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John G. Laffey - One of the best experts on this subject based on the ideXlab platform.
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comparison of the c mac airtraq and macintosh Laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization
BJA: British Journal of Anaesthesia, 2011Co-Authors: J Mcelwain, John G. LaffeyAbstract:Background. We aimed at comparing the performance of the C-MAC w , Airtraq w , and Macintosh Laryngoscopes when performing tracheal intubation in patients undergoing neck immobilization using manual inline axial cervical spine stabilization. Methods. Ninety consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a C-MAC w (n¼30), Airtraq w (n¼29), or Macintosh (n¼31) Laryngoscope. All patients were intubated by one anaesthetist experienced in the use of each Laryngoscope. Results. The Airtraq w Laryngoscope performed best in these patients, reducing the Intubation Difficulty Scale score, improving the Cormack and Lehane glottic view, and reducing the need for optimization manoeuvres, compared with both the Macintosh and the C-MAC w . The C-MAC w and Macintosh Laryngoscopes performed similarly. There were
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A comparison of the Glidescope^®, Pentax AWS^®, and Macintosh Laryngoscopes when used by novice personnel: a manikin study
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2009Co-Authors: Muhammad A. Malik, Patrick Hassett, John Carney, Brendan D. Higgins, Brian H. Harte, John G. LaffeyAbstract:Objectif L’intubation trachéale par laryngoscopie directe est une procédure potentiellement salutaire, mais il s’agit également d’une compétence difficile à acquérir et à maintenir. Les conséquences de tentatives d’intubation mal réalisées sont potentiellement graves. Le Pentax AWS^® et le Glidescope^® sont des Laryngoscopes indirects qui pourraient nécessiter une compétence moindre. Ainsi, nous avons émis l’hypothèse que l’AWS^® et le Glidescope^® donneraient de meilleurs résultats que le Laryngoscope Macintosh lors de leur utilisation par du personnel inexpérimenté pour l’intubation de voies aériennes normales ou rendues difficiles par simulation. Méthode Dans cette étude croisée randomisée et prospective qui a été menée à la suite d’une formation didactique standard, des étudiants en médecine n’ayant pas d’expérience antérieure en matière de laryngoscopie ont réalisé une intubation trachéale à l’aide de chacun des appareils. Chaque étudiant avait droit à un maximum de trois tentatives d’intubation sur un simulateur d’intubation Laerdal^® dans le cadre de deux scénarios de laryngoscopie, dont l’un sur un mannequin Laerdal^® SimMan^®. Les étudiants ont ensuite réalisé une seconde intubation trachéale dans une voie aérienne normale afin de déterminer la courbe d’apprentissage de chaque appareil. Résultats Le Pentax AWS^® a procuré de meilleures conditions d’intubation que le Glidescope^® ou le Macintosh, ce qui a eu pour résultat un taux de réussite de l’intubation plus élevé et ce, particulièrement dans les situations de laryngoscopie difficile. Le Glidescope^® a démontré des avantages par rapport au Macintosh, notamment dans les situations de laryngoscopie plus difficile. L’AWS^® et le Glidescope^® ont permis de réduire la durée des tentatives d’intubation, le nombre de manœuvres nécessaires, ainsi que le potentiel d’un traumatisme dentaire. En comparaison directe, l’AWS^® était le Laryngoscope procurant les meilleures conditions d’intubation. Conclusion Le Laryngoscope Pentax AWS^® semble constituer une meilleure alternative au Macintosh pour permettre au personnel inexpérimenté d’acquérir les compétences nécessaires à l’intubation trachéale. Purpose Direct laryngoscopic tracheal intubation is a potentially lifesaving procedure, but a difficult skill to acquire and maintain. The consequences of poorly performed intubation attempts are potentially severe. The Pentax AWS^® and the Glidescope^® are indirect Laryngoscopes that may require less skill to use. We therefore hypothesized that AWS^® and Glidescope^® would prove superior to the Macintosh Laryngoscope when used by novices in the normal and simulated difficult airway. Methods In this prospective randomized crossover trial following standardized didactic instruction, medical students with no prior experience of laryngoscopy performed tracheal intubation using each device. Each student was allowed up to three attempts to intubate in a Laerdal^® Intubation Trainer in two laryngoscopy scenarios and in a Laerdal^® SimMan^® manikin in one scenario. The students then performed tracheal intubation of the normal airway a second time to characterize the learning curve for each device. Results The Pentax AWS^® provided better intubation conditions than the Glidescope^® or the Macintosh, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. The Glidescope^® demonstrated advantages over the Macintosh, particularly in the more difficult scenarios. Both the AWS^® and the Glidescope^® decreased the duration of intubation attempts, reduced the number of maneuvers required, and reduced the potential for dental trauma. In direct comparisons, the AWS^® provided the best intubation conditions. Conclusions The Pentax AWS^® appears to constitute a better alternative to the Macintosh for novice personnel to acquire the skills of tracheal intubation.
