Comparison of the Laryngeal View during Tracheal Intubation Using Airtraq and Macintosh Laryngoscopes by Unskillful Anesthesiology Residents: A Clinical Study

Background and Objective. The Airtraq laryngoscope (Prodol Meditec, Vizcaya, Spain) is a novel tracheal intubation device. Studies, performed until now, have compared the Airtraq with the Macintosh laryngoscope, concluding that it reduces the intubation times and increase the success rate at first intubation attempt, decreasing the Cormack-Lehane score. The aim of the study was to evaluate if, in unskillful anesthesiology residents during the laryngoscopy, the Airtraq compared with the Macintosh laryngoscope improves the laryngeal view, decreasing the Cormack-Lehane score.Methods. A prospective, randomized, crossed-over trial was carried out on 60 patients. Each one of the patients were intubated using both devices by unskillful (less than two hundred intubations with the Macintosh laryngoscope and 10 intubations using the Airtraq) anesthesiology residents. The Cormack-Lehane score, the success rate at first intubation attempt, and the laryngoscopy and intubation times were compared.Results. The Airtraq significantly decreased the Cormack-Lehane score (). On the other hand, there were no differences in times of laryngoscopy (; IC 95% 3.1, +4.8) and intubation (; C95% −6.1, +10.0) between the two devices. No relevant complications were found during the maneuvers of intubation using both devices.Conclusions. The Airtraq is a useful laryngoscope in unskillful anesthesiology residents improving the laryngeal view and, therefore, facilitating the tracheal intubation.

Download Full-text

Comparison of the Bonfils and Levitan Optical Stylets for Tracheal Intubation: A Clinical Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x1103900618 ◽

2011 ◽

Vol 39 (6) ◽

pp. 1093-1097 ◽

Cited By ~ 8

Author(s):

A. Webb ◽

H. Kolawole ◽

S. Leong ◽

T. E. Loughnan ◽

T. Crofts ◽

...

Keyword(s):

Clinical Study ◽

Tracheal Intubation ◽

Prior Experience ◽

Phase 1 ◽

The Other ◽

Surgical Patients ◽

Second Phase ◽

Phase 2 ◽

High Failure Rate ◽

Novice Users

The Bonfils and Levitan FPS™ scopes are rigid fibreoptic stylets that may assist routine or difficult intubation. This study compared the effectiveness of each in patients with predicted normal airways when used by specialist anaesthetists with no prior experience using optical stylets. Twelve anaesthetists and 324 elective surgical patients participated. Six anaesthetists were randomised to first intubate 20 patients with the Levitan scope (Phase 1) followed by a further seven patients with the Bonfils scope (Phase 2). The other six participating anaesthetists undertook their first 20 intubations with the Bonfils (Phase 1), followed by seven intubations with the Levitan (Phase 2). Outcomes recorded were success rate, total time to intubation, number of attempts, ease of intubation score and incidence of complications. Overall failure rates were similar for the two scopes with 5.6% of patients not intubated after three attempts. Median total times to intubation were similar for the Levitan (44 seconds) and Bonfils (36 seconds) (P=0.11). Participants using the Bonfils in Phase 1 had significantly higher chance of success on first attempt (73%) compared to Levitan users during Phase 1 (57%) (P=0.008). These differences were not significant in the second phase and ease of intubation scores were similar for both scopes (P=0.9). This study showed the two scopes were comparable but the high failure rate amongst novice users demonstrated the importance of familiarity and skill development prior to their introduction to a difficult airway cart.

