Predictive model for difficult laryngoscopy using machine learning: retrospective cohort study

Abstract Background Both predictions and predictors of difficult laryngoscopy are controversial. Machine learning is an excellent alternative method for predicting difficult laryngoscopy. This study aimed to develop and validate practical predictive models for difficult laryngoscopy through machine learning. Methods Variables for the prediction of difficult laryngoscopy included age, Mallampati grade, body mass index, sternomental distance, and neck circumference. Difficult laryngoscopy was defined as grade 3 and 4 by the Cormack-Lehane classification. Pre-anesthesia and anesthesia data of 616 patients who had undergone anesthesia at a single center were included. The dataset was divided into a base training set (n = 492) and a base test set (n = 124), with equal distribution of difficult laryngoscopy. Training data sets were trained with six algorithms (multilayer perceptron, logistic regression, supportive vector machine, random forest, extreme gradient boosting, and light gradient boosting machine), and cross-validated. The model with the highest area under the receiver operating characteristic curve (AUROC) was chosen as the final model, which was validated with the test set. Results The results of cross-validation were best using the light gradient boosting machine algorithm with Mallampati score x age and sternomental distance as predictive model parameters. The predicted AUROC for the difficult laryngoscopy class was 0.71 (95% confidence interval, 0.59-0.83; p= 0.014), and the recall (sensitivity) was 0.85. Conclusion Predicting difficult laryngoscopy is possible with three parameters. Severe damage resulting from failure to predict difficult laryngoscopy with high recall is small with the reported model. The model's performance can be further enhanced by additional data training.

Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma / 中国基层医药

Objective:To investigate the application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation and its effects on pulmonary infection in patients with craniocerebral trauma.Methods:A total of 105 patients with craniocerebral trauma who received treatment in Yiwu Central Hospital from January 2020 to December 2020 were included in this study. They were randomly allocated to undergo endotracheal intubation with a video laryngoscope (control group, n = 50) or a video laryngoscope combined with a fiberoptic bronchoscope (observation group, n = 55). Glottic exposure, intubation, vital signs, lung infection rate during hospitalization, and incidence of complications were monitored/determined in each group. Results:Glottic exposure in the observation group was superior to that in the control group ( Z = 4.29, P < 0.001). First-pass success rate was significantly higher in the observation group than in the control group [96.36% (53/55) vs. 82.00% (41/50), χ2 = 5.76, P < 0.05]. The number of intubation attempts and the time to successful intubation were (1.07 ± 0.53) times and (85.12 ± 15.36) seconds, respectively in the observation group, which were significantly less or shorter than those in the control group [(1.92 ± 0.74) times, (106.13 ± 16.34) seconds, t = 6.81, 6.79, both P < 0.001). The changes in mean arterial pressure and heart rate during intubation were less in the observation group than in the control group (both P < 0.05). The amplitude of increase in blood oxygen saturation after intubation was greater in the observation group than in the control group ( P < 0.05). Lung infection rate was significantly lower in the observation group than in the control group [10.91% (6/55) vs. 30.00% (15/50), χ2 = 5.96, P < 0.05]. The incidence of complications was significantly lower in the observation group than in the control group [5.45% (3/55) vs. 18.00% (9/50), χ2 = 4.07, P < 0.05]. Conclusion:Application of a video laryngoscope combined with a fiberoptic bronchoscope in emergency endotracheal intubation can increase the first-pass success rate, reduce repeated intubation attempts, shorten time to successful intubation, help to maintain stable vital signs, prevent lung infection and complication. Therefore, the combined method is of clinical application value.

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.