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Comparison of the Airtraq^® and Truview^®Laryngoscopes to the Macintosh Laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins
BMC Emergency Medicine, 2009Co-Authors: Sajid Nasim, Muhammad A. Malik, Brendan D. Higgins, Brian H. Harte, Chrisen H Maharaj, Ihsan Butt, John O' Donnell, John G. LaffeyAbstract:Background Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect Laryngoscopes, such as the Airtraq^® and Truview^® Laryngoscopes may reduce this risk. Methods We compared the efficacy of these devices to the Macintosh Laryngoscope when used by 21 Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Airtraq^® and Truview^® Laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan^® manikin. Results The Airtraq^® reduced the number of optimization manoeuvres and reduced the potential for dental trauma when compared to the Macintosh, in both the normal and simulated difficult intubation scenarios. In contrast, the Truview^® increased the duration of intubation attempts, and required a greater number of optimization manoeuvres, compared to both the Macintosh and Airtraq^® devices. Conclusion The Airtraq^® Laryngoscope performed more favourably than the Macintosh and Truview^® devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting.
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comparison of the glidescope the pentax aws and the truview evo2 with the macintosh Laryngoscope in experienced anaesthetists a manikin study
BJA: British Journal of Anaesthesia, 2009Co-Authors: M A Malik, John G. Laffey, Cathal Odonoghue, J Carney, C H Maharaj, B H HarteAbstract:Abstract Background The Pentax Airwayscope®, the Glidescope®, and the Truview EVO2® constitute three novel Laryngoscopes that facilitate visualization of the vocal cords without alignment of the oral, pharyngeal, and tracheal axes. We compared these devices with the Macintosh Laryngoscope in a simulated easy and difficult laryngoscopy. Methods Thirty-five experienced anaesthetists were allowed up to three attempts to intubate in each of four laryngoscopy scenarios in a Laerdal® SimMan® manikin. The time required to perform tracheal intubation, the success rate, number of intubation attempts and of optimization manoeuvres, and the severity of dental compression were recorded. Results In the simulated easy laryngoscopy scenarios, there was no difference between the study devices and the Macintosh in success of tracheal intubation. In more difficult tracheal intubation scenarios, the Glidescope® and Pentax AWS®, and to a lesser extent the Truview EVO2® Laryngoscope demonstrated advantages over the Macintosh Laryngoscope including a better view of the glottis, greater success of tracheal intubation, and ease of device use. The Pentax AWS® was more successful in achieving tracheal intubation, required less time to successfully perform tracheal intubation, caused less dental trauma, and was considered by the anaesthetists to be easier to use. Conclusions The Pentax AWS® Laryngoscope demonstrated more advantages over the Macintosh Laryngoscope than either the Truview EVO2® or the Glidescope® Laryngoscope, when used by experienced anaesthetists in difficult tracheal intubation scenarios.
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learning and performance of tracheal intubation by novice personnel a comparison of the airtraq and macintosh Laryngoscope
Anaesthesia, 2006Co-Authors: Brendan D. Higgins, John G. Laffey, C H Maharaj, B H Harte, J F CostelloAbstract:Summary Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq® Laryngoscope is a novel intubation device which may possess advantages over conventional direct Laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal® Intubation Trainer and one scenario in a Laerdal® SimMan® Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.
H Sugimoto - One of the best experts on this subject based on the ideXlab platform.
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Distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy ( P
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distortion of anterior airway anatomy during laryngoscopy with the glidescope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy (P \ 0.05). Anterior deviations of the vertebral bodies from baseline were 27, 32, 36, and 39% less at the atlas, C2, C3, and C4 vertebrae, respectively, during the GlideScope procedure than those measured during Macintosh laryngoscopy (P \ 0.01). Cervical extension between the occiput and C4 during the GlideScope procedure was 23% less than that during Macintosh laryngoscopy (P \ 0.05). Conclusion Both anterior airway distortion and cervical spine movement during laryngeal visualization were less with the GVL than with the Macintosh Laryngoscope.
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a comparison of cervical spine movement during laryngoscopy using the airtraq or macintosh Laryngoscopes
Anaesthesia, 2008Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airtraq® Laryngoscope has an oropharyngeal airway-shaped blade that provides a non-line-of-sight view of the glottis. The configuration of the blade should mean that less movement of the cervical spine is required during laryngeal visualisation. We compared the degree of cervical spine movement in laryngoscopy performed using the Airtraq and conventional Macintosh Laryngoscope. In 20 patients requiring general anaesthesia and tracheal intubation, we measured cervical spine movement using radiography in the same patient during consecutive procedures using the two Laryngoscopes. Although significant movement of the cervical spine from baseline was noted during all procedures (p < 0.05), cervical spinal extension with the Airtraq was 29% less than that measured during Macintosh laryngoscopy between the occiput and C4, and 44% less at the C3/C4 motion segment (p < 0.05). Anterior deviations of the vertebral bodies from baseline were 32%, 35%, 38% and 40% less at the atlas, C2, C3, and C4 vertebrae, respectively, during Airtraq laryngoscopy than those measured during Macintosh laryngoscopy (p < 0.01). Our study demonstrated that laryngoscopy using the Airtraq Laryngoscope involves less movement of the cervical spine compared to conventional procedures using a Macintosh Laryngoscope.
