Authors: A Norris, T Heidegger

Topics: Laryngoscopes; Laryngoscopy

PubMed: 27251753
DOI: 10.1093/bja/aew122

Randomized Controlled Trial

Authors: M Kriege, R R Noppens, T Turkstra...

Before completion of this study, there was insufficient evidence demonstrating the superiority of videolaryngoscopy compared with direct laryngoscopy for elective tracheal intubation. We hypothesised that using videolaryngoscopy for routine tracheal intubation would result in higher first-pass tracheal intubation success compared with direct laryngoscopy. In this multicentre randomised trial, 2092 adult patients without predicted difficult airway requiring tracheal intubation for elective surgery were allocated randomly to either videolaryngoscopy with a Macintosh blade (McGrath™) or direct laryngoscopy. First-pass tracheal intubation success was higher with the McGrath (987/1053, 94%), compared with direct laryngoscopy (848/1039, 82%); absolute risk reduction (95%CI) was 12.1% (10.9-13.6%). This resulted in a relative risk (95%CI) of unsuccessful tracheal intubation at first attempt of 0.34 (0.26-0.45; p < 0.001) for McGrath compared with direct laryngoscopy. Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (84/1039, 8%) compared with McGrath (8/1053, 0.7%; p < 0.001) No significant difference in tracheal intubation-associated adverse events was observed between groups. This study demonstrates that using McGrath videolaryngoscopy compared with direct laryngoscopy improves first-pass tracheal intubation success in patients having elective surgery. Practitioners may consider using this device as first choice for tracheal intubation.

Topics: Adult; Humans; Laryngoscopy; Laryngoscopes; Intubation, Intratracheal; Elective Surgical Procedures; Evidence Gaps; Video Recording

PubMed: 36928625
DOI: 10.1111/anae.15985

Review

Authors: Puja Gaur Khaitan, Thomas A D'Amico

OBJECTIVE

To highlight some of the legendary figures in the medical field who have paved the path of thoracic surgery today.

METHODS

We reviewed historical articles and landmark studies published in anesthesiology, pulmonology, and thoracic surgery, and summarized them as they pertain to current practice.

RESULTS

Throughout our article, we have attempted to chronologically depict how our field has evolved, starting from the development of the stethoscope to reconstructing the esophagus using an extracorporeal tube to minimally invasive complex surgeries that we practice today.

CONCLUSIONS

We hope that our article can inspire the young minds to further grow the field and take it to higher levels.

Topics: History, 15th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Laryngoscopes; Minimally Invasive Surgical Procedures; Respiratory System; Robotic Surgical Procedures; Stethoscopes; Thoracic Surgical Procedures; Thoracoscopes

PubMed: 29501230
DOI: 10.1016/j.jtcvs.2017.12.149

Authors: Sabina Maglio, Francesco Cavallin, Chiara Sala...

How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope.    Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known: • Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions. • Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New: • Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease. • The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure.

Topics: Infant, Newborn; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Manikins

PubMed: 38260994
DOI: 10.1007/s00431-023-05418-x

Review

Authors: Fu-Shan Xue, Ben-Quan Yang, Ya-Yang Liu...

OBJECTIVE

UEscope is a new angulated videolaryngoscope (VL). This review aimed to describe the features of UEscope and provide clinical evidences regarding the efficacy and safety of this video device in adult tracheal intubation and its roles in airway management teaching.

DATA SOURCES

The Wan Fang Data, CNKI, PubMed, Embase, Cochrane Library, and Google Scholar were searched for relevant English and Chinese articles published up to January 15, 2017, using the following keywords: "HC video laryngoscope", "UE videolaryngoscope", "video laryngoscope", and "videolaryngoscopy".

STUDY SELECTION

Human case reports, case series, observable studies, and randomized controlled clinical trials were included in our search. The results of these studies and their reference lists were cross-referenced to identify a common theme.