Study on the effect of a cold environment on the quality of three video laryngoscopes: McGrath MAC, GlideScope Ranger, and Pentax Airway Scope

OBJECTIVE: Several environmental factors influence the prehospital use of video laryngoscopes (VLs). For example, fogging of the VL lens can occur in cold environments, and the low temperature can cause the VLs to malfunction. As relevant research on the effect of environment on VLs is lacking, we aimed to study the effect of a cold environment on three commonly used VLs.METHODS: McGrath MAC, Pentax Airway Scope (AWS), and GlideScope Ranger were exposed to temperatures of -5°C, -10°C, -20°C, and -25°C for 1 hour each and then applied to a manikin in a thermohydrostat room 5 times. Immediately after turning on the power and inserting the blade, the time until an appropriate glottic image appeared on the screen was measured.RESULTS: McGrath MAC was able to accomplish immediate intubation regardless of the temperature drop. However, GlideScope Ranger required an average of 4.9 seconds (-5°C to -20°C) and 10.1 seconds (-25°C) until appropriate images were obtained for intubation. AWS showed adequate image acquisition immediately after blade insertion despite slight fogging at -20°C, but at -25°C, images suitable for intubation did not appear on the screen for an average of 4.7 minutes.CONCLUSION: All three devices appear to be usable without any limitations up to -20°C. However, GlideScope Ranger and AWS may not produce images immediately at temperatures below -25°C. Thus, medical practitioners performing VL in a cold environment should be aware of the characteristics of the VL devices in advance.

The role of videolaryngoscope in endotracheal intubation training programs / O papel do videolaringoscópio em programas de treinamento de intubação endotraqueal

Abstract Background Macintosh laryngoscopes are widely used for endotracheal intubation training of medical students and paramedics whereas there are studies in the literature that supports videolaryngoscopes are superior in endotracheal intubation training. Our aim is to compare the endotracheal intubation time and success rates of videolaryngoscopes and Macintosh laryngoscopes during endotracheal intubation training and to determine the endotracheal intubation performance of the students when they have to use an endotracheal intubation device other than they have used during their education. Methods Endotracheal intubation was performed on a human manikin owing a standard respiratory tract by Macintosh laryngoscopes and C-MAC® videolaryngoscope (Karl Storz, Tuttligen, Germany). Eighty paramedic students were randomly allocated to four groups. At the first week of the study 10 endotracheal intubation trials were performed where, Group-MM and Group-MV used Macintosh laryngoscopes; Group-VV and Group-VM used videolaryngoscopes. Four weeks later all groups performed another 10 endotracheal intubation trial where Macintosh laryngoscopes was used in Group-MM and Group-VM and videolaryngoscopes used in Group-VV and Group-MV. Results Success rates increased in the last 10 endotracheal intubation attempt in groups MM, VV and MV (p = 0.011; p = 0.021, p = 0.290 respectively) whereas a decrease was observed in group-VM (p = 0.008). Conclusions The success rate of endotracheal intubation decreases in paramedic students who used VL during endotracheal intubation education and had to use Macintosh laryngoscopes later. Therefore we believe that solely videolaryngoscopes is not enough in endotracheal intubation training programs.

Resumo Justificativa Os laringoscópios Macintosh são amplamente utilizados para o treinamento de estudantes de medicina e paramédicos em intubação endotraqueal; contudo, há mais estudos na literatura que apoiam os videolaringoscópios no treinamento de intubação endotraqueal. Nosso objetivo foi comparar o tempo de intubação endotraqueal e as taxas de sucesso de videolaringoscópios e laringoscópios Macintosh durante o treinamento de intubação endotraqueal e determinar o desempenho da intubação endotraqueal dos alunos quando precisam usar um dispositivo de intubação endotraqueal diferente daquele que usaram durante seu treinamento. Métodos A intubação endotraqueal foi realizada em modelo humano com trato respiratório padrão usando laringoscópios Macintosh e videolaringoscópio C-MAC® (Karl Storz, Tuttligen, Alemanha). Oitenta estudantes paramédicos foram randomicamente alocados em quatro grupos. Na primeira semana do estudo, 10 tentativas de intubação endotraqueal foram realizadas, nas quais o Grupo-MM e Grupo-MV utilizaram laringoscópios Macintosh e o Grupo-VV e Grupo-VM utilizaram videolaringoscópios. Quatro semanas depois, todos os grupos realizaram mais 10 tentativas de intubação endotraqueal, nas quais laringoscópios Macintosh foram utilizados pelo Grupo-MM e Grupo-VM e videolaringoscópios pelo Grupo VV e Grupo-MV. Resultados As taxas de sucesso aumentaram nas últimas 10 tentativas de intubação endotraqueal nos grupos MM, VV e MV (p = 0,011; p = 0,021, p = 0,290, respectivamente), enquanto uma redução foi observada no Grupo-VM (p = 0,008). Conclusões A taxa de sucesso da intubação endotraqueal diminuiu nos estudantes paramédicos que utilizaram VL durante o treinamento em intubação endotraqueal e precisaram usar laringoscópios Macintosh posteriormente. Portanto, acreditamos que o uso isolado de videolaringoscópios não é suficiente em programas de treinamento de intubação endotraqueal.

