Video-assisted instruction improves the success rate for tracheal intubation by novices.

BACKGROUND: Tracheal intubation via laryngoscopy is a fundamental skill, particularly for anaesthesiologists. However, teaching this skill is difficult since direct laryngoscopy allows only one individual to view the larynx during the procedure. The purpose of this study was to determine if video-assisted laryngoscopy improves the effectiveness of tracheal intubation training. METHODS: In this prospective, randomized, crossover study, 37 novices with less than six prior intubation attempts were randomized into two groups, video-assisted followed by traditional instruction (Group V/T) and traditional instruction followed by video-assisted instruction (Group T/V). Novices performed intubations on three patients, switched groups, and performed three more intubations. All trainees received feedback during the procedure from an attending anaesthesiologist based on standard cues. Additionally, during the video-assisted part of the study, the supervising anaesthesiologist incorporated feedback based on the video images obtained from the fibreoptic camera located in the laryngoscope. RESULTS: During video-assisted instruction, novices were successful at 69% of their intubation attempts whereas those trained during the non-video-assisted portion were successful in 55% of their attempts (P=0.04). Oesophageal intubations occurred in 3% of video-assisted intubation attempts and in 17% of traditional attempts (P<0.01). CONCLUSIONS: The improved rate of successful intubation and the decreased rate of oesophageal intubation support the use of video laryngoscopy for tracheal intubation training.

Seeing is believing: the importance of video laryngoscopy in teaching and in managing the difficult airway.

Of the several million patients who undergo surgery in North America annually, a large proportion undergo intubation of the trachea. In approximately 90% of these patients, the endotracheal tube is introduced using a traditional laryngoscope with a battery in the handle and a small bulb near the tip of the blade. This bulb provides a limited and often dim view of the glottic structures. In about 10% of cases, the patient is intubated using a flexible fiberoptic intubating scope. The authors have developed a video laryngoscope that preserves the standard blade configuration with a modified handle. A 3-mm image light guide is built into the blade, replacing the bulb. A small TV camera with an incorporated light bundle is inserted into the handle. A wide-angle panoramic view of the upper airway anatomy is displayed on a TV screen, which can be positioned at a convenient working distance. The use of a TV monitor is a well-accepted standard during minimally invasive surgical procedures.

Experience with the Arndt paediatric bronchial blocker.

Previously reported techniques for single lung ventilation in children have failed to provide consistent, single lung ventilation with relative ease and reliability. We report our experience with the use of a new device, the Arndt 5 French (Fr) paediatric endobronchial blocker, for single lung ventilation in a series of 24 children. We were able to achieve single lung ventilation in 23 of the 24 patients (aged 2-16 yr). Placement required approximately 5-15 min. Attempts at placement were aborted in one patient who was unable to tolerate even short periods of apnoea because of lung pathology. Although it has some limitations, our experience suggests that the paediatric bronchial blocker can be used as a consistent, safe method of single lung ventilation in most young children.

Residential releases of number 2 fuel oil: a contributor to indoor air pollution.

OBJECTIVES: Analysis of data from the New York City Fire Department showed that residential fuel oil releases frequently occur in quantities ranging from 5 to 1000 gal, primarily from storage tank leaks and overfill. A risk assessment was conducted to determine whether Number 2 fuel oil basement spills pose a significant risk to human health. METHODS: Exposure was derived from a simulated field study spill of Number 2 fuel oil in a townhouse basement to develop emission rates for the indicator constituent xylene. Distribution of xylene throughout the townhouse was determined using a multizone contaminant dispersal model. RESULTS: Spills of 85 and 21 gal resulted in xylene exposure estimates as high as 20 and 5 mg/kg/day, respectively. CONCLUSIONS: A spill of about 21 gal or more of Number 2 fuel oil would present a human health risk for central nervous and reproductive systems for 8 days or longer. Tank inspection and supervised delivery would provide effective prevention at minimal expense.

Biochemical properties of wild mouse oncornaviruses with lymphomagenic and neurotropic activities.

The close immunologic relation between the group-specific and polymerase proteins of the wild mouse derived and the established strains of mouse type C oncornaviruses, and the lack of any unusual structural polypeptide or RNA components in the wild mouse virions, eliminate the possibility of detectable contamination by a class of virus different from the mouse oncornavirus class in the wild mouse virus preparations. Liquid hybridization studies with a wild mouse viral 70S 3H-RNA and cellular DNA under conditions of DNA excess, suggest that a significant fraction but not all of the virus-specific nucleotide sequences is present in all normal and tumored wild mouse tissues tested. These virus related sequences may possibly be attributed to a hypothetical endogenous inherited type C virus genome(s) carried by all wild mice or to an infection by one or more but not all of the different exogenous strains of wild mouse type C viruses which could possibly be present in the virus preparation used. The findings are consistent with wild mouse derived type C viruses being either entirely exogenous or a mixture of endogenous and exogenous viruses. This interpretation is also consistent with the earlier observation that certain wild mouse type C viruses are exogenously transmitted, transplacentally, and via milk. The possible relation of the virus heterogeneity or the distinct characteristics of the virus surface molecules to the diverse pathogenicity of the wild mouse oncornaviruses is discussed.