RESULTS

UEscope features the low-profile portable design, intermediate blade curvatures, all-angle adjustable monitor, effective anti-fog mechanisms, and built-in video recording function. During the past 5 years, there have been a number of clinical studies assessing the application and roles of UEscope in airway management and education. As compared with direct laryngoscope, UEscope improves laryngeal visualization, decreases intubation time (IT), and increases intubation success rate in adult patients with normal and difficult airways. These findings are somewhat different from the previous results regarding the other angulated VLs; they can provide an improved laryngeal view, but no conclusive benefits with regard to IT and intubation success rate. Furthermore, UEscope has extensively been used for intubation teaching and shown a number of advantages.

CONCLUSIONS

UEscope can be used as a primary intubation tool and may provide more benefits than other VLs in patients with normal and difficult airways. However, more studies with large sample are still needed to address some open questions about clinical performance of this new VL.

Topics: Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopes; Video Recording

PubMed: 28748861
DOI: 10.4103/0366-6999.211536

Authors: Gamze Küçükosman, Keziban Bollucuoğlu, Mahmut Ava...

: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. : A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. : Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL ( = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. : Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.

Topics: Adult; Humans; Child; Laryngoscopes; Prospective Studies; Laryngoscopy; Anesthesia; Glottis

PubMed: 38256323
DOI: 10.3390/medicina60010062

Randomized Controlled Trial

Authors: Lei Jiang, Shuangba He, Guoyan Sun...

To study the application value of humidified high flow nasal cannula （HHFNC） combined with visual laryngoscopy in the arytenoid cartilage dislocation. Twenty-nine patients with arytenoid cartilage dislocation were randomly double-blind into HHFNC group and general nasal catheter oxygen suction group, and the intraoperative and postoperative evaluation indicators, anesthesia-related indicators and postoperative vocal cord were compared. There were statistically significant differences in intraoperative blood oxygen saturation, microstream end-tidal carbon dioxide partial pressure EtCO₂, respiratory rate and respiratory intervention times between the two groups （<0.05）, and statistically significant differences in postoperative heart rate, oxygen saturation and respiratory rate （<0.05）. After reduction, the voice disturbance index, the degree of voice abnormality, rough voice, breath sound, powerless pronunciation and catatonic pronunciation changed significantly after operation. HHFNC combined with visual laryngoscopy in the arytenoid cartilage dislocation has high anesthetic safety, good cooperation of patients, and good surgical effect.

Topics: Humans; Cannula; Laryngoscopes; Laryngoscopy; Catheterization; Voice Disorders; Arytenoid Cartilage

PubMed: 36597372
DOI: 10.13201/j.issn.2096-7993.2023.01.013

Authors: N Rouvière, S Chkair, F Auger...

INTRODUCTION

Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch.

METHODS

The ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management.

RESULTS

In 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of COeq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m per year and water savings of 221.6 m per year. The average cost per intubation varies from 3.16 [3.15-3.16] for SUB to 2.81 [2.77-2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00-6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively.

CONCLUSION

In a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of COeq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.

Topics: Humans; Laryngoscopes; Cost-Benefit Analysis; Intubation, Intratracheal; Disposable Equipment; Hospitals, University

PubMed: 37437711
DOI: 10.1016/j.accpm.2023.101276

Randomized Controlled Trial

Authors: Pawel Ratajczyk, Michal Fedorczak, Przemyslaw Kluj...

BACKGROUND

New devices are more available in the pre-hospital environment operational theaters and emergency departments. One is an intubrite laryngoscope (INT) with Dual LED lighting that combines ultraviolet and white LED. The study aimed to compare the efficacy of endotracheal intubation using INT and conventional laryngoscope performed by inexperienced paramedics (paramedics students) and paramedics with experience in advanced airways management in full and limited accessibility settings.

