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1.
Eur J Anaesthesiol ; 36(3): 221-226, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30308524

RESUMO

BACKGROUND: In patients with predictive features associated with easy direct laryngoscopy, videolaryngoscoy with the GlideScope has been shown to require less force when compared with Macintosh direct laryngoscopy. OBJECTIVE: The aim of this study was to compare forces applied with Glidescope vs. Macintosh laryngoscopes in patients with predictive features associated with difficult direct laryngoscopy. DESIGN: A randomised study. SETTING: Toronto General Hospital, a university tertiary centre in Canada. PATIENTS: Forty-four patients aged over 18 years, with one or more features of difficult intubation, undergoing elective surgery requiring single-lumen tracheal intubation. INTERVENTION: We measured the force applied to oropharyngeal tissues by attaching three FlexiForce Sensors (A201-25) to the concave surface of Macintosh and GlideScope laryngoscope blades.Anaesthetists or experienced anaesthesia residents performed laryngoscopies with both devices in a randomised sequence. MAIN OUTCOME MEASURES: The primary outcome was peak force. The secondary outcomes were average force and impulse force. The latter is the integral of the force over the time during which the force acted. RESULTS: Complete data were available for 40 individuals. Peak and average forces decreased with GlideScope (17 vs. 21 N, P = 0.03, and 6 vs. 11 N, P < 0.001, respectively). Laryngoscopy time increased with the GlideScope (30 vs. 18 s, P < 0.001), resulting in similar median impulse forces (206 vs. 175 N, P = 0.92). CONCLUSION: GlideScope laryngoscopy resulted in reduced peak and average forces, but as the laryngoscopy duration increased, the product of force and time (impulse force) was similar with both devices. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01814176.


Assuntos
Manuseio das Vias Aéreas/instrumentação , Desenho de Equipamento/instrumentação , Intubação Intratraqueal/instrumentação , Laringoscópios , Laringoscopia/instrumentação , Cirurgia Vídeoassistida/instrumentação , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Desenho de Equipamento/normas , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/métodos , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cirurgia Vídeoassistida/métodos , Cirurgia Vídeoassistida/normas
2.
Crit Care ; 22(1): 235, 2018 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-30241488

RESUMO

BACKGROUND: For critically ill patients, effective airway management with a high first-attempt success rate for endotracheal intubation is essential to prevent hypoxic complications during securing of the airway. Video guidance may improve first-attempt success rate over direct laryngoscopy (DL). METHODS: With ethics approval, this randomised controlled trial involved 54 critically ill patients who received endotracheal intubation using a tube with an integrated video camera (VivaSight™-SL tube, VST, ETView Ltd., Misgav, Israel) or using conventional intubation under DL. RESULTS: The two groups did not differ in terms of intubation conditions. The first-attempt success rate was VST 96% vs. DL 93% (not statistically significant (n. s.)). When intubation at first attempt failed, it was successful in the second attempt in all patients. There was no difference in the median average time to intubation (VST 34 s (interquartile range 28-39) vs. DL 35 s (28-40), n. s.). Neither vomiting nor aspiration or accidental oesophageal intubation were observed in either group. The lowest pulsoxymetric oxygen saturation for VST was 96 (82-99) % vs. 99 (95-100) % for DL (n. s.). Hypotension defined as systolic blood pressure < 70 mmHg occurred in the VST group at 20% vs. the DL group at 15% (n. s.). CONCLUSION: In this pilot study, no advantage was shown for the VST. The VST should be examined further to identify patient groups that could benefit from intubation with the VST, that is, patients with difficult airway conditions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02837055 . Registered on 13 June 2016.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscopia/métodos , Gravação em Vídeo/normas , Idoso , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Desenho de Equipamento/métodos , Feminino , Humanos , Intubação Intratraqueal/normas , Intubação Intratraqueal/estatística & dados numéricos , Laringoscopia/normas , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Gravação em Vídeo/instrumentação
4.
Dtsch Arztebl Int ; 115(26): 437-444, 2018 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-30017026

