scholarly journals Intubación orotraqueal por medio de fibrobroncoscopio flexible sin conductor vs guiada con máscara laríngea AuraGain en simuladores pediátricos: Ensayo clínico cross over

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Mario Zamudio Burbano ◽  
Sebastián Tamayo Orozco ◽  
Carolina Alzate Saldarriaga ◽  
Juan Luis Ramírez Latorre ◽  
Fabián Casas Arroyave
Keyword(s):  
Cardiac Arrest ◽  
Pediatric Population ◽  
Upper Airway ◽  
Orotracheal Intubation ◽  
Laryngeal Mask ◽  
Intubation Time ◽  
Successful Intubation ◽  
Airway Obstructions ◽  
Potential Risks ◽  
Ensayo Clínico

Antecedentes: La incidencia de intubación difícil en población pediátrica es de 2 a 11 casos por 1000 pacientes llevados a anestesia general, lo que conlleva riesgos potenciales como hipoxemia, parada cardíaca y muerte. Dentro de las estrategias para el manejo de la vía aérea difícil en los niños se encuentra el uso de fibroscopia flexible para guiar la intubación, que se puede combinar con un dispositivo supraglótico con la finalidad de facilitar su inserción, superar obstrucciones de la vía aérea superior y permitir una ventilación simultánea. El objetivo de este estudio fue comparar la intubación orotraqueal en simuladores pediátricos, utilizando fibrobroncoscopio flexible sin conductor versus el uso de la máscara laríngea AuraGain como conductor, con el fin de demostrar si el uso de dicho dispositivo supra glótico tiene alguna ventaja comparado con intubar sin conductor. Métodos: 41 anestesiólogos y residentes de anestesiología, fueron asignados al azar para realizar una intubación orotraqueal en un simulador pediátrico, utilizando fibrobroncoscopio flexible sin conductor o utilizando como guía la máscara laríngea AuraGain. Resultados: La intubación exitosa en el primer intento se consiguió en 38 de 41 intubaciones en el grupo de fibrobroncoscopia sin conductor y en 32 de 41 intubaciones en el grupo de fibrobroncoscopia con AuraGain, sin encontrar diferencias estadísticamente significativas. El grupo de fibrobroncoscopia sin conductor tuvo una mediana de tiempo de intubación significativamente más corta (41 segundos), comparado con el grupo de fibrobroncoscopia y AuraGain (67.5 segundos). Conclusiones: Usar el dispositivo AuraGain como conductor para intubar simuladores pediátricos con fibra óptica no mejora la intubación al primer intento, la intubación global, ni la visualización glótica, comparado con intubar solo con fibra óptica. Usar AuraGain aumenta los tiempos de intubación, sin embargo, dichos hallazgos deben ser confirmados en estudios con humanos. Background: The incidence of difficult intubation in pediatric population is 2 to 11 cases per 1000 patients brought to general anesthesia, which carries potential risks such as hypoxemia, cardiac arrest and death. Among the strategies for the management of difficult airway in children is the use of flexible fiberscopy to guide intubation, which can be combined with a supraglottic device in order to facilitate its insertion, overcome upper airway obstructions and allow simultaneous ventilation. The aim of this study was to compare orotracheal intubation in pediatric simulators, using a flexible fibrobronchoscope without driver versus using the AuraGain laryngeal mask as a driver, in order to demonstrate whether the use of such a supraglottic device has any advantage compared to intubating without a driver. Methods: 41 anesthesiologists and anesthesiology residents were randomly assigned to perform orotracheal intubation in a pediatric simulator using either a flexible fibrobronchoscope without a driver or the AuraGain laryngeal mask as a guide. Results: Successful intubation on the first attempt was achieved in 38 of 41 intubations in the driverless fibrobronchoscopy group and in 32 of 41 intubations in the fibrobronchoscopy with AuraGain group, with no statistically significant differences. The driverless fibrobronchoscopy group had a significantly shorter median intubation time (41 seconds) compared to the fibrobronchoscopy and AuraGain group (67.5 seconds). Conclusions: Using the AuraGain device as a driver to intubate pediatric simulators with fiberoptics does not improve first-attempt intubation, overall intubation, or glottic visualization compared with intubating with fiberoptics alone. Using AuraGain increases intubation times, however, such findings need to be confirmed in human studies.

scholarly journals Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population

2020 ◽  
pp. 014556132091910
Author(s):  
Lauren E. Miller ◽  
Adva Buzi ◽  
Ashley Williams ◽  
Rachel S. Rogers ◽  
Angel G. Ortiz ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Upper Airway ◽  
Office Visit ◽  
Rater Agreement ◽  
Vocal Cords ◽  
Coupling Device ◽  
Overall Evaluation ◽  
Survey Results ◽  
Device Use ◽  
False Vocal

Introduction: Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL). Methods: A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic. Results: Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly. Conclusion: A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.

