Comparison of tracheal intubation with direct laryngoscope using an assistive technique for novice: a manikin study

원준혁,강인혜,김영화,김용환,이준호,조광원,황성연,이동우 대한응급의학회 2020 대한응급의학회지 Vol.31 No.6

Objective: Tracheal intubation is an essential procedure in many emergencies. Direct laryngoscopy is the best method of intubation, but its success is not assured in a difficult airway. This study was designed to compare the performance of two intubation-assisted maneuvers that can help an unskilled person to perform a successful intubation. Methods: A randomized crossover trial for intubation was conducted in three airway scenarios: normal airway, tongue edema (TE) and cervical immobilization (CI). Sixty paramedic students performed intubation on a manikin using single operator intubation (SM), external laryngeal manipulation (ELM), and colleague assisted laryngoscopic maneuver (CALM). The degree of the visual field, intubation success rate, time to ventilation (TTV), tooth fracture, and difficulty of intubation were measured. Results: There was no statistically significant difference in success rates between the three intubation methods, except in CI, where CALM had a significantly higher success rate (91.7%) as compared to ELM (78.3%) and SM (71.7%). There was no significant difference in TTV between the three intubation methods in all scenarios. However, with an improvement in the degree of visual field with ELM and CALM, evaluated using the Cormack-Lehane classification system, there was a statistically significant improvement in both TE and CI. Tooth fractures were lowest when CALM was used. The degree of difficulty felt by operators during intubation also tended to be lower in CALM than other methods, particularly, in CI. Conclusion: For a novice, intubation using CALM was on par or better than ELM in the manikin study. And CALM was a more effective assistive method, specifically in CI cases.

Pre-hospital i-gel blind intubation for trauma: a simulation study

김재국,Wonhee Kim,강구현,장용수,최현영,김형태,Minji Kim 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.1

Objective This study aimed to evaluate the efficacy of i-gel blind intubation (IGI) as a rescue device for definitive airway management in ground intubation for pre-hospital trauma patients. Methods A prospective randomized crossover study was conducted with 18 paramedics to examine intubation performance of two blind intubation techniques through a supraglottic airway devices (IGI and laryngeal mask airway Fastrach), compared with use of a Macintosh laryngoscope (MCL). Each intubation was conducted at two levels of patient positions (ground- and stretcher-level). Primary outcomes were the intubation time and the success rate for intubation. Results The intubation time (sec) of each intubation technique was not significantly different between the two positions. In both patient positions, the intubation time of IGI was shortest among the three intubation techniques (17.9±5.2 at the ground-level and 16.9±3.8 at the stretcher-level). In the analysis of cumulative success rate and intubation time, IGI was the fastest to reach 100% success among the three intubation techniques regardless of patient position (all P<0.017). The success of intubation was only affected by the intubation technique, and IGI achieved more success than MCL (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6; P=0.03). Conclusion The patient position did not affect intubation performance. Additionally, the intubation time with blind intubation through supraglottic airway devices, especially with IGI, was significantly shorter than that with MCL.

119 대원에 의하여 지면 위 자세에서 이루어지는 기관내 삽관에서 비디오 후두경과 부지의 사용이 가지는 효과: 무작위 시뮬레이션 연구

송형우,강구현,장용수,김원희,최현영,김재국,이윤재,김태용,방성환 대한응급의학회 2021 대한응급의학회지 Vol.32 No.4

Objective: This study aimed to evaluate the efficacy of a bougie and glidescope video laryngoscope (GVL) for ground intubation by novice prehospital caregivers. We hypothesized that the intubation outcome using a bougie or GVL was superior to that using the Macintosh laryngoscope (MCL) with a stylet (MCLS) in ground intubation. Methods: A randomized crossover manikin study was conducted. Studied groups were categorized into 4 according to the intubation devices used; MCLS, Macintosh laryngoscope with bougie (MCLB), glidescope video laryngoscope with a stylet (GVLS), and glidescope video laryngoscope with bougie (GVLB). The primary outcome was the total endotracheal intubation time and the secondary outcome was the success rate for endotracheal intubation. Results: The use of a bougie did not cause a significant difference in the intubation time (MCLS vs. MCLB, P=0.213; GVLS vs. GVLB, P=0.633) and the success rate of endotracheal intubation (MCLS vs. MCLB, P>0.990; GVLS vs. GVLB, P=0.077) was compared with the use of a stylet in MCL and GVL. The use of GVL showed a longer endotracheal intubation time compared with MCLS (MCLS vs. GVLS, P<0.001; MCLS vs. GVLB, P<0.001). GVLB showed a decreased success rate of endotracheal intubation compared with the use of MCL (MCLS vs. GVLB, P=0.004; MCLB vs. GVLB, P<0.001). Conclusion: The use of the GVL and a bougie could not affect the performance of endotracheal intubation on the ground. The use of MCL and a stylet for ground intubation could increase the intubation success rate and shorten intubation time compared with the use of a bougie or the use of GVL.

