scholarly journals An Exploration and Technical Notes for Advanced Airway Management on the Ski Slope: A Simulation Experiment

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Peng Bai ◽  
Tian Xia ◽  
Zhongwei Yang ◽  
Wei Huai ◽  
Xiangyang Guo ◽  
...  
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Operation Time ◽  
Laryngeal Mask ◽  
Bite Block ◽  
Optimal Method ◽  
Artificial Airway ◽  
Advanced Airway ◽  
Laryngeal Mask Insertion ◽  
Significant Difference

Background. Skiing is a high-risk winter sport, and the rate of injury fatality is the highest compared to other winter sports. During skiing rescue, the harsh natural environments will increase the difficulty of artificial airway establishment. There has been no research focusing on the establishment of the artificial airway during skiing rescue site. This study aims to simulate the real-world scenario, calculating and comparing the operation time of different artificial airways on the cold slope, and to explore the optimal method of establishing artificial airway on the cold slope, sharing our experience, technical notes, and pitfalls we encountered, hoping to help establish a standard operating procedure in advanced airway management on the ski slope. Methods. The simulated human was placed on the cold slope with the head under the feet. Artificial airway was established by the same anesthesiologist using endotracheal intubation (endotracheal intubation group), LMA Supreme laryngeal mask (LMA group), and I-gel laryngeal mask (I-gel group). Each method was repeated 5 times, and the operation time and whether it was successful by one attempt were recorded and compared between groups. Results. Three groups of artificial airway were successful by one attempt.. The bite block dropped and drifted away for one time in the endotracheal intubation group. Operation time is 209.2 ± 32.7 seconds in the endotracheal intubation group, 72.2 ± 3.1 seconds in the LMA group, and 52.6 ± 4.2 seconds in the I-gel group. ANOVA showed that there was a significant difference in the operation time among the three groups ( p < 0.001 ). Tukey’s post hoc test showed that there were statistically significant differences between the endotracheal intubation group and the other two groups in operation time, p < 0.001 , while there was no significant difference between the LMA group and I-gel group ( p = 0.275 ). Conclusion. The artificial airway can be completed by endotracheal intubation and LMA and I-gel laryngeal mask insertion on the cold slope. Artificial airway with the I-gel laryngeal mask takes the shortest time in this study. Extra caution should be paid to slippery and drifting.

scholarly journals Comparison of the Skill of Emergency Medical Technicians in Terms of Advanced Airway Management Using Endotracheal Tube vs Laryngeal Mask Airway in an OSCE Using a Mannequin

2020 ◽  
Author(s):  
Peyman Saberian ◽  
Ehsan Karimialavijeh ◽  
Mostafa Sadeghi ◽  
Mojgan Rahimi ◽  
Parisa Hasani-Sharamin ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Supraglottic Airway ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Significant Difference ◽  
The Mean

Background: Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard. Methods: In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared. Results: Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427). Conclusion: In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

Comprehensive Overview of Pediatric Airway Management

2019 ◽  
Author(s):  
Dale Woolridge ◽  
Lisa Goldberg ◽  
Garrett S. Pacheco
Keyword(s):  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Emergency Physician ◽  
Laryngeal Mask ◽  
Volume Control ◽  
Comprehensive Overview ◽  
Insertion Depth ◽  
Pediatric Airway ◽  
Core Skill

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Success of placement and complications during v-gel placement and maintenance of anaesthesia

2021 ◽  
pp. 1098612X2110506
Author(s):  
Kathrin Hecker-Turkovic ◽  
Katrin Hartmann ◽  
René Dörfelt
Keyword(s):  
Clinical Study ◽  
Airway Management ◽  
Airway Obstruction ◽  
Endotracheal Intubation ◽  
Laryngeal Mask ◽  
Prospective Clinical Study ◽  
Laryngeal Masks ◽  
The Third ◽  
Dorsal Position

Objectives Airway management during anaesthesia in cats is always a demanding task and is associated with several complications. The aim of this study was to evaluate the practicability and complications during feline-specific laryngeal mask placement in anaesthetised cats as an alternative to endotracheal intubation. Methods In this prospective clinical study, laryngeal masks were placed in 148 anaesthetised cats. Success of placement was evaluated by capnography. Results Placement was possible at the first attempt in 136 cats, at the second attempt in eight cats and at the third attempt in one cat. In one cat, placement was not possible. Two cats were excluded. Failure to position the laryngeal mask at the first attempt was not different between laryngeal mask sizes ( P = 0.313) or positioning during placement ( P = 0.406). In nine cats, the laryngeal mask dislocated during the procedure. Dislocation occurred more often in the dorsal position than in the sternal ( P = 0.018) and right lateral positions ( P = 0.046). Mucous obstruction of the laryngeal mask occurred in one of these cats and regurgitation in another. Material-related issues, such as disconnection of the parts of the laryngeal mask and leakage of the balloon, were observed in 2/8 laryngeal masks. Conclusions and relevance The placement of a feline-specific laryngeal mask was easy to perform. In about 7% of the cases, replacement of the device was required due to mispositioning or dislocation. Full monitoring, including capnography, should be provided to uncover dislocation and airway obstruction immediately.

Comprehensive Overview of Pediatric Airway Management

2019 ◽  
Author(s):  
Dale Woolridge ◽  
Lisa Goldberg ◽  
Garrett S. Pacheco
Keyword(s):  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Emergency Physician ◽  
Laryngeal Mask ◽  
Volume Control ◽  
Comprehensive Overview ◽  
Insertion Depth ◽  
Pediatric Airway ◽  
Core Skill

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

scholarly journals Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy

OTO Open ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. 2473974X1770791 ◽  
Author(s):  
Art Ambrosio ◽  
Kastley Marvin ◽  
Colleen Perez ◽  
Chelsie Byrnes ◽  
Cory Gaconnet ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Difficult Airway ◽  
Direct Laryngoscopy ◽  
Training Session ◽  
Laryngeal Mask ◽  
Normal Infant ◽  
Difficult Airway Management ◽  
Video Assisted ◽  
Advanced Airway

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.

scholarly journals Unilateral Vocal Cord Paralysis following Insertion of a Supreme Laryngeal Mask in a Patient withSjögren’sSyndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
T. O. J. Masarwa ◽  
I. H. F. Herold ◽  
M. Tabor ◽  
R. A. Bouwman
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Vocal Cord ◽  
Endotracheal Intubation ◽  
Vocal Cord Paralysis ◽  
Case Reports ◽  
Ease Of Use ◽  
Laryngeal Mask ◽  
Less Invasive ◽  
Unilateral Vocal Cord Paralysis

Since its introduction in 1988 by Dr. Archie Brain, the laryngeal mask airway (LMA) is being used with increasing frequency. Its ease of use has made it a very popular device in airway management and compared to endotracheal intubation it is less invasive. The use of LMA was on the rise, so has been the incidence of its related complications. We report severe unilateral vocal cord paralysis following the use of the supreme laryngeal mask (sLMA) in a patient withSjögren’ssyndrome. In addition, we propose possible mechanisms of injury, review the existing case reports, and discuss our findings.

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