Endotracheal Intubation Using McGrath Videolaryngoscope in Klippel-Feil Syndrome / 이화의대지

Patients with Klippel-Feil syndrome require much attention during anesthesia because of congenital abnormalities in head and neck regions and the high probability of neurological damage from cervical spine instability during endotracheal intubation. We report a case of successful endotracheal intubation using a videolaryngoscope in a patient with Klippel-Feil syndrome who experienced difficult transnasal intubation.

Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts / 예방의학회지

OBJECTIVES: To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts. METHODS: One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ2-test and Fisher exact test. RESULTS: One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05). CONCLUSIONS: Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.

Application of standard video combined with visual laryngoscopy simulation model in tracheal intu-bation teaching / 中华医学教育探索杂志

Tracheal intubation is one of the most important emergency techniques, and it is a key and difficult point in advanced life support training for cardiopulmonary resuscitation. Our treatment is trying to combine standard video with visual laryngoscopes for tracheal intubation teaching. Firstly, the students watch the standard video. Then, the teacher shows how to perform a tracheal intubation by visual laryngo-scope. Finally, the students practice the intubation process on the simulation device. In this way, the teach-ing process is more intuitive, easier to be mastered, more normalized and repeatable. This method is worth to be promoted.

A randomised crossover trial comparing the Airtraq ® NT, McGrath ® MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin / Estudo cruzado e randômico comparando os laringoscópios Airtraq ® NT, McGrath ® MAC e Macintosh para intubação nasotraqueal em simulação de via aérea fácil e difícil em manequim

ABSTRACT OBJECTIVE: Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS: Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS: Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p < 0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p < 0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p < 0.001). CONCLUSION: In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.

RESUMO OBJETIVO: Vários dispositivos podem ajudar a intubação nasotraqueal no manejo de via aérea difícil. Os laringoscópios McGrath MAC e Airtraq NT foram comparados com um laringoscópio Macintosh em estudo do desempenho de anestesistas com diferentes níveis de experiência, em manequim com cenário de via aérea fácil ou difícil. MÉTODOS: Foram recrutados 63 anestesistas para um estudo randômico, no qual cada um fez intubação nasotraqueal com todos os laringoscópios, em ambos os cenários. O desfecho primário foi o tempo de intubação. Desfechos adicionais incluíram vista laringoscópica, sucesso na intubação, número de manobras de aprimoramento, cliques dentais audíveis e força aplicada nas vias aéreas superiores. RESULTADOS: O tempo de intubação foi significativamente menor com o uso do laringoscópio McGrath MAC em ambos os cenários e com o uso do Airtraq no cenário difícil, em comparação com o laringoscópio Macintosh. Ambos os dispositivos obtiveram mais grau 1 ou 2 de Cormack e Lehane para visualização do que o Macintosh em cenário difícil (p < 0,001). O McGrath MAC teve a melhor taxa de sucesso na primeira tentativa (98,4% vs. 96,8% e 95,8%, p < 0,001, para os laringoscópios Airtraq NT e Macintosh, respectivamente). O número de manobras de aprimoramento, os cliques dentais audíveis e a avaliação subjetiva do grau de força aplicada foram significativamente menores para os laringoscópios indiretos versus o laringoscópio Macintosh (p < 0,001). CONCLUSÃO: Em um manequim, os laringoscópios Airtraq e McGrath pareceram superiores ao laringoscópio Macintosh para lidar com cenários das vias aéreas simuladas. Ambos os dispositivos foram associados a melhores visibilidades, tempos de intubação e taxas de sucesso, especialmente em simulação de "via aérea difícil". A satisfação geral foi maior com o laringoscópio McGrath. Estudos clínicos similares são necessários.

