381 Success and Satisfaction of Emergency Physicians Using a Video-Assisted Semirigid Fiberoptic Stylet for Intubation of a Difficult Airway Model

Objective Difficult airway management is a key skill required by all pediatric physicians, yet training on multiple modalities is lacking. The objective of this study was to compare the rate of, and time to, successful advanced infant airway placement with direct laryngoscopy, video-assisted laryngoscopy, and laryngeal mask airway (LMA) in a difficult airway simulator. This study is the first to compare the success with 3 methods for difficult airway management among pediatric trainees. Study Design Randomized crossover pilot study. Setting Tertiary academic medical center. Methods Twenty-two pediatric residents, interns, and medical students were tested. Participants were provided 1 training session by faculty using a normal infant manikin. Subjects then performed all 3 of the aforementioned advanced airway modalities in a randomized order on a difficult airway model of a Robin sequence. Success was defined as confirmed endotracheal intubation or correct LMA placement by the testing instructor in ≤120 seconds. Results Direct laryngoscopy demonstrated a significantly higher placement success rate (77.3%) than video-assisted laryngoscopy (36.4%, P = .0117) and LMA (31.8%, P = .0039). Video-assisted laryngoscopy required a significantly longer amount of time during successful intubations (84.8 seconds; 95% CI, 59.4-110.1) versus direct laryngoscopy (44.9 seconds; 95% CI, 33.8-55.9) and LMA placement (36.6 seconds; 95% CI, 24.7-48.4). Conclusions Pediatric trainees demonstrated significantly higher success using direct laryngoscopy in a difficult airway simulator model. However, given the potential lifesaving implications of advanced airway adjuncts, including video-assisted laryngoscopy and LMA placement, more extensive training on adjunctive airway management techniques may be useful for trainees.

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A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study

BMJ Open ◽

10.1136/bmjopen-2014-006416 ◽

2014 ◽

Vol 4 (10) ◽

pp. e006416 ◽

Cited By ~ 7

Author(s):

Tadahiro Goto ◽

Yasuaki Koyama ◽

Takashiro Kondo ◽

Yusuke Tsugawa ◽

Kohei Hasegawa

Keyword(s):

Emergency Medicine ◽

Difficult Airway ◽

Macintosh Laryngoscope ◽

Maximum Force ◽

High Fidelity ◽

Emergency Physicians ◽

Direct Laryngoscope ◽

Normal Airway ◽

Glottic View ◽

Maxillary Incisors

ObjectiveWe sought to determine whether the use of Pentax-AWS Airwayscope (AWS) applied less force on oral structures during intubation attempts than a conventional direct laryngoscope (DL).DesignProspective cross-over study.ParticipantsA total of 37 physicians (9 transitional-year residents, 20 emergency medicine residents and 8 emergency physicians) were enrolled.InterventionsWe used four simulation scenarios according to the difficulty of intubation and devices and used a high-fidelity simulator to quantify the forces applied on the oral structures.Outcome measuresPrimary outcomes were the maximum force applied on the maxillary incisors and tongue. Other outcomes of interest were time to intubation and glottic view during intubation attempts.ResultsThe maximum force applied on the maxillary incisors in the normal airway scenario was higher with the use of AWS than that with DL (107 newton (N) vs 77 N, p=0.02). By contrast, the force in the difficult airway scenario was significantly lower with the use of AWS than that of the DL (89 N vs 183 N, p<0.01). Likewise, the force applied on the tongue was significantly lower with the use of AWS than the use of DL in both airway scenarios (11 N vs 27 N, p<0.001 in the normal airway scenario; 12 N vs 40 N, p<0.01 in the difficult airway scenario).ConclusionsThe use of AWS during intubation attempts was associated with decreased forces applied to oral structures in the simulated difficult airway scenario.

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The Percutaneous Transtracheal Jet Ventilation in a Patient with Partial Upper Airway Obstruction

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790100800406 ◽

2001 ◽

Vol 8 (4) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

KY Fung ◽

MC Yuen ◽

WK Tung

Keyword(s):

Airway Obstruction ◽

Difficult Airway ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Emergency Physicians ◽

Jet Ventilation ◽

Partial Upper Airway Obstruction ◽

Set Up

Difficult airway is a challenging emergency problem for emergency physicians. We reported a patient with partial upper airway obstruction managed by percutaneous transtracheal jet ventilation (PTJV) before definite airway was secured. The development, the set up, the advantages, and the precautions of using PTJV are briefly described.

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Management of the predicted difficult airway: a comparison of conventional blade laryngoscopy with video-assisted blade laryngoscopy and the GlideScope

European Journal of Anaesthesiology ◽

10.1097/eja.0b013e32832d328d ◽

2010 ◽

Vol 27 (1) ◽

pp. 24-30 ◽

Cited By ~ 79

Author(s):

Götz Serocki ◽

Berthold Bein ◽

Jens Scholz ◽

Volker Dörges

Keyword(s):

Difficult Airway ◽

Video Assisted

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Comparison of videolaryngoscopy alone with video-assisted fibreoptic intubation in a difficult cadaver airway model

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001333 ◽

2021 ◽

Vol 38 (3) ◽

pp. 318-319

Author(s):

Erik M. Koopman ◽

Michael W. van Emden ◽

Jeroen J.G. Geurts ◽

Lothar A. Schwarte ◽

Patrick Schober

Keyword(s):

Fibreoptic Intubation ◽

Video Assisted ◽

Airway Model

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The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model

Frontiers in Medicine ◽

10.3389/fmed.2021.677626 ◽

2021 ◽

Vol 8 ◽

Author(s):

Nurfadilah Mahli ◽

Jaafar Md Zain ◽

Siti Nidzwani Mohamad Mahdi ◽

Yeoh Chih Nie ◽

Liu Chian Yong ◽

...

Keyword(s):

Difficult Airway ◽

Success Rate ◽

Median Time ◽

Direct Laryngoscopy ◽

Study Finding ◽

Ease Of Use ◽

The Novel ◽

First Pass ◽

Video Demonstration ◽

Airway Model

This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8–41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8–69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.

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