Anesthesia and analgesia最新文献

Background: Several health care networks have fully adopted second-generation supraglottic airway (SGA) i-gel. Real-world evidence of enhanced patient safety after such practice change is lacking. We hypothesized that the implementation of i-gel compared to the previous LMA®-Unique™ would be associated with a lower risk of airway-related safety events.

Methods: Adult patients undergoing general anesthesia with LMA-Unique or i-gel between January 2013 and June 2020 at an academic health care network were included. We assessed the influence of i-gel implementation on the trends of intraoperative airway-related safety events, a composite outcome of respiratory disturbances including intraoperative desaturation (<90%), hypo- or hypercapnia (<25 or >50 mm Hg), high driving pressures (>30 cmH2O), low tidal volumes (<4 mL/kg), multiple attempts of SGA placement, or emergency replacement with a tracheal tube, using adjusted ordinary least-squares regression interrupted time series analysis.

Results: A total of 21,417 patients were included, and 5193 experienced airway-related safety events (24.2%). After the wider uptake of i-gel in January 2018, the reduction in the monthly trend of airway-related safety events was magnified to -0.3% per month (95% confidence interval [CI], -0.1% to -0.4%, P < .001), compared to the LMA-Unique period (-0.2% per month, 95% CI, -0.1% to -0.3%; P = .002).

Conclusions: We found a significant decline in the monthly trend of airway-related safety events after the full implementation of i-gel in our health care network. This study provides real-world patient safety and clinical effectiveness information to clinicians and decision-makers.

Background: The difficult airway is frequently encountered across many scenarios. The extreme form is a "cannot intubate and cannot oxygenate" scenario, which lacks a reliable rescue technique. Previous case reports or studies with small sample sizes indicate the feasibility and efficiency of an endotracheal tube in the pharynx (TTIP) to ventilate patients. We hypothesize that ventilation via TTIP is an effective rescue technique for failed mask ventilation.

Method: One hundred forty-seven patients with potentially difficult airways were randomly assigned to the sequence (Tube first) of tube first ventilation via TTIP for 1 minute after induction, followed by via mask ventilation for 1 minute or in reverse sequence (Mask first). The ventilation was done with pressure control mode, a peak inspiratory airway pressure of 20 cmH 2 O, an inspiratory to expiratory time ratio of 1:2, and a respiratory rate of 10 breaths/min.

Results: A total of 136 patients underwent final analysis. The overall success rate (primary outcome) of ventilation via TTIP and mask, defined as the presence of expired carbon dioxide, was 93.4% (127/136) and 84.6% (115/136), respectively ( P = .02). The success rate, 85.7% (6/7), of mask ventilation rescuing a failed TTIP ventilation and 100% (13/13) of TTIP rescuing a failed mask ventilation were comparable ( P = .35).

Conclusions: The success rates of TTIP and mask ventilation are comparable. Ventilation via TTIP could be an alternative rescue technique for managing a difficult airway.

Background: Proficiency in endotracheal intubation (ETI) is essential for medical professionals and its training should start at medical schools; however, large caseload may be required before achieving an acceptable success rate with direct laryngoscopy. Video laryngoscopy has proven to be an easier alternative for intubation with a faster learning curve, but its availability in medical training may be an issue due to its high market prices. We devised a low-cost 3-dimensionally printed video laryngoscope (3DVL) and performed a randomized trial to evaluate if the intubation success rate on the first attempt with this device is noninferior to a standard commercially available video laryngoscope (STVL).

Methods: Two hundred and nine medical students from 5 medical schools were enrolled and randomized to start with the STVL (McGrath MAC) or the 3DVL. Four stations (standard airway using the STVL/3DVL and difficult airway using the STVL/3DVL) were set to simulate ETI with standard Airway Management Trainer manikins (Laerdal Medical Ltd.). The noninferiority margin of 7.5% was defined for the success rate on the first attempt, considering the difference in proportions between the STVL (expected to be higher) and 3DVL groups.

Results: Regarding the standard airway station, 60.7% (n = 65) of the students successfully performed TI on the first attempt with the STVL within the established timeframe, compared to 36.3% (n = 37) of the students using the 3DVL. This represented a difference of 24.4% (95% confidence interval, 17.5%-31.3%). Considering the difficult airway station, the success rates on the first intubation attempt with the 2 VLs did not differ.

Conclusions: The 3DVL was inferior in achieving first-attempt intubation when compared with the STVL with a difference in success rate >7.5% margin in simulated scenarios with medical students. Tracheal intubation might require a set of psychomotor skills for which the McGrath MAC device is superior to the low-cost alternative.