Download Full-text

Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial

BioMed Research International ◽

10.1155/2015/806243 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 15

Author(s):

Ryosuke Mihara ◽

Nobuyasu Komasawa ◽

Sayuri Matsunami ◽

Toshiaki Minami

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Intubation Time ◽

Direct Laryngoscope ◽

Mcgrath Mac ◽

Significant Difference ◽

Intubation Success ◽

Intubation Success Rate

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

Download Full-text

Surgery of the Lacrimal System

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0021 ◽

2011 ◽

Author(s):

Roger A. Dailey ◽

Mauricio R. Chavez

Keyword(s):

Prospective Study ◽

Success Rate ◽

Nasolacrimal Duct ◽

The Other ◽

Success Rates ◽

Lacrimal Sac ◽

Other Hand ◽

A Prospective Study ◽

External Dcr

Obstruction of the tear outflow system can occur anywhere along its course from the tear lake to the inferior meatus of the nose. Surgical techniques designed to relieve this functional or complete obstruction have been available for a long time. Toti of Italy described the dacryocystorhinostomy (DCR) procedure in 1908 as a treatment modality for obstruction of the nasolacrimal duct. His technique did not make use of mucosal flaps. Dupuy-Dutemps of France, on the other hand, encouraged the use of flaps. He recommended suturing together the nasal mucosal and lacrimal sac flaps. The success rate of the operation improved dramatically. Today the external DCR procedure makes use of modifications of both of these historically described procedures. In recent years, intranasal DCR has enjoyed renewed popularity. This procedure had been performed by Lester Jones and others for years but was dropped because the success rate was 80% at best. Although the use of endoscopic techniques and laser technology has been advocated by some authorities, the success rate (approximately 70%) with relatively short-term follow-up has limited its acceptance. More recently, Javate and associates reported a series of patients undergoing endoscopic DCR with the radiofrequency Ellman unit. Their reported success rate of 90% compared favorably with a 94% success rate in 50 age-matched patients undergoing external DCR with a follow-up of 9 months. This rate also compares favorably to the present authors’ success rate of approximately 95% in uncomplicated cases undergoing external DCR and a similar rate with the endoscopic approach without use of a laser. Therefore, the laser does not appear to offer any significant advantage over more traditional intranasal approaches, and the cost may actually be a financial disincentive to its use. The benefit of mitomycin continues to be debated. You and associates performed a prospective study showing favorable long-term success rates with the use of mitomycin. On the other hand, Liu and associates performed a prospective study that demonstrated no benefit. While the DCR works well for lacrimal sac or nasolacrimal duct obstruction, it does not address obstructions of the puncta and canaliculi.

Download Full-text

Evaluation of protein-ligand docking methods on peptide-ligand complexes for docking small ligands to peptides

10.1101/212514 ◽

2017 ◽

Cited By ~ 2

Author(s):

Sandeep Singh ◽

Hemant Kumar Srivastava ◽

Gaurav Kishor ◽

Harinder Singh ◽

Piyush Agrawal ◽

...

Keyword(s):

Success Rate ◽

Scientific Community ◽

Web Server ◽

The Other ◽

Ligand Docking ◽

Peptide Ligand ◽

Autodock Vina ◽

The Past ◽

Link Type ◽

Other Hand

ABSTRACTIn the past, many benchmarking studies have been performed on protein-protein and protein-ligand docking however there is no study on peptide-ligand docking. In this study, we evaluated the performance of seven widely used docking methods (AutoDock, AutoDock Vina, DOCK 6, PLANTS, rDock, GEMDOCK and GOLD) on a dataset of 57 peptide-ligand complexes. Though these methods have been developed for docking ligands to proteins but we evaluate their ability to dock ligands to peptides. First, we compared TOP docking pose of these methods with original complex and achieved average RMSD from 4.74Å for AutoDock to 12.63Å for GEMDOCK. Next we evaluated BEST docking pose of these methods and achieved average RMSD from 3.82Å for AutoDock to 10.83Å for rDock. It has been observed that ranking of docking poses by these methods is not suitable for peptide-ligand docking as performance of their TOP pose is much inferior to their BEST pose. AutoDock clearly shows better performance compared to the other six docking methods based on their TOP docking poses. On the other hand, difference in performance of different docking methods (AutoDock, AutoDock Vina, PLANTS and DOCK 6) was marginal when evaluation was based on their BEST docking pose. Similar trend has been observed when performance is measured in terms of success rate at different cut-off values. In order to facilitate scientific community a web server PLDbench has been developed (http://webs.iiitd.edu.in/raghava/pldbench/).

