USS or Consultation First in a Lump in the Neck Clinic? (original) (raw)
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Academic Emergency Medicine, 2011
Objectives: Prediction of difficult laryngoscopy in emergency care settings is challenging. The preintubation clinical screening tests may not be applied in a large number of emergency intubations due to the patient's clinical condition. The objectives of this study were 1) to determine the utility of sonographic measurements of thickness of the tongue, anterior neck soft tissue at the level of the hyoid bone, and thyrohyoid membrane in distinguishing difficult and easy laryngoscopies and 2) to examine the association between sonographic measurements (thickness of tongue and anterior neck soft tissue) and difficult airway clinical screening tests (modified Mallampati score, thyromental distance, and interincisor gap).
European journal of anaesthesiology, 2018
Unpredictable difficult laryngoscopy remains a challenge for anaesthesiologists, especially if difficult ventilation occurs during standard laryngoscopy. Accurate airway assessment should always be performed, but the common clinical screening tests have shown low sensitivity and specificity with a limited predictive value. Ultrasound-based airway assessment has been proposed recently as a useful, simple, noninvasive bedside tool as an adjunct to clinical methods, but to date, few studies are available about the potential role of ultrasound in difficult airway evaluation, and these are mostly limited to specific groups of patients. The aim of this study was to determine the correlation between the sonographic measurements of anterior cervical soft tissues thickness and Cormack-Lehane grade view at direct laryngoscopy in patients with normal clinical screening tests. Prospective, single blinded, observational study. Operating theatre of a teaching hospital from May 2017 to September 2...
Advances in Medical Education and Practice, 2014
Introduction: A review of the literature was conducted to analyze the impact of simulation-based training for direct and video laryngoscopy (VL) skills for health care professionals and health care students. Methods: This review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop airway management skills and identify pertinent literature by searching PubMed from inception of the database up to July 2013. This current review addresses the question of whether airway management simulation-based training improves the acquisition of resuscitation skills for health care profession learners. Results: A total of eleven articles qualified for this systematic review based on the inclusion and exclusion criteria. These studies were analyzed and the specific simulators, participants, assessments, and details related to: time of intubation; Cormack and Lehane classification; success and failure rate; and number of attempts. Conclusion: This review suggests that simulation-based training is one effective way to teach VL skills. VL allows for a higher success rate, faster response time, and a decrease in the number of attempts by health care students and health care professionals under the conditions based on the eleven studies reviewed.
PLOS ONE, 2018
Objectives We determined the usefulness of C-MAC video laryngoscope (C-MAC) as a safe training tool for the direct laryngoscopy technique in the emergency department. Methods We retrospectively analyzed an institutional airway registry of adult (�18 years old) patients from April 2014 through October 2016. In this study, the operator used C-MAC as a direct laryngoscope (DL) with limited access to the screen, and the supervisor instructed the operator via verbal feedback while watching the screen. Patients were categorized into the DL group if a conventional DL was used and the C-DL group if a C-MAC used as a DL. Results Of 744 endotracheal intubations, 163 propensity score-matched pairs were generated (1-ton matching: C-DL group, 163 vs. DL group, 428). For the propensity-matched groups, the overall first pass success rate was 69%, while those in the C-DL and DL groups were 79% and 65%, respectively. Overall, multiple attempts were required in 8% of patients, with 4% in the C-DL group and 9% in the DL group. The overall complication rate was 11%, with 4% in the C-DL group and 14% in the DL group. In multivariable analysis, the adjusted odds ratios of C-DL use for first pass success, multiple attempts, and complications were 2.05 (95% confidence interval [CI] 1.18-2.87, p < 0.01), 0.38 (95% CI 0.15-0.94; p < 0.01), and 0.28 (95% CI 0.12-0.63; p < 0.01), respectively.