Processamento de cabos de laringoscópio: revisão integrativa / Procesamiento de los mangos del laringoscopio: revisión integradora / Laryngoscope handles reprocessing: integrative review

Objetivo: Estudo de revisão integrativa da literatura científica com base na seguinte questão norteadora: ?Qual o tipo de processamento necessário para a segurança do reuso do cabo de laringoscópio??. Método: Foi realizada uma revisão integrativa utilizando os portais e as bases Pubmed, Embase, Scopus, Web of Science e CINAHL. Resultado: Foram identificados sete estudos experimentais cujos resultados demonstraram indefinição da classificação do cabo de laringoscópio quanto ao risco de causar infecção, comprovada pela diversidade de métodos de processamento. Conclusão: Conclui-se que os cabos de laringoscópio não podem ser considerados materiais independentes das lâminas e, portanto, são materiais semicríticos. Levando-se em conta a carga microbiana e orgânica identificada nesta revisão, o processamento mínimo recomendado é a limpeza seguida de desinfecção de alto nível. Um inventário pequeno e a falta de acesso às tecnologias para processamento não são razões aceitáveis para recomendações improvisadas, evitando assim a certificação e propagação de más práticas.

Objetivo: Estudio de una revisión integradora de la literatura científica basándose en la siguiente pregunta de investigación: ?¿Cuál tipo de procesamiento se requiere para la seguridad de la reutilización del mango del laringoscopio??. Método: Se hizo una revisión integradora utilizando los portales y las bases PubMed, Embase, Scopus, Web of Science y CINAHL. Resultados: Fueron identificados siete estudios experimentales cuyos resultados demostraron una indefinición de la clasificación del mango del laringoscopio en relación al riesgo de causar infección, comprobado por la variedad de métodos de procesamiento. Conclusión: Los mangos del laringoscopio no pueden ser considerados materiales independientes de las láminas y, por lo tanto, son materiales semicríticos. Teniendo en cuenta las cargas microbiana y orgánica identificadas en esta revisión, el procesamiento mínimo recomendado es la limpieza seguida de la desinfección de alto nivel. Un inventario pequeño y la falta de acceso a las tecnologías al procesamiento no son razones aceptables para las recomendaciones improvisadas, evitándose así la certificación y la propagación de más prácticas.

Objective: This is a integrative review study of the scientific literature based on the following guiding question: ?What kind of processing is required for the safety reuse of the laryngoscope handle?? Method: It was made an integrative review using the portals and basis Pubmed, Embase, Scopus, Web of Science and CINAHL. Results: Seven experimental studies were found and the results showed the uncertainty of the classification of the laryngoscope handle, as the risk of causing infection, proven by the diversity of reprocessing methods identified. Conclusion: We concluded that the laryngoscope handles cannot be considered apart of the blades and, therefore, they are semi-critical materials. Considering the microbial and the organic load identified in this review, the recommended minimal processing is cleaning, followed by the high-level disinfection. A small inventory and the lack of access to technologies for reprocessing are not acceptable reasons for improvised recommendations, thus avoiding the certification and the spread of the bad practices.

Comparison of the GlideScope and the McGrath method using vascular forceps and a tube exchanger in cases of simulated difficult airway intubation / 대한마취과학회지

BACKGROUND: A "difficult airway" can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. METHODS: Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. RESULTS: There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). CONCLUSIONS: Our results suggest that there are no significant differences in the intubations with GlideScope and McGrath using vascular forceps and tube exchangers in difficult intubation scenarios.