RESUMO

BACKGROUND: Emergency intubation carries a higher risk of complications than elective airway management. Video laryngoscopy (VL) could potentially improve patient safety. The goal of this study was to determine whether VL is superior to direct laryngoscopy for the emergency intubation of adults in the inpatient setting. METHODS: Pertinent studies were retrieved by a systematic literature search in the MEDLINE, Embase, and CENTRAL databases. The selection of studies, data extraction, and assessment of the potential for bias were carried out independently by two of the authors. Effect sizes were reported as odds ratios (OR) or mean differences (MD). The primary endpoint was successful intubation at the first attempt. Further variables were considered as secondary endpoints. RESULTS: 1098 titles and abstracts were retrieved, and the full texts of 43 articles were examined. Eight randomized and controlled trials, with a total of 1796 patients, were analyzed. VL was not found to confer any statistically significant advantage with respect to successful intubation at the first attempt (OR 0.72, 95% confidence interval [0.47; 1.12]) or with respect to the time to successful intubation (MD -8.99 seconds [-24.00; 6.01]). On the other hand, the use of VL was significantly associated with a lower number of intubation attempts (MD -0.17 [-0.31; -0.03]) and with a lower frequency of esophageal intubation (OR 0.27 [0.10; 0.75]). CONCLUSION: The routine use of VL for airway management in emergency medicine might improve patient safety, as VL is associated with a lower number of intubation attempts and with a lower frequency of esophageal intubation. Further randomized controlled trials are needed before any definitive conclusions can be drawn about the advantages of video laryngoscopy.


Assuntos
Intubação Intratraqueal/instrumentação , Laringoscopia/métodos , Laringoscopia/normas , Adulto , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/normas , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Masculino
6.
Am J Speech Lang Pathol ; 27(3): 887-905, 2018 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-29955816

RESUMO

Purpose: The aim of this study was to recommend protocols for instrumental assessment of voice production in the areas of laryngeal endoscopic imaging, acoustic analyses, and aerodynamic procedures, which will (a) improve the evidence for voice assessment measures, (b) enable valid comparisons of assessment results within and across clients and facilities, and (c) facilitate the evaluation of treatment efficacy. Method: Existing evidence was combined with expert consensus in areas with a lack of evidence. In addition, a survey of clinicians and a peer review of an initial version of the protocol via VoiceServe and the American Speech-Language-Hearing Association's Special Interest Group 3 (Voice and Voice Disorders) Community were used to create the recommendations for the final protocols. Results: The protocols include recommendations regarding technical specifications for data acquisition, voice and speech tasks, analysis methods, and reporting of results for instrumental evaluation of voice production in the areas of laryngeal endoscopic imaging, acoustics, and aerodynamics. Conclusion: The recommended protocols for instrumental assessment of voice using laryngeal endoscopic imaging, acoustic, and aerodynamic methods will enable clinicians and researchers to collect a uniform set of valid and reliable measures that can be compared across assessments, clients, and facilities.


Assuntos
Acústica da Fala , Patologia da Fala e Linguagem/normas , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Qualidade da Voz , Acústica , Fenômenos Biomecânicos , Consenso , Humanos , Laringoscopia/normas , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medida da Produção da Fala/normas , Patologia da Fala e Linguagem/métodos , Estroboscopia/normas , Distúrbios da Voz/fisiopatologia , Distúrbios da Voz/terapia
7.
Eur J Anaesthesiol ; 35(8): 605-612, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29889671

RESUMO

BACKGROUND: Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common clinical screening tests have shown low sensitivity and specificity with a limited predictive value. Ultrasound-based airway assessment has been proposed recently as a useful, simple, noninvasive bedside tool as an adjunct to clinical methods, but to date, few studies are available about the potential role of ultrasound in difficult airway evaluation, and these are mostly limited to specific groups of patients. OBJECTIVES: The aim of this study was to determine the correlation between the sonographic measurements of anterior cervical soft tissues thickness and Cormack-Lehane grade view at direct laryngoscopy in patients with normal clinical screening tests. DESIGN: Prospective, single blinded, observational study. SETTING: Operating theatre of a teaching hospital from May 2017 to September 2017. PATIENTS: A total of 301 patients at least 18 years of age undergoing elective surgery under general anaesthesia with tracheal intubation were included in the study. OUTCOME MEASURES: Pre-operative evaluation was performed before surgery, demographic variables were collected and clinical screening tests to predict a difficult airway were performed. Patients with predicted difficult intubation were excluded. A 10 to 13-MHz linear ultrasound transducer was placed in the transverse plane and the thickness of the anterior cervical soft tissues was measured at two levels [thyrohyoid membrane (pre-epiglottic space) and vocal cords (laryngeal inlet)] with the patient's head in a neutral position. At each level, the distance from the skin in the median axis and the surrounding area was measured. The laryngoscopic view was graded by a different anaesthetist with more than 5 years of experience with direct laryngoscopy, blinded to the ultrasound assessments. RESULTS: The 'pre-epiglottic space thickness' at the level of thyrohyoid membrane was measured as the median distance from skin to epiglottis (mDSE) and the pre-epiglottic area was calculated; the mDSE cut-off value of 2.54 cm (sensitivity 82%, specificity 91%) and the pre-epiglottic area cut-off value of 5.04 cm (sensitivity 85%, specificity 88%) were the best predictors of a Cormack-Lehane grade at least 2b at direct laryngoscopy and of difficult intubation. The cut-off value of mDSE showed greater sensitivity in female patients (94 vs. 86%) and greater specificity in male patients (92 vs. 83%). No correlation was found between difficult laryngoscopy and ultrasound assessments at the level of the vocal cords. CONCLUSION: Airways ultrasounds might be considered as a predictor of restricted/difficult laryngoscopy and unpredicted difficult intubation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03547193.