The American Journal of Emergency Medicine, 2013
Objective: The aim of this study was to compare first-attempt and overall success rates and success rates in relation to placement time among 5 different airway management devices: Storz CMAC, Glidescope GVL, AirTraq, King LTS-D, and direct laryngoscopy (DL). Methods: Emergency medical technician basic (EMT-B), EMT-paramedics (EMT-P), and emergency medicine residents and staff physicians placed each of the 5 devices in a random order into an AirSim (TruCorp, Belfast, UK) part-task training manikin. The difficult airway scenario was created by fixing the manikin head to a stationary object and introducing simulated emesis into the hypopharynx. First-attempt and overall success and success in relation to placement time were compared. Provider feedback about device performance was also evaluated. Results: Ninety-four providers (16 EMT-basics, 54 EMT-paramedics, and 24 emergency department doctors of medicine) consented to participation. First-attempt and overall success rates for DL, King LTS-D, GVL, and CMAC were not statistically different. Compared with DL, the AirTraq was 96% less likely to be placed successfully (odds ratio, 0.04; 95% confidence interval [CI], 0.01-0.14). When time was factored into the model, the odds of successful placement of the King LTS-D were higher compared with DL (hazard ratio [HR], 1.80; 95% CI, 1.34-2.42) and lower for GVL (HR, 0.59; 95% CI, 0.44-0.80) and AirTraq (HR, 0.228; 95% CI, 0.16-0.325). Providers ranked the CMAC first in terms of performance and preference for use in their practice setting. Conclusion: Overall success rates for DL, King-LTS-D, and both video laryngoscope systems were not different. When time was factored into the model, the King LTS-D was more likely to be placed successfully.
Cureus
Background: The anticipation of a challenging airway can be demanding in emergency care settings. Due to the patient's clinical condition, executing the pre-intubation clinical screening tests during the management of the airway in an emergency situation can be sometimes troublesome. Ultrasonographic airway assessment may become a helpful tool, but no specific sonographic measurements can precisely visualize the prospect of meeting a difficult airway. Therefore, the present study aimed to verdict some correlation between preoperative sonographic airway assessment parameters and the Cormack-Lehane (CL) grading at laryngoscopic view in patients undergoing general anesthesia with endotracheal intubation. Methods: This observational study was conducted on 150 elective surgery subjects undergoing general anesthesia. The clinician in the pre-anesthetic clinic performed clinical airway and ultrasonographic airway assessments to predict difficult intubation and correlated with the CL grade viewed at laryngoscopy in the operative room during intubation. The parameters assessed were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: In this study, the incidence of difficult intubation was 13.3%. The Mallampatti Grading (MPG) showed the maximum receiver operating characteristic (ROC) and area under the curve (AUC) among the clinical predictors, with 86.7% sensitivity. At the same time, the skin-to-hyoid distance has the maximum ROC among the sonographic parameters, and the skin-to-thyroid isthmus has the utmost sensitivity to predict difficult laryngoscopy. Conclusions: Among the clinical predictors, MPG and the sonographic parameters, like the skin-to-hyoid distance and skin-to-thyroid isthmus, are favorable predictors of difficult laryngoscopy.
Academic Emergency Medicine, 2007
Introduction: A number of devices, including video laryngoscopy, are used to aid in managing difficult airways. The goal of this study was to compare timing and success of video laryngoscopy to standard laryngoscopic intubation using a simulation mannequin in normal and difficult airway scenarios. Methods: Residents and attending physicians of a PGY 2-4 emergency medicine residency program participated. A single, high-fidelity simulation mannequin was used. Each participant received an in-service on the video laryngoscope (GlideScope). Three airway settings were used: standard, decreased neck mobility, and tongue edema. Participants intubated with a Macintosh blade and video laryngoscope in each scenario, and graded the best view achieved using the Cormack-Lehane classification. Outcome measures included time to view the vocal cords, time to intubation, grading of view, and intubation success or failure. Institutional Review Board approval was obtained. Results: Fifty-two participants were enrolled. Participants successfully intubated the mannequin faster using the Macintosh blade in both the normal and neck immobility settings (9.4 seconds faster, 95% CI 3.2-15.7, P ϭ 0.004, 16.1 seconds faster, 95% CI 3.6-28.7, P ϭ 0.01). In the tongue edema setting, however, video laryngoscopy provided a better grade view of the cords, a higher success rate of viewing the cords at time of intubation (50% vs. 12%), and a higher rate of successful intubations (83% vs. 23%). The GlideScope also significantly reduced the time needed to view the cords (89 seconds reduction, 95% CI 54.4-123.7, P Ͻ 0.0001) and intubate (131.3 seconds reduction, 95% CI 99.1-163.6, P Ͻ 0.0001) for the tongue edema setting. Conclusions: In the most difficult airway case, tongue edema, the video laryngoscope provided an enhanced view of the cords using less time, increased intubation success, and decreased the time to intubation.