The Effect of Successful Intubation on Patient Outcomes After Out-of-Hospital Cardiac Arrest in Taipei

2018 ◽  
Vol 71 (3) ◽  
pp. 387-396.e2 ◽  
Author(s):  
Wen-Chu Chiang ◽  
Ming-Ju Hsieh ◽  
Hsin-Lan Chu ◽  
Albert Y. Chen ◽  
Shin-Yi Wen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Patient Outcomes ◽  
Successful Intubation ◽  
Hospital Cardiac Arrest

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

scholarly journals Paediatric paediatric tracheostomy: Changing indications and key complications

2020 ◽  
Vol 8 (6) ◽  
pp. 175-180
Author(s):  
Guilherme Movio ◽  
Ms Shadaba Ahmed
Keyword(s):  
Health Care Professionals ◽  
Survival Rates ◽  
Ventilatory Support ◽  
Upper Airway ◽  
Multidisciplinary Teams ◽  
Vaccination Programs ◽  
Airway Obstructions ◽  
Life Threatening ◽  
Indications And Complications

Background: Paediatric Tracheostomy is a procedure used to ventilate children through a hole in the trachea. Indications for the procedure were once primarily for acute upper airway obstruction due to infections but have now changed. Generally, there is poor knowledge surrounding tracheostomies and a limited knowledge of guidelines amongst health-care professionals. Aim: The aim of this review is to discuss the basis of changes to the indications of paediatric tracheostomy. It  will also investigate the key complications related to the procedure and discuss the importance of multidisciplinary teams being aware of the emergency algorithms for dealing with such complications. Findings: Indications have changed due to advancements in medicine with increased life expectancy and survival rates for children with often life threatening congenital conditions. Tracheostomies can offer these children long term ventilatory support. Upper airway obstructions due to infections are now infrequently indicated for tracheostomy due to successful vaccination programs. Complications today are because of obstructions and decannulations. Intra-operative complications are infrequent, due to refinements in surgical technique. Conclusion: Paediatric Tracheostomy is a rapidly evolving field because of continuous advancements in neonatal and intensive care medicine. The indications and complications have changed together over the last four decades. A greater understanding of tracheostomy complications is requiredfor successful management.

Artificial Intelligence in Predicting Cardiac Arrest: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Asma Alamgir ◽  
Osama Mousa 2nd ◽  
Zubair Shah 3rd
Keyword(s):  
Artificial Intelligence ◽  
At Risk ◽  
Cardiac Arrest ◽  
Scoping Review ◽  
Pediatric Population ◽  
Data Extraction ◽  
Warning System ◽  
Reference List ◽  
Evaluation Tool ◽  
Patients At Risk

BACKGROUND Cardiac arrest is a life-threatening cessation of heart activity. Early prediction of cardiac arrest is important as it provides an opportunity to take the necessary measures to prevent or intervene during the onset. Artificial intelligence technologies and big data have been increasingly used to enhance the ability to predict and prepare for the patients at risk. OBJECTIVE This study aims to explore the use of AI technology in predicting cardiac arrest as reported in the literature. METHODS Scoping review was conducted in line with guidelines of PRISMA Extension for Scoping Review (PRISMA-ScR). Scopus, Science Direct, Embase, IEEE, and Google Scholar were searched to identify relevant studies. Backward reference list checking of included studies was also conducted. The study selection and data extraction were conducted independently by two reviewers. Data extracted from the included studies were synthesized narratively. RESULTS Out of 697 citations retrieved, 41 studies were included in the review, and 6 were added after backward citation checking. The included studies reported the use of AI in the prediction of cardiac arrest. We were able to classify the approach taken by the studies in three different categories - 26 studies predicted cardiac arrest by analyzing specific parameters or variables of the patients while 16 studies developed an AI-based warning system. The rest of the 5 studies focused on distinguishing high-risk cardiac arrest patients from patients, not at risk. 2 studies focused on the pediatric population, and the rest focused on adults (n=45). The majority of the studies used datasets with a size of less than 10,000 (n=32). Machine learning models were the most prominent branch of AI used in the prediction of cardiac arrest in the studies (n=38) and the most used algorithm belonged to the neural network (n=23). K-Fold cross-validation was the most used algorithm evaluation tool reported in the studies (n=24). CONCLUSIONS : AI is extensively being used to predict cardiac arrest in different patient settings. Technology is expected to play an integral role in changing cardiac medicine for the better. There is a need for more reviews to learn the obstacles of implementing AI technologies in the clinical setting. Moreover, research focusing on how to best provide clinicians support to understand, adapt and implement the technology in their practice is also required.

