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This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists. Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI. What is Known: • Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality.• Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure. What is New: • This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children.• In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary. Electronic supplementary material The online version of this article (10.1007/s00431-019-03395-8) contains supplementary material, which is available to authorized users.

Introduction The gold standard for airway management in the pre-hospital and hospital care still remains endotracheal intubation. Purpose Comparison of the standard laryngoscope with Macintosh blade (MAC), laryngoscope TruView EVO2 (EVO) and videolaryngoscope TruView PCD (PCD) during child intubation in two rescue scenarios: (1) the patient with cervical spine immobilization, (2) the patient with cervical spine immobilization and tongue edema. Material and methods This was randomized, cross-over, simulation trial. Fifty-two paramedics participated in the study. We analyzed intubation time, the effectiveness of the first attempt of intubation, total efficiency, Cormack-Lehane grade, dental compression and ease of intubation. Results Time to intubation (median [interquartile range]) using MAC, EVO and PCD was varied and amounted to: 26.5 s [23–30,5] vs. 29 s [25-33.5] vs. 20.5 s [18–23] for scenario A and 38.3 s [30–47] vs. 36 s [30,5–45] vs. 24 s [22–27,5] for scenario B. Efficacy first attempt intubation during scenario A was 53.8% vs. 76.8% vs. 100% (MAC EVO PCD), while during scenario B it was 48.1% vs. 73.1% vs. 96.2%. Conclusions In this manikin study, paramedics performed with greater efficiency intubation using a videolaryngoscope TruView PCD, both in scenarios A and B. Videolaryngoscope TruView PCD may be an alternative to the standard direct laryngoscopy.

Aim Neonatal intubation is a technically challenging procedure, and pressure-related injuries to surrounding structures have been reported. The primary objective of this study was to determine the pressure exerted on the upper jaw during tracheal intubation using a neonatal mannequin. Method Multidisciplinary care providers working at a neonatal intensive care unit were requested to intubate a neonatal mannequin using the standard laryngoscope and 3.0-mm (internal diameter) endotracheal tube. Compression force exerted was measured by using pressure-sensitive film taped on the upper jaw before every intubation attempt. Pressure, area under pressure and time taken to intubate were compared between the different types of health-care professionals. Results Thirty care providers intubated the mannequin three times each. Pressure impressions were observed on the developer film after every intubation attempt (n = 90). The mean pressure exerted during intubation across all health-care providers was 568 kPa (SD 78). The mean area placed under pressure was 142 mm2 (SD 45), and the mean time taken for intubation was 14.7 s (SD 4.3). There was no difference in pressure exerted on the upper jaw between frequent and less frequent intubators. It was found that pressure greater than 400 kPa was inadvertently applied on the upper jaw during neonatal intubation, far exceeding the 250 kPa shown to cause tissue injury in animal models. Conclusion The upper jaw is exposed to a significant compression force during intubation. Although such exposure is brief, it has the potential to cause tissue injury. Contact of the laryngoscope blade with the upper jaw occurred in all intubation attempts with the currently used design of laryngoscope.

У статті представлено результати анестезіологічного забезпечення 75 хворих на флегмону шиї. В проведеному дослідженні було встановлено, що основними причинами тяжкої інтубації трахеї у хворих з флегмоною шиї є: обмеження відкривання рота менше 3 см, набряк гортані і ригідний надгортанник при одонтогенній флегмоні порожнини рота і шиї. При інтубації трахеї за допомогою лампового ларингоскопа частота тяжких інтубацій становила 62,6 %, із них 9,3 % інтубацій були невдалими. Частота тяжких інтубацій трахеї при використанні фібробронхоскопа і відеоларингоскопа “Flaplight” склала 8,1 і 7,9 % відповідно порівняно з ламповим ларингоскопом. Таким чином, відеоларингоскоп Flaplight можна рекомендувати для інтубації трахеї у хворих з флегмоною шиї.