International Journal of Advanced Research (IJAR), 2019
Background : The major responsibility of the anaesthesiologist is to provide adequate ventilation to the patient. Most vital element for this is the airway. Difficulties in optimal airway management can lead to serious adverse effects and failure can even lead to mortality. We have evaluated the feasibility of sonography as an imaging tool in identifying important airway anatomical structures on the anterior aspect of the neck and correlated the ultrasound-guided measurements of the airway parameters with the Cormack Lehane classification of the direct laryngoscopy for prediction of the difficult airway. Aim : To predict Difficult Laryngoscopy by Ultrasound guided valuation Of Anterior Neck Soft Tissue Thickness. Method : The study was a prospective observational study. For this study, n (no of cases) =100 considering power of 95% from the previous study; including patients between the age group of 18 to 65 years, ASA I to III grades, scheduled for elective surgery and requiring general anaesthesia with directlaryngoscopy and endotracheal intubation. Patient with anticipated difficult airway were excluded. Modified Mallampati score, Neck circumference at the level of the thyroid cartilage, Thyromental distance, BMI, distance from skin to hyoid bone and distance from skin to the anterior commissure of vocal cords using the USG machine followed by MCLS grade on laryngoscopy were noted. Result : With reference to ROC analysis, the optimal cut-offs of DSHB, DSAC, neck circumference and BMI measurements for the prediction of difficult Laryngoscopy is 0.81 cm, 0.92 cm, 35.75cm and 24.8 kg/m2 respectively with the area under the curves being 0.944, 0.970, 0.801 and 0.745 respectively. Similarly, the optimal cut-off value for modifiedMallampati grades for the prediction of difficult Laryngoscopy is Grade II and above with area under the curves being 0.718. We also found that with experience the required time to measure the distances using USG was reduced with experience. Conclusion : We conclude from our study that the BMI, modified Mallampati grade and neck circumference are good predictors of difficult laryngoscopy. However, USG guided measurements at the level of hyoid bone and anterior commissure of vocal cords showed a higher specificity and sensitivity for the prediction of difficult laryngoscopy.
Efficacy of video-guided laryngoscope in airway management skills of medical students
Journal of Anaesthesiology Clinical Pharmacology, 2014
Our training program for medical students for airway management traditionally focused on direct laryngoscopy as Background & Aims: Video-guided laryngoscopy, though unproven in achieving better success rates of laryngoscopy outcome and intubation, seems to provide better glottic visualization compared with direct laryngoscopy.The objective of this study was to compare the efficacy of video-guided laryngoscope (VGL) in the airway management skills of medical students. Materials and Methods: Medical students throughout their anesthesiology rotations were enrolled in this study.All students received standard training in the airway management during their course and were randomly allocated into two 20 person groups. In Group D, airway management was performed by direct laryngoscopy via Macintosh blade and in Group G intubation was performed via VGL. Time to intubation, number of laryngoscopy attempts and success rate were noted. Successful intubation was considered as the primary outcome. Statistical Analysis: All data were analyzed using SPSS 16 software. Chi-square and Fisher's exact test were used for analysis of categorical variables. For analyzing continuous variables independent t-test was used. P < 0.05 was considered as statistically significant. Results: Number of laryngoscopy attempts was less in Group G in comparison to Group D; this, however, was statistically insignificant (P: 0.18). Time to intubation was significantly less in Group G as compared to Group D (P: 0.02). Successful intubation in Group G was less frequently when compared to Group D (P: 0.66). Need for attending intervention, esophageal intubation and hypoxemic events during laryngoscopy were less in Group G; this, however, was statistically insignificant. Conclusions: The use of video-guided laryngoscopy improved the first attempt success rate, time to intubation, laryngoscopy attempts and airway management ability of medical students compared to direct laryngoscopy.