A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study.

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.

Comparison of three videolaryngoscopes for double-lumen tubes intubation in simulated easy and difficult airways: a randomized trial.

BACKGROUND: The King Vision™ (KVL) and Airtraq® videolaryngoscopes may reduce the time to double lumen tube (DLT) intubation compared to the GlideScope® and MacIntosh in simulated easy and difficult airways. METHODS: Twenty-one staff anesthesiologists with limited prior experience in using videolaryngoscopes for DLT intubation were assigned randomly to insert a DLT using the MacIntosh, GlideScope®, Airtraq® and KVL videolaryngoscopes on easy and difficult airway simulators in a randomized crossover order. Time to DLT intubation, laryngoscopic view, intubation difficulty, optimizing manoeuvers and failure to intubation - defined as an attempt taking longer than 150 s - were recorded. RESULTS: The three videolaryngoscopes had comparable times to intubation and glottis visualization in both scenarios. Compared with the MacIntosh, the KVL had longer intubation times in the simulated easy airway scenario (mean 9.2 vs. 21.1 s, respectively, P<0.001). In both scenarios, the Airtraq® took a longer intubation time than the MacIntosh (P<0.001 and P=0.019, respectively). The GlideScope® was easier to use than the Airtraq® and KVL in the easy airway scenario (P=0.021 and P=0.001, respectively). The KVL had higher intubation difficulty scores than the GlideScope® and Airtraq® (P=0.002 and P=0.008, respectively) in both scenarios and required more frequent optimizing manoeuvers than the GlideScope® (P=0.012) in the simulated easy airway. Two participants failed to intubate the difficult airway simulator; one with the MacIntosh and the other with the KVL. CONCLUSIONS: The Airtraq® and non-channeled KVL required more time over the MacIntosh for DLT intubation, as a primary outcome, but the success rates for the 3 videolaryngoscopes were very high.

Effects of perineural administration of dexmedetomidine in combination with bupivacaine in a femoral-sciatic nerve block.

BACKGROUND AND AIM: Perineural administration of dexmedetomidine, a α2-adrenoceptor agonist, prolongs the duration of analgesia. We hypothesized that adding dexmedetomidine to bupivacaine would prolong postoperative analgesia after below knee surgery. MATERIALS AND METHODS: After ethical approval, 60 patients scheduled for below knee surgery under combined femoral-sciatic nerve block were randomly allocated into two groups to have their block performed using bupivacaine 0.5% alone (group B) or bupivacaine 0.5% combined with 100 µg bupivacaine-dexmedetomidine (group BD). Motor and sensory block onset times; durations of blockades and analgesia were recorded. RESULTS: Sensory and motor block onset times were shorter by 20% in group BD than in group B (P < 0.01). Sensory and motor blockade durations were longer in group BD (+45% and +40%, respectively) than in group B (P < 0.01). Duration of analgesia was longer in group BD by 75% than in group B (P < 0.01). Systolic, diastolic arterial blood pressure levels, and heart rate were significantly less in group BD, six patients in group BD, and no patients in group B developed bradycardia (P < 0.05). CONCLUSION: The addition of dexmedetomidine 100 µg to bupivacaine 0.5% during ultrasound-guided combined femoral and sciatic block for below knee surgery was associated with a prolonged duration of analgesia. However, this may be associated with significant bradycardia requiring treatment.