Heart rate responses in critical care trainees during airway intubation: a comparison between the simulated and clinical environments.

OBJECTIVE: This study aimed to compare the heart rate response to stress during airway intubations in clinical practice and a simulated environment. METHODS: Twenty-five critical care registrars participated in the study over a 3-month period. Heart rate data during intubations was recorded by a FitBit® Charge 2 worn by each participant during their clinical practice, and during a single simulated airway management scenario. The heart rate range was calculated by subtracting the baseline working heart rate (BWHR) from the maximum functional heart rate (MFHR). For each airway intubation performed participants recorded an airway diary entry. Data from intubations performed in the clinical environment was compared to data from a simulated environment. Heart rate changes were observed in two ways: percentage rise (median) across the 20-min intubation period and; percentage rise at point of intubation (median). RESULTS: Eighteen critical care registrars completed the study, mean age 31.8 years (SD = 2.015, 95% CI = 30.85-32.71). Throughout the 20-min peri-intubation recording period there was no significant difference in the median change in heart rates between the clinical (14.72%) and simulation (15.96%) environment (p = 0.149). At the point of intubation there was no significant difference in the median change in heart rate between the clinical (16.03%) and the simulation (25.65%) environment groups (p = 0.054). CONCLUSION: In this small population of critical care trainees, a simulation scenario induced a comparable heart rate response to the clinical environment during intubation. This provides evidence that simulation scenarios are able to induce a comparable physiological stress response to the clinical environment and thus facilitates effective teaching of a high-risk procedure in a safe manner.

A randomised crossover comparison of two endotracheal tube introducers: the FROVA and the Flexible Tip Bougie for GlideScope intubation of a difficult airway manikin by infrequent intubators.

BACKGROUND: This unblinded randomised crossover study compares two endotracheal tube introducers (ETIs): the FROVA and the "Flexible Tip Bougie" (FTB), in an airway manikin mimicking difficult intubation with a percentage of glottic opening view of 30%. Participants were Emergency Medicine and Anaesthesia trainees with recent experience of less than twenty patient intubations. The primary outcome was time to intubation, further divided into time taken to pass the ETI and time to railroad the endotracheal tube (ETT) over the ETI. The secondary outcome was the difficulty of intubation. RESULTS: The median total time to ETT placement was significantly shorter with the FTB (37.5 s) compared with the FROVA ETI (63.0 s), P = 0.0006. The median difficulty reported (scores 0-10 with 0 being no difficulty) with the FTB was 2 compared with 5 for the FROVA, P < 0.0001. CONCLUSIONS: The FTB enabled significantly faster and easier placement of the endotracheal tube compared with the FROVA in inexperienced hands intubating a difficult intubation manikin.

Use of a Flexible-Tipped "Bougie" During Videolaryngoscopic Intubation in a Patient With a Base of Tongue Tumor: A Case Report.

A patient with a base of tongue tumor was judged to be safe to intubate under general anesthesia, with a new flexible tip "bougie." This enabled rapid and easy navigation around the distorted anatomy caused by the tumor. The bougie's tip can be flexed or extended by activating a slide on the shaft and was intended for use with the hyperangulated blade of a videolaryngoscope.

Volatile components in dorsal gland secretions of the Chacoan peccary, Catagonus wagneri.

The dorsal gland secretions of captive-reared male and female Chacoan peccaries (Catagonus wagneri) were analyzed by gas chromatography-mass spectrometry. C8-C19 carboxylic acids, squalene, cholesterol, cholestanol, and cholest-7-en-3-ol were present in both males and females. Heptylbenzene, C14-C18 methyl esters, and an isomer of springene were observed in males. C15-C19 aldehydes were observed in females. The composition of the dorsal gland secretions of C. wagneri is compared to what has been reported for other peccaries (Tayassu spp.).