굴곡성 내시경을 이용한 경비기관내삽관 시 후두경으로 관찰한 후두시야(Laryngeal View) 등급과 구강내 출혈이 삽관의 난이도에 미치는 영향

김한욱,서광석,신터전,김현정,Kim, Han-Wook,Seo, Kwang-Suk,Shin, Teo-Jeon,Kim, Hyun-Jeong 대한치과마취과학회 2009 Journal of Dental Anesthesia and Pain Medicine Vol.9 No.2

Background: Nasotracheal intubation for general anesthesia is preferred for oral and maxillofacial procedures because it provides improved access to the operative site. Fiberopic nasotracheal intubation is a useful technique when airway management seems difficult. But, intaoral bleeding is considered as the important factor that makes fiberopic nasotracheal intubation difficult. The purpose of our study was to elucidate the effect of laryngeal view and bleeding on intubation difficulty during fiberopic intubation. Methods: We studied 461 patients undergoing nasotracheal intubation with permission. Laryngeal view grades were examined with laryngoscope and were recorded. Then, intubation time and the amounts of bleeding were measured during fibroptic nasotracheal intubation under general anesthesia. Results: There was no significant difference between laryngeal view grade and intubation difficulty (P > 0.05). But severity of bleeding increased intubation difficulty (P < 0.05). Conclusions: In this study, the significant amounts of bleeding had an effect on intubation difficulty.

전신마취를 시행한 구강외과 환자에서 어려운 기관내삽관: 후향적 연구

권오선,김철홍,Kwon, O-Seon,Kim, Cheul-Hong 대한치과마취과학회 2008 Journal of Dental Anesthesia and Pain Medicine Vol.8 No.2

Background: This retrospective study aims to describe the airway management and to search predictive parameter for difficult intubation in 700 patients undergoing oromaxillary surgery. Methods: The medical records of 700 patients undergone oromaxillary surgery were reviewed for airway management during perioperative period. The cases of difficult intubation were selected and those radiologic findings were reviewed. The mandibular depth (MD), mandibular length (ML), thyromental distance (TMD) were measured. Results: In 41 cases difficult intubation were recorded in anesthetic record. The grade of Cormack and Lehane was III in 36 patients and IV in 5 cases. The MD of difficult intubation cases was $4.2{\pm}3.2\;cm$. The ML of difficult intubation cases was $10.1{\pm}3.8\;cm$. The TMD of difficult intubation cases was $5.9{\pm}4.3\;cm$. Under the fiberoptic guided awake intubation was undertaken in 75 patient. In none of the cases was failed nasotracheal intubation. Conclusions: The patients undergoing oromaxillar surgery have a potentially difficult airway but, if managed properly during perioperative preiod, morbidity and mortality can be reduced or avoided. The radiologic findings were poor predict for difficult intubation. The fiberoptic guided awake intubation is a safe alternative to direct laryngoscopic intubation.

Endotracheal intubation in patients undergoing open abdominal surgery in the lateral position: a comparison between the intubating video stylet and fiberoptic intubating bronchoscopy

Wahdan Amr Samir,El-Refai Nesrine Abdel rahman,Omar Sohaila Hussien,Abdel Moneem Shady Amr,Mohamed Mennatallah Magdi,Hussien Mohamed Mahmoud 대한마취통증의학회 2021 Korean Journal of Anesthesiology Vol.74 No.3