Assuntos
Manuseio das Vias Aéreas/normas , Laringoscopia/normas , Pescoço/diagnóstico por imagem , Ultrassonografia de Intervenção/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Epiglote/diagnóstico por imagem , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Método Simples-Cego , Ultrassonografia de Intervenção/métodos , Prega Vocal/diagnóstico por imagem , Adulto Jovem
8.
Otolaryngol Head Neck Surg ; 159(1): 136-142, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29737927

RESUMO

Objective To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol. Methods A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation. Results A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%. Discussion The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes. Implications for Practice The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Laringoscopia/normas , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Adulto Jovem
9.
Prehosp Emerg Care ; 22(5): 602-607, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29465279

RESUMO

INTRODUCTION: Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. OBJECTIVES: The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success. METHODS: The Helicopter Advanced Resuscitation Training (HeART) program was implemented across 160 bases in 2015. The HeART program includes a novel conceptual framework based on thorough understanding of physiology, critical thinking using a novel algorithm, difficult airway predictive tools, training in the optimal use of specific airway techniques and devices, and integrated performance improvement efforts to address opportunities for improvement. The C-MAC video/direct laryngoscope and high-fidelity human patient simulation laboratories were implemented during the study period. Chi-square test for trend was used to evaluate for improvements in airway management and RSI success (overall intubation success, first-attempt success, first-attempt success without desaturation) over the 25-month study period following HeART implementation. RESULTS: A total of 5,132 patients underwent RSI during the study period. Improvements in first-attempt intubation success (85% to 95%, p < 0.01) and first-attempt success without desaturation (84% to 94%, p < 0.01) were observed. Overall intubation success increased from 95% to 99% over the study period, but the trend was not statistically significant (p = 0.311). CONCLUSIONS: An integrated advanced airway management program was successful in improving RSI intubation performance in a large air medical company.


Assuntos
Resgate Aéreo/normas , Intubação Intratraqueal/normas , Melhoria de Qualidade/estatística & dados numéricos , Idoso , Resgate Aéreo/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Intubação Intratraqueal/estatística & dados numéricos , Laringoscopia/normas , Laringoscopia/estatística & dados numéricos , Masculino , Simulação de Paciente , Avaliação de Programas e Projetos de Saúde/métodos , Estudos Retrospectivos
10.
Eur Arch Otorhinolaryngol ; 275(5): 1319-1325, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29442164

RESUMO

PURPOSE: Proper training and assessment of skill in flexible pharyngo-laryngoscopy are central in the education of otorhinolaryngologists. To facilitate an evidence-based approach to curriculum development in this field, a structured analysis of what constitutes flexible pharyngo-laryngoscopy is necessary. Our aim was to develop an assessment tool based on this analysis. METHODS: We conducted an international Delphi study involving experts from twelve countries in five continents. Utilizing reiterative assessment, the panel defined the procedure and reached consensus (defined as 80% agreement) on the phrasing of an assessment tool. RESULTS: FIFTY PANELISTS COMPLETED THE DELPHI PROCESS. THE MEDIAN AGE OF THE PANELISTS WAS 44 YEARS (RANGE 33-64 YEARS). MEDIAN EXPERIENCE IN OTORHINOLARYNGOLOGY WAS 15 YEARS (RANGE 6-35 YEARS). TWENTY-FIVE WERE SPECIALIZED IN LARYNGOLOGY, 16 WERE HEAD AND NECK SURGEONS, AND NINE WERE GENERAL OTORHINOLARYNGOLOGISTS. AN ASSESSMENT TOOL WAS CREATED CONSISTING OF TWELVE DISTINCT ITEMS.: Conclusion The gathering of validity evidence for assessment of core procedural skills within Otorhinolaryngology is central to the development of a competence-based education. The use of an international Delphi panel allows for the creation of an assessment tool which is widely applicable and valid. This work allows for an informed approach to technical skills training for flexible pharyngo-laryngoscopy and as further validity evidence is gathered allows for a valid assessment of clinical performance within this important skillset.


