Comparison of fastrach LMA and ILMA methods for airway management

The aim of this study is to compare the hemodynamic responses, durations of intubation, intubation success rates and postoperative upper airway complications between the intubation performed with direct laryngoscopy and blind intubation performed with LMA-Fastrach application in normotensive patients. This present study was performed with the approval of ethical committee and in the surgery rooms between the date March 2010-August 2010. The study was performed on 80 patients aged between 18 and 60 and had American Anesthetists Assosiation (ASA) classification I-II. Endotracheal intubation was essential in their elective abdomen surgeries. The patients were divided into 2 groups as ILMA-Fastrach Group (Group I, n=40) and laryngoscopy group (Group L, n=40). 80 patients aged between 18 and 60. Of those, 54 (67.5%) were female and 26 (32.5%) were male. The age average of the patients was 46.3 ± 10.7. There was not a statistically significant difference between the demographic parameters of the patients. When compared to the onset value of SAP in Group I and Group L, a statistically significant difference was not detected in the groups in terms of SAP 1st minute and 5th minute values. When compared to the SAP onset value of the cases, the decrease in the 1st minute was statistically significant and when compared to the 1st minute value, the decrease in the 5th minute was not statistically significant. In the groups, a statistically significant difference was not observed in terms of DAP outset 1st and 5th minute values. When compared to the DAP onset value of the patients in Group L, the increase in the 1st minute was statistically significant. When compared to the 1st minute value, the decrease in the 5th minute was statistically significant. When compared to the onset value of MAP in Group L, the increase in the 1st minute was statistically significant. In terms of HR onset 1st and 5th minute values a statistically significant value was not detected. In conclusion, patients performed endotracheal intubation with LMA-Fastrach was more stabile than the ones intubated with direct laryngoscopy in terms of hemodynamics. Fewer complications were observed in LMA-Fastrach group and there was not any difference in terms of success rates.

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Comparison of Video Laryngoscopy and Direct Laryngoscopy in the Success of Intubation Performed by Novice Personnel in Patients with Cervical Immobilization: A Manikin Study

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i4.6693 ◽

2021 ◽

Author(s):

Özge Can ◽

Sercan Yalcinli ◽

Yusuf Ali Altunci

Keyword(s):

Success Rate ◽

Direct Laryngoscopy ◽

Video Laryngoscope ◽

Video Laryngoscopy ◽

First Year ◽

Success Rates ◽

Significant Difference ◽

Intubation Success ◽

Cervical Immobilization ◽

Second Year

Introduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization. Methods: In this cross-sectional study, the manikin’s neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.

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A Comparison of Paramedic First Pass Endotracheal Intubation Success Rate of the VividTrac VT-A 100, GlideScope Ranger, and Direct Laryngoscopy Under Simulated Prehospital Cervical Spinal Immobilization Conditions in a Cadaveric Model

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17006872 ◽

2017 ◽

Vol 32 (6) ◽

pp. 621-624 ◽

Cited By ~ 2

Author(s):

Ryan Hodnick ◽

Tony Zitek ◽

Kellen Galster ◽

Stephen Johnson ◽

Bryan Bledsoe ◽

...