scholarly journals Comparative Study of Propofol Versus Thiopental Sodium with Succinylcholine for Laryngeal Mask Airway (LMA) Insertion

2018 ◽  
Vol 10 (1) ◽  
pp. 11-15
Author(s):  
Chandra Shekhar Karmakar ◽  
Md Afzalur Rahman ◽  
Mohammad Rezaul Karim ◽  
Monirul Islam ◽  
Md Shahidul Islam ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Low Dose ◽  
Upper Airway ◽  
Laryngeal Mask ◽  
Airway Reflex ◽  
Haemodynamic Changes ◽  
Thiopental Sodium ◽  
Group 2 ◽  
Insertion Condition ◽  
Group 1

Background: The increasing emphasis on day case anaesthesia has lead to the greater use of the laryngeal mask airway (LMA) as an alternative to intubation. Laryngoscopy and tracheal intubation are noxious stimuli, which cause a reflex increase in both sympathetic and sympathoadrenal activity that may result in tachycardia, hypertension and dysarrhythmias. Insertion of Laryngeal mask airway (LMA) is associated with less haemodynamic changes, minimal increase in intraocular and intracranial pressure and lower incidence of sore throat. Still its insertion requires sufficient depth of anesthesia to prevent airway reflex (gagging, coughing nd spasms). To insert LMA successfully propofol is the most frequently administered medication. But most of all recommend not using propofol singly for LMA insertion. Thiopental can’t suppress the upper airway reflexes as propofol but with low dose succinylcholine upper airway reflexes are attenuated so combination of thiopental sodium with succinylcholine may be another choice of drug.Objectives: This Prospective study was conducted to evaluate the effectiveness of Thiopental sodium and Succinylcholine for insertion of the LMA in comparison with Propofol.Methods: This interventional study was carried out in Sixty patients, aged 3-45 years who were scheduled for elective surgical procedure under general anaesthesia in ShSMCH. Patients were randomly assigned to two groups by odd and even number basis. In Group-1 (N1=30), LMA was inserted after induction with Thiopental sodium (5 mg/kg body weight i.v.) and Succinylcholine (0.5mg/kg i.v); in Group-2 (N2 = 30), the LMA was inserted with Propofol (2.5mg/kg i.v). Jaw relaxation, incidence of coughing- gagging , overall insertion condition and haemodynamic changes were observed.Results: Grade of jaw relaxation in Group-1 was Good in 93.3%, incomplete in 6.7% and 0% poor but in Group-2, 86.7% was good 10% incomplete and 3.3% was poor. Coughing occurred in 33.3% of patients in the Group-2 and there was only 10% in succinyl group (P=0.028) which is significantly higher in Group-2. Overall insertion condition in Group -1 was excellent in 86.7%, Good in 10% cases and poor in only 3.3% cases on the other hand in Group-2 excellent in 53.3%, Good in 33.3% cases and poor in only 13.3% cases (P=0.019).Conclusion: There was statistically significant difference in jaw relaxation in two groups and incidence of Gagging or Coughing is higher in Group-2. Overall insertion condition was significantly better in Group-1. We concluded that Thiopental sodium with low dose Suxamethonium is an effective alternative of Propofol.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 11-15

Validity of administrative claims‐based algorithms for ventricular arrhythmia and cardiac arrest in the pediatric population

2020 ◽  
Vol 29 (11) ◽  
pp. 1499-1503 ◽  
Author(s):  
Angela S. Czaja ◽  
Kathryn Collins ◽  
Robert J. Valuck ◽  
Heather D. Anderson ◽  
Debashis Ghosh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Arrhythmia ◽  
Pediatric Population ◽  
Administrative Claims

scholarly journals Pharyngo-laryngeal discomfort after breast surgery: Comparison between orotracheal intubation and laryngeal mask

The Breast ◽  
2009 ◽  
Vol 18 (1) ◽  
pp. 1 ◽  
Author(s):  
Matteo Parotto ◽  
Massimo Micaglio ◽  
Carlo Ori ◽  
Daniele Trevisanuto
Keyword(s):  
Breast Surgery ◽  
Orotracheal Intubation ◽  
Laryngeal Mask
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