Download Full-text

Ultrasound-guided versus Shikani optical stylet-aided tracheal intubation: a prospective randomized study

10.21203/rs.3.rs-39586/v1 ◽

2020 ◽

Author(s):

Yuanyuan Ma ◽

Yan Wang ◽

Ping Shi ◽

Xue Cao ◽

Shengjin Ge

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Sore Throat ◽

Elective Surgery ◽

Randomized Study ◽

Prospective Randomized Study ◽

Intubation Attempt ◽

Successful Intubation ◽

Ultrasound Guided ◽

Normal Airway

Abstract Background To compare ultrasound-guided tracheal intubation (UGTI) versus Shikani optical stylet (SOS)-aided tracheal intubation in patients with anticipated normal airway.Methods Sixty patients aged 18–65 years old who presented for elective surgery under general anesthesia were recruited in this prospective randomized study. They were assigned into two equal groups, either an ultrasound-guided group (Group UG, n = 30) or an SOS-aided group (Group SOS, n = 30). After the induction of anesthesia, the tracheal intubation was performed by a specified skilled anesthesiologist. The number of tracheal intubation attempt and the duration of successful intubation on the first attempt were recorded. Complications relative to tracheal intubation including desaturation, hoarseness and sore throat were also recorded.Results The first-attempt success rate is 93.3% (28/30) in Group UG and 90% (27/30) in Group SOS (P = 0.64). The second-attempt was all successful for the 2 and 3 patients left in the two groups, and the overall success rate of both groups was 100%. The duration of successful intubation on the first attempt of Group UG was not significantly different from that of Group SOS (34.0 ± 20.8 s vs 35.5 ± 23.2 s, P = 0.784). One patient in Group SOS had desaturation (P = 0.313), and there was none hoarseness in the two groups. Sore throat was detected in both group (4 in Group UG, 5 in Group SOS, P = 0.718).Conclusion Ultrasound-guided tracheal intubation was as effective as Shikani optical stylet-aided tracheal intubation in adult patients with anticipated normal airway.Trial registration: Chinese Clinical Trial Registry, ChiCTR-IIC-17010875. Date of Registration: 15 March 2017.

Download Full-text

Abstract P167: Pentax-AWS is More Useful Than Macintosh Laryngoscope and Airtraq to Establish Tracheal Intubation while Uninterrupted Chest Compression: a Comparative Study with Manikin

Circulation ◽

10.1161/circ.118.suppl_18.s_1481-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jun-ichi Koyama

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Chest Compression ◽

Reporting System ◽

Macintosh Laryngoscope ◽

Spontaneous Circulation ◽

Medical Emergency ◽

Chest Compressions ◽

Compression Time ◽

Rate Of Success

Purpose. In resuscitation, chest compression is essential, and it should be performed appropriately and uninterruptedly to obtain the return of spontaneous circulation and breathing. However, attempt of tracheal intubation with the Macintosh laryngoscope (Mac) occasionally needs a temporary pause of chest compression and delays its resuming. Consequently, we studied the efficacy of the new video-laryngoscopes, PENTAX-AWS (AWS) and Airtraq (ATQ) as device used for tracheal intubation while nonstop chest compression. Materials and Methods. Twenty seven participants including 11 non-anesthetic doctors, 1 paramedic, 11 nurses and 4 medical students enrolled in this study. At first, Participants and supplementary assistant who concentrated on chest compression simulated CPR with the use of Resusci Anne Simulator manikin (Laerdal) placed on medical emergency bed as 30:2 protocol proposed in 2005 AHA Guidelines. Strength and rhythm of the compression were monitored in real-time by PC skill-reporting system. After the chest compressions became constant, participants were requested to intubate with using Mac, AWS and ATQ in both situations without chest compression and while the compression. Results. Tracheal intubation was successfully achieved within 3 attempts by 92.6% participants in Mac and 100% in AWS and ATQ without chest compression, and 66.7% in Mac, 100% in AWS and 81.5% in ATQ while chest compression. Rate of success in the 1st attempt was 55.6% in Mac, 96.3% in AWS and 51.9% in ATQ while compression. Time to intubate while compression with AWS was 14.6s, which was significantly shorter than 26.1s with ATQ in the successful attempts. Conclusions. With using AWS, high success rate of tracheal intubation was achieved even in chest compression situation in comparison with the other two devices. Macintosh laryngoscope is the most inconvenient among these devices when tracheal intubation is attempted while chest compression. ATQ showed significant decrease of success rate in compression situation despite it achieved 100% success without compression. PENTAX-AWS is expected to be more useful than Macintosh laryngoscope and Airtraq to establish tracheal intubation while uninterrupted chest compression in clinical use.

