The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult 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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Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study

10.21203/rs.3.rs-446796/v1 ◽

2021 ◽

Author(s):

Ashka Shah ◽

Lauren Knecht ◽

Cameron Jacobson ◽

Sean Runnels ◽

Angela Presson ◽

...

Keyword(s):

Success Rate ◽

Case Control Study ◽

Salt Lake ◽

Salt Lake City ◽

Ease Of Use ◽

Retrospective Case ◽

First Pass ◽

Lake City ◽

Combined Technique ◽

Control Study

Abstract Difficult intubations can require advanced intubation techniques. Studies point to potential advantages of combined techniques using video laryngoscopes (VL) and dynamic stylets for anticipated difficult intubations. This study is designed to compare combined techniques to awake and asleep fiberoptic (FOB) techniques.Methods: 138,387 consecutive anaesthesia cases were reviewed for use of: FOB awake, FOB asleep, or combined technique (VL for visualization and either a FOB or a novel TCITM articulating introducer ((TCITM; Through The Cords, LLC; Salt Lake City, UT)) as dynamic stylets as a primary approach for anticipated difficult intubations. Primary end points measured: first attempt success rate, failure to intubate with the primary technique, “in-room to intubation’ time, reported traumatic intubation rate, and reported ease of intubation.Results: Significant differences were found between techniques. First pass success rate was highest in combined techniques (either VL + FOB or VL + TCITM) (88.7%) followed by FOB awake (74.2%, P<0.001) and FOB asleep (80.7%, P=0.06). “Failure to intubate with the primary technique” was lowest in combined techniques (1.8%) followed by FOB asleep (4.6%, P=0.11) and FOB awake (9.2%, P=0.002). “In room to intubated” time was fastest in combined techniques (13.0 minutes) followed by FOB asleep (15.1 minutes, P=0.002) and FOB awake (21.2 minutes, P<0.001). Combined techniques were rated as ‘easy’ more often (72%) followed by FOB asleep (62.9%, P=0.12) and FOB awake (38.2%, P<0.001). Combined techniques were rated as “atraumatic” more often (91.1%) followed by FOB asleep (89.4%, P=0.91) and FOB awake (75.8%, P<0.001). In subgroup analysis of combined techniques, VL + TCITM had the highest first attempt success rate (90.2%), lowest failure rate (1%, P=0.56), and shortest “in room to intubated time” (12.1 minutes, P=0.12). It was also rated as "easy” (83.3%, P<0.001), and “atraumatic“ (96.1%, P=0.009) more often than VL + FOB, FOB awake or FOB asleep.Conclusions: Combined techniques outperformed FOB techniques in terms of effectiveness, speed, ease of use, and patient injury in patients with risk factors for difficult intubation. As a sub-group of combined technique, VL + TCITM outperformed all other techniques. Combined techniques should be considered when managing difficult intubations.

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Does Video Laryngoscopy or Direct Laryngoscopy affect first pass success rates for intubation among Attending and Non-Attending Emergency Physician in the Emergency Department?

10.21203/rs.2.13427/v1 ◽

2019 ◽

Author(s):

Paul Weng Wan ◽

Zakaria Nur Diana ◽

Seow Gek Ching ◽

Wong Evelyn

Keyword(s):

