Kazuaki Atagi

Comparison of optic laryngoscope Airtraq ® and Miller laryngoscope for tracheal intubation during infant cardiopulmonary resuscitation

BACKGROUND Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Miller laryngoscope (Mil) with Airtraq (ATQ) during chest compression in an infant manikin. METHODS Twenty staff doctors in intensive care and emergency medicine performed tracheal intubation on an infant manikin with Mil and ATQ with or without chest compression. RESULTS In Mil trials, no participants failed without chest compression, but 6 of them failed during chest compression (P < 0.05). In ATQ trials, all participants successfully secured the airway regardless of chest compression. Intubation time was significantly lengthened due to chest compression in Mil trials, but not in ATQ trials. The visual analog scale (VAS) for laryngoscope image did not significantly change due to chest compression for ATQ or Mil trials. In contrast, chest compression worsened VAS scores for tube passage through the glottis in Mil trials, but not in ATQ trials. CONCLUSION We conclude that ATQ performed better than Mil for endotracheal intubation during chest compression in infant simulations managed by expert doctors.

Comparison of air-Q® and Soft Seal® laryngeal mask for airway management by novice doctors during infant chest compression: A manikin study

BACKGROUND Recent resuscitation guidelines for infant cardiopulmonary resuscitation (CPR) emphasise that rescuers should minimise the interruption of chest compressions. To that end, supraglottic devices such as laryngeal mask airways (LMAs) are suggested as a backup for airway management during infant CPR. We therefore compared the utility of the air-Q(®) LMA (air-Q) with that of the Soft Seal(®) LMA (Soft Seal) for infant CPR in an infant manikin. METHODS Twenty-four novice doctors in the anaesthesia department performed insertion and ventilation with air-Q and Soft Seal on an infant manikin with or without chest compression. RESULTS Two doctors failed to insert the Soft Seal without chest compression, while nine failed during chest compression (P<0.05). However, only one doctor failed to insert the air-Q without chest compression, and two doctors failed during chest compression. Insertion time was not significantly increased with chest compression using either device. Insertion time during chest compression was significantly shorter for the air-Q than for the Soft Seal (P<0.05). The visual analogue scale (VAS) was used to evaluate difficulty of use (0mm (extremely easy) to 100mm (extremely difficult)). VAS scores did not change significantly by the addition of chest compression with either device; however, VAS scores during chest compression were significantly higher with Soft Seal than with the air-Q device. CONCLUSION We conclude that novice doctors find the air-Q easier to use than Soft Seal for emergency airway management during chest compression in infants, in an infant manikin.

Can a Simulation-based Sedation Training Course Improve the Safety of Sedation in Various Areas?

日本医学シミュレーション学会SED世話人会は, 米国麻酔科学会(ASA)による非麻酔科医のための 鎮静・鎮痛ガイドライン(Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. An Updated Report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists:ASA-SED)に基 づくセデーショントレーニングコース(SED実践セ ミナー)を開発し,一般的な鎮静時の注意点と安全 管理の訓練を行っている. ASA-SEDでは,鎮静深度の定義を行い,鎮静施 行時の留意点を提唱している 1), .鎮静には,意識 状態は覚醒であり全身状態も安定している状態か ら,強い刺激にも反応がないほど深く,呼吸抑制・ 循環抑制が発生する状態まで連続性がある.この前 提に基づいて,鎮静担当者がASA-SEDの推奨に準 じて,1患者術前評価と鎮静計画,2鎮静実行(患 者監視モニターの装着を含む),3鎮静の変更・追 加(患者再評価を含む),4鎮静終了後の患者評価, を行うという基本はどの領域においても不変であ る . しかし,受講生の内訳は多岐の診療科にわたり, 看護師も多い .このため鎮静の訓練のニーズに応 え,各診療科における医療安全向上に反映させるに は,鎮静の難渋点の抽出と検討が重要である.ここ では,SED実践セミナーの中での各職種の専門分 第8回日本医学シミュレーション学会パネルディスカッション 日臨麻会誌 Vol.34 No.2, 281 〜 285, 2014