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Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh Laryngoscope
Anaesthesia, 2007Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airway Scope is a new rigid Laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. We compared the degree of cervical spine movement during laryngoscopy with the Airway Scope and conventional direct Laryngoscope. Twenty patients requiring general anaesthesia and tracheal intubation were studied. Movements of the cervical spine were measured using radiography in the same patient during laryngoscopy with the Airway Scope and a Macintosh Laryngoscope. Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh Laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p
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cervical spine movement during laryngoscopy using the airway scope compared with the macintosh Laryngoscope
Anaesthesia, 2007Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airway Scope is a new rigid Laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. We compared the degree of cervical spine movement during laryngoscopy with the Airway Scope and conventional direct Laryngoscope. Twenty patients requiring general anaesthesia and tracheal intubation were studied. Movements of the cervical spine were measured using radiography in the same patient during laryngoscopy with the Airway Scope and a Macintosh Laryngoscope. Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh Laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p < 0.05). The movement of the atlanto-occipital distance using the Airway Scope was 42% less than that during laryngoscopy using the Macintosh Laryngoscope (p < 0.05). Laryngoscopy using the Airway Scope involves less movement of the cervical spine compared to conventional laryngoscopy using the Macintosh Laryngoscope.
Yoshihiro Hirabayashi - One of the best experts on this subject based on the ideXlab platform.
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nasotracheal intubation using glidescope videoLaryngoscope or macintosh Laryngoscope by novice laryngoscopists
Masui. The Japanese journal of anesthesiology, 2010Co-Authors: Mami Shimada, Yoshihiro HirabayashiAbstract:BACKGROUND: We compared the performance of GlideScope videoLaryngoscope with that of the conventional Macintosh Laryngoscope for nasotracheal intubation by non-anesthesia residents. METHODS: Forty patients requiring nasal endotracheal intubation for surgical convenience were allocated to intubation with the GlideScope videoLaryngoscope or Macintosh Laryngoscope. Each intubation was performed by non-anesthesia residents. RESULTS: The time to secure the airway was shorter with GlideScope laryngoscopy than with the Macintosh laryngoscopy. Magill forceps were not needed for any patient during GlideScope videolaryngoscopy, while Macintosh laryngoscopy required Magill forceps utilization for 75% of the patients. CONCLUSIONS: The unobstructed view of the glottic opening on the video monitor helped the laryngoscopist performing the nasal endotracheal intubation while an assistant provided laryngeal manipulation to improve the coordinated effort. GlideScope seems to facilitate nasotracheal intubation for individuals training in airway management.
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Distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy ( P
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distortion of anterior airway anatomy during laryngoscopy with the glidescope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy (P \ 0.05). Anterior deviations of the vertebral bodies from baseline were 27, 32, 36, and 39% less at the atlas, C2, C3, and C4 vertebrae, respectively, during the GlideScope procedure than those measured during Macintosh laryngoscopy (P \ 0.01). Cervical extension between the occiput and C4 during the GlideScope procedure was 23% less than that during Macintosh laryngoscopy (P \ 0.05). Conclusion Both anterior airway distortion and cervical spine movement during laryngeal visualization were less with the GVL than with the Macintosh Laryngoscope.
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a comparison of cervical spine movement during laryngoscopy using the airtraq or macintosh Laryngoscopes
Anaesthesia, 2008Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airtraq® Laryngoscope has an oropharyngeal airway-shaped blade that provides a non-line-of-sight view of the glottis. The configuration of the blade should mean that less movement of the cervical spine is required during laryngeal visualisation. We compared the degree of cervical spine movement in laryngoscopy performed using the Airtraq and conventional Macintosh Laryngoscope. In 20 patients requiring general anaesthesia and tracheal intubation, we measured cervical spine movement using radiography in the same patient during consecutive procedures using the two Laryngoscopes. Although significant movement of the cervical spine from baseline was noted during all procedures (p < 0.05), cervical spinal extension with the Airtraq was 29% less than that measured during Macintosh laryngoscopy between the occiput and C4, and 44% less at the C3/C4 motion segment (p < 0.05). Anterior deviations of the vertebral bodies from baseline were 32%, 35%, 38% and 40% less at the atlas, C2, C3, and C4 vertebrae, respectively, during Airtraq laryngoscopy than those measured during Macintosh laryngoscopy (p < 0.01). Our study demonstrated that laryngoscopy using the Airtraq Laryngoscope involves less movement of the cervical spine compared to conventional procedures using a Macintosh Laryngoscope.