Emergency Department ◽

Success Rate ◽

Direct Laryngoscopy ◽

Video Laryngoscopy ◽

Secondary Outcome ◽

Emergency Physicians ◽

Success Rates ◽

Direct Laryngoscope ◽

First Pass ◽

Lemon Score

Abstract Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending Emergency Physicians in South-East Asia. We aim to identify whether the use of Direct Laryngoscopy (DL) compared to Video Laryngoscopy (VL) affects first pass success rates between Attending Emergency Physicians (AEP) and Non-Attending Emergency Physicians (NAEP). Materials and Methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by and academic Emergency Department in Singapore. Primary outcome is first pass success intubation rate. The secondary outcome was first pass success rate for difficult intubations. Difficult intubations were defined as LEMON score of more than 1 or more than 1 attempt at intubation. Results: There were 2909 intubation carried out by emergency physicians in the Emergency Department from 2009 to 2016. AEP conducted 1748 intubations while NAEP conducted 1161 intubations. The first pass success rates for AEP was 84.2% while that for NAEP was 67.4%. 86.2% of intubations by AEP were done with a direct laryngoscope. 89.0% of the intubations by NAEP were done with a direct laryngoscope. 18.9% of intubations by the AEP were difficult compared to 35.2% by the NAEP (p<0.01 95% C.I 13.0%-19.6%). First pass success rate with VL was lower than DL for all intubations (OR 0.66, 95% C.I 0.51-0.84). In the subgroup of difficult intubations, VL did not improve first pass success rate among AEP (OR 0.77, 95% C.I 0.38-1.58) but it did for NAEP (OR 2.46, 95% C.I 0.94-6.45). Conclusion: Our study showed that VL has a poorer first pass success rate for all intubations in general. However, specifically for difficult intubations, VL is associated with improved first pass success rates among NAEP.

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Gum Elastic Bougie vs. Styletted Endotracheal Intubation: Success and Ease of Use among Out-of-hospital Providers in a Difficult Airway Model

Academic Emergency Medicine ◽

10.1197/j.aem.2006.03.146 ◽

2006 ◽

Vol 13 (5Supplement 1) ◽

pp. S64-S64

Author(s):

D. Pettit

Keyword(s):

Difficult Airway ◽

Endotracheal Intubation ◽

Ease Of Use ◽

Intubation Success ◽

Airway Model

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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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Does video laryngoscopy or direct laryngoscopy affect first-pass success rates for intubation among attending and non-attending emergency physicians in the emergency department?

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920910631 ◽

2020 ◽

pp. 102490792091063

Author(s):

Wan Paul Weng ◽

Nur Diana Bte Zakaria ◽

Seow Gek Ching ◽

Evelyn Wong

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Success Rate ◽

Direct Laryngoscopy ◽

Video Laryngoscopy ◽

Secondary Outcome ◽

Emergency Physicians ◽

Success Rates ◽

Mallampati Score ◽

First Pass

Background: To our knowledge, there has been no study comparing intubation characteristics between attending and non-attending emergency physicians in Southeast Asia. We aim to identify whether the use of direct laryngoscopy compared to video laryngoscopy affects first-pass success rates between attending emergency physicians and non-attending emergency physicians. Materials and methods: Retrospective analysis of data from 2009 to 2016 in an existing airway registry managed by an academic Emergency Department in Singapore. Primary outcome was first-pass success intubation rate. Secondary outcome was first-pass success rate for difficult intubations. Difficult intubations were defined as LEMON (Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility) score of more than 1. Results: There were a total of 2909 intubations. Attending emergency physicians conducted 1748 intubations, while non-attending emergency physicians conducted 1161 intubations. The first-pass success rates for AEP were 84.2% and 67.4% for non-attending emergency physicians. Direct laryngoscopy was used in 86.2% of intubation by attending emergency physicians compared to 89.0% in the intubation by non-attending emergency physicians. Also, 7.6% of intubations by the attending emergency physicians were difficult compared to 8.8% by the non-attending emergency physicians (p = 0.25). Logistic regression of the effect of laryngoscopy device on first-pass success in all intubations showed a negative association with video laryngoscopy (odds ratio, 0.70; 95% confidence interval, 0.56–0.88). In the subgroup of difficult intubations, non-attending emergency physicians are 1.54 times (95% confidence interval, 0.53–4.42) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. On the contrary, in the subgroup of difficult intubations, attending emergency physicians are 0.90 times (95% confidence interval, 0.38–2.12) as likely to have first-pass success with video laryngoscopy compared to that with direct laryngoscopy. Conclusion: Our study showed that video laryngoscopy has a lower first-pass success rate for all intubations in general. Intubations performed by attending emergency physicians with direct laryngoscopy were associated with a higher first-pass success rate.