Assuntos
Avaliação Educacional/métodos , Laringoscopia , Otolaringologia/educação , Adulto , Competência Clínica , Técnica Delfos , Feminino , Humanos , Capacitação em Serviço/métodos , Capacitação em Serviço/normas , Laringoscopia/educação , Laringoscopia/métodos , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
11.
J Voice ; 32(6): 734-755, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29103609

RESUMO

OBJECTIVE: Laryngeal endoscopy with stroboscopy, a critical component of the assessment of voice disorders, is rarely used as a treatment outcome measure in the scientific literature. We hypothesized that this is because of the lack of a widely used standardized, validated, and reliable method to assess and report laryngeal anatomy and physiology, and undertook a systematic literature review to determine the extent of the inconsistencies of the parameters and scales used in voice treatment outcome studies. STUDY DESIGN: Systematic literature review. METHODS: We searched PubMed, Ovid, and Cochrane for studies where laryngeal endoscopy with stroboscopy was used as a treatment outcome measure with search terms representing "stroboscopy" and "treatment" guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. RESULTS: In the 62 included articles, we identified 141 terms representing 49 different parameters, which were further classified into 20 broad categories. The six most common parameters were magnitude of glottal gap, mucosal wave amplitude, location or shape of glottal gap, regularity of vibration, phase symmetry, and presence and size of specific lesions. Parameters were assessed on scales ranging from binary to 100 points. The number of scales used for each parameter varied from 1 to 24, with an average of four different scales per parameter. CONCLUSIONS: There is a lack of agreement in the scientific literature regarding which parameters should be assessed to measure voice treatment outcomes and which terms and scales should be used for each parameter. This greatly diminishes comparison and clinical implementation of the results of treatment outcomes research in voice disorders. We highlight a previously published tool and recommend it for future use in research and clinical settings.


Assuntos
Doenças da Laringe/diagnóstico por imagem , Laringoscopia/normas , Estroboscopia/normas , Calibragem , Humanos , Doenças da Laringe/fisiopatologia , Doenças da Laringe/terapia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Padrões de Referência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
12.
J Cardiothorac Vasc Anesth ; 32(1): 277-286, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29056498

RESUMO

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.


Assuntos
Competência Clínica , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Ventilação Monopulmonar/métodos , Cirurgia Vídeoassistida/métodos , Adolescente , Adulto , Competência Clínica/normas , Feminino , Humanos , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/normas , Projetos Piloto , Estudos Prospectivos , Cirurgia Vídeoassistida/normas , Adulto Jovem
13.
Anesth Analg ; 126(5): 1565-1574, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29239965

RESUMO

BACKGROUND: Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied. METHODS: We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers. One hundred sixty-eight adult patients requiring prehospital emergency intubation were treated by an emergency physician and randomized to 1 of 3 portable videolaryngoscopes (A.P. Advance, C-MAC PM, and channeled blade KingVision) with different blade types. The primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices. P values for pairwise comparisons are corrected by the Bonferroni method for 3 tests (P[BF]). All presented P values are adjusted for center. RESULTS: Glottis visualization was comparable with all 3 devices. Overall intubation success for A.P. Advance, C-MAC, and KingVision was 96%, 97%, and 61%, respectively (overall: P < .001, A.P. Advance versus C-MAC: odds ratio [OR], 0.97, 95% confidence interval [CI], 0.13-7.42, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001; C-MAC versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001). Intubation success on the first attempt with A.P. Advance, C-MAC, and KingVision was 86%, 85%, and 48%, respectively (overall: P < .001, A.P. Advance versus C-MAC: OR, 0.89, 95% CI, 0.31-2.53, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.24, 95% CI, 0.055-0.38, P[BF] = 0.0054; C-MAC versus KingVision: OR, 0.21, 95% CI, 0.043-.34, P[BF] < 0.003). Direct laryngoscopy for successful intubation with the videolaryngoscopic device was necessary with the A.P. Advance in 5 patients, and with the C-MAC in 4 patients. In the KingVision group, 21 patients were intubated with an alternative device. CONCLUSIONS: During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.