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Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh Laryngoscope
Anaesthesia, 2007Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airway Scope is a new rigid Laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. We compared the degree of cervical spine movement during laryngoscopy with the Airway Scope and conventional direct Laryngoscope. Twenty patients requiring general anaesthesia and tracheal intubation were studied. Movements of the cervical spine were measured using radiography in the same patient during laryngoscopy with the Airway Scope and a Macintosh Laryngoscope. Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh Laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p
Richard M Cooper - One of the best experts on this subject based on the ideXlab platform.
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Direct versus indirect laryngoscopy using a Macintosh video Laryngoscope: a mannequin study comparing applied forces
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2020Co-Authors: Joanna K. Gordon, Vaughan E. Bertram, Francesco Cavallin, Matteo Parotto, Richard M CooperAbstract:Purpose Upper airway injury and sympathetic activation may be related to the forces applied during laryngoscopy. We compared the applied forces during laryngoscopy using direct and indirect visualization of a standardized mannequin glottis. Methods Force transducers were applied to the concave surface of a GlideScope T-MAC Macintosh-style video Laryngoscope that can also be used as a conventional direct-view Laryngoscope. Thirty-four anesthesiologists performed four laryngoscopies (two direct and two indirect views) on an Ambu mannequin in a randomized sequence. During each laryngoscopy, participants were instructed to obtain views corresponding to > 80% and 50% of the glottic opening aperture. Peak and impulse forces were measured for each view. Results To achieve a 50% glottic opening view, the top 10^th percentile force was higher with direct vs indirect laryngoscopy in terms of peak (difference, 9.1 newton; 99% confidence interval [CI], 7.4 to 13.9) and impulse (difference, 56.4 newton·sec; 99% CI, 49.0 to 81.7) forces. To achieve >80% view of the glottic opening, median force was higher with direct vs indirect laryngoscopy in terms of peak (difference, 3.6 newton; 99% CI, 1.6 to 7.3) and impulse (difference, 20.4 newton·sec; 99% CI, 11.7 to 35.1) forces. Conclusions In this mannequin study, lower forces applied during indirect vs direct laryngoscopy may reflect an advantage of video laryngoscopy, but additional studies using patients are required to confirm the clinical implications of these findings. Objectif Les lésions aux voies aériennes supérieures et l’activation du système sympathique pourraient être dues aux forces appliquées pendant la laryngoscopie. Nous avons comparé les forces appliquées pendant une laryngoscopie avec visualisation directe vs indirecte d’une glotte standardisée sur mannequin. Méthode Des transducteurs ont été appliqués à la surface concave d’un vidéoLaryngoscope de type Macintosh GlideScope T-MAC, un dispositif qui peut également être utilisé comme Laryngoscope conventionnel avec visualisation directe. Trente-quatre anesthésiologistes ont chacun réalisé quatre laryngoscopies (deux visualisations directes et deux indirectes) sur un mannequin Ambu en suivant une séquence randomisée. Pendant chaque laryngoscopie, les participants avaient pour consigne d’obtenir des vues correspondant à > 80 % et 50 % de l’ouverture glottique. Les forces maximales et impulsions ont été mesurées pour chaque visualisation. Résultats Pour obtenir une visualisation à 50 % de l’ouverture glottique, le 10^e percentile maximal était plus élevé en cas de laryngoscopie directe qu’en cas de laryngoscopie indirecte tant au maximum de la force (différence, 9,1 newton; intervalle de confiance [IC] 99 %, 7,4 à 13,9) qu’à l’impulsion (différence, 56,4 newton·sec; IC 99 %, 49,0 à 81,7). Pour obtenir une visualisation à > 80 % de l’ouverture glottique, la médiane était également plus élevée en cas de laryngoscopie directe qu’en cas de laryngoscopie indirecte, tant au maximum de la force (différence, 3,6 newton; intervalle de confiance [IC] 99 %, 1,6 à 7,3) qu’à l’impulsion (différence, 20,4 newton·sec; IC 99 %, 11,7 à 35,1). Conclusion Dans cette étude sur mannequin, les forces et impulsions moins prononcées appliquées pendant la laryngoscopie indirecte plutôt que directe pourraient refléter un avantage de la vidéolaryngoscopie, mais des études supplémentaires sur patient sont nécessaires afin de confirmer les implications cliniques de ces résultats.
