Difficult for intubation in a simulator with laryngoscope with and without mirror
Main Article Content
Keywords
Laryngoscopes, Surgical procedures, operative, Intratraqueal, intubation
Abstract
Background: the mirror laryngoscope blade (Siker blade) is used often in patients with anatomical variations, because it improves the visibility of epiglottis, shortening the intubation time. The objective was to compare the degree of difficulty in intubation with Macintosh blade versus Siker blade in a simulator, among anesthesiologists and residents in training.
Methods: a comparative study in 29 medical residents in training and 21 anesthesiologists was conducted. They had three attempts of 30 seconds to perform intubation with each laryngoscope in two different stages. The time and the intubation attempt, in which a successful intubation was performed, were registered. The data were processed using Statistica software, version 6.
Results: there was no difference for intubation between anesthesiologists and residents. Siker blade required more number of attempts (normal airway p < 0.001, difficult airway p = 0.02) and longer time for intubation (normal airway p < 0.0001, difficult airway p = 0.003). With a greater proportion of anesthesiologists, 20 % of the sample failed the intubation with Siker blade.
Conclusions: it was more difficult for anesthesiologists and residents in training the use of the Siker blade in both stages, with normal or difficult airway on a simulator.
References
Burkle CM, Zepeda FA, Bacon DR, Rose SH. A historical perspective on use of the laryngoscope as a tool in anesthesiology. Anesthesiology. 2004;100(4):1003-6.
Cooper RM. Laryngoscopy. Its past and future. Can J Anesth. 2004;51(6):R1-5.
Phillips O, Duerksen RL. Endotracheal intubation: a new blade for direct laryngoscopy. Anesth Analg. 1973;52(5):691-8.
Dupanovic M. Success rate of orotracheal intubation via Glidescope versus direct laryngoscopy in manikin-only-trained medical personnel. Anesthesiology. 2009;111(2):446. Author reply 447. doi: 10.1097/ALN.0b013e3181acf988.
Aldrete JA. Texto de anestesiología teórico-práctica. Segunda edición. México: Manual Moderno; 2004. p. 62.
El-Orbany M, Plambeck C, Antapli M. Changing the laryngoscope blade and its effect on laryngeal visualization. Anesthesiology. 2010;113(3):750. Author reply 750-1. doi: 10.1097/ALN.0b013e3181eab402.
Twigg SJ, McCormick B, Cook TM. Randomized evaluation of the performance of single-use laryngoscopes in simulated easy and difficult intubation. Br J Anaesth. 2003;90(1):8-13. Texto libre en http://bja.oxfordjournals.org/content/90/1/8.long
Asai T, Matsumoto S, Fujise K, Johmura S, Shingu K. Comparison of two Macintosh laryngoscope blades in 300 patients. Br J Anaesth. 2003;90(4):457-60. Texto libre en http://bja.oxfordjournals.org/content/90/4/457.long
Covarrubias A, Martínez-G JL, Reynada-T JL. Actualidades en vía aérea difícil. Rev Mex Anest. 2004;27(4):210-8. Texto libre en http://www.comexan.com.mx/revista/vol27_oct-dic/actualidades.pdf
Oriol SA. Valoración, predicción y presencia de intubación difícil. Rev Mex Anest. 2009;32(1):41-9. Texto libre en http://www.medigraphic.com/pdfs/rma/cma-2009/cma091g.pdf
Powell L, Andrzejowski J, Taylor R, Turnbull D. Comparison of the performance of four laryngoscopes in a high-fidelity simulator using normal and difficult airway. Br J Anaesth. 2009;103(5):755-60. Texto libre en http://bja.oxfordjournals.org/content/103/5/755.long
Kunze NS. Análisis de algoritmos de manejo en vía aérea difícil. Rev Chil Anest. 2009;38:91-100.
Malik MA, O’Donoghue C, Carney J, Maharaj CH, Harte BH, Laffey JG. Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study. Br J Anaesth. 2009;102(1):128-34. Disponible en http://bja.oxfordjournals.org/content/102/1/128.long
Siker ES. A mirror laryngoscope. Anesthesiology. 1956;17(1):38-42.
Neustein SM. Mirror-guided tracheal intubation. Anesth Analg. 2007;104(5):1293-4.
McMorrow RC, Mirakhur RK. A new mirrored laryngoscope. Anaesthesia. 2003;58(10):998-1002.
Olaosun AO, Oguntola AS, Adegbosin O, Akinloye A. Mirror laryngoscopy: a review of 43 cases. Surg J. 2009;4(2):29-34.
Galindo-López J, Visbal-Spirko L. Simulación, herramienta para la capacitación médica. Salud Uninorte. 2007;23(1):79-95. Texto libre en http://www.scielo.org.co/pdf/sun/v23n1/v23n1a09.pdf
Walker L, Brampton W, Halai M, Hoy C, Lee E, Scott I, et al. Randomized controlled trial of intubation with the McGrath series 5 videolaryngoscope by inexperienced anaesthetists. Br J Anaesth. 2009;103(3):440-5. doi: 10.1093/bja/aep191. Epub 2009 Jul 15. Texto libre en http://bja.oxfordjournals.org/content/103/3/440.long
Nouruzi-Sedeh P, Schumann M, Groeben H. Laryngoscopy via Macintosh blade versus Glidescope; success rate and time for endotracheal intubation in untrained medical personnel. Anesthesiology. 2009;110(1):32-7. doi: 10.1097/ALN.0b013e318190b6a7.
Schwid HA, Rooke GA, Carline J, Steadman RH, Murray WB, Olympio M. Evaluation of anesthesia residents using mannequin-based simulation. Anesthesiology. 2002;97(6):1434-44.
Murray DJ, Boulet JR, Avidan M, Kras JF, Henrichs B, Wood J, et al. Performance of residents and anesthesiologist in a simulation based skill assessment. Anesthesiology. 2007;107(5):705-13.