METHODS

It was an open, prospective, crossover manikin study. Sixty paramedics and paramedic students were recruited. Participants were divided into 2 equal groups depending on their experience (n = 30). Experienced participants were further randomly divided into 2 groups (n = 15). Inexperienced participants were also randomly divided into 2 groups (n = 15). The criterion of inexperience was 5 or fewer intubation by any laryngoscope. Inexperience participants were asked to perform tracheal intubation in standard pre-hospital settings (without limited access to manikin) (scenario A) and difficult pre-hospital settings (limited access to manikin - narrow space between benches) (scenario B). Experience participants were asked to intubate manikin in difficult pre-hospital settings.

RESULTS

In the normal pre-hospital environment, the success rate after the first attempt was 56,7% for conventional laryngoscope and 66,7% for intubrite. However, the overall effectiveness of tracheal intubation using both laryngoscopes in 3 attempts was 90% for both devices. The successful rate of first attempt intubation in a difficult environment by inexperienced was 73,3% for INT and 50% for conventional laryngoscope. Overall effectiveness was 83,3% and 86,7% respectively. The successful rate of first attempt intubation in the experienced group was 86,7% with INT compared to 60% with a conventional laryngoscope in difficult settings. Overall effectiveness was 96,7% for both devices.

CONCLUSION

Intubrite provided better working conditions and make up for deficiencies in successful tracheal intubation by inexperienced participants in a normal and difficult environment. Tracheal intubation with intubrite was more effective in the experienced group. Tracheal intubation effectiveness with intubrite was also higher in the experienced group.

Topics: Humans; Laryngoscopes; Manikins; Prospective Studies; Intubation, Intratracheal; Emergency Medical Technicians; Cross-Over Studies; Laryngoscopy

PubMed: 37960794
DOI: 10.1097/MD.0000000000035846

Meta-Analysis

Authors: Takumi Nagumo, Hiroshi Hoshijima, Koichi Maruyama...

BACKGROUND

It is important to reduce the hemodynamic response during tracheal intubation. We performed a systematic review and meta-analysis of the Airway Scope and Macintosh laryngoscope to determine whether they reduce the hemodynamic responses of heart rate (HR) and mean blood pressure (MBP) after tracheal intubation under general anesthesia.

METHODS

We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim of our meta-analyst is to determine if the Airway Scope reduces hemodynamic responses (HR and mean MBP) 60 seconds after tracheal intubation compared to the Macintosh laryngoscope. We expressed pooled differences in hemodynamic responses between the 2 devices as weighted mean differences with 95% confidence intervals. We conducted trial sequential analysis. Secondarily, we investigated the ability of the Airway Scope and Macintosh laryngoscope to reduce hemodynamic responses at 120 seconds, 180 seconds, and 300 seconds after tracheal intubation.

RESULTS

We identified clinical trials comparing hemodynamic response via a comprehensive literature search. Of 185 articles found in the search, we selected 8. In comparison to the Macintosh laryngoscope, the Airway Scope significantly reduced HR and MBP at 60 seconds after tracheal intubation (HR; weighted mean difference = -7.29; 95% confidence interval, -10.9 to -3.62; P < .0001; I2 = 57%, MBP; weighted mean difference = -11.5; 95% confidence interval, -20.4 to -2.65; P = .01; I2 = 91%). At the secondary outcome, the Airway Scope significantly reduced the fluctuation of HR after 120 seconds and 180 seconds of tracheal intubation. However, the Airway Scope did not significantly reduce MBP 120 seconds, 180 seconds, and 300 seconds after tracheal intubation. Trial sequential analysis suggested that the total sample size reached the required information size for heart rate.

CONCLUSIONS

Our finding suggested that the Airway Scope attenuated hemodynamic responses at 60 seconds after tracheal intubation in comparison with that of the Macintosh laryngoscope. However, the MBP sample size is small and further research is needed.

Topics: Humans; Laryngoscopy; Laryngoscopes; Intubation, Intratracheal; Hemodynamics; Heart Rate

PubMed: 36827056
DOI: 10.1097/MD.0000000000033047