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The effect of verbal and video feedback on learning direct laryngoscopy among novice laryngoscopists: a randomized pilot study
Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2017Co-Authors: Jennifer E. Sainsbury, Matteo Parotto, Branislav Telgarsky, Ahtsham Niazi, David T. Wong, Richard M CooperAbstract:Objectif L’acquisition de compétences en laryngoscopie directe et en intubation trachéale est complexe. L’objectif de cette étude pilote était d’évaluer la faisabilité et de déterminer la taille d’échantillon nécessaire à réaliser une étude subséquente comparant l’enseignement de la laryngoscopie directe à l’aide d’un vidéoLaryngoscope avec une lame de Macintosh (MacVL), avec ou sans enregistrement vidéo, à un enseignement traditionnel de la laryngoscopie directe. Méthode Des étudiants en médecine n’ayant aucune expérience préalable de laryngoscopie ont été recrutés pendant leur rotation d’anesthésie de deux semaines. Pendant la première semaine (FORMATION), les étudiants ont été randomisés en trois groupes: le groupe témoin (laryngoscopie direct avec lame de Macintosh), le groupe VL-1 (MacVL avec rétroaction en temps réel), et VL-2 (MacVL avec rétroaction en temps réel et enregistrements vidéo des laryngoscopies). Pendant la deuxième semaine (ÉVALUATION), tous les étudiants ont été évalués en utilisant un Laryngoscope direct avec une lame de Macintosh. Les objectifs de faisabilité étaient les taux de recrutement et d’abandon, la capacité à mesurer la durée et à réaliser des enregistrements vidéo des intubations, et la disponibilité d’un MacVL. Le critère d’évaluation principal clinique pendant la semaine d’ÉVALUATION était le temps total jusqu’à intubation, et les critères secondaires étaient le taux de réussite d’intubation, les occasions d’intubation, les complications et les scores de confiance. Résultats Soixante-huit des 87 (78 %) étudiants en médecine consécutifs auxquels on a demandé de participer à l’étude ont été recrutés au cours d’une période de 18 mois. Huit (12 %) étudiants se sont retirés de l’étude, et des données étaient disponibles pour les 60 participants restants. Les temps jusqu’à intubation ont été enregistrés dans 92 % des intubations réalisées durant l’ÉVALUATION, mais seules 71 % des intubations de la semaine de FORMATION ont été enregistrées dans le groupe VL-2. Les MacVL étaient disponibles dans 100 % des cas. Nous estimons qu’il faudrait 190 participants pour réaliser une étude se limitant à comparer la laryngoscopie directe vs la vidéolaryngoscopie avec rétroaction en temps réel. Conclusion Cette étude pilote a déterminé la faisabilité et propose un estimé de la taille d’échantillon nécessaire à une future étude randomisée contrôlée. Certaines modifications seraient nécessaires au protocole de l’étude, notamment une implication plus importante dans l’hôpital ainsi que des considérations quant à la standardisation de la formation sur les voies aériennes, l’enseignement, les rétroactions et les caractéristiques du patient. Purpose Skill acquisition in direct laryngoscopy (DL) and tracheal intubation is complex. This pilot study aims to assess feasibility and determine sample size for a subsequent trial comparing DL instruction using a Macintosh-style video Laryngoscope (MacVL), with and without video recordings, with conventional DL instruction. Methods Medical students with no prior laryngoscopy experience were recruited during their two-week anesthesia rotation. During the first (TRAINING) week, students were randomized into three groups: Control (Macintosh direct Laryngoscope), VL-1 (MacVL with real-time feedback), and VL-2 (MacVL with real-time feedback plus video recordings of laryngoscopies). During the second (TESTING) week, all students were tested using a Macintosh direct Laryngoscope. Feasibility objectives were recruitment and attrition rates, ability to time and video record intubations, and the availability of a MacVL. The primary clinical outcome during the TESTING week was total time to intubate, and secondary outcomes included intubation success rate, intubating opportunities, complications, and confidence scores. Results Sixty-eight of 87 (78%) consecutive medical students approached to participate in the study were recruited over 18 months. Eight (12%) students withdrew from the study, and data are available on the remaining 60 participants. The times to intubate were recorded for 92% of the TESTING intubations, but only 71% of the TRAINING intubations in the VL-2 group were video recorded. The MacVLs were available in 100% of cases. We estimate that 190 participants would be required for a study restricted to a comparison of DL vs video laryngoscopy with real-time feedback. Conclusion This pilot study establishes feasibility and provides a sample size estimate for a future RCT. Required modifications to the study protocol include wider hospital involvement and consideration regarding standardization of airway education, teaching, feedback, and patient characteristics.
