Dataset Information

A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study.

ABSTRACT:

Objective

We sought to determine whether the use of Pentax-AWS Airwayscope (AWS) applied less force on oral structures during intubation attempts than a conventional direct laryngoscope (DL).

Design

Prospective cross-over study.

Participants

A total of 37 physicians (9 transitional-year residents, 20 emergency medicine residents and 8 emergency physicians) were enrolled.

Interventions

We used four simulation scenarios according to the difficulty of intubation and devices and used a high-fidelity simulator to quantify the forces applied on the oral structures.

Outcome measures

Primary outcomes were the maximum force applied on the maxillary incisors and tongue. Other outcomes of interest were time to intubation and glottic view during intubation attempts.

Results

The maximum force applied on the maxillary incisors in the normal airway scenario was higher with the use of AWS than that with DL (107 newton (N) vs 77 N, p=0.02). By contrast, the force in the difficult airway scenario was significantly lower with the use of AWS than that of the DL (89 N vs 183 N, p<0.01). Likewise, the force applied on the tongue was significantly lower with the use of AWS than the use of DL in both airway scenarios (11 N vs 27 N, p<0.001 in the normal airway scenario; 12 N vs 40 N, p<0.01 in the difficult airway scenario).

Conclusions

The use of AWS during intubation attempts was associated with decreased forces applied to oral structures in the simulated difficult airway scenario.

SUBMITTER: Goto T

PROVIDER: S-EPMC4194748 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Publications

A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study.

Goto Tadahiro T Koyama Yasuaki Y Kondo Takashiro T Tsugawa Yusuke Y Hasegawa Kohei K

BMJ open 20141008 10

<h4>Objective</h4>We sought to determine whether the use of Pentax-AWS Airwayscope (AWS) applied less force on oral structures during intubation attempts than a conventional direct laryngoscope (DL).<h4>Design</h4>Prospective cross-over study.<h4>Participants</h4>A total of 37 physicians (9 transitional-year residents, 20 emergency medicine residents and 8 emergency physicians) were enrolled.<h4>Interventions</h4>We used four simulation scenarios according to the difficulty of intubation and dev ...[more]

PMID: 25296656

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Project description:A variety of instruments are used to perform airway management by tracheal intubation. In this study, we compared the MacIntosh balde (MB) laryngoscope with the Bonfils intubation fibrescope as intubation techniques. The aim of this study was to identify the technique (MB or Bonfils) that would allow students in their last year of medical school to perform tracheal intubation faster and with a higher success probability. Data were collected from 150 participants using an airway simulator ['Laerdal Airway Management Trainer' (Laerdal Medical AS, Stavanger, Norway)]. The participants were randomly assigned to a sequence of techniques to use. Four consecutive intubation 'trials' were performed with each technique. These trials were evaluated for differences in the following categories: the 'time to successful ventilation', 'success probability' within 90 s,'time to visualisation' of the vocal cords (glottis), and 'quality of visualisation' according to the Cormack and Lehane score (C&L, grade 1-4). The primary endpoint was the 'time to successful ventilation'in the fourth and final trial.There was no statistically significant difference in the 'time to successful ventilation' between the two techniques in trial 4 ('time to successful ventilation': median: MB: 16 s, Bonfils: 14 s, p = 0.244). However, the 'success probability' within 90 s was higher when using a Macintosh blade than when using a Bonfils (95 vs. 87%). The glottis could be better visualised when using a Bonfils (C&L score of 1 (best view): MB: 41%, Bonfils: 93%), but visualisation was achieved more rapidly when using a Macintosh blade (median: 'time to visualisation': MB: 6 s, Bonfils: 8 s, p = 0.003).The time to ventilation using the MacIntosh blade and Bonfils mainly did to differ, however success probabilities and time to visualisation primary favoured the MacIntosh blade as intubation technique, although the Bonfils seem to have a steeper learning curve. The Bonfils is still a promising intubation technique and might be easier to learn as the MB, at least in a manikin.

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Dataset Information

A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study.

Objective

Design

Participants

Interventions

Outcome measures

Results

Conclusions

Publications

A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study.

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