outcome, but the success rates for the 3 videolaryngoscopes were very high.

Dexmedetomidine suppresses intractable hiccup during anesthesia for cochlear implantation.

We report on the successful use of dexmedetomidine to treat persistent intractable hiccup in a child who underwent cochlear implantation under sevoflurane-fentanyl anesthesia.

Comparison of the Macintosh, GlideScope®, Airtraq®, and King Vision™ laryngoscopes in routine airway management.

BACKGROUND: We hypothesized that the use of the channeled King Vision™ and Airtraq® would shorten the time for tracheal intubation compared with the Macintosh or GlideScope® laryngoscopes in patients with normal airways. METHODS: Eighty-six patients were randomly assigned to intubate the trachea using either the Macintosh (N.=22), Glidescope® (N.=21), Airtraq® (N.=21), or King Vision™ (N.=22) laryngoscope. The primary outcome was the time to tracheal intubation. Secondary outcomes included the laryngoscopic view, numbers of laryngoscopy attempts, first-pass success rate, optimization maneuvers, ease of intubation, and postoperative sore throat. RESULTS: Compared with the Macintosh and GlideScope®, the use of the channeled videolaryngoscopes had significantly longer times to tracheal intubation (mean times: Airtraq® 44 s [95% CI: 39.6 to 46.7]; King Vision™ 34.5 s [95% CI: 33.1 to 40.2]; Macintosh 20 s [95% CI: 19.7 to 26.7]; GlideScope® 27.9 s [95% CI: 25.1 to 30.7], P<0.002) and caused less mucosal trauma (P=0.006). The King Vision™ is slightly faster than the Airtraq® (P=0.035). Compared with the Macintosh and the Airtraq®, the GlideScope® was easier to use (P<0.001). The 4 groups had comparable glottis views, number of laryngoscopy and optimising manoeuvres and first attempt success rate. The Airtraq® and King Vision™ had a lower incidence of sore throat than with the Macintosh or GlideScope® (P=0.001). No patient had failed intubation. CONCLUSIONS: The King Vision™ and Airtraq® require longer intubation times, as primary outcome, and cause less sore throat than the Macintosh and GlideScope® when used by anesthesiologists with limited experience in patients with normal airways. Our conclusion is difficult to extrapolate to the expert anesthesiologists who are using videolaryngoscopes on a regular basis.

Is sealing cuff pressure, easy, reliable and safe technique for endotracheal tube cuff inflation?: A comparative study.

OBJECTIVE: To compare the three common methods of endotracheal tube cuff inflation (sealing pressure, precise standard pressure or finger estimation) regarding the effective tracheal seal and the incidence of post-intubation airway complications. METHODS: Seventy-five adult patients scheduled for N(2) O free general anesthesia were enrolled in this study. After induction of anesthesia, endotracheal tubes size 7.5 mm for female and 8.0 mm for male were used. Patients were randomly assigned into one of three groups. Control group (n=25), the cuff was inflated to a pressure of 25 cm H(2)O; sealing group (n=25), the cuff was inflated to prevent air leaks at airway pressure of 20 cm H(2)O and finger group (n=25), the cuff was inflated using finger estimation. Tracheal leaks, incidence of sore throat, hoarseness and dysphagia were tested. RESULTS: Although cuff pressure was significantly low in the sealing group compared to the control group (P<0.001), the incidence of sore throat was similar in both groups. On the other hand, cuff pressure as well as the incidence of sore throat were significantly higher in the finger group compared to both the control and the sealing group (P<0.001 and P=0.008). The incidence of dysphagia and hoarseness were similar in the three groups. None of the patients in the three groups developed air leak around the endotracheal tube cuff.. CONCLUSIONS: In N(2)O, free anesthesia sealing cuff pressure is an easy, undemanding and safe alternative to the standard technique, regarding effective sealing and low incidence of sore throat.

Electives during medical internship.

OBJECTIVE: The purpose of the study was to find out the reasons for selecting elective rotations during a rotating medical internship. METHODS: One hundred and seventy-eight medical interns in the College of Medicine, King Faisal University, Dammam, Kingdom of Saudi Arabia during the period March 2001 to August 2002 completed a questionnaire for their selection reasons with responses on a scale of 1-5. RESULTS: The study comprised 60% males and 98.3% Saudis. The most frequently chosen electives are dermatology 28.1%, radiology 20.8%, anesthesia 9.6% and otorhinolaryngology (ear, nose and throat [ENT]) 9%. Significantly, more males (89.2%) chose radiology rotation and more females (75%) chose ENT rotation. The leading reasons to choose an elective rotation are: 1. to gain broad medical training and education, 2. to assist in choice of future specialty, and 3. being relevant to future specialty. The mean score for ENT and dermatology is higher than radiology and anesthesia for the response "to participate in medical practice in different institute", while dermatology is higher than anesthesia for the response "to help getting acceptance for job in the same institute", and radiology is higher than ENT and anesthesia for the response "it has infrequent or no night duties". CONCLUSION: The reasons chosen reflect the educational value of the electives and their important role in choosing future career. Dermatology and radiology rotations are most popular electives, with additional though different reasons.

Successful separation of thoracopagus conjoined twins.

The first successful separation of thoracopagus conjoined twins in Eastern Saudi Arabia with 2-year follow up is presented. Physical examination and radiographic studies revealed a conjunction that extended from midsternum to a common umbilicus. The shared internal organs included liver and pericardium. The separation was performed at the age of 4 months. The resulting chest wall defects in both twins were covered by dacron-reinforced silastic prosthesis. The abdominal wall defect was primarily closed in the "left twin," and covered with a dacron reinforced silastic sheet in the "right". Primary skin closure was achieved in both, following extensive mobilization of the skin. The musculoskeletal deformities in the neck, chest and vertebral column showed marked improvement 20 months after separation.