scholarly journals Current practice of German anesthesiologists in airway management

2021 ◽  
Author(s):  
Nina Pirlich ◽  
Matthias Dutz ◽  
Eva Wittenmeier ◽  
Marc Kriege ◽  
Nicole Didion ◽  
...  
Keyword(s):  
Airway Management ◽  
Current Practice ◽  
Management Practice ◽  
German Society ◽  
Video Laryngoscope ◽  
Questionnaire Response ◽  
Potential Safety ◽  
Difficult Airways ◽  
The Difference ◽  
Airway Devices

Abstract Background There is a worldwide consensus among experts that guidelines and algorithms on airway management contribute to improved patient safety in anesthesia. The present study aimed to determine the current practice of airway management of German anesthesiologists and assess the safety gap, defined as the difference between observed and recommended practice, amongst these practitioners. Objective To determine the effect of implementing the guidelines on airway management practice in Germany amongst anesthesiologists and identify potential safety gaps. Methods A survey was conducted in September 2019 by contacting all registered members of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) via email. The participants were asked about their personal and institutional background, adherence to recommendations of the current German S1 guidelines and availability of airway devices. Results A total of 1862 DGAI members completed the questionnaire (response rate 17%). The main outcome was that anesthesiologists mostly adhered to the guidelines, yet certain recommendations, particularly pertaining to specifics of preoxygenation and training, showed a safety gap. More than 90% of participants had a video laryngoscope and half had performed more than 25 awake intubations using a flexible endoscope; however, only 81% had a video laryngoscope with a hyperangulated blade. An estimated 16% of all intubations were performed with a video laryngoscope, and 1 in 4 participants had performed awake intubation with it. Nearly all participants had cared for patients with suspected difficult airways. Half of the participants had already faced a “cannot intubate, cannot oxygenate” (CICO) situation and one in five had to perform an emergency front of neck access (eFONA) at least once. In this case, almost two thirds used puncture-based techniques and one third scalpel-based techniques. Conclusion Current practice of airway management showed overall adherence to the current German guidelines on airway management, yet certain areas need to be improved.

Video Laryngoscopy in the Prehospital Setting

2009 ◽  
Vol 24 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Lars P. Bjoernsen ◽  
Bruce Lindsay
Keyword(s):  
Airway Management ◽  
Case Reports ◽  
Video Laryngoscope ◽  
Prehospital Setting ◽  
Video Laryngoscopy ◽  
Cervical Spine Injuries ◽  
Emergency Airway ◽  
Spine Mobility ◽  
Prehospital Emergency ◽  
Difficult Airways

AbstractIn the prehospital setting, the emergency care provider must anticipate that some patients will manifest with difficult airways. The use of video laryngoscopy to secure an airway in the prehospital setting has not been explored widely, but has the potential to be a useful tool. This article briefly reviews some of the major video laryngoscopes on the market and their usefulness in the prehospital setting. Studies and case reports indicate that the video laryngoscope is a promising device for emergency intubation, and it has been predicted that, in the future, video laryngoscopy will dominate the field of emergency airway management.Direct laryngoscopy always should be retained as a primary skill; however, the video laryngoscope has the potential to be a good primary choice for the patient with potential cervical spine injuries or limited jaw or spine mobility, and in the difficult-to-access patient.The role of video laryngoscopes in securing an airway in head and neck trauma victims in the prehospital setting has yet to be determined, but offers interesting possibilities. Further clinical studies are necessary to evaluate its role in airway management by prehospital emergency medical services.

The Difficult Airway (DRAFT)

2018 ◽  
Author(s):  
Dennis Phillips ◽  
Joshua Knight
Keyword(s):  
Laryngeal Mask Airway ◽  
Difficult Airway ◽  
Rapid Response Team ◽  
Video Laryngoscope ◽  
Rapid Response ◽  
Response Team ◽  
Airway Response ◽  
Difficult Airways ◽  
Surgical Airway ◽  
Airway Devices

The difficult airway invariably presents itself to all airway managers and is mostly unpredictable in the context of rapid response team (RRT) calls. A multiprofessional difficult airway team (DAT) that could be called for airway emergencies is likely to reduce complications and death. The DAT is organized with predefined roles for each member so that rapid intervention occurs during the emergency. Priority is given to oxygenation throughout the airway response. The anticipated and unanticipated difficult airways should be approached differently and often require medication adjuncts that should be carefully chosen. Airway devices such as the video laryngoscope and the laryngeal mask airway (LMA) have dramatically improved the ability to secure an airway quickly. Finally, it is important to recognize when a surgical airway is needed in the setting of the RRT calls.