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superior glottic views with the glidescope and airtraq Laryngoscopes compared with an anterior commissure Laryngoscope
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2011Co-Authors: Sofia Khan, Richard M CooperAbstract:To the Editor, In the unanticipated difficult airway, an anesthesiologist or otolaryngologist may perform direct laryngoscopy with a rigid anterior commissure Laryngoscope. There have been case reports of using the anterior commissure Laryngoscope for laryngoscopic rescue in difficult airways. We describe a case in which the view we obtained using two different video Laryngoscopes was improved over that seen by an experienced otolaryngologist using an anterior commissure Laryngoscope and over that seen by an anesthesiologist using a direct Laryngoscope. This observation provides anecdotal support for the role of video laryngoscopy as an early rescue device when direct laryngoscopy affords an inadequate laryngeal view. This report is presented with the written consent of the patient. A 41-yr-old man presented with a recurrence of a squamous cell carcinoma of the tongue. On this occasion, we planned a diagnostic panendoscopy tracheostomy, bilateral neck dissection, composite mandibular resection, and reconstruction. Twelve months earlier, the patient had undergone a panendoscopy, bilateral neck dissection, mandibulotomy, partial glossectomy, and a free forearm flap to the floor of the mouth. Seven months later, a recurrence prompted cisplatin chemotherapy and irradiation with 70 Gy delivered in 35 fractions over seven weeks. The anesthesia chart from the first operation revealed no problems with bag-mask ventilation; direct laryngoscopy offered a Cormack-Lehane (C/L) grade 1 laryngeal view. The patient’s airway assessment prior to the second operation revealed an obvious flap reconstruction of the right tongue, modified Mallampati 2 view, mouth opening greater than three finger breadths, and normal neck flexion with slightly restricted extension. He had full dentition and a prominent overbite but could just approximate his maxillary and mandibular incisors. His anterior neck was swollen and firm to the touch. His body mass index was 21 kg m, and he denied any gastro-esophageal reflux. We felt that direct laryngoscopy would be difficult, but not bag-mask ventilation. Anesthesia was induced with midazolam 2 mg, remifentanil 40 lg, propofol 150 mg, and succinylcholine 100 mg iv. Following induction of anesthesia bag-mask, ventilation was easily achieved. The staff otolaryngologist inserted the anterior commissure Laryngoscope as part of the panendoscopy. Since this was achieved with some difficulty, the surgeon introduced an Eschmann Tracheal Tube Introducer (Smiths Medical International Ltd, Hythe, Kent, UK) into the patient’s trachea over which an 8-mm (internal diameter) endotracheal tube was advanced. The best laryngeal view obtained with the anterior commissure Laryngoscope, by using external laryngeal pressure and considerable force, was a C/L 2-B. Once a tracheostomy had been performed, three different Laryngoscopes were compared by one of the authors (S.K.). Direct laryngoscopy using a Macintosh #3 provided a C/L 3 view. The Airtraq Optical Laryngoscope (Prodol Meditec, Viscaya, Spain) and the GlideScope Cobalt Advanced Video Laryngoscope (AVL) (Verathon Medical, Bothell, WA, USA), both indirect Laryngoscopes, provided better views compared with the previous two Laryngoscopes. No Electronic supplementary material The online version of this article (doi:10.1007/s12630-010-9413-2) contains supplementary material, which is available to authorized users.
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use of a new videoLaryngoscope glidescope in the management of a difficult airway
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2003Co-Authors: Richard M CooperAbstract:Purpose: To describe the clinical use of a new videoLaryngoscope in a patient who had repeatedly been difficult or impossible to intubate by conventional direct laryngoscopy. This device provided excellent glottic visualization and permitted easy endotracheal intubation. Clinical features: A 74-yr-old male presenting for repeat elective surgery had a history of failed intubations by direct laryngoscopy and pulmonary aspiration with a laryngeal mask airway. He refused awake flexible fibreoptic intubation. After the induction of general anesthesia, laryngoscopy was performed using a GlideScope®. This provided complete glottic exposure and easy endotracheal intubation. Conclusion: This new videoLaryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy. The clinical role of this device awaits confirmation in a large series of difficult airways. Objectif : Decrire l’utilisation clinique d’un nouveau videoLaryngoscope chez un patient pour qui l’intubation avait ete difficile ou impossible a quelques reprises en laryngoscopie directe traditionnelle. Ce dispositif a fourni une excellente visualisation glottique et permis une intubation endotracheale facile. Elements cliniques : Un homme de 74 ans, vu a maintes reprises en chirurgie elective, avait subi des intubations souvent impossibles par laryngoscopie directe et une aspiration pulmonaire lors de l’usage d’un masque larynge. Il refusait l’intubation vigile avec un fibroscope flexible. Apres l’induction de l’anesthesie generale, la laryngoscopie a ete realisee avec un GlideScope®. L’appareil a fourni une exposition glottique complete et permis une intubation endotracheale facile. Conclusion : Ce nouveau videoLaryngoscope a fourni une excellente exposition laryngee chez un patient qui avait subi a de multiples reprises des difficultes ou meme l’impossibilite d’intubation par laryngoscopie directe. Le role clinique de cet appareil devrait etre confirme par une grande serie sur les intubations difficiles. NTUBATION using direct laryngoscopy is successful in the majority of patients, even when a line-of-sight view of the glottis is not possible. Although poor glottic visualization is encountered between 1.5–8.5% of attempts, 1 success can generally be achieved with additional force, external laryngeal manipulation, the use of airway adjuncts such as articulated Laryngoscopes, bougies and stylets or alternative techniques such as a lightwand or intubating laryngeal mask. Poor glottic exposure is more likely to require prolonged or multiple attempts and be associated with complications. 2 Flexible fibreoptic devices are well suited for many settings where a line-of-sight cannot be achieved, however after the fibrescope is introduced into the trachea, tube advancement is usually accomplished without visual control. Though rigid fibreoptic Laryngoscopes do not suffer from the above limitation, they are not widely used, perhaps in part because they are perceived as being difficult to use. 3 A new videoLaryngoscope is described which is similar in technique to direct laryngoscopy but does not depend upon a line-of-sight. The image is captured by a miniature video camera embedded in the undersurface of the blade and transmitted to a monitor, permitting verifiable glottic exposure and video capture of the image. Larger studies, however will be required to determine its role in routine and complex airway cases.
