scholarly journals Optical Devices in Tracheal Intubation—State of the Art in 2020

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 575
Author(s):  
Jan Matek ◽  
Frantisek Kolek ◽  
Olga Klementova ◽  
Pavel Michalek ◽  
Tomas Vymazal
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Mouth Opening ◽  
Optical Devices ◽  
Tube Placement ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Endotracheal Tube Placement ◽  
Supraglottic Airway Devices ◽  
Thoracic Anesthesia

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

scholarly journals Pecha Kucha with Part-Task Training Improves Airway Management in Fresh Frozen Cadavers: A Case-Control Observational Study

2020 ◽  
Vol 29 (6) ◽  
pp. 532-537
Author(s):  
Kemal Tolga Saracoglu ◽  
Mehmet Yilmaz ◽  
Ayse Zeynep Turan ◽  
Alparslan Kus ◽  
Tuncay Colak ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Tracheal Tube ◽  
Complication Rate ◽  
Task Group ◽  
Tube Placement ◽  
Fiberoptic Intubation ◽  
Fresh Frozen ◽  
Task Training

<b><i>Objective:</i></b> The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. <b><i>Subjects and Methods:</i></b> The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (<i>n</i> = 9) received part-task training and group 2 (<i>n</i> = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. <b><i>Results:</i></b> Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

2021 ◽  
Vol 6 (3) ◽  
pp. 24-30
Author(s):  
Amani Alenazi ◽  
Bashayr Alotaibi ◽  
Najla Saleh ◽  
Abdullah Alshibani ◽  
Meshal Alharbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Airway Management ◽  
Success Rate ◽  
Phase 1 ◽  
Adult Patients ◽  
Supraglottic Airway ◽  
Future Research ◽  
Phase 2 ◽  
Advanced Airway ◽  
Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

Airway Management in Children

2019 ◽  
Author(s):  
James Peyton ◽  
Raymond Park
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Fiberoptic Bronchoscopy ◽  
Difficult Tracheal Intubation ◽  
Airway Device ◽  
Successful Outcome ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Factors Associated ◽  
Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references.  Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

scholarly journals The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times

2020 ◽  
Vol 163 (5) ◽  
pp. 934-937 ◽  
Author(s):  
Joshua D. Smith ◽  
Michelle M. Chen ◽  
Karthik Balakrishnan ◽  
Douglas R. Sidell ◽  
Arianna di Stadio ◽  
...  
Keyword(s):  
Airway Management ◽  
Clinical Decision Making ◽  
Care Delivery ◽  
Clinical Decision ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Protective Equipment ◽  
Trade Offs ◽  
Airway Pathology ◽  
The Impact

The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.

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