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Intubation Attempt ◽

Spinal Immobilization ◽

Significant Difference ◽

Intubation Success ◽

First Pass ◽

Intubation Success Rate ◽

Cadaveric Model

AbstractObjectiveThe primary goal of this study was to compare paramedic first pass success rate between two different video laryngoscopes and direct laryngoscopy (DL) under simulated prehospital conditions in a cadaveric model.MethodsThis was a non-randomized, group-controlled trial in which five non-embalmed, non-frozen cadavers were intubated under prehospital spinal immobilization conditions using DL and with both the GlideScope Ranger (GL; Verathon Inc, Bothell, Washington USA) and the VividTrac VT-A100 (VT; Vivid Medical, Palo Alto, California USA). Participants had to intubate each cadaver with each of the three devices (DL, GL, or VT) in a randomly assigned order. Paramedics were given 31 seconds for an intubation attempt and a maximum of three attempts per device to successfully intubate each cadaver. Confirmation of successful endotracheal intubation (ETI) was confirmed by one of the six on-site physicians.ResultsSuccessful ETI within three attempts across all devices occurred 99.5% of the time overall and individually 98.5% of the time for VT, 100.0% of the time for GL, and 100.0% of the time for DL. First pass success overall was 64.4%. Individually, first pass success was 60.0% for VT, 68.8% for GL, and 64.5% for DL. A chi-square test revealed no statistically significant difference amongst the three devices for first pass success rates (P=.583). Average time to successful intubation was 42.2 seconds for VT, 38.0 seconds for GL, and 33.7 for seconds for DL. The average number of intubation attempts for each device were as follows: 1.48 for VT, 1.40 for GL, and 1.42 for DL.ConclusionThe was no statistically significant difference in first pass or overall successful ETI rates between DL and video laryngoscopy (VL) with either the GL or VT (adult).HodnickR, ZitekT, GalsterK, JohnsonS, BledsoeB, EbbsD. A comparison of paramedic first pass endotracheal intubation success rate of the VividTrac VT-A 100, GlideScope Ranger, and direct laryngoscopy under simulated prehospital cervical spinal immobilization conditions in a cadaveric model. Prehosp Disaster Med. 2017;32(6):621–624.

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C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation

Medicina ◽

10.3390/medicina55060225 ◽

2019 ◽

Vol 55 (6) ◽

pp. 225 ◽

Cited By ~ 1

Author(s):

Byeong Chul Min ◽

Jong Eun Park ◽

Gun Tak Lee ◽

Tae Rim Kim ◽

Hee Yoon ◽

...

Keyword(s):

Emergency Department ◽

Logistic Regression ◽

Cardiopulmonary Resuscitation ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Multiple Logistic Regression Analysis ◽

Video Laryngoscope ◽

Multiple Logistic Regression ◽

Total N ◽

Significant Difference

Background and objectives: To compare the first pass success (FPS) rate of the C-MAC video laryngoscope (C-MAC) and conventional Macintosh-type direct laryngoscopy (DL) during cardiopulmonary resuscitation (CPR) in the emergency department (ED). Materials and Methods: This study was a single-center, retrospective study conducted from April 2014 to July 2018. Patients were categorized into either the C-MAC or DL group, according to the device used on the first endotracheal intubation (ETI) attempt. The primary outcome was the FPS rate. A multiple logistic regression model was developed to identify factors related to the FPS. Results: A total of 573 ETIs were performed. Of the eligible cases, 263 and 310 patients were assigned to the C-MAC and DL group, respectively. The overall FPS rate was 75% (n = 431/573). The FPS rate was higher in the C-MAC group than in the DL group, but there was no statistically significant difference (total n = 431, 79% compared to 72%, p = 0.075). In the multiple logistic regression analysis, the C-MAC use had higher FPS rate (adjusted odds ratio: 1.80; 95% CI, 1.17–2.77; p = 0.007) than that of the DL use. Conclusions: The C-MAC use on the first ETI attempt during cardiopulmonary resuscitation in the emergency department had a higher FPS rate than that of the DL use.

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Factors Influencing Successful Intubation in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042138 ◽

1995 ◽

Vol 10 (4) ◽

pp. 259-264 ◽

Cited By ~ 56

Author(s):

James V. Doran ◽

Bartholomew J. Tortella ◽

Walter J. Drivet ◽

Robert F. Lavery

Keyword(s):

Airway Management ◽

Endotracheal Intubation ◽

Life Support ◽

Advanced Life Support ◽

High Volume ◽

Success Rates ◽

Structured Interviews ◽

Technical Problems ◽

Patients Âgés ◽

Prehospital Airway Management

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

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Comparison of GlideScope Videolaryngoscopy to Direct Laryngoscopy for Intubation of a Pediatric Simulator by Novice Physicians