Changes in the first-pass success rate with the GlideScope video laryngoscope and direct laryngoscope: a ten-year observational study in two academic emergency departments

OBJECTIVE: The aim of this study was to assess the success rate of the GlideScope video laryngoscope (GVL) and direct laryngoscope (DL) over ten years in two academic emergency departments. METHODS: We used adult intubation data using DL and GVL collected from airway management registries at two academic emergency departments. We analyzed changes in first-pass success (FPS) rate by device and operator training level. We conducted a multivariate logistic regression analysis to predict the FPS according to time period. RESULTS: Over the study period (2006 to 2010, season I; 2013-2015, season II) the DL usage rate dropped from 91.6% to 45.0% while the GVL usage rate increased from 8.4% to 55.4%. The FPS rate using DL also declined from 90.8% in 2007 to 75.5% in 2015. On the other hand, the FPS rate using GVL increased from 87.8% to 95.2%. With DL, all operators’ FPS rate declined by approximately 10% in season II compared to season I. The FPS rate with GVL was significantly higher in the providers of postgraduate year over 3 years (P=0.043). Multivariate logistic regression analysis revealed an adjusted odds ratio for GVL FPS of 0.799 during season I (P=0.274). However, the adjusted odds ratio for GVL FPS was 3.744 during season II (P<0.001). CONCLUSION: We found that the FPS rates of GVL have slightly increased but DL’s FPS rate has significantly decreased during the last ten years.

Investigation of clinical application of the self-made curved laryngoscope / 中国耳鼻咽喉头颈外科

OBJECTIVE To discuss the clinical utility of the self-made curved laryngoscope.METHODS Clinical data of 198 patients with vocal cord polyps from September 2012 to October 2014 was analyzed retrospectively in which 99 cases were treated under the self-made curved larngoscopic surgeries (curved laryngoscope group) and 99 cases were treated by microlaryngoscopic surgeries (microlaryngoscope group).The duration of follow-up was 3 months in all patients.The clinical efficacy, times of inserting laryngoscope, glottic exposure and operation complications of two kinds of operations were observed and compared.RESULTS The total clinical efficacy in curved laryngoscope group showed no significant difference as compared with that in microlaryngoscope group. But for patients with difficult laryngeal exposure,the efficacy of curved laryngoscopic surgery was significantly better compared with that in the microlaryngoscopic surgery group. The results of times of inserting laryngoscope, glottic exposure and operation complications in the self-made curved larngoscope group were all better than those in microlaryngoscope group (P <0.05). CONCLUSION The operation under the self-made curved laryngoscope is a minimal invasive procedure to the laryngeal mucosa, with such more advantages like clear view of operation field and accurate management to the lesion tissue.Furthermore, the self-made curved laryngoscopic surgery is the first choice for the treatment of patients with difficult laryngeal exposure.

Efficacy of endobronchial intubation with double-lumen tube using fiberoptic bronchoscope assisted by video laryngoscope / 中华麻醉学杂志

Objective To evaluate the efficacy of endobronchial intubation with double-lumen tube using fiberoptic bronchoscope assisted by video laryngoscope.Methods Thirty patients of both sexes,who underwent failed endobronchial intubation with double-lumen tube using direct laryngoscope,aged 25-64 yr,with body mass index of 23-34 kg/m2,were randomly divided into 2 groups (n=15 each) using a random number table:fiberoptic bronchoscope group (group F) and fiberoptic bronchoscope assisted by video laryngoscope group (group VF).The patients were intubated with double-lumen tube under the guide of fiberoptic bronchoscope in group F.The patients were intubated with double-lumen tube under the guide of fiberoptic bronchoscope assisted by video laryngoscope in group VF.The rate of successful intubation,intubation time,and glottis and epiglottis exposure condition when the video laryngoscope was used in group VF were recorded.The patients were followed up postoperatively,and the development of intubation-related complications (sore throat,hoarseness and swallowing difficulty) was also recorded.Results Compared with group F,the intubation time was significantly shortened,and the success rate of intubation at first attempt and second success rate of intubation were significantly increased in group VF (P＜0.05).There was no statistically significant difference in the incidence of intubation-related complications between the two groups (P＞0.05).Conclusion Video laryngoscope provides better efficacy for endobronchial intubation with double-lumen tube using fiberoptic bronchoscope.

Ease of Intubation with the McGRATH® MAC, C-MAC® or Macintosh Laryngoscopes by Novice Operators in Simulated Difficult Airways – A Manikin Study.

