Using the intubating laryngeal tube in a manikin - user evaluation of a new airway device.

This work describes the use of a new intubation device, the intubating laryngeal tube (iLTA) as developed by Boedeker. Emergency Department residents and staff from the University of Nebraska Medical Center performed intubations using the Laerdal Difficult Airway Trainer Manikin(TM). The participants' perceived value of the intubating laryngeal tube as well as its efficacy in intubation performance were measured and found to be highly favorable.

Airway management in unusual environments.

Critically injured patients are often found in unusual positions and environments which can hinder the first responder's access to render necessary care. This work describes the use of the videolaryngoscope in airway management of the critically injured patient under unusual conditions.

Use of a cardiac algorithm in a preoperative evaluation clinic - a pilot study.

The preoperative evaluation is vital in providing information to reduce the risks associated with the anesthesia and surgery and improve the quality of care. In the VA Nebraska-Western Iowa Health Care System, we introduced a computer-based cardiac algorithm as part of the preoperative evaluation software. Following the pre-op examination and use of the algorithm, the provider completed a survey regarding their perceived usefulness of the algorithm software. The survey results showed that effective preoperative evaluation can be performed using a preoperative evaluation clinic, users are receptive to the computer-based format and, in most cases, prefer to have the algorithm software available for use in preoperative assessment.

Intubation success rates and perceived user satisfaction using the video laryngoscope to train deploying far forward combat medical personnel.

Studies show the video laryngoscope enhances intubation training by facilitating visualization of airway anatomy. We examined the performance and training of military healthcare providers in a brief intubation training course which included both direct and indirect (video) laryngoscopy. This training format with the video laryngoscope improved airway visualization and intubation performance, promoting increased trainee confidence levels for successful intubation. Web-based training paired with hands-on instruction with the video laryngoscope should be considered as a model for military basic airway management training.

Technology transfer at the University of Nebraska Medical Center.

The course of developing a new product from an idea is a complicated process. This paper will discuss that process, in detail, from conception to product. We approach this by first discussing what the inventor must do begin the process of developing his or her idea, and then two pathways that occur simultaneously: the Technology Transfer process of patenting, marketing, and licensing the invention; and the engineering process of developing, modifying, and manufacturing the invention. Although the process is lengthy and most ideas never become a marketed product, there are those few ideas that do become realized into marketed products.

Validation of a virtual preoperative evaluation clinic: a pilot study.

Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope with a novel modification.

BACKGROUND: The Bonfils intubating fiberscope has a limited upward tip angle of 40 degrees and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60 degrees curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation. METHODS: Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure. RESULTS: Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 +/- 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 +/- 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20). CONCLUSIONS: With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.