Background: Some situations compel anesthetists to execute endotracheal intubation in the lateral position. We compared elective endotracheal intubation in the lateral decubitus position using the video stylet (VS) device with the fiberoptic (FO) bronchoscope device in patients undergoing abdominal surgery.Methods: Overall, 50 patients were enrolled in this prospective, randomized study. They were randomly classified into the VS intubation or FO intubating bronchoscope group. After anesthesia induction, patients were placed in the lateral decubitus position, and a single investigator well-versed with the use of the VS and FO bronchoscope performed the intubation. The primary outcome was the time taken for intubation. Secondary outcomes included the intubation success rate, hemodynamic response at specific time points and perioperative complications.Results: The average time taken for intubation was significantly lesser in the VS group than in the FO group, with values of 39.5 ± 10.0 and 75.6 ± 16.2 s, respectively (P < 0.001). Incidences of a successful first attempt of intubation in the VS and FO groups were 88% and 100%, respectively, showing no significant difference. There was a negligible difference in complications between the groups, except sore throat, which showed a higher incidence in the VS group than in the FO group (P = 0.002).Conclusions: In laterally positioned patients, elective endotracheal intubation with VS provides less intubation time; however, its use is accompanied by a significant increase in the hemodynamic response after intubation and an increased incidence of sore throat.

기관내 삽관이 힘든 경우에서 Bonfils Intubation Fibrescope 사용의 임상적인 효과

이덕희,권일치 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

직접 후두경하에 기관내 삽관의 난이도를 Cormack & Lehane 등급에 따라 분류하여 등급 3 또는 4에 해당하는 환자 40명을 대상으로 하였다. 모든 환자들이 적절한 마취 심도에 도달한 후 직접 후두경으로 성대와 후두개의 노출 여부를 판단하여 Cormack & Lehane 등급 3 또는 4에 해당되면 직접 후두경을 제거하고 대신 Bonfils intubation fibrescope으로 기관 내 삽관을 시도하였다. 기관내 삽관의 성공 여부, 삽관 시도 횟수, 삽관에 소용되는 시간, 턱에서 갑상연골의 상부 방패패임까지의 길이(thyromental distance), 턱에서 흉골 상부까지의 길이(sternomental distance) 그리고 SpO₂가 90%이하로 감소하는 지의 여부를 기록하였다. 이 외에 기관내 삽관동안 폐내흡인, 역류, 기관지경련, 기도 폐쇄, 경추 손상 그리고 치아 손상 여부 등이 발생하는지를 관찰하였다. Cormack & Lehane 등급 3에서는 96.9%의 기관내 삽관 성공률을 보였으며 등급 4에서는 50%의 성공률을 나타내어 등급 간 통계적으로 유의한 차이가 있었다(P<0.01). 기관내 삽관에 소요된 시간은 등급 3에서 20 (10-49[7-300])초였고 등급 4에서 180 (31-300[10-300])초로 통계적으로 유의하였다(P=0.01). 기관내 삽관시 SpO₂가 90% 이하로 감소된 경우는 등급 3에서 3.1%, 등급 4에서 50%로 통계적으로 유의한 차이를 나타내었다(P<0.01). 기관내 삽관 성공률과 삽관에 소요된 시간으로 보아 Bonfils intubation fibrescope은 Cormack & Lehane 등급 3인 환자에서 유용한 기도 관리 장비로 보이나 등급 4인 환자에서는 항상 선택적으로 사용할 수 있는 기도 관리 장비라고는 할 수 없으며, 기관내 삽관 시 다른 대체 장비가 필요할 가능성도 있음을 알아야 하겠다. Background: This study was undertaken to evaluate the effectiveness of the Bonfils intubation fibrescope for cases of difficult tracheal intubation. Materials and Methods : For patients with an ASA physical status 1 or 2 betwen the ages of 20-90, direct laryngoscopy was performed and the layngoscopic view graded according to the Cormack and Lehane classification. Forty patients with Cormack and Lehane grade 3 or 4 were intubated using the Bonfils intubation fibrescope. During intubation, the success rates for tracheal intubation, overall time to intubation, number of attempts and adverse effects were recorded. The Thyromental and sternomental distances were recorded after the orotracheal intubation. Results : The success rates were significantly higher in Cormack and Lehane grade 3 (96.9%) patients compared to grade 4 (50%) (P<0.01). The time to intubation was significantly faster in patients with grade 3 compared to grade 4 (20 (10-49[7-300]) sec vs. 180 (31-300[10-300]) sec, P=0.01). The number of cases with a SpO₂<90% was significantly lower in patients with grade 3 (3.1%) compared to grade 4 (50%) (P<0.01). Conclusion : In patients with Cormack and Lehane grade 3, tracheal intubation using the Bonfils intubation fibrescoper appears to be an effective technique for the management of a difficult intubation. However, the Bonfils intubation fibrescope can not always be used for the management of a difficult intubation in grade 4 patients; for these patients other effective instruments should be considered for difficult intubations.

