scholarly journals Cervical collar makes difficult airway: a simulation study using the LEMON criteria

2018 ◽  
Vol 5 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Moonsu Yuk ◽  
Woonhyung Yeo ◽  
Kangeui Lee ◽  
Jungin Ko ◽  
Taejin Park
2020 ◽  
Vol 29 (3) ◽  
pp. 156-162
Author(s):  
Jacqueline Xiu Ling Sim ◽  
Geoffrey Haw Chieh Liew ◽  
Hairil Abdullah ◽  
Theodore Gar Ling Wong ◽  
Patrick Wong

Background: Fibreoptic intubation via a supraglottic device (SAD) is ‘low skill fibreoptic intubation’ (LSFOI). ‘Standard’ second generation SADs (i-gelTM) have a gastric port. ‘Specialised’ second generation SADs (air-QTM) are designed to facilitate LSFOI and have wider ventilation ports. Our hypothesis was that performance of LSFOI differs between i-gelTM and air-QTM in a manikin with a simulated difficult airway. Methods: Our primary outcome was fibreoptic intubation success rate. Our secondary outcomes included SAD insertion and LSFOI times. A difficult airway was simulated by applying a hard cervical collar to a manikin. Anaesthetists performed LSFOI serially using both SADs in a random sequence. In the manikin study, 80 anaesthetists were recruited. To test the robustness of the conclusion from our manikin study, we repeated the study in 22 anaesthetised patients. Patients were fitted with the same cervical collar and randomly allocated to either devices. We used McNemar’s statistical test to analyse our primary outcome of successful intubations and paired nominal data. A Wilcoxon signed-ranks test was used to analyse nonparametric paired data and a Mann–Whitney U test was used for unpaired data analysis where appropriate. A p-value of <0.05 was considered statistically significant. Results: In the manikin study, the i-gelTM was superior to the air-QTM for successful tracheal intubation (98.8% vs 83.8%, respectively; p=0.002) and LSFOI times (34.0 s vs 36.0 s, respectively; p=0.012). In the patient study, LSFOI success rates were not significantly different between i-gelTM and air-QTM (100% vs 91.6%, respectively; p=0.545) but intubation times were shorter (52.5 s vs 60.0 s, respectively; p=0.036). Conclusion: In conclusion, we obtained LSFOI success rates for the i-gelTM or air-QTM of 98.8% and 83.8% respectively in a manikin; and 100% and 91.6% respectively in patients. It is in fact ‘low skill’ as many participants were successful despite no prior experience with LSFOI. The i-gelTM is superior for LSFOI compared with the air-QTM. This is despite being a ‘standard’ second generation SAD as compared to a ‘specialised’ second generation SAD (air-QTM). Trial Registration: The manikin and patient studies were conducted after being approved by the SingHealth Centralised Institutional Review Board (CRB reference number 2014/2039 and 2016/2069, respectively). The patient study was registered at ClinicalTrials.gov (ID: NCT02663843).


2020 ◽  
Vol 30 ◽  
pp. e137
Author(s):  
Fabricio Batistella Zasso ◽  
Sev Perelman ◽  
Ms Martina Melvin ◽  
Walter Tavares ◽  
Kong Eric You-Ten

Anaesthesia ◽  
2020 ◽  
Vol 75 (10) ◽  
pp. 1301-1306 ◽  
Author(s):  
J. Schumacher ◽  
J. Arlidge ◽  
D. Dudley ◽  
M. Sicinski ◽  
I. Ahmad

2006 ◽  
Vol 11 (1) ◽  
pp. 12-24 ◽  
Author(s):  
Alexander von Eye

At the level of manifest categorical variables, a large number of coefficients and models for the examination of rater agreement has been proposed and used. The most popular of these is Cohen's κ. In this article, a new coefficient, κ s , is proposed as an alternative measure of rater agreement. Both κ and κ s allow researchers to determine whether agreement in groups of two or more raters is significantly beyond chance. Stouffer's z is used to test the null hypothesis that κ s = 0. The coefficient κ s allows one, in addition to evaluating rater agreement in a fashion parallel to κ, to (1) examine subsets of cells in agreement tables, (2) examine cells that indicate disagreement, (3) consider alternative chance models, (4) take covariates into account, and (5) compare independent samples. Results from a simulation study are reported, which suggest that (a) the four measures of rater agreement, Cohen's κ, Brennan and Prediger's κ n , raw agreement, and κ s are sensitive to the same data characteristics when evaluating rater agreement and (b) both the z-statistic for Cohen's κ and Stouffer's z for κ s are unimodally and symmetrically distributed, but slightly heavy-tailed. Examples use data from verbal processing and applicant selection.


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