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Evaluating the Reaction to a Complex Rotated Object in the American Quarter Horse (Equus caballus)

Animals ◽

10.3390/ani11051383 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1383

Author(s):

Megan Elizabeth Corgan ◽

Temple Grandin ◽

Sarah Matlock

Keyword(s):

Behavioral Responses ◽

Equus Caballus ◽

T Test ◽

Complex Object ◽

The Novel ◽

Novel Object ◽

Quarter Horse ◽

First Pass ◽

Young Horses ◽

Familiar Objects

It is dangerous for both riders and horses when a horse suddenly startles. Sometimes horses do this in familiar environments because familiar objects may look different when rotated. The purpose of this study was to determine whether horses that had been habituated to a complex object (children’s playset) would react to the object as novel when rotated 90 degrees. Twenty young horses were led past the playset 15 times by a handler. Next, the rotated group was led past the rotated playset 15 times. Each time the horse was led by the object was a pass. The behavioral responses observed and analyzed were ears focused on the object, nostril flares, neck raising, snort, avoid by stopping, avoid by moving feet sideways, and avoid by flight. An increasing reactivity scale was used to quantify behavioral responses. A two-sample t-test was performed on the reactivity scores comparing the first pass by the novel object to the first pass by the rotated object. The horses in the rotated group reacted to the rotated orientation similarly to the first exposure (p = 0.001, α < 0.05). Being aware of potential reactions to changes in previously familiar environments can help keep the handler safer.

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Lack of influence of the antidopaminergic drug domperidone on basal and TRH-stimulated TSH-serum levels after oral administration

Acta Endocrinologica ◽

10.1530/acta.0.1010550 ◽

1982 ◽

Vol 101 (4) ◽

pp. 550-554 ◽

Cited By ~ 2

Author(s):

K. W. Wenzel ◽

J. Döring

Keyword(s):

Oral Administration ◽

Thyroid Function ◽

Oral Absorption ◽

Statistical Significance ◽

Oral Intake ◽

Serum Levels ◽

The Novel ◽

Antiemetic Drug ◽

First Pass ◽

The Difference

Abstract. Since antidopaminergic drugs are known to elevate basal and TRH-stimulated TSH-serum levels and since this effect was also shown after iv administration of the novel dopamine antagonistic agent domperidone, it was investigated, whether this antiemetic drug could interfere after oral intake with the evaluation of thyroid function. Oral domperidone caused a marked TSH-enhancement of TRH-induced TSH increments in 6 out of 14 euthyroid subjects, with no statistical significance, however. The difference between oral and parenteral influence as well as inter-individual changes are probably due to the varying first pass effect of the drug after oral absorption.

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Applications of a Novel Lost Circulation Additive

10.2523/iptc-21397-ms ◽

2021 ◽

Author(s):

Qi Zhu

Keyword(s):

Particle Size ◽

Success Rate ◽

Crack Width ◽

Leakage Rate ◽

The Novel ◽

Leakage Loss ◽

Lost Circulation ◽

Well Field ◽

Complicated Situation ◽

Scanning Electron

Abstract Lost circulation is a complicated situation in the drilling operation, wasting a lot of time and mud during processing. A serious lost circulation can cause hazards, such as sticking, blowout and collapse of well. There are some problems in conventional plugging technology, such as particle size of plugging material does not match crack width, slip of the blocking zone, and weak adhesion of lost circulation additive to the rock, which restricts the success rate of lost circulation operation. Regular and elastic polyhedron structure material compounds elastic variable network plugging material and rigid plugging materials to form a loss circulation materials (LCM)plugging mixture for different leakage speed and crack width affected by stress. Through plugging and HTHP sand bed experiment loss circulation materials(LCM) and amount of gel were optimized and improved. Through indoor simulation about leakage process of different leakage speed and different crack sizes, the on-site construction formula suitable for wells under different temperature is formed and determined. Scanning electron microscope shows the plugging gel has a variable network structure. By changing the ratio of elastic plugging material, rigid plugging material and gel, a LCM plugging formula for high temperature and high pressure formations can be formed to meet the pressure requirement of 7.5MPa. Leakage simulation formed on-site plan under different leakage rate to adapt to 180°C. The novel CPM material has been well-field tested and used for HPHT reservoirs. When the rate of leakage less than 30 m3/h and 30-60 m3/h, success rate of single plugging is more than 95% and rate of leakage greater than 60 m3/h success rate of single plugging beyond 80%. Leakage loss time is more than 80% shorter than conventional plugging techniques.

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