Assuntos
Manuseio das Vias Aéreas/métodos , Serviços Médicos de Emergência/métodos , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Papel do Médico , Gravação em Vídeo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/normas , Serviços Médicos de Emergência/normas , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/normas , Laringoscopia/instrumentação , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Gravação em Vídeo/normas , Adulto Jovem
14.
Eur J Anaesthesiol ; 35(3): 173-183, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29189318

RESUMO

BACKGROUND: The surgical plethysmographic index (SPI) is one of the available indexes of the nociception-antinociception (NAN) balance. Individually adjusting the NAN balance to prevent somatic responses to noxious stimulation remains a challenge. OBJECTIVES: To assess whether guiding remifentanil administration according to the SPI response to a calibrated noxious stimulus (NANCAL) can blunt the haemodynamic response to tracheal intubation and surgical incision. DESIGN: Randomised multicentre study. SETTING: Two Belgian university hospitals from January 2014 to April 2015. PATIENTS: After ethic review board approval and informed consent, 48 American Society of Anesthesiologists I or II adult patients scheduled for surgery under general anaesthesia were enrolled. INTERVENTIONS: Patients were randomly assigned to a SPI group, where remifentanil effect-site concentration was adjusted according to NANCAL, or a control group, where it was fixed at 4 ng ml. Propofol concentration was always adjusted to maintain the bispectral index close to 40. NANCAL consisted of a 100 Hz, 60 mA electrical tetanic stimulation during 30 s at the wrist before tracheal intubation and before surgical incision. MAIN OUTCOME MEASURES: The primary endpoint was the efficacy of the NANCAL-guided remifentanil administration to prevent the haemodynamic response to tracheal intubation and surgical incision. The secondary aim was to compare the ability of SPI, analgesia nociception index, pupil diameter and mean arterial pressure response to NANCAL to predict the haemodynamic response to tracheal intubation and surgical incision. RESULTS: Our SPI response to NANCAL-based correcting scheme for remifentanil administration was not superior to a fixed remifentanil concentration at blunting the haemodynamic response to tracheal intubation or surgical incision. Among all tested NAN balance indices, only mean arterial pressure had significant predictive ability with regard to the haemodynamic response to surgical incision. CONCLUSION: Further research is needed to define the best NANCAL stimulus and the best remifentanil correcting scheme to help individualised tailoring of antinociception for each specific subpopulation of surgical patients. TRIAL REGISTRATION: Clinicaltrials.gov NCT: 02884310; https://clinicaltrials.gov/ct2/show/NCT02884310.


Assuntos
Hemodinâmica/efeitos dos fármacos , Laringoscopia/normas , Monitorização Intraoperatória/normas , Medição da Dor/normas , Remifentanil/administração & dosagem , Ferida Cirúrgica/tratamento farmacológico , Adulto , Analgésicos Opioides/administração & dosagem , Feminino , Hemodinâmica/fisiologia , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/normas , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Medição da Dor/métodos , Pletismografia/métodos , Pletismografia/normas , Ferida Cirúrgica/complicações , Adulto Jovem
15.
J Intensive Care Med ; 33(6): 354-360, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27298389

RESUMO

OBJECTIVES: In the last decade, the practice of intubation in the intensive care unit (ICU) has evolved. To further examine the current intubation practice in the ICU, we administered a survey to critical care physicians. DESIGN: Cross-sectional survey study design. SETTING: Thirty-two academic/nonacademic centers nationally and internationally. MEASUREMENTS AND MAIN RESULTS: The survey was developed among a core group of physicians with the assistance of the Survey Research Center at Mayo Clinic, Rochester, Minnesota. The survey was pilot tested for functionality and reliability. The response rate was 82 (51%) of 160 among the 32 centers. Although propofol was the induction drug of choice, there was a significant difference with actual ketamine use and those who indicated a preference for it (ketamine: 52% vs 61%; P < .001). The most common airway device used for intubation was direct laryngoscopy (Miller laryngoscope blade) at 56 (68%) followed by video laryngoscopy at 26 (32%). Most (>90%) indicated that they have a difficult airway cart, but only 55 (67%) indicated they have a documented plan to handle a difficult airway with even lower results for documented review of adverse events (49%). CONCLUSION: Although propofol was the induction drug of choice, ketamine was a medication that many preferred to use, possibly relating to the fact that the most common complication postintubation is hypotension. Direct laryngoscopy remains the primary airway device for endotracheal intubation. Finally, although the majority stated they had a difficult airway cart available, most did not have a documented plan in place when encountering a difficult airway or a documented process to review adverse events surrounding intubation.


Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Intubação Intratraqueal/normas , Laringoscopia/normas , Anestésicos Intravenosos , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Unidades de Terapia Intensiva/normas , Padrões de Prática Médica
16.
BMC Anesthesiol ; 17(1): 160, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29191160

RESUMO

BACKGROUND: McGrath MAC video laryngoscope offers excellent laryngosopic views and increases the success rate of orotracheal intubation in some cases. The aim of this study was to determine the usefulness of McGrath MAC for routine nasotracheal intubation by comparing McGrath MAC with Airway scope and Macintosh laryngoscope. METHODS: A total of 60 adult patients with ASA physical status class 1 or 2, aged 20-70 years were enrolled in this study. Patients were scheduled for elective oral surgery under general anesthesia with nasotracheal intubation. Exclusion criteria included lack of consent and expected difficult airway. Patients were randomly allocated to three groups: McGrath MAC (n = 20), Airway scope (n = 20), and Macintosh laryngoscope (n = 20). After induction, nasotracheal intubation was performed by six expert anesthesiologists with more than 6 years of experience. RESULTS: There were no significant differences in preoperative airway assessment among the three groups. Successful tracheal intubation time was 26.8 ± 5.7 (mean ± standard deviation) s for McGrath MAC, 36.4 ± 11.0 s for Airway scope, and 36.5 ± 8.9 s for Macintosh laryngoscope groups. The time for successful tracheal intubation for McGrath MAC group was significantly shorter than that for Airway scope and Macintosh laryngoscope (p < 0.01). McGrath MAC significantly improved the Cormack Lehane grade for nasotracheal intubation compared with Macintosh laryngoscope (p < 0.05). CONCLUSION: McGrath MAC significantly facilitates routine nasotracheal intubation compared with Airwayscope and Macintosh laryngoscope by shortening the tracheal intubation time and improving the Cormack Lehane grade. TRIAL REGISTRATION: UMINCTR Registration number UMIN000023506 . Registered 5 Aug 2016.


Assuntos
Anestesia Geral/métodos , Desenho de Equipamento/métodos , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Adulto , Idoso , Anestesia Geral/instrumentação , Anestesia Geral/normas , Desenho de Equipamento/normas , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/instrumentação , Laringoscopia/normas , Masculino , Pessoa de Meia-Idade
17.
Crit Care ; 21(1): 288, 2017 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-29178953

RESUMO

BACKGROUND: There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients. METHODS: We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017. Only randomized controlled trials comparing video and direct laryngoscopy for tracheal intubation in emergency department, intensive care unit, and prehospital settings were selected. The primary outcome was the first-attempt success rate. Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of evidence for all outcomes. RESULTS: Twelve studies (2583 patients) were included in the review for data extraction. Pooled analysis did not show an improved first-attempt success rate using video laryngoscopy (relative risk [RR], 0.93; P = 0.28; low-quality evidence). There was significant heterogeneity among studies (I 2 = 91%). Subgroup analyses showed that, in the prehospital setting, video laryngoscopy decreased the first-attempt success rate (RR, 0.57; P < 0.01; high-quality evidence) and overall success rate (RR, 0.58; 95% CI, 0.48-0.69; moderate-quality evidence) by experienced operators, whereas in the in-hospital setting, no significant difference between two devices was identified for the first-attempt success rate (RR, 1.06; P = 0.14; moderate-quality evidence), regardless of the experience of the operators or the types of video laryngoscopes used (P > 0.05), although a slightly higher overall success rate was shown (RR, 1.11; P = 0.03; moderate-quality evidence). There were no differences between devices for other outcomes (P > 0.05), except for a lower rate of esophageal intubation (P = 0.01) and a higher rate of Cormack and Lehane grade 1 (P < 0.01) when using video laryngoscopy. CONCLUSIONS: On the basis of the results of this study, we conclude that, compared with direct laryngoscopy, video laryngoscopy does not improve intubation outcomes in emergency and critical patients. Prehospital intubation is even worsened by use of video laryngoscopy when performed by experienced operators.