Download Full-text

Macintosh laryngoscope, i-view™, and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: A randomized, crossover, manikin study

10.21203/rs.3.rs-90522/v1 ◽

2020 ◽

Author(s):

Toshiyuki Nakanishi ◽

Yoshiki Sento ◽

Yuji Kamimura ◽

Kazuya Sobue

Keyword(s):

Intensive Care ◽

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Video Laryngoscope ◽

Interquartile Range ◽

Intubation Time ◽

Lehane Grade ◽

Significant Difference ◽

Difficulty Scale

Abstract Background: The aerosol box was designed to prevent cough droplets from spreading, but it can impede tracheal intubation. We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the i-view™ video laryngoscope (i-view) with an integrated display, or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.Methods: This prospective, randomized, crossover simulation study was conducted at an operating room of the two hospitals (a university hospital and a tertiary teaching hospital). We recruited 37 medical personnel (36 anesthesiologists and 1 dental anesthesiologist) who were working in the fields of anesthesia and intensive care with > 2 years of dedicated anesthesia experience from five hospitals. We divided the participants into six groups to use the laryngoscope in a determined order. After the training using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least two-hour intervals. The primary outcome was the intubation time. The secondary outcomes were the success rate, Cormack-Lehane grade, and subjective difficulty scale score (numeric rating scale 0–10, 0: no difficulty, 10: highest difficulty). We used the Friedman test and the Wilcoxon signed-rank test with Bonferroni adjustment. Data are shown as median [interquartile range].Results: Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P=0.247). The success rate was 95%–100% without significant difference (P=0.135). The i-view and C-MAC video laryngoscopes exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh laryngoscope; however, there were no differences between the i-view and C-MAC video laryngoscopes.Conclusions: Rapid and highly successful tracheal intubation was possible with Macintosh laryngoscope, i-view, and C-MAC video laryngoscopes on a manikin with an aerosol box. Improved Cormack-Lehane grade and ease of procedure may support the use of video laryngoscopes.Trial registration: UMIN Clinical Trials Registry, identifier UMIN000040269.

Download Full-text

Comparison of Direct and Video Laryngoscopes during Different Airway Scenarios Performed by Experienced Paramedics: A Randomized Cross-Over Manikin Study

BioMed Research International ◽

10.1155/2020/5382739 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Kurt Ruetzler ◽

Lukasz Szarpak ◽

Jacek Smereka ◽

Marek Dabrowski ◽

Szymon Bialka ◽

...

Keyword(s):

Airway Management ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Cervical Collar ◽

Ease Of Use ◽

Intubation Attempt ◽

Intubation Time ◽

Management Scenarios ◽

Urgent Surgery ◽

Lehane Grade

Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine. Aim. The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios. Methods. This prospective cross-over simulation study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. Results. In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16–21) for MAC, 18 s (IQR: 16–21) for McGrath, and 27 s (IQR: 23–34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p<0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p<0.001). Intubation time was 21 s (IQR: 19–29) for MAC, 18 s (IQR: 18–24.5) for McGrath, and 30 s (IQR: 23–39) for PCD. In scenario D, the success rate with MAC was 32%, 69% with McGrath, and 58% with PCD (p<0.001). Intubation time was 26 s (IQR: 20–29) for MAC, 26 s (IQR: 20–29) for McGrath, and 45 s (IQR: 33–56) for PCD. In scenario E, the success rate with MAC was 32%, but 64% with McGrath and 62% with PCD (p<0.001). Intubation time was 28 s (IQR: 25–39) for MAC, 19 s (IQR: 18–26) for McGrath, and 34 s (IQR: 27–45) for PCD. Conclusions. The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.