Emergency Medicine International ◽

10.1155/2013/407547 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Joni E. Rabiner ◽

Marc Auerbach ◽

Jeffrey R. Avner ◽

Dina Daswani ◽

Hnin Khine

Keyword(s):

Crossover Study ◽

Difficult Airway ◽

Direct Laryngoscopy ◽

Successful Intubation ◽

Success Rates ◽

Normal Airway ◽

Intubation Success ◽

Mean Time ◽

Randomized Crossover Study

Objective. To compare novice clinicians’ performance using GlideScope videolaryngoscopy (GVL) to direct laryngoscopy (DL).Methods. This was a prospective, randomized crossover study. Incoming pediatric interns intubated pediatric simulators in four normal and difficult airway scenarios with GVL and DL. Primary outcomes included time to intubation and rate of successful intubation. Interns rated their satisfaction of the devices and chose the preferred device.Results. Twenty-five interns were included. In the normal airway scenario, there were no differences in mean time for intubation with GVL or DL (61.4 versus 67.4 seconds, ) or number of successful intubations (19 versus 18, ). In the difficult airway scenario, interns took longer to intubate with GVL than DL (87.7 versus 61.3 seconds, ), but there were no differences in successful intubations (14 versus 15, ). There was a trend towards higher satisfaction for GVL than DL (7.3 versus 6.4, ), and GVL was chosen as the preferred device by a majority of interns (17/25, 68%).Conclusions. For novice clinicians, GVL does not improve time to intubation or intubation success rates in a pediatric simulator model of normal and difficult airway scenarios. Still, these novice clinicians overall preferred GVL.

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The Value of Ozone in CT-Guided Drainage of Multiloculated Pyogenic Liver Abscesses: A Randomized Controlled Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/1236974 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Bing Li ◽

Chuan Liu ◽

Lang Wang ◽

Yang Li ◽

Yong Du ◽

...

Keyword(s):

Clinical Symptoms ◽

Pyogenic Liver Abscess ◽

Nonparametric Test ◽

Controlled Study ◽

Success Rates ◽

Catheter Drainage ◽

Ct Guided ◽

Group I ◽

Significant Difference ◽

Group Ii

Objective. This study was designed to compare the effects of catheter drainage alone and combined with ozone in the management of multiloculated pyogenic liver abscess (PLA). Methods. The prospective study included 60 patients diagnosed with multiloculated PLA. All patients were randomly divided into two groups: catheter drainage alone (group I) and catheter drainage combined with ozone (group II). Drainage was considered successful when (1) the abscess cavity was drained and (2) clinical symptoms were resolved. Kruskal-Wallis nonparametric test was used to compare the success rates, length of stay (LOS), and need for further surgery of the two groups. P<0.05 indicates significant difference. Results. All patients’ catheters were successfully placed under CT guidance. Group I was treated with catheters alone and group II was treated with catheters and ozone. The success rates of groups I and II were 86% and 96%, respectively (P<0.05). And compared with group II, the duration of fever in group I was longer (P<0.05), and the LOS was also longer (P<0.05). Conclusion. Catheter drainage combined with ozone is an effective and safe treatment in multiloculated PLA. The Clinical Registration Number is ChiCTR1800014865.

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

Emergency Medicine International ◽

10.1155/2021/9241891 ◽

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.

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Comparison of Clinical Performance of Supraglottic Airway Devices in Elderly Patients: A Prospective Randomized Trial

Journal of Anesthesiology and Reanimation Specialists’ Society ◽

10.5222/jarss.2021.27147 ◽

2021 ◽

Author(s):

Reyhan Polat ◽

Sibel Çatalca ◽

Julide Ergil ◽

İlkay Baran ◽

Aylin Tamam ◽

...