Assuntos
Laringoscopia/métodos , Gravação em Vídeo/instrumentação , Desenho de Equipamento/normas , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscopia/normas , Gravação em Vídeo/métodos
19.
Mil Med Res ; 4: 20, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28630743

RESUMO

BACKGROUND: The critically ill or injured patient undergoing military medical evacuation may require emergent intubation. Intubation may be life-saving, but it carries risks. The novice or infrequent laryngoscopist has a distinct disadvantage because experience is critical for the rapid and safe establishment of a secured airway. This challenge is compounded by the austere environment of the back of an aircraft under blackout conditions. This study determined which of five different video-assisted intubation devices (VAIDs) was best suited for in-flight use by U.S. Air Force Critical Care Air Transport Teams by comparing time to successful intubation between novice and expert laryngoscopists under three conditions, Normal Airway Lights on (NAL), Difficult Airway Lights on (DAL) and Difficult Airway Blackout (DAB), using manikins on a standard military transport stanchion and the floor with a minimal amount of setup time and extraneous light emission. METHODS: A convenience sample size of 40 participants (24 novices and 16 experts) attempted intubation with each of the 5 different video laryngoscopic devices on high-fidelity airway manikins. Time to tracheal intubation and number of optimization maneuvers used were recorded. Kruskal-Wallis testing determined significant differences between the VAIDs in time to intubation for each particular scenario. Devices with significant differences underwent pair-wise comparison testing using rank-sum analysis to further clarify the difference. Device assembly times, startup times and the amount of light emitted were recorded. Perceived ease of use was surveyed. RESULTS: Novices were fastest with the Pentax AWS in all difficult airway scenarios. Experts recorded the shortest median times consistently using 3 of the 5 devices. The AWS was superior overall in 4 of the 6 scenarios tested. Experts and novices subjectively judged the GlideScope Ranger as easiest to use. The light emitted by all the devices was less than the USAF-issued headlamp. CONCLUSIONS: Novices intubated fastest with the Pentax AWS in all difficult airway scenarios. The GlideScope required the shortest setup time, and participants judged this device as the easiest to use. The GlideScope and AWS exhibited the two fastest total setup times. Both devices are suitable for in-flight use by infrequent and seasoned laryngoscopists.


Assuntos
Intubação Intratraqueal/normas , Laringoscópios/normas , Laringoscopia/instrumentação , Laringoscopia/normas , Cirurgia Vídeoassistida/métodos , Aeronaves/instrumentação , Altitude , Competência Clínica/normas , Desenho de Equipamento/normas , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Laringoscopia/métodos , Manequins , Militares
20.
J Perinatol ; 37(8): 979-983, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28518132

RESUMO

BACKGROUND: To study the impact of videolaryngoscopy (VL) on intubation success among pediatric trainees compared with direct laryngoscopy (DL). METHODS: One hundred pediatric residents were enrolled in a randomized, crossover, simulation study comparing VL to DL. Following a didactic session on neonatal intubation, residents intubated a standard neonatal mannequin. Three Neonatal Resuscitation Program (NRP) scenarios were then conducted, followed by a mannequin intubation with the alternate device. Number of attempts and time to intubation were recorded for all intubations. RESULTS: Proportion of successful intubations on first attempt was greater with VL compared with DL (88% versus 63%; P=0.008). The DL group increased success after crossover with VL (63% versus 89%; P=0.008). Exposure to VL also reduced intubation time after device crossover (median intubation time: 31 versus 17 s; P=0.048). CONCLUSIONS: VL increased the success of endotracheal intubation by pediatric residents in simulation, with skills transferrable to DL.


Assuntos
Internato e Residência/métodos , Intubação Intratraqueal , Laringoscopia , Pediatria , Treinamento por Simulação/métodos , Competência Clínica , Estudos Cross-Over , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Laringoscopia/métodos , Laringoscopia/normas , Manequins , Pediatria/educação , Pediatria/métodos , Ressuscitação/educação , Ressuscitação/métodos , Fatores de Tempo , Gravação em Vídeo/métodos
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