Ben H. Boedeker

Comparison of the Magill forceps and the Boedeker (curved) intubation forceps for removal of a foreign body in a Manikin

STUDY OBJECTIVE To compare the straight Magill and the curved Boedeker Intubation Forceps in foreign body removal in a manikin with a difficult airway using the videolaryngoscope. DESIGN Prospective comparative study. SETTING University Medical Center. SUBJECTS 17 medical providers, 16 anesthesia staff, and one respiratory therapist. MEASUREMENTS The observed Cormack-Lehane (CL) glottic view and success/failure of the removal attempts were recorded. MAIN RESULTS The CL scores obtained using the Magill and Boedeker forceps were not significantly different (P = 0.3984). However, the differences in success rates for removal of the foreign object using standard (0 = success, 17 = failure) and Boedeker forceps (0 = failure, 17 = success) were strongly significant (P < 0.0001). CONCLUSION The curve of the Boedeker Intubation Forceps allows both the tip of the forceps and the glottic opening to be simultaneously visible in the field of view during videolaryngoscopy, making removal of glottic foreign bodies easier.

Endotracheal intubation in a medical transport helicopter - comparing direct laryngoscopy with the prototype Storz CMAC videolaryngoscope in a simulated difficult intubating position.

This pilot study examined backward intubation of the Laerdal Difficult Airway Manikin in a medical transport helicopter using the prototype (a new more compact) Storz CMAC videolaryngoscope. The standard manikin airway Cormack Lehane (CL) view scores were 2.00 +/- 1.00 for direct view and 1.375 +/- 0.517 for the indirect view (CMAC). Success rates for backward intubation in the standard airway were 100% (CMAC) and 87.5% (DV). Average CL grades in the difficult airway were 3.63 +/- 0.74 (DV) and 2.00 +/- 0.926 (CMAC)(p = 0.002). The success rates for backward intubation of the difficult airway were 12.5% (DV) and 63% (CMAC). Our results show that in backward intubation of the difficult airway in a helicopter setting, the prototype CMAC videolaryngoscope significantly improved the airway score by 1-2 grades and improved intubation success 5-fold. Studies using the portable CMAC videolaryngoscope under challenging rescue conditions and positions should be considered.

Endotracheal intubation comparing a prototype Storz CMAC and a glidescope videolaryngoscope in a medical transport helicopter - a pilot study.

In this pilot study, experienced medical helicopter personnel evaluated and compared the prototype Storz CMAC and GlideScope (GS) videolaryngoscopes in intubating a Laerdal Difficult Airway Manikin in a helicopter. No significant differences were found between the devices in the standard airway mode with 100% success rates for the intubations. In the difficult airway mode, there was a significant difference (p = 0.03) between the Cormack Lehane scores observed with Direct View (DV) (3.75 +/- 0.46 - average +/- standard deviation) compared to the view with the prototype CMAC (2.25 +/- 0.71). The view was 3.00 +/- 0.76 with GS In the difficult airway, there were significantly more participants who obtained a Grade 1 or 2 view when using the CMAC compared to when using the Mac 3 blade (DV) (p = 0.025; Fisher Exact Probability Test). The success rate for intubating the difficult airway was 0% with DV; compared to 63% with the CMAC and 50% with the GS (p = 0.03). The participants answered a post study questionnaire regarding the characteristics of the devices and indicated preference for the CMAC over the GS in intubation of the difficult airway.

The initiation of a preoperative and postoperative telemedicine urology clinic.

This work describes the establishment of a Telemedicine Urology Clinic at the VA Medical Center in Omaha, Nebraska to serve an underserved veteran population in rural Nebraska. Results from patient satisfaction surveys show that both the patient and the healthcare provider benefit from the telemedicine encounter for both the preoperative and the postoperative setting.

Nasotracheal intubation in a difficult airway using the Storz C-MAC Videolaryngoscope, the Boedeker Bougie endotracheal introducer, and the Boedeker curved forceps.

Airway management has multiple indications for nasotracheal intubation. In this study, we focus on its indication in difficult airways. This work describes a modified procedure of nasotracheal intubation using the new Storz CMAC® Videolaryngoscope, the malleable Boedeker Bougie and the curved Boedeker Forceps in the intubation of a difficult airway manikin.

Validation of a virtual preoperative evaluation clinic: a pilot study.

Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope™ with a novel modification

BackgroundThe Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The Center for Advanced Technology and Telemedicine at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.MethodsTwenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.ResultsParticipants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).ConclusionsWith this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.

Airway intubation in a helicopter cabin: Video vs. direct laryngoscopy in manikins

INTRODUCTION Airway management may be required during medical evacuation in a helicopter when patients deteriorate en route. Laryngoscopist positioning at the head of the patient may not be possible, making it difficult to perform direct laryngoscopy (DIR). An alternative method is video laryngoscopy (VID) that displays magnified images of the glottic opening on a video monitor and allows intubation despite nonstandard positioning. METHODS There were 21 experienced aeromedical emergency medical personnel who intubated a recumbent manikin with the operator seated at the head of a secured helicopter stretcher in a power-off helicopter. Each subject performed intubations using DIR and VID in standard- and difficult-airway manikins (STD and DIF, respectively). Data were collected for subjective glottic visualization grades, intubation times, and intubation success rates. RESULTS Visualization grades were 2.43 +/- 0.81 for STD-DIR and 1.10 +/- 0.30 for STD-VID, compared to 1.76 +/- 0.54 for DIF-DIR and 3.72 +/- 0.57 for DIF-VID. Success rates were 95% for both STD-DIR and STD-VID, 5% for DIF-DIR and 95% DIF-VID. Mean intubation time for DIF-VID was 0.90 min +/- 0.80 min, not different from STD-DIR. DISCUSSION The success rate for difficult airway intubation by aeromedical personnel in a power-off evacuation helicopter was significantly improved by enhancing glottic visualization using VID vs. DIR in a manikin.

Using the Battlefield Telemedicine System (BTS) to train deployed medical personnel in complicated medical tasks - a proof of concept.

This work describes the use of Adobe Connect software along with algorithm software to provide the necessary audio visual communication platform for telementoring a complex medical procedure to novice providers located at a distant site.

A comparison of an integrated suction blade versus a traditional videolaryngoscope blade in the endotracheal intubation of a hemorrhagic cadaver model - a pilot study.

In this pilot study, we evaluated two types of videolaryngoscope blades (integrated suction vs. traditional) with the Storz CMAC videolaryngoscope in the intubation of a lightly embalmed hemorrhagic cadaver model. No significant differences were found between the devices in the success rates for the intubations. The study subjects indicated a preference for the integrated suction blade in hemorrhagic airway intubation.