Eleni Koudouna

Video-laryngoscopes in the adult airway management: a topical review of the literature

The aim of the present paper is to review the literature regarding video‐laryngoscopes (Storz V‐Mac and C‐Mac, Glidescope, McGrath, Pentax‐Airway Scope, Airtraq and Bullard) and discuss their clinical role in airway management. Video‐laryngoscopes are new intubation devices, which provide an indirect view of the upper airway. In difficult airway management, they improve Cormack–Lehane grade and achieve the same or a higher intubation success rate in less time, compared with direct laryngoscopes. Despite the very good visualization of the glottis, the insertion and advancement of the endotracheal tube with video‐laryngoscopes may occasionally fail. Each particular devices features may offer advantages or disadvantages, depending on the situation the anaesthesiologist has to deal with. So far, there is inconclusive evidence indicating that video‐laryngoscopy should replace direct laryngoscopy in patients with normal or difficult airways.

Propofol: A review of its non-anaesthetic effects

Propofol, a short-acting intravenous anaesthetic agent has gained wide acceptance since its introduction in the late 80s, not only in operating rooms but also in other departments, due to its several advantages. Apart from its multiple anaesthetic advantages, it has been reported recently that propofol exerts a number of non-anaesthetic effects. The drug stimulates constitutive nitric oxide (NO) production and inhibits inducible NO production. Propofol has also anxiolytic properties, which may be related to several neuromediator systems. Moreover, it has antioxidant, immunomodulatory, analgesic, antiemetic and neuroprotective effects. Furthermore, propofol inhibits both platelet aggregation and intracellular calcium increases in response to thrombin or ADP and it also exerts direct inhibitory effects on recombinant cardiac sarcolemmal KATP channels. All these beneficial properties may expand propofols clinical use.

Combination pharmacotherapy in the treatment of experimental cardiac arrest

STUDY OBJECTIVES Full recovery after cardiopulmonary resuscitation (CPR) is poor. We hypothesized that the coadministration of epinephrine, a beta-blocker such as atenolol, and a calcium sensitizer such as levosimendan during CPR would improve survival and postresuscitation myocardial function. METHODS Ventricular fibrillation was induced in 60 piglets, which were left untreated for 8 minutes before attempted resuscitation. Animals were randomized into 4 groups (n = 15), to receive epinephrine (group E), epinephrine + atenolol (group E + A), epinephrine + levosimendan (group E + L) and epinephrine + atenolol + levosimendan (group E + A + L) during CPR. Electrical defibrillation was attempted 2 minutes after drug administration. RESULTS Five animals in group E survived for 48 hours in comparison to 8 animals in groups E + A and E + L and 12 animals in group E + A + L. Postresuscitation cardiac output was significantly better in the animals of group E + A + L. Troponin I remained significantly lower in groups E + A and E + A + L. Serum astroglial protein (S-100) and neuron-specific enolase values in group E + L and E + A + L were statistically lower than those measured in groups E and E + A during the entire observation period. The neurologic alertness score was higher in group E + A + L compared to groups E and E + A. CONCLUSIONS The administration of a drug combination of epinephrine + atenolol + levosimendan, when given during CPR, in a pig model of cardiac arrest, results in improved 48-hour survival and improves postresuscitation cardiac function.

Glidescope® videolaryngoscope improves intubation success rate in cardiac arrest scenarios without chest compressions interruption: A randomized cross-over manikin study