A variety of video laryngoscopes have been introduced to facilitate endotracheal intubations as failed intubations can result in morbidity and mortality. We aimed to compare the use of the conventional Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes among novice operators. 37 medical students were recruited to perform oro-tracheal intubations in a human patient stimulator with simulated ‘difficult airway’ scenario using 3 devices: The Macintosh laryngoscope, McGRATH® MAC and C- MAC® video laryngoscopes. The success rate of tracheal intubation using the C-MAC® video laryngoscope (84%) was higher than both the McGRATH® MAC (59%) and the Macintosh laryngoscope (57%) (p=0.005). The use of video laryngoscopes were associated with lower incidence of oesophageal intubation (p<0.001) and deemed easier to use (p<0.001). Overall, the C-MAC® yielded a higher rate of successful tracheal intubation, a shorter time to glottic visualisation and was deemed to provide the greatest ease of intubation with novice practitioners.

Comparison of Tracheal Intubation Using the Macintosh Laryngoscope Versus the Disposable Laryngoscope by Inexperienced Personnel: A Manikin Study

PURPOSE: Disposable one piece laryngoscope (DOL), which probably carries a lower risk of infection than conventional reusable ones, is the only device which has received approval by the Korean Ministry of Food and Drug safety. In the current study, we evaluated the effectiveness and usefulness of the conventional Macintosh laryngoscope (MAC) and DOL in inexperienced personnel. METHODS: A randomized crossover trial was designed. Ninety seven participants (Medical students, Paramedic students) were enrolled and performed endotracheal intubation with MAC and DOL in Manikin (SimMan(R) Laedal Medical Corporation, Stravanger; Norway). Cormack-Lehane grade, the number of attempts, time required for intubation, and dental compression were measured to evaluate the effectiveness. The participants were given a questionnaire survey on the usefulness of laryngoscopes (easier to use, lightness, brightness, manageable to use, delivering power, safer for patients, intense to use). RESULTS: Regarding the aspect of effectiveness, a significant difference in dental compression was observed between DOL and MAC (p=0.011). Others showed no significant differences. Regarding the aspect of usefulness, DOL was superior to MAC except in delivering power. CONCLUSION: The DOL appears to be a reasonable device for use in emergency airway management. It should be verified for effectiveness and usefulness of newly developed equipment in emergency airway management because it is directly related to life.

Comparison between Glidescope and Lightwand for tracheal intubation in patients with a simulated difficult airway / 대한마취과학회지

BACKGROUND: Although Lightwand and Glidescope have both shown high success rates for intubation, there has been no confirmation as to which device is most effective for difficult endotracheal intubation. We compared the Glidescope and Lightwand devices in terms of duration of intubation and success rate at the first attempt in a simulated difficult airway situation. METHODS: Fifty-eight patients were randomized to undergo tracheal intubation with either the Glidescope (Glidescope group, n = 29) or the Lightwand (Lightwand group, n = 29). All patients were fitted with a semi-hard cervical collar in order to simulate a difficult airway, and intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as the interincisor distance, hemodynamic variables, and adverse effects. RESULTS: There was no difference between Glidescope group (92.6%) and Lightwand group (96.4%) in terms of success rate for the first attempt at intubation. The duration of successful intubation for the first tracheal intubation attempt was significantly longer in Glidescope group than in Lightwand group (46.9 sec vs 29.5 sec, P = 0.001). All intubations were completed successfully within two intubation attempts. The incidence of hypertension was significantly higher in Glidescope group than in Lightwand group (51.9% vs 17.9%, P = 0.008). CONCLUSIONS: In a simulated difficult airway situation, endotracheal intubation using Lightwand yielded a shorter duration of intubation and lower incidence of hypertension than when using Glidescope.