Endotracheal Intubation (ETI) is an airway procedure commonly used to secure the airway for a variety of medical conditions. Endotracheal tube placement is most commonly performed under direct vision of the glottis with the use of a standard laryngoscope and blade. Proficiency in ETI procedures requires significant clinical experience and insufficient data currently exists describing the physical ergonomics of successful direct laryngoscopy. The research objectives of this study were to examine how ETI time, error and practitioner biomechanics varied among clinical experience levels and hospital bed heights. The participant population included novice and expert subgroups recruited from the University of Nebraska Medical Center, and the department of Emergency Medicine. Using a standard laryngoscope handle and blade, participants performed ETI trials on an airway manikin trainer at a minimum and maximum bed height. Participants were evaluated based on ETI completion time, endotracheal tube placement, wrist...

The thyroid disease is still common in our country. Divers complications have been described in this type of surgery. Paralysis of the vocal cords and particularly bilateral paralysis are exceptional. The diagnosis is made by examen of the vocal cords before extubation. The standard laryngoscope is the most device commonly used for this indication. The interest of the new devices is not clear. We report the use of the Airtraq laryngoscope for the diagnosis of bilateral vocal cord paralysis after a thyroidectomy under general anesthesia. Through this case and review of the literature, we discuss the interest of the new devices in the diagnosis of this complication and the means of its prevention.

Purpose This study was designed to compare videolaryngoscopy with direct laryngoscopy with respect to ease of intubation when inserting a double lumen tube (DLT).

Traditional teaching of laryngoscopy is difficult due to the trainer and trainee lacking a shared view. The Karl Storz BERCI DCI Video Laryngoscope provides a video image for the trainer and a direct view identical to that of a standard laryngoscope for the trainee. Forty-nine novice subjects were randomly assigned to a control group (n = 24) taught using a standard Macintosh laryngoscope or a study group (n = 25) taught using the Video Laryngoscope. Following training all subjects were assessed using a standard laryngoscope. Under simulated difficult airway conditions the study group performed better in terms of number of attempts (p = 0.02), number of repositioning manoeuvres required (p = 0.046) and teeth trauma (p = 0.034). The study group were more confident of the success of their tube placement (p = 0.035), found it easier than the control group (p = 0.042) and had improved knowledge of airway anatomy (p = 0.011). We conclude that video laryngoscopy confers benefits in the teaching of tracheal intubation.

Background The use of a video-assisted laryngoscope (VL) has been shown to reduce the time to achieve intubation with a double-lumen endobronchial tube (DLT). As the blade of the VL is curved differently to a standard laryngoscope, the DLT must be angled into a hockey stick shape to fit properly. We conducted a study to establish which direction of angulation was best to facilitate correct positioning of the DLT when using a VL. Methods We enrolled patients scheduled for thoracic surgery who required intubation with a DLT. They were prospectively randomized into one of two groups: those intubated with a DLT angled to conceal the tracheal orifice (the tracheal orifice-covered, TOC) group or the tracheal orifice-exposed (TOE) group. The composite primary outcome measures were time taken to intubate and the frequency of first-time success. The time taken to intubate was divided into: T1, the time from mouth opening to visualization of the vocal cords with the VL; and T2, the time taken to advance the DLT through the cords until its tip lay within the trachea and three carbon dioxide waveforms had been detected by capnography. The hemodynamic responses to intubation and intubation-related adverse events were also recorded. Results Sixty-six patients completed the study, with 33 in each group. Total intubation time was significantly shorter in the TOC group (mean 30.6 ± standard deviation 2.7 seconds versus 38.7 ± 3.3 seconds, p

Objective.Advanced airway management, endotracheal intubation (ETI), during CPR is more difficult than, for example, during anesthesia. However, new devices such as video laryngoscopes should help in such circumstances. The aim of this study was to assess the performance of the KingVision video laryngoscopes in a manikin cardiopulmonary resuscitation (CPR) scenario.Methods.Thirty students enrolled in the third year of paramedic school took part in the study. The simulated CPR scenario was ETI using the standard laryngoscope with a Macintosh blade (MCL) and ETI using the KingVision video laryngoscope performed during uninterrupted chest compressions. The primary endpoints were the time needed for ETI and the success ratio.Results.The mean time required for intubation was similar for both laryngoscopes: 16.6 (SD 5.11, median 15.64, range 7.9–27.9) seconds versus 17.91 (SD 5.6, median 16.28, range 10.6–28.6) seconds for the MCL and KingVision, respectively (P=0.1888). On the first attempt at ETI, the success rate during CPR was comparable between the evaluated laryngoscopes:P=0.9032.Conclusion.The KingVision video laryngoscope proves to be less superior when used for endotracheal intubation during CPR compared to the standard laryngoscope with a Mackintosh blade. This proves true in terms of shortening the time needed for ETI and increasing the success ratio.