AIM The aim of this study was to assess the performance of the Glidescope(®) in a manikin cardiopulmonary resuscitation (CPR) scenario. METHODS Following a brief didactic session, 45 volunteer doctors inexperienced with airway management, attempted to intubate a manikin using a Macintosh laryngoscope and Glidescope(®) with uninterrupted and without chest compressions. Primary endpoints were intubation times and success rate with each device. Dental compression and level of self-confidence in using each device were also assessed. RESULTS In the scenario without chest compressions the cumulative success rate related to time to intubation was significantly higher with the Macintosh blade than with the Glidescope(®) (p<0.001). On the contrary, in the scenario with continuous chest compressions, the cumulative rate related to time to intubation was significantly higher with the Glidescope(®) (p=0.035). Significantly fewer attempts were required for the first successful intubation with the Macintosh blade in the non-CPR scenario versus the CPR scenario (p=0.007). Moreover, the number of attempts for the first successful intubation was significantly lower for the Glidescope(®) in the non-CPR (p=0.001) and the CPR scenario (p<0.001). Dental compression was significantly lower with the Glidescope(®) in both scenarios (p<0.001). CONCLUSIONS Using the GlideScope(®) in a manikin CPR scenario provides extremely high intubation success rates in short times with the first attempt, in medical practitioners inexperienced in intubation.

Atenolol in combination with epinephrine improves the initial outcome of cardiopulmonary resuscitation in a swine model of ventricular fibrillation

STUDY OBJECTIVES The aim of the present study was to assess whether a beta-adrenergic blocking agent such as atenolol, administered during cardiopulmonary resuscitation, would improve initial resuscitation success. METHODS Ventricular fibrillation was induced in 20 Landrace/Large White piglets, which were left untreated for 8 minutes before attempted resuscitation with precordial compression, mechanical ventilation, and electrical defibrillation. Animals were randomized into 2 groups (10 animals each) to receive saline as placebo (20 mL dilution, bolus) + epinephrine (0.02 mg/kg) (group A) or atenolol (0.05 mg/kg per 20 mL dilution, bolus) + epinephrine (0.02 mg/kg) (group B) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 minutes of ventricular fibrillation. RESULTS Nine animals in group B restored spontaneous circulation in comparison to only 4 in group A. Aortic systolic and diastolic pressures as well as coronary perfusion pressure were significantly increased during cardiopulmonary resuscitation in group B. Furthermore, postresuscitation heart rate of the atenolol-treated group was significantly decreased. CONCLUSIONS A beta-adrenergic blocking agent, when administered during cardiopulmonary resuscitation, significantly improves initial resuscitation success and increases blood and coronary perfusion pressures during cardiopulmonary resuscitation.

Nurses are more efficient than doctors in teaching basic life support and automated external defibrillator in nurses

BACKGROUND Cardiac arrest (CA) is a leading cause of death worldwide. The European Resuscitation Council (ERC) has developed basic life support/automated external defibrillation (BLS/AED) courses for uniform training in out-of-hospital CA. OBJECTIVE The present study compares the resuscitation skills of two groups of nursing staff, one taught by newly trained ERC nurse-instructors and the other by newly trained doctor-instructors. METHOD Eighteen doctors and 18 nurses were asked to teach a total of 108 nurses in a (BLS/AED) course. One month after its completion, all 108 nurses were asked to be re-evaluated, with the use of the objective structured clinical examination. CONCLUSIONS No statistical significant difference between the two groups was noted in the written test, in contrast with data collected from the practice skills check-list. Nurses in group A could easily identify the patient in cardiac arrest but had difficulties concerning chest compressions and handling the AED. Nurses in group B were more focused during the performances, used AED more accurately and continued cardiopulmonary resuscitation with no delays. Nurses prove to be more efficient in training nurses.

Levosimendan improves the initial outcome of cardiopulmonary resuscitation in a swine model of cardiac arrest

Background:  Cardiac arrest remains the leading cause of death in Western societies. Advanced Life Support guidelines propose epinephrine (adrenaline) for its treatment. The aim of this study was to assess whether a calcium sensitizer agent, such as levosimendan, administered in combination with epinephrine during cardiopulmonary resuscitation, would improve the initial resuscitation success.