Download Full-text

A Comparison of the GlideScope® with the Macintosh Laryngoscope for Tracheal Intubation in Patients with Simulated Difficult Airway

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300215 ◽

2005 ◽

Vol 33 (2) ◽

pp. 243-247 ◽

Cited By ~ 70

Author(s):

Y. Lim ◽

S. W. Yeo

Keyword(s):

Tracheal Intubation ◽

Difficult Airway ◽

Controlled Trial ◽

Macintosh Laryngoscope ◽

Good Alternative ◽

Intubation Time ◽

Laryngeal View ◽

Lehane Grade ◽

Primary Hypothesis ◽

Written Informed Consent

We compared the use of the GlideScope® and the conventional Macintosh laryngoscope in a simulated difficult airway. The primary hypothesis was that time to intubation would be shorter using the GlideScope® than using the Macintosh laryngoscope. After obtaining approval from the ethics committee and written informed consent, we recruited 60 ASA 1 and 2 patients to our randomized controlled trial. Group G (n=30) had tracheal intubation performed using the GlideScope® and Group M (n=30) were intubated using a Macintosh laryngoscope. We simulated a difficult airway in each patient by having an experienced assistant provide in-line manual stabilization of the head and neck. We recorded the best laryngeal view; difficulty of the tracheal intubation; time taken for successful tracheal intubation; manoeuvre needed to aid tracheal intubation and complications associated with the tracheal intubation. The median Cormack and Lehane grade was significantly better in Group G than Group M. Group G had a significantly shorter intubation time than group M (mean 41.8s±SD 20.2 vs mean 56.2s±26.6, P<0.05). The GlideScope® improved the laryngeal view and decreased time for tracheal intubation time when compared with the Macintosh laryngoscope in patients with simulated difficult airway. The GlideScope® may be a good alternative for managing the difficult airway but clinical trials evaluating its use on patients with an actual difficult airway are needed.

Download Full-text

Learning Curves of Macintosh Laryngoscope in Nurse Anesthetist Trainees Using Cumulative Sum Method

Anesthesiology Research and Practice ◽

10.1155/2014/850731 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Panthila Rujirojindakul ◽

Edward McNeil ◽

Rongrong Rueangchira-urai ◽

Niranuch Siripunt

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Macintosh Laryngoscope ◽

Orotracheal Intubation ◽

Nurse Anesthetists ◽

Learning Curves ◽

Learning Ability ◽

Nurse Anesthetist ◽

Life Saving ◽

Cumulative Summation

Background. Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare professionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their performance of orotracheal intubation with the Macintosh laryngoscope.Methods. Eleven nurse anesthetist trainees were enrolled in the study during the first three months of their training. All trainees attended formal lectures and practice sessions with manikins at least one time on performing successful tracheal intubation under supervision of anesthesiology staff. Learning curves for each nurse anesthetist trainee were constructed with the standard cumulative summation (cusum) methods.Results. Tracheal intubation was attempted on 388 patients. Three hundred and six patients (78.9%) were successfully intubated on the trainees’ first attempt and 17 patients (4.4%) on the second attempt. The mean±SD number of orotracheal intubations per trainee was35.5 ± 5.1(range 30–47). Ten (90.9%) of 11 trainees crossed the 20% acceptable failure rate line. A median of 22 procedures was required to achieve an 80% orotracheal intubations success rate.Conclusion. At least 22 procedures were required to reach an 80% success rate for orotracheal intubation using Macintosh laryngoscope in nonexperienced nurse anesthetist trainees.

Download Full-text