Background: The use of videolaryngoscopes is recommended as a part of routine practice in anaesthesia for morbidly obese patients. The aim of this study was to evaluate C-Mac in a group of morbidly obese patients to see if it improves intubation conditions. Methods: 86 morbidly obese (BMI > 40 kg m -2 ) patients scheduled for bariatric surgery were included in the study. In every studied case, C-Mac was used with a Mackintosh shaped blade. For the first attempt, the anaesthetists performing the intubation were asked to use a videolaryngoscope as a standard laryngoscope (they were blinded to the monitor display) and evaluate the glottic view in direct laryngoscopy. Then they were asked to look at the monitor of the videolaryngoscope and intubate the patient. The laryngoscopy conditions were evaluated using the Cormack-Lahane (CL) scale. The time from picking up the laryngoscope to inserting the endotracheal tube was recorded. Results: The evaluation of CL grade in direct laryngoscopy was: 44 patients — grade 1; 23 patients — grade 2; 13 patients — grade 3; six patients — grade 4. In all cases of CL grade > 1 in direct laryngoscopy, the use of C-Mac improved CL grade to 1. Mean time of intubation was 17.2 ± 2.5 sec. Conclusion: The C-Mac improves laryngeal view in morbidly obese patients, and allows for fast endotracheal intubation.

The prototypes of two novel warning devices for protection against dental trauma during direct laryngoscopy are described. Either can be attached to a standard laryngoscope blade (e.g., Macintosh). The basic design is that of as witch that is closed by pressure on the maxillary incisors by the laryngoscope blade.

Tomasz Gaszynski Department of Emergency and Disaster Medicine, Medical University of Lodz, Lodz, Poland Background: Super-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts. Patients and methods: Twenty-four super-obese patients (body mass index >50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack. Results: In all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases. Conclusion: TotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients. Keywords: super-obese, intubation, ventilation, laryngeal mask, standard laryngoscope, video laryngoscope&nbsp

Objective. To compare the view at simulated direct laryngoscopy obtained with a standard laryngoscope, with and without a disposable cover and a disposable laryngoscope blade. Design. Randomized non-blinded comparison. Setting. The high-fidelity human patient simulator at the Scottish Clinical Simulation Centre. Participants. Thirty-two anaesthetists with between 11 months and 25 years of experience. Interventions. A randomized comparison of ease of laryngoscopy with each laryngoscope option for simulated easy and difficult laryngoscopy. Main outcome measures. The best grade achievable at laryngoscopy (Cormack and Lehane grade) for each laryngoscope, for both easy and difficult laryngoscopy. Results. For the easy setting, 34% (P = 0.001) of anaesthetists graded laryngoscopy more difficult with the covered laryngoscope, and 22% (P = 0.008) with the disposable laryngoscope considered laryngoscopy more difficult than with the standard laryngoscope. For the difficult simulator setting, 69% (P < 0.001) found laryngoscopy more difficult with the covered laryngoscope and 69% (P < 0.001) with the disposable laryngoscope, when compared with the standard laryngoscope. There was no difference between the laryngoscopy grades for the covered and disposable laryngoscope for either easy (P = 0.21) or difficult (P = 0.87) simulation. Conclusions. Single-use equipment, as presently recommended for tonsillectomy surgery by the UK Department of Health, makes laryngoscopy more difficult for anaesthetists.

The laryngoscope is identified as a potential vector for cross-infection. Case reports are presented, as are reports of bacterial and occult blood contamination of laryngoscope blades and handles. Infection control policies covering laryngoscope blade and handle processing are outlined relative to procedures of a teaching hospital department. Repeated decontamination of laryngoscope blades has resulted in a perceived decrease in reliability. This is reflected in a departmental survey where 86% of respondents consider the standard laryngoscope is only intermittently reliable and that there is room for improvement.

