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British Journal of Anaesthesia Aug 2016
Topics: Laryngoscopes; Laryngoscopy
PubMed: 27251753
DOI: 10.1093/bja/aew122 -
Chinese Medical Journal Aug 2017UEscope is a new angulated videolaryngoscope (VL). This review aimed to describe the features of UEscope and provide clinical evidences regarding the efficacy and safety... (Review)
Review
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 -
Annals of Emergency Medicine Oct 2023Successful intubation on the first attempt has historically been defined as successful placement of an endotracheal tube (ETT) using a single laryngoscope insertion....
STUDY OBJECTIVES
Successful intubation on the first attempt has historically been defined as successful placement of an endotracheal tube (ETT) using a single laryngoscope insertion. More recent studies have defined successful placement of an ETT using a single laryngoscope insertion followed by a single ETT insertion. We sought to estimate the prevalence of first-attempt success using these 2 definitions and estimate their associations with the duration of intubation and serious complications.
METHODS
We performed a secondary analysis of data from 2 multicenter randomized trials of critically ill adults being intubated in the emergency department or ICU. We calculated the percent difference in successful intubations on the first attempt, median difference in the duration of intubation, and percent difference in the development of serious complications by definition.
RESULTS
The study population included 1,863 patients. Successful intubation on the first attempt decreased by 4.9% (95% confidence interval 2.5% to 7.3%) when defined as 1 laryngoscope insertion followed by 1 ETT insertion (81.2%) compared with when defined as only 1 laryngoscope insertion (86.0%). When successful intubation with 1 laryngoscope and 1 ETT insertion was compared with 1 laryngoscope and multiple ETT insertions, the median duration of intubation decreased by 35.0 seconds (95% confidence interval 8.9 to 61.1 seconds).
CONCLUSION
Defining successful intubation on the first attempt as placement of an ETT in the trachea using 1 laryngoscope and 1 ETT insertion identifies attempts with the shortest apneic time.
Topics: Adult; Humans; Laryngoscopes; Intubation, Intratracheal; Trachea; Emergency Service, Hospital
PubMed: 37074254
DOI: 10.1016/j.annemergmed.2023.03.021 -
Journal of Anesthesia Dec 2022Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this... (Observational Study)
Observational Study
The relationship between years of anesthesia experience and first-time intubation success rate with direct laryngoscope and video laryngoscope in infants: a retrospective observational study.
PURPOSE
Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this is true for infants remains unclear. Therefore, this study aimed to evaluate whether the use of video laryngoscope would result in smaller differences in success rate according to anesthesiologists' expertise than those in direct laryngoscope.
METHODS
Medical records and video recordings from the operating room of patients aged < 1 year who underwent non-cardiac surgery between March 2019 and September 2021 were reviewed. Tracheal intubations between April 8, 2020, and June 20, 2021, were excluded due to the shortage of video laryngoscope blades during the COVID-19 pandemic. Rates of first-time tracheal intubation success were compared by years of anesthesia experience and initial intubation device.
RESULTS
In total, 125 of 175 tracheal intubations were analyzed (direct laryngoscope group, n = 72; video laryngoscope group, n = 53). The first-time tracheal intubation success rate increased with years of experience as an anesthesiologist in the direct laryngoscope group (odds ratio OR 1.70, 95% confidence interval CI 1.15, 2.49; P = 0.0070), but not the video laryngoscope group (OR 0.99, 95% CI 0.74, 1.35; P = 0.99).
CONCLUSION
The differences in success rate according to the anesthesiologists' years of experience were non-significant when using video laryngoscope in infants, compared to those in direct laryngoscope.
Topics: Adult; Infant; Humans; Laryngoscopes; Pandemics; COVID-19; Laryngoscopy; Intubation, Intratracheal; Anesthesia; Video Recording
PubMed: 36125551
DOI: 10.1007/s00540-022-03106-y -
European Journal of Pediatrics Apr 2024How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized...
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 -
Medicina (Kaunas, Lithuania) Dec 2023: 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...
: 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 -
Anaesthesia Dec 2011The Airtraq laryngoscope is a single-use laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways. The aim of this... (Comparative Study)
Comparative Study Meta-Analysis Review
The Airtraq laryngoscope is a single-use laryngoscope designed to facilitate tracheal intubation in patients with either normal or difficult airways. The aim of this systematic review and meta-analysis was to compare the Airtraq with the conventional Macintosh laryngoscope. Data were retrieved from Medline, Embase, the Cochrane register of controlled trials, and by a manual search of bibliographies. Twelve randomised controlled trials (published between 2006 and 2011) including 1061 patients met the inclusion criteria. The Airtraq reduced intubation time significantly (mean difference -15 s; 95% CI -25 to -4 s, p < 0.00001) used by both experienced anaesthetists and novices, and it increased the first attempt success rate only in novices (relative risk 1.25; 95% CI 1.05-1.49, p = 0.07). The incidence of oesophageal intubation (relative risk 0.12; 95% CI 0.03-0.48, p < 0.05) was significantly reduced by the Airtraq. We conclude that the Airtraq laryngoscope facilitates a more rapid and accurate intubation, especially when used by novices.
Topics: Humans; Laryngoscopes; Randomized Controlled Trials as Topic
PubMed: 21883130
DOI: 10.1111/j.1365-2044.2011.06871.x -
Medicine Nov 2023New devices are more available in the pre-hospital environment operational theaters and emergency departments. One is an intubrite laryngoscope (INT) with Dual LED... (Randomized Controlled Trial)
Randomized Controlled Trial
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 -
Acta Medica Academica Aug 2022Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower... (Observational Study)
Observational Study
OBJECTIVE
Airway management has undergone a dramatic transformation since the arrival of video laryngoscope (VL). VL has higher intubation success rate on first try and lower complications in comparison to direct laryngoscope (DL). The use of VL is recommended in intubating COVID-19 patients to speed up intubation time and reduce failure rate. A team from Airlangga University developed Wycope Video Laryngoscope (Wycope VL), a VL with Wi-Fi connection to smartphones for an easier VL with low cost. This study aimed to compare the effectiveness of Wycope VL, C-MAC Video Laryngoscope (C-MAC VL), and DL.
MATERIALS AND METHODS
This study was an analytic observational study with a cross sectional design, involving 63 patients who were divided into 3 groups based on the type of laryngoscope, namely Wycope VL, C-MAC VL, and DL. Intubation is carried out by 4th year anaesthesiology resident. Research subjects were patients who will undergo elective surgery at Dr. Soetomo General Hospital under general anaesthesia using orotracheal tube. Inclusion age of 19-64 years, PS ASA 1-2, no anatomical abnormalities of the airway, did not have difficult airway, and was willing to participate in the study.
RESULTS
All patients were successfully intubated without complications. C-MAC VL (5.33±1.42 seconds) and Wycope VL (5.95±0.74 seconds) was significantly faster in seeing vocal folds and glottis compared to DL (7.14±0.72 seconds) with P=0.000. DL was significantly faster in average time of intubation (15.52±5.90 seconds) compared to C-MAC VL (16.95±1.11 seconds) and Wycope VL (20.29±2.81 seconds) with P=0.000.
CONCLUSION
DL was faster compared to VL in speed of intubation while C-MAC VL and Wycope VL was faster in viewing the vocal folds and glottis compared to DL.
Topics: Humans; Young Adult; Adult; Middle Aged; Laryngoscopes; Cross-Sectional Studies; Intubation, Intratracheal; COVID-19; Laryngoscopy
PubMed: 36318002
DOI: 10.5644/ama2006-124.378 -
Anaesthesia, Critical Care & Pain... Oct 2023Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed...
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