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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 -
Nigerian Journal of Clinical Practice May 2022Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and... (Observational Study)
Observational Study
BACKGROUND AND AIM
Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and glottis visualization of McGrath video laryngoscope with the Macintosh laryngoscope for routine nasotracheal intubation.
MATERIALS AND METHODS
Records of seventy-one ASA (American Society of Anesthesiologists) I-II patients were evaluated and allocated into two groups (McGrath video laryngoscope (VL) and Macintosh groups). Intubation times, modified intubation difficulty scale (MIDS) scores, and hemodynamic parameters (heart rate and mean arterial pressure) were compared after the anesthesia induction and the intubation.
RESULTS
Mean intubation time in the McGrath group (24.9 ± 5.9 seconds) was significantly lower than that of the Macintosh group (28 ± 6.2 seconds; P = 0.037). Magill forceps were needed less in the McGrath group compared to the Macintosh group (13.89% vs. 42.86%; P = 0.009). Total MIDS scores were similar (P = 0.778). There was no significant difference in the hemodynamic parameters between the groups.
CONCLUSION
The McGrath VL significantly reduced the intubation time and the use of Magill forceps compared with Macintosh direct laryngoscope and can be utilised effectively for routine nasotracheal intubation.
Topics: Anesthesia, General; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Surgery, Oral
PubMed: 35593613
DOI: 10.4103/njcp.njcp_1923_21 -
Biomedical Engineering Online Oct 2022To verify a test prototype of a novel flexible video laryngoscope in a difficult airway management simulator and to compare the efficacy of the flexible video...
BACKGROUND
To verify a test prototype of a novel flexible video laryngoscope in a difficult airway management simulator and to compare the efficacy of the flexible video laryngoscope with that of a conventional video laryngoscope.
METHODS
Fifteen clinical anesthesiologists performed endotracheal intubation with a flexible video laryngoscope and a conventional video laryngoscope in a difficult airway management simulator in the neutral position with intermediate and difficult mouth opening. The rate of intubation success, intubation time, and classification of glottic exposure were recorded. After endotracheal intubation, participants were asked to assess the difficulty of intubation of the two laryngoscopes.
RESULTS
The success rate of endotracheal intubation with flexible video laryngoscope was significantly higher than that with video laryngoscope in neutral positions with both intermediate (P = 0.025) and difficult (P = 0.005) mouth opening. The Cormack Lehane score of the flexible video laryngoscope was significantly lower than that of the video laryngoscope in the neutral position with intermediate mouth opening (P < 0.001) and difficult mouth opening (P < 0.001). There was no significant difference in intubation time in the neutral position with intermediate mouth opening (P = 0.460) or difficult mouth opening (P = 0.078). The difficulty score of endotracheal intubations with the flexible video laryngoscope was also significantly lower than that of the video laryngoscope in the neutral position with intermediate mouth opening (P = 0.001) and difficult mouth opening (P = 0.001).
CONCLUSIONS
Compared with conventional video laryngoscopy, flexible video laryngoscopy can provide superior glottic exposure and improve the success rate of intubation in a difficult airway management simulator.
Topics: Airway Management; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Video Recording
PubMed: 36192780
DOI: 10.1186/s12938-022-01043-1 -
Brazilian Journal of Anesthesiology... 2021
Topics: Humans; Intubation, Intratracheal; Laryngoscopes
PubMed: 34403649
DOI: 10.1016/j.bjane.2021.07.024 -
JNMA; Journal of the Nepal Medical... Jul 2021Laryngoscopy and intubation are stressful as they lead to a rise in heart rate and blood pressure. Though transient, it may be detrimental to the cardiac and...
INTRODUCTION
Laryngoscopy and intubation are stressful as they lead to a rise in heart rate and blood pressure. Though transient, it may be detrimental to the cardiac and neurosurgical patients. There is a need to explore the possibility of obtunding the pressor response to laryngoscopy and intubation with the use of McCoy blade laryngoscope. We aimed to find out the hemodynamic response to laryngoscopy and intubation using McCoy laryngoscope in adult patients undergoing general anesthesia.