In 1896 G. Killianl constructed and devised a series of endoscopic instruments which are the precursors of the present day bronchoscopic equipment. The bronchoscope which is used universally today is the 1915 Chevalier Jackson modification of the Killian bronchoscope.1 Hill in 1909' introduced the idea of a slot in the standard laryngoscope which is covered by a removable spatula, this was made to facilitate instrumentation. At the same time he devised a slotted esophagoscope for the same purpose. Frenkner in 1934l described several instruments for endobronchial catheterization and for bronchospirometry. Among the instrumenta he described is a bronchoscope with an optical system similar to a cystoscope and a side lumen with a slide and slot to facilitate introduction and manipulation into position of urethral catheters for the purpose of gas sampling. The slide is removed once the catheter is in place and the bronchoscope is removed without dislodging the catheter. In 1952l. 2. a slotted bronchoscope* was described (Fig. 1) resembling the Hill esophagoscope. This bronchoscope had a wide slot along its whole length. I t was primarily used to facilitate the introduction of endobronchial blockers and removal of the bronchoscope for the control of secretions during anesthesia. I t was later found that the slot along the whole length of the bronchoscope presented certain advantages during routine bronchoscopy. A modified bronchoscope was then devised which has features similar to the Sill and Jackson laryngoscopes and a t the same time incorporates features of Frenkner's bronchoscope for bronchospirometry. The new type of slotted bronchoscope** is a modified Chevalier Jackson instrument with a slot along its whole length (Fig. 2). There are two interchangeable slides. A long slide which converts the slotted bronchoscope into a standard type (Fig. 3) and a short slide which covers approximately two thirds of the length of the slot (Fig. 4) , leaving the distal one third open. The slides can be removed and interchanged while the bronchoscope is in the tracheobronchial tree. These slides were found necessary in order to protect the teeth when the bronchoscope is rotated 360 degrees, a t the same time it keeps out the soft tissues in the oral cavity to fall inside the lumen of the bronchoscope and obstruct the visual field. For the past three years this type of slotted bronchoscope has been routinely used a t the George Washington University Hospital. Careful evalu

Summary An adaptor is described which can be fitted to a standard laryngoscope to overcome the difficulty associated with tracheal intubation in certain obstetric cases.

Magnification for endolaryngeal visualization, biopsy, and removal of benign lesions and carcinoma in situ is achieved using a telescope inserted in stripping type forceps. The combined telescope and forceps are passed easily through any standard laryngoscope with a holder. Excellent visualization is achieved through the telescope, which can be provided with 0°, 30°, or 70° optics. In most circumstances, these instruments obviate the use of the operating microscope, being simpler and just as exact. The field of vision, however, is smaller. The instruments are also ideal for cervical tracheoscopy and mediastinoscopy.

The Fallopian tubes can be easily identified using a modified laryngoscope for female sterilization. The scar is small and placed inside the pubic hairline. No insufflation of gas is needed. The operation requires only 10-12 minutes. No morbidity has followed. A standard laryngoscope has been modified with a straight MacGill blade in place of the usual curved MacIntosh blade. A right-angled fiberoptic attachment has replaced the light bulb. General anesthesia has been used. The bladder has been catheterized preoperatively. A 2 cm incision is made inside the pubic hairline. The peritoneum is grasped and incised. Forceps used are left in place to locate the peritoneal edges later. The tubes and ovaries are visible with the blade introduced part way. Tubes can be grasped and drawn into the wound. Any standard tubal occlusion can then be done. A uterine cannula to maneuver the uterus has not been needed. The abdomen is closed routinely.

LARYNGEAL surgery requiring utilization of the operating microscope has led to the development of several new laryngoscopes. The new instrument reported here permits microscopic laryngeal surgery and consists of a simple right-angle tubular handle to which a standard laryngoscope support can be easily attached (Figure). The blade is a large oval tube similar to other laryngeal instruments. The tip is elevated, giving it characteristics desirable in an anterior commissure instrument; the width of the tip, however, is greater and the shape flatter than that of the usual anterior commissure laryngoscope. The distal one third of the blade is open, allowing full visualization of the posterior and lateral walls of the hypopharynx as well as of the larynx. The proximal portion of the blade is an oval tube which allows binocular vision. It differs from other instruments by having slots on each side to allow easy insertion of instruments, particularly when