Comparison of different front plastic angle with reinforced plastic endotracheal tube guidance by McGrath -5 video laryngoscope for orotracheal intubation in obesity / 中国基层医药

Objective To compare the different front plastic angle with reinforced plastic endotracheal tube guidance by McGrath -5 video laryngoscope for orotracheal intubation in obesity.Methods 1 20 cases with obesity undergoing general anesthesia,ASA gradeⅠ -Ⅲ who planned intubation guidance by McGrath -5 video laryngo-scope,were randomly divided into three group according to different front plastic angle for endotracheal tube:group A (catheter 60°),group B(catheter 75°),C group(catheter 90°),40 cases in each group.General information and air-way evaluation indexes such as Mallampati classification,the degree of open mouth,neck circumference,thyromental distance,atlanto -occipital joint stretch degree preoperatively were recorded.C /L classification with laryngoscopic exposure,the successful rate of first intubation,time of first intubation,cases of second intubation,the incidence of blood stained catheter and postoperative sore throat and hoarseness were recorded also.Results There were no signif-icant differences of patients with general information and airway evaluating indexes such as Mallampati classification, the degree of open mouth,neck circumference,thyromental distance,atlanto -occipital joint stretch degree among three groups(P >0.05).The successful rate of catheter alignment glottal was 97.5% in group B,which was signifi-cantly higher than that of group A(80.0%)and group C(85.0%)(χ2 =8.36,P 0.05).Conclusion McGrath -5 video laryngoscope which guided endotracheal tube with front plastic angle at 75°degree has highest success rate of intubation,shortest intubation time,least compli-cation and is suitable for the application of tracheal intubation in obese patients.

Application of Two Kinds of Video Laryngoscope in General Anesthesia during UPPP Operation / 天津医药

Objective To compare success rate of intubation and safety of two types of video laryngoscopes during anesthesia in uvulopalatopharyngoplasty surgery (UPPP) for obstructive sleep apnea syndrome (OSAS) patients. Methods UPPP surgery were operated to 60 patients between January and October of 2013 and those patients were randomly divided into McGrath MAC video laryngoscope group (M group), GlideScope video laryngoscope (G group), and SHUCMAN direct la-ryngoscopy (S group), with 20 patients per group. Mallampati classification scores, Cormack-Lehane grade, intubation suc-cess rate, pre-intubation vs post-intubation heart rate and blood pressure changes were recorded and compared. Results Mallampati classification scores were not significantly different between these three groups, and Cormack-Lehane grade be-tween M group and G group were also not statistically different. M and G group had distinct advantages in Cormack-Lehane grade, success rate in intubation, heart rate, blood pressure at completion of intubation (T3) and 1 minute after intubation (T4), and the differences are statistically significant (P < 0.05). Blood pressure changes were stabler in G group than M group. Conclusion The two video laryngoscopes used in anesthesia intubation during UPPP surgery can both effectively re-veal the structure of the throat, but also work with high success rate and safety. What’s more, in this study the McGrath MAC video laryngoscope was shown to be superior to GlideScope video laryngoscope.

Comparison of influence of visual endoscope and general laryngoscope under general anesthesia on postopera-tive sore throat / 中国基层医药

Objective To compare the influence of visual endoscope and general laryngoscope under general anesthesia on postoperative sore throat , in order to provide reference for clinical surgery .Methods 320 patients under non-neck and non-throat surgeries were selected .They were randomly divided into the control group and obser-vation group,160 cases in each group.Same intubation was used in both the two groups ,general laryngoscope was used in the control group and visual endoscope was used in the observation group .Clinical indicators and pain score after surgery were compared between the two groups .Results The air pressure,time of anesthesia and operation time in the observation group were similar with the control group ,the differences were not significant (t =0.834,0.943, 1.034,all P>0.05); 2h,24h,48h,96h after surgery,the VAS scores in the observation group were (11.93 ± 2.04)points,(17.44 ±3.27)points,(3.88 ±0.83)points,(1.12 ±0.31)points,the incidence rate of throat bleed-ing within 96h was 7.50%,which were significantly lower than those in the control group [(18.43 ±3.21) points, (22.55 ±4.19)points,(6.33 ±0.64)points,(3.29 ±0.58)points,17.50%],there were significant differences (t=7.493,5.773,4.834,7.231,χ2 =8.221,all P<0.05).Conclusion Intubation with visual endoscope can decrease postoperative sore throat ,which can be a priority for clinical surgery .