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The unanticipated difficult airway with recommendations for management
Canadian Journal of Anaesthesia, 1998Co-Authors: Edward T. Crosby, Richard M Cooper, M. Joanne Douglas, D. John Doyle, Orlando R. Hung, Pascal Labrecque, Holly Muir, Michael F. Murphy, Roanne P. Preston, D. Keith RoseAbstract:Purpose To review the current literature and generate recommendations on the role of newer technology in the management of the unanticipated difficult airway. Methods A literature search using key words and filters of English language and English abstracted publications from 1990–96 contained in the Medline, Current Contents and Biological Abstracts databases was carried out. The literature was reviewed and condensed and a series of evidence-based recommendations were evolved. Conclusions The unanticipated difficult airway occurs with a low but consistent incidence in anaesthesia practice. Difficult direct laryngoscopy occurs in 1.5–8.5% of general anaesthetics and difficult intubation occurs with a similar incidence. Failed inubation occurs in 0.13–0.3% general anaesthetics. Current techniques for predicting difficulty with laryngoscopy and intubation are sensitive, non-specific and have a low positive predictive value. Assessment techniques which utilize multiple characteristics to derive a risk factor tend to be more accurate predictors. Devices such as the laryngeal mask, lighted stylet and rigid fibreoptic Laryngoscopes, in the setting of unanticipated difficult airway, are effective in establishing a patent airway, may reduce morbidity and are occasionally lifesaving. Evidence supports their use in this setting as either alternatives to facemask and bag ventilation, when it is inadequate to support oxygenation, or to the direct Laryngoscope, when trachéal intubation has failed. Specifically, the laryngeal mask and Combitube™ have proved to be effective in establishing and maintaining a patent airway in “cannot ventilate” situations. The lighted stylet and Bullard (rigid) fibreoptic scope are effective in many instances where the direct Laryngoscope has failed to facilitate trachéal intubation. The data also support integration of these devices into strategies to manage difficult airway as the new standard of care. Training programmes should ensure graduate physicians are trained in the use of these alternatives. Continuing medical education courses should allow physicians in practice the opportunity to train with these alternative devices. Objectif Passer en revue la documentation courante et fournir des recommandations sur le rôle de la nou velle technologie dans la conduite à tenir lors d’une intubation difficile. Méthodes On a procédé à une recherche documentaire selon des mots-clés et des filtres de langue anglaise et des publications de résumés anglais de 1990 à 1996, contenus dans les bases de données de Medline, Current Contents et Biological Abstracts. La littérature a été revue et résumée et une série de recommandations basées sur les faits ont été élaborées. Conclusion Les difficultés d’intubation non prévues surviennent selon une incidence faible, mais constante, dans la pratique de l’anesthésie. Des problèmes de laryngoscopie directe et des difficultés d’intubation ont lieu dans 1,5–8,5 % des anesthésies générales. Léchéc de l’intubation survient dans 0,13–0,3 % des anesthésies générales. Les techniques habituelles de prédiction des difficultés de laryngoscopie et d’intubation sont sensibles, mais non spécifiques et ont une faible valeur prédictive. Des techniques d’évaluation qui utilisent plusieurs caractéristiques pour en déduire un facteur de risque ont généralement de meilleures qualités prédictives. Lors d’une intubation difficile inattendue, des appareils comme le masque laryngé, le stylet lumineux et le Laryngoscope fibroscopique rigide sont efficaces dans le rétablissement de la perméabilité des voies aériennes, ils peuvent réduire la morbidité et peuvent parfois sauver des vies. Lexpérience encourage leur emploi en remplacement du masque et de la ventilation manuelle quand la ventilation assistée est inappropriée, ou à la place du Laryngoscope direct quand l’intubation endotrachéale a été un échec. Le masque laryngé et le Combitube® ont été spécialement efficaces dans le rétablissement et le maintien de la perméabilité des voies aériennes, dans les situations où l’on ne peut ventiler. Le stylet lumineux et le fibroscope rigide Bullard réussissent souvent à faciliter l’intubation endotrachéale quand le Laryngoscope direct a échoué. Les données favorisent également l’intégration de ces dispositifs, considérée comme le nouveau standard de soins, dans la démarche à suivre lors de l’intubation difficile. Les programmes de formation devraient garantir que les médecins diplômés soient familiarisés avec l’usage de ces solutions de remplacement. L’éducation médicale continue devrait donner aux praticiens l’occasion d’apprendre à utiliser ces dispositifs.