Keyword(s):

Elderly Patients ◽

Clinical Performance ◽

The Elderly ◽

Supraglottic Airway ◽

Positive Pressure ◽

Success Rates ◽

Group I ◽

Supraglottic Airway Devices ◽

Significant Difference ◽

Airway Devices

INTRODUCTION: Airway management in the elderly may be challenging. Supraglottic airway devices (SADs) may be used to provide airway security. The aim of study was to compare the efficacy and safety of different SADs, LMA classic (c-LMA), proseal LMA (p-LMA) and i-gel in anaesthetised and non-paralysed elderly patients. METHODS: The study was approved by a local ethics committee. Eighty patients, aged older than 65 years, who were scheduled to undergo elective urological or orthopaedic surgery participated in the study. Each patient was randomly allocated into 1 of 3 groups: Group C: c-LMA (n = 26), Group P: p-LMA (n = 27) or Group I: i-gel (n = 27). The primary outcome was oropharyngeal sealing pressure (OSP). Secondary outcomes included the adequacy of positive pressure ventilation, ease of insertion, success rates, time to insertion, haemodynamic response and complications such as sore throat and dysphagia. RESULTS: There were no significant differences among the groups with respect to OSP (p=0.852), whereas there was a statistically significant difference between Group I and Group C in terms of leak volume and leak fraction ( p= 0.042 and p = 0.020, respectively ). Adverse events were similar among the groups (p > 0.05). DISCUSSION AND CONCLUSION: In this study, although the leak volume and leak fraction were lower in i-gel inserted patients, it was shown that i-gel, c-LMA and p-LMA provided adequate airway in elderly patients who were not applied muscle relaxants and will be operated under general anesthesia.

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Comparison between Sniffing Position and 25 Degree Backup Position in View of Glottis During Direct Laryngoscopy and Intubation - A Study from Mangalore, Karnataka

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/647 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3573-3577

Author(s):

AKhil Rao U.K. ◽

Athira Soman ◽

Anuradha Yadav ◽

Yashwant R. ◽

Sucheth Sharat

Keyword(s):

General Anaesthesia ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Elective Surgery ◽

Controlled Trial ◽

Randomized Study ◽

Group I ◽

Head Positioning ◽

Difficulty Scale ◽

Group Ii

BACKGROUND Endotracheal intubation for the purpose of providing anaesthesia was first described by William Mc Ewan. Jackson1 stressed the importance of anterior flexion of the lower cervical spine, in addition to obvious extension of the atlanto-occipital joint. Sniffing position has been commonly advocated as a standard head positioning for direct laryngoscopy which is achieved by flexion of the neck on chest and extension of the head at the atlanto-occipital joint. Present study was designed to evaluate the glottis view and ease of intubation achieved with direct laryngoscopy in the sniffing position with that of 25 degree backup position in a study group of 100 patients divided in 2 groups of 50 each. METHODS This study is a controlled comparative study. Controlled trial in 50 consecutive patients in each group [Group I and Group II] was conducted on patients who underwent elective surgery under general anaesthesia. Inclusion Criteria - General anaesthesia with endotracheal intubation, Aged 18 to 60 years, American society of Anaesthesiologists (ASA) grades I and II. Exclusion Criteria - Patients with body mass index more than 30 kg/m2. 1. Bucked teeth. 2. Restricted neck movement. 3. Inter-incisor gap less than 35 mm. 4. Thyro-mental distance less than 6 mm. 5. Patients with risk of regurgitation and aspiration. 6. Pharyngeal pathology. 7. Limitation of anterior and posterior movement of mandible 8. Pregnant patients Groups wereGroup I – Sniffing position Group II– 25 degree back up position RESULTS The glottis visualization was assessed by Cormack Lehane grading which revealed that glottis view was better in 25 degree backup position than sniffing position. CONCLUSIONS In our prospective randomized study in a series of 50 patients undergoing general anaesthesia in SIMS & RC, intubation difficulty scale (IDS) score was better in 25 degree backup position than sniffing position. It implies glottis view is better in 25 degree backup position than sniffing position. KEYWORDS Sniffing Position, 25 Degree Backup Position, Laryngoscopy

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