임상연구 : Bonfils Intubation Fibrescope과 후두경을 이용한 기관내 삽관 시 혈압과 심박수 변화의 비교

윤지환 ( Ji Hwan Yun ),이덕희 ( Deok Hee Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5

Background: The hemodynamic changes associated with orotracheal intubation may result from direct laryngoscopy and the endotracheal intubation. This study evaluated and compared the cardiovascular changes after either Bonfils intubation fiberscope or conventional laryngoscopic endotracheal intubation. Methods: Sixty patients, aged 20 to 30 years, were randomly allocated into two groups, the Bonfils intubation fiberscope group (BF group, n = 30) and conventional intubation using a rigid laryngoscope (LS group, n = 30). Bonfils intubation fiberscope or laryngoscopic oral endotracheal intubation was performed after inducing anesthesia. The systolic and diastolic arterial pressures, heart rate, peripheral oxygen saturation and intubation time were recorded before and after orotracheal intubation. Results: In both groups, the systolic and diastolic arterial pressures increased significantly after endotracheal intubation. The heart rate increased significantly after the induction of anesthesia in both groups. However, the arterial blood pressure, heart rate and intubation time were similar in both groups. Conclusions: The use of a Bonfils intubation fibrescope does not modify the hemodynamic response associated with endotracheal intubation compared with conventional laryngoscopy. (Korean J Anesthesiol 2006; 51: 547~51)

Pentax AWS와 Macintosh 후두경을 이용한 비기관내 삽관의 비교

심여해 ( Yeo Hae Sim ),박성준 ( Sung Jun Park ),김건식 ( Keon Sik Kim ),김미경 ( Mi Kyeong Kim ) 경희대학교 경희의료원 2015 慶熙醫學 Vol.30 No.1

Purpose: Pentax-Airway Scopeⓡ system (AWS; Pentax Corporation, Tokyo, Japan) can facilitate tracheal intubation. In this study, We assessed the Pentax- AWS compared with Macintosh laryngoscope whether it increase the success rate of intubation and provide a better field of vision in the oral and maxillofacial surgery patients requiring nasotracheal intubation. Methods: The control and experimental groups of 31 were randomly assigned to each of the oral and maxillofacial surgery patients requiring nasotracheal intubation under general anesthesia. The patient``s preoperative Mallampati classification, thyromental distance and interincisor distance was measured. The primary endpoint was the spending time of intubation. After successful intubation, practitioners were recorded Cormack and Lehane grade and ease of intubation. Results: Time for nasotracheal intubation with the Pentax-AWS (mean 71 [SD 21.7] sec) was significantly shorter than with the Macintosh laryngoscope (mean 96 [SD 37.4] sec]. There was no significant difference in the number of intubation attempts between the two groups. The Pentax-AWS had a good visibility by Cormack and Lehane classification. Ease of intubation was showed significantly in pentax-AWS group. Conclusion: The Pentax-AWS ensure a better field of view and short time of intubation compared to the Macintosh laryngoscope in nasotracheal intubation for the oral and maxillofacial surgery.

응급센터에서의 기관내 삽관

서길준 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background. Endotracheal intubation is one of the most important and challenging tasks that an emergency physician has to perform. Complications associated with this procedure range from local trauma of the airway to death caused by unrecognized misplacement of the endotracheal tube. This study was designed to investigate complications of intubation including rapid sequence intubation in the emergency department. Method. One hundred four consecutive patients requiring endotracheal intubation in the emergency department of the Stanford Medical Center over a 8-month period were studied prospectively. Result. The indications for intubation were acute respiratory failure(60.5%), airway protection(30.8%), and cardiopulmonary arrest(8.7%). 97(93.3%) intubations were inserted orally, remaining 7(6.7%) were intubated via the nasotracheal route. Of 97 orotracheal intubations, rapid sequence intubation was used in 71(73.2%) cases. Grouped by level of training, junior residents attempted 69(66.3%) intubations, senior residents 21(20.2%), and staff 13(12.5%). Of the 104 intubations, 92(88.5%) were successful on the first or second attempt. 12 procedures(11.5%) required more than two attempts at intubation. A total of 36(34.6%) complications occurred. Esophageal intubations occurred in 13 cases, right main stem intubation in 13, pulmonary aspiration in 4, and others in 6. Fourteen patients(13.5%) died after intubation. Conclusion. The complication rate of endotracheal intubation in the emergency department is high. In order to decrease the complication, detailed knowledge, skill, and equipments about endotracheal intubation are required. The good condition of a patient before intubation appears to be important for survival.