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Distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy ( P
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distortion of anterior airway anatomy during laryngoscopy with the glidescope videoLaryngoscope
Journal of Anesthesia, 2010Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Purpose A non-line-of-sight view is expected to cause less movement of the anterior airway anatomy and cervical spine during laryngeal visualization. Reduced distortion of anterior airway anatomy during laryngoscopy with the GlideScope videoLaryngoscope (GVL), compared with the Macintosh Laryngoscope, could explain the relatively easier nasotracheal intubation with the GVL. The purpose of this radiographic study was to compare the degree of anterior airway distortion and cervical spine movement during laryngoscopy with the GVL and the conventional Macintosh Laryngoscope. Methods Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy using the first-generation GVL and a direct Laryngoscope with a Macintosh blade. During each laryngoscopy, a radiograph was taken when the best view of the larynx was obtained. Independent radiologists with subspeciality training in musculoskeletal imaging evaluated anterior airway distortion and cervical spine movement. Results The distance between the epiglottis and the posterior pharyngeal wall during the GlideScope procedure was 21% less than that during the Macintosh laryngoscopy (P \ 0.05). Anterior deviations of the vertebral bodies from baseline were 27, 32, 36, and 39% less at the atlas, C2, C3, and C4 vertebrae, respectively, during the GlideScope procedure than those measured during Macintosh laryngoscopy (P \ 0.01). Cervical extension between the occiput and C4 during the GlideScope procedure was 23% less than that during Macintosh laryngoscopy (P \ 0.05). Conclusion Both anterior airway distortion and cervical spine movement during laryngeal visualization were less with the GVL than with the Macintosh Laryngoscope.
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a comparison of cervical spine movement during laryngoscopy using the airtraq or macintosh Laryngoscopes
Anaesthesia, 2008Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airtraq® Laryngoscope has an oropharyngeal airway-shaped blade that provides a non-line-of-sight view of the glottis. The configuration of the blade should mean that less movement of the cervical spine is required during laryngeal visualisation. We compared the degree of cervical spine movement in laryngoscopy performed using the Airtraq and conventional Macintosh Laryngoscope. In 20 patients requiring general anaesthesia and tracheal intubation, we measured cervical spine movement using radiography in the same patient during consecutive procedures using the two Laryngoscopes. Although significant movement of the cervical spine from baseline was noted during all procedures (p < 0.05), cervical spinal extension with the Airtraq was 29% less than that measured during Macintosh laryngoscopy between the occiput and C4, and 44% less at the C3/C4 motion segment (p < 0.05). Anterior deviations of the vertebral bodies from baseline were 32%, 35%, 38% and 40% less at the atlas, C2, C3, and C4 vertebrae, respectively, during Airtraq laryngoscopy than those measured during Macintosh laryngoscopy (p < 0.01). Our study demonstrated that laryngoscopy using the Airtraq Laryngoscope involves less movement of the cervical spine compared to conventional procedures using a Macintosh Laryngoscope.
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Cervical spine movement during laryngoscopy using the Airway Scope compared with the Macintosh Laryngoscope
Anaesthesia, 2007Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airway Scope is a new rigid Laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. We compared the degree of cervical spine movement during laryngoscopy with the Airway Scope and conventional direct Laryngoscope. Twenty patients requiring general anaesthesia and tracheal intubation were studied. Movements of the cervical spine were measured using radiography in the same patient during laryngoscopy with the Airway Scope and a Macintosh Laryngoscope. Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh Laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p
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cervical spine movement during laryngoscopy using the airway scope compared with the macintosh Laryngoscope
Anaesthesia, 2007Co-Authors: Yoshihiro Hirabayashi, A. Fujita, H SugimotoAbstract:Summary The Airway Scope is a new rigid Laryngoscope. This intubation device provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualisation. We compared the degree of cervical spine movement during laryngoscopy with the Airway Scope and conventional direct Laryngoscope. Twenty patients requiring general anaesthesia and tracheal intubation were studied. Movements of the cervical spine were measured using radiography in the same patient during laryngoscopy with the Airway Scope and a Macintosh Laryngoscope. Cervical spine movement during laryngoscopy with the Airway Scope was 37%, 37% and 68% less than that with the Macintosh Laryngoscope at the C0/C1, C1/C2 and C3/C4 motion segments, respectively (p < 0.05). The movement of the atlanto-occipital distance using the Airway Scope was 42% less than that during laryngoscopy using the Macintosh Laryngoscope (p < 0.05). Laryngoscopy using the Airway Scope involves less movement of the cervical spine compared to conventional laryngoscopy using the Macintosh Laryngoscope.