Conventional Direct Laryngoscopy versus Videolaryngoscopy with the GlideScope®: A Neonatal Manikin Study with Inexperienced Intubators

We hypothesized that because the view of the glottis is better with videolaryngoscopes, successful intubation in neonates would be accomplished in a shorter time with the GlideScope (®) (Verathon, Inc., Bothell, WA) videolaryngoscope (GVL). Forty-five students of the University of Athens, inexperienced in both techniques, participated in the study (21 medical students and 24 nursing students, crossover randomized study). Following a brief educational session, each participant practiced and attempted intubation on a neonatal manikin using conventional laryngoscope and GVL, as many times as required to secure the airway. The time required to successful intubation and the number of attempts with each device were recorded. No significant difference was observed between the number of attempts required for successful intubation with either laryngoscope. The time required for the first successful intubation with the conventional laryngoscope was significantly shorter compared with that required with the GVL ( P = 0.0013). There was no difference regarding the time required for the successful intubation between medical and nursing students, using the conventional laryngoscope or the GVL. The number of attempts to successful intubation with either device did not differ. The time required for intubation with the GVL was longer, and this is probably due to a design flaw.

Inexperienced nurses and doctors are equally efficient in managing the airway in a manikin model

OBJECTIVE The aim of the present study was to investigate whether minimally trained medical and nursing school graduates would be equally efficient in placing a laryngeal mask airway (LMA) and in intubating the trachea with the Macintosh blade or a videolaryngoscope in a manikin model. Airway management is an essential skill for both physicians and nurses who may be confronted with a critically ill patient, because in the emergency department the airway is not exclusively managed by medical personnel. Several studies have shown that other healthcare professionals are not any less efficient in securing the airway. METHODS Ninety-six graduates from medical and nursing faculties comprised our study population. After a brief educational session, participants were randomly allocated into 3 groups to secure the airway in manikins with 3 techniques: LMA (The Laryngeal Mask Company Limited, Buckinghamshire, UK) insertion and intubation with the Macintosh blade and with a videolaryngoscope (GlideScope, Verathon Inc, Bothell, WA). The number of attempts until the first successful intubation, time required for the first successful attempt, and severity of dental trauma were assessed. RESULTS No statistically significant difference was observed between physicians and nurses in the number of attempts and in the time required for the first successful attempt with any of the 3 techniques studied. From the 3 techniques studied, LMA placement was the fastest (P < .001). No significant difference was observed between physicians and nurses in the severity of dental trauma. CONCLUSION Nurses are as efficient as physicians in managing the airway safely and adequately with the 3 different techniques in manikins.

Using the 30:2 compression-ventilation ratio: five cycles is easier to follow than 2 min of cardiopulmonary resuscitation.

This study assessed the time it takes for newly trained basic life-support/automated external defibrillator (BLS/AED) providers to complete five cycles of cardiopulmonary resuscitation (CPR) and whether it is easier to follow a 2-min time frame or to count five cycles of CPR. Then, it assesses how many chest compressions are delivered with each of the two methods and the time needed to deliver the first two rescue breaths. Eighty BLS/AED providers were asked to provide 2 min of CPR with a compression–ventilation ratio of 30 : 2 and at a compression rate of 100/min without looking at any timing device and then to provide five cycles of CPR with the same compression–ventilation ratio. The number of chest compressions delivered, the time needed to complete five cycles of CPR, and the time needed to perform the first two rescue breaths were recorded. Finally, a scripted set of questions was asked to each participant. The time required to perform five cycles of CPR was 115±5 s and to perform the 2 min of CPR was 102±19 s (P = NS). Chest compressions delivered in the presumed 2-min CPR were 123±12 and 149±2 in the five cycles CPR (P<0.05). Sixty-two participants (77.5%) found it easier to count five cycles of CPR. The time needed to deliver the first two rescue breaths was between 12 and 15 s. The average time to complete five cycles of CPR is approximately 2 min for newly trained BLS/AED providers and the majority of the participants found it easier to perform five cycles.