Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice.

BACKGROUND: Proficient manipulation of the fibreoptic bronchoscope is an important component of competent bronchoscopic airway management. We studied the duration of specialized bench training necessary to achieve this proficiency and the subsequent transfer of this psychomotor skill to human subjects. METHODS: Twenty-nine novice endoscopists undertook the training associated with a commercial non-anatomic endoscopic dexterity training system, Dexter. Bronchoscopic driving performance was assessed after each hour of self-directed training, using a global rating scale from 1 (unskilled) to 5 (expert) with a score of 3 linked to proficiency. The scale was applied to anonymized recordings of the endoscopic view as the bronchoscope was manipulated from the mouth to the carina of an anatomic manikin. Once bench proficiency was achieved, the ability of participants to perform the skill on volunteer co-participants was assessed. RESULTS: Ninety-six per cent of participants achieved proficiency on the manikin within 4 h of practice. Ninety-three per cent then drove the bronchoscope proficiently from the mouth to the carina of clinical volunteers on the first attempt. CONCLUSIONS: The endoscopic dexterity required to proficiently drive a bronchoscope in human subjects to an anatomic endpoint relevant to fibreoptic intubation is achievable after 2-4 h of specialized bench training. Training in the local environment may be more conducive to success than in time-limited workshops. Achieving a defined proficiency standard on bench models contributes to the development of basic bronchoscopic competence. This has the potential to protect patients from novice learning curves, optimize clinical education and efficiency, and assist compliance with difficult airway algorithms.

Anaesthesia in a child with autosomal recessive omodysplasia.

A child with a recently described form of dwarfism, autosomal recessive omodysplasia, presented for general anaesthesia for dental conservation. Despite the patient's dysmorphic features and craniofacial and mandibular deformities, no significant anaesthetic problems were encountered. Anaesthetic implications of the condition are reviewed.