METHODS
The descriptive cross-sectional study was conducted in 37 American Society of Anesthesiologists' Physical Status I/IIpatients, with normal airway from December 2019- May 2020 in a tertiary care hospital. Ethical approval was obtained from Institutional Research Committee (reference number.: MEMG/IRC/290/GA). Convenience sampling method was used. The mean systolic and diastolic blood pressures were measured at baseline, one, three and five minutes after laryngoscopy and intubation. Data were analyzed using the Statistical Package for the Social Sciences Version 21.0.
RESULTS
In the first minute after laryngoscopy and intubation, the rise in mean blood pressure was noted in 14 (37.83%) cases. The peak rise in mean blood pressure was 3%, note done minute after laryngoscopy and intubation.
CONCLUSIONS
We noted better attenuation of pressor response to laryngoscopy and intubation using McCoy blade laryngoscope in adult patients undergoing general anesthesia.
Topics: Adult; Cross-Sectional Studies; Hemodynamics; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy
PubMed: 34508397
DOI: 10.31729/jnma.6752 -
Anaesthesia Oct 2003A new laryngoscope has been designed, incorporating an adjustable mirror and a levered tip similar to the McCoy blade, in an attempt to bridge the gulf between simple... (Comparative Study)
Comparative Study
A new laryngoscope has been designed, incorporating an adjustable mirror and a levered tip similar to the McCoy blade, in an attempt to bridge the gulf between simple direct laryngoscopy and fiberoptic laryngoscopy. Manual in-line neck stabilisation was used to simulate difficult laryngoscopy in 14 anaesthetised patients after full neuromuscular blockade. The best view at laryngoscopy was assessed using a standard Macintosh laryngsocope, a size 3 McCoy laryngoscope and the mirrored laryngoscope. The best laryngeal view obtained in all cases with the Macintosh blade was a grade 3. The mirrored laryngoscope improved this view in 10 cases (71%) compared with five cases (36%) with the McCoy laryngoscope (p = 0.005); in seven cases (50%), the view improved to a grade 1 compared with no cases when the McCoy was used (p = 0.02). We conclude that the mirrored laryngoscope offers considerable advantages over the Macintosh and the McCoy laryngoscopes in simulated difficult laryngoscopy, is simple to use and requires no special training.
Topics: Anesthesia, General; Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy
PubMed: 12969041
DOI: 10.1046/j.1365-2044.2003.03343.x -
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 -
BMC Emergency Medicine Oct 2020This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the...
BACKGROUND
This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes.
METHOD
One hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study.
RESULTS
The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s.
CONCLUSION
Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.
Topics: Clinical Competence; Cross-Over Studies; Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopes; Manikins; Military Personnel; Singapore; Video Recording
PubMed: 33028220
DOI: 10.1186/s12873-020-00375-2 -
Anaesthesia Aug 2017
Topics: Intubation; Laryngoscopes; Laryngoscopy
PubMed: 28695595
DOI: 10.1111/anae.13995 -
Anaesthesia Jun 1993This is a report of a modification of the standard Macintosh laryngoscope blade to facilitate tracheal tube placement in cases of difficult visualisation of the larynx....
This is a report of a modification of the standard Macintosh laryngoscope blade to facilitate tracheal tube placement in cases of difficult visualisation of the larynx. The modification offers the unique advantage of a hinged blade tip, controlled by a lever on the handle of the laryngoscope which allows elevation of the epiglottis while decreasing the overall laryngoscopic elevation or levering movement required. It is an adaptation which can be applied to most laryngoscope blades, does not require any special training in its use and will prove useful for both routine intubations as well as those which may be difficult and associated with an anterior larynx.
Topics: Adult; Equipment Design; Humans; Intubation, Intratracheal; Laryngoscopes; Larynx
PubMed: 8292132
DOI: 10.1111/j.1365-2044.1993.tb07075.x