scholarly journals Elective use of supraglottic airway devices for primary airway management in children with difficult airways †

2014 ◽  
Vol 112 (4) ◽  
pp. 742-748 ◽  
Author(s):  
N. Jagannathan ◽  
L. Sequera-Ramos ◽  
L. Sohn ◽  
B. Wallis ◽  
A. Shertzer ◽  
...  
Keyword(s):  
Airway Management ◽  
Supraglottic Airway ◽  
Supraglottic Airway Devices ◽  
Difficult Airways ◽  
Airway Devices

An Update on Airway Management

2020 ◽  
Keyword(s):  
Airway Management ◽  
Surgical Techniques ◽  
Daily Practice ◽  
Postoperative Management ◽  
Diagnostic Methods ◽  
Emergency Rooms ◽  
Specific Patient ◽  
Medical Practitioners ◽  
Preoperative Diagnostic ◽  
Airway Devices

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases

scholarly journals Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jürgen Knapp ◽  
Bettina Eberle ◽  
Michael Bernhard ◽  
Lorenz Theiler ◽  
Urs Pietsch ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Control ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Success Rate ◽  
Video Laryngoscope ◽  
Solar Irradiation ◽  
Video Laryngoscopy ◽  
Trauma Patients ◽  
Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

scholarly journals Successful tracheal intubation with video laryngoscope when awake fiberoptic bronchoscopy failed in a patient with hypopharyngeal mass

2017 ◽  
Vol 4 (1) ◽  
pp. 35-37
Author(s):  
Somnath Goyal ◽  
Anita Kulkarni
Keyword(s):  
Computed Tomography ◽  
Fiberoptic Bronchoscopy ◽  
Video Laryngoscope ◽  
Clinical Scenario ◽  
Tube Insertion ◽  
Feeding Jejunostomy ◽  
Difficult Airways ◽  
Difficult Endotracheal Intubation ◽  
Carcinoma Of Hypopharynx ◽  
Ryle’S Tube

Video laryngoscope is one of best alternative in managing difficult airways. Our patient presented with left side neck pain and hoarseness of voice for three months, dysphagia to solids for two months. Computed tomography revealed large hypopharyngeal mass and a diagnosis of carcinoma of hypopharynx was made. As endoscopic Ryle’s tube insertion by gastroenterologist was unsuccessful so he was posted for Feeding jejunostomy under general anaesthesia. We anticipated difficult endotracheal intubation. Our first attempt to secure airway with awake fiberoptic bronchoscopic intubation was unsuccessful. Using an alternative method with bougie and video laryngoscopy, the trachea was successfully intubated. In rare clinical scenario fiberoptic bronchoscopic intubation may fail, hence we need to be prepared with the backup plan for airway management. A video laryngoscope might be useful in such situations.

scholarly journals A Comparative Study of Intubation Performance between Channelled vs. Non-Channelled Blade of King Vision Video Laryngoscope in Orotracheal Intubation

2021 ◽  
Vol 8 (12) ◽  
pp. 732-736
Author(s):  
Shalini Bajpai
Keyword(s):  
Comparative Study ◽  
Statistical Difference ◽  
Orotracheal Intubation ◽  
Video Laryngoscope ◽  
Intubation Time ◽  
Anaesthesia Practice ◽  
Measured Time ◽  
Difficult Airways

BACKGROUND Video laryngoscope is an important tool for orotracheal intubation in anaesthesia practice particularly in difficult airways. It provides an indirect view of glottis without the need of alignment of oropharyngeal-laryngeal axis. We compared the intubation characteristics of channelled versus non-channelled blades of King VisionTM Video Laryngoscope. METHODS In this study 60 patients were randomly allocated to two groups; group C were intubated with channelled and group NC with non-channelled blade of King Vision. We measured time for glottis visualisation and intubation time using both blades. Percentage of glottis opening (POGO), insertion attempts, intubation attempts, and ease of intubation were also assessed. RESULTS The time for glottis visualisation was 8.5 ± 3 seconds for group C and 7 ± 2 seconds for group NC. Intubation time was 24 ± 8.5 seconds for group C and 44 ± 5 seconds for NC. There was no statistical difference in POGO, insertion attempts, intubation attempts and ease of intubation between the two groups. CONCLUSIONS We concluded that the time for glottis recognition is longer but intubation time is shorter when using King Vision video laryngoscope channelled blade as compared to non-channelled blade. KEYWORDS Video Laryngoscope, King Vision, Channelled, Non-Channelled

Sign in / Sign up

Export Citation Format

Share Document