Nobuyasu Komasawa

Validation of the Pentax-AWS Airwayscope utility as an intubation device during cardiopulmonary resuscitation on the ground

PurposeThe 2005 American Heart Association guidelines for cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions even for endotracheal intubation. We previously reported that the utility of the Pentax-AWS Airwayscope (AWS) was superior to that of the Macintosh laryngoscope (McL) for securing airways during chest compression in “on the bed” simulated circumstances. However, because most cardiopulmonary arrest happens “on the ground” in the real world, we compared the utility of the McL and the AWS during chest compression on the ground and on the bed.MethodsFourteen doctors training in the anesthesia department performed tracheal intubation on a manikin with the McL and the AWS in simulations “on the bed” and “on the ground”.ResultsIn the McL trial, 6 participants failed on the bed, and 10 of them also failed on the ground during chest compression. In the AWS trial, all participants successfully secured the airway regardless of chest compression both on the bed and on the ground. With the AWS, intubation time was not lengthened because of chest compression either on the bed or on the ground. The AWS scored better than the McL on the visual analog scale in laryngoscopy and tube passage of the glottis both on the bed and on the ground.ConclusionWe conclude that the AWS is an effective device for endotracheal intubation during chest compression not only on the bed but also on the ground.

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.

Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope : a manikin study

PurposeIn emergency situations, rescuers must occasionally secure the airway while the patient is in a restricted position rather than in the ideal supine position. We hypothesized that the Pentax-AWS Airway Scope (AWS) may be useful for emergent tracheal intubation in such positions.MethodsThirteen non-anesthesia residents performed tracheal intubation on a simulated manikin in the supine (Supine), left-lateral decubitus (Left-LT), right-lateral decubitus (Right-LT), prone (Prone), and sitting (Sitting) position, respectively, to assess AWS performance.ResultsIntubations were successful in all five positions. The time needed to secure the airway did not differ significantly between the Left-LT and Supine positions. Doctors required significantly more time to secure the airway in the Prone, Sitting, and Right-LT positions than in the Supine position. Visual analog scale (VAS) scoring of the subjective difficulty of laryngoscopy was lower in the Supine position rather than in the Right-LT, Prone, and Sitting positions. The VAS score of subjective difficulty of tracheal tube passage through the glottis was significantly higher in the Sitting position than in the other four positions.ConclusionAlthough tracheal intubations with AWS in all five positions tested were successful, intubation with the patient in the Sitting, Right-LT, and Prone positions was more difficult and required more time than that in the Supine position.

Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial.

Background. Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings. Methods. Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations. Results. In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P = 0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P = 0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P < 0.001, compared to McL or McGRATH in both settings). Conclusion. The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.

Comparison of McGrath and Pentax-AWS Airwayscope for tracheal intubation by anaesthesiologists during chest compression in a manikin: A randomised crossover trial.

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Comparison of Pentax-AWS Airwayscope and Glidescope for Infant Tracheal Intubation by Anesthesiologists during Cardiopulmonary Arrest Simulation: A Randomized Crossover Trial

Background. Recent guidelines for infant cardiopulmonary resuscitation emphasize that all rescuers should minimize interruption of chest compressions, even for endotracheal intubation. We compared the utility of the Pentax-AWS Airwayscope (AWS) with the Glidescope (GS) during chest compressions on an infant manikin. Methods. Twenty-four anesthesiologists with more than two years of experience performed tracheal intubation on an infant manikin using the AWS and GS, with or without chest compressions. Results. In GS trials, none of the participants failed without compressions, while three failed with compressions. In AWS trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the GS (P < 0.05), but not with the AWS. Difficulty of operation on a visual analog scale (VAS) for laryngoscopy did not increase significantly with chest compressions with either the GS or the AWS, while the VAS for tube passage through the glottis increased with compressions with the GS, but not with the AWS. Conclusion. We conclude that in infant simulations managed by anesthesiologists, the AWS performed better than the GS for endotracheal intubation with chest compressions.

Comparison of Quick Track and Melker for emergent invasive airway management during chest compression: A crossover simulation trial.

In our case, we used 30 ml of air, and this may have exceeded the volume required by this particular patient. As we did not use cuff manometry during the operation, the intracuff pressure is unknown. In practice, there is a poor correlation between the intracuff pressure and the ‘compression’ pressure exerted on the tissues. Due to this poor correlation, simply measuring the intracuff pressure might not be very helpful.

Significance of basic airway management simulation training for medical students.

The American Heart Association cardiopulmonary guidelines recommend not only tracheal intubation (TI), but also bag-valve-mask (BVM) ventilation and supraglottic device (SGD) ventilation in emergent situations. However, given their lack of experience, novice doctors and medical students may find it difficult to implement these recommendations. Here, we used simulation training to have medical students experience the practical difficulties associated with basic airway management. This study was approved by the Research Ethics Committee of Osaka Medical College (No. 1493). From April through July 5, 2015, we conducted simulation training with 32 5th year medical students who had no experience with airway management as a part of their routine training at Osaka Medical College. At our institution, we teach medical students about basic airway management using manikin simulation, BVM ventilation with various techniques, SGD insertion (eg, with laryngeal masks or laryngeal tubes), and TI with the Macintosh laryngoscope. At the end of training, participants rated the difficulty of the three strategies on a Visual Analog Scale, which ranged from 0 mm (extremely easy) to 100 mm (extremely difficult). We also asked the students about the subjective difficulty of laryngoscopy and passage of the tracheal tube through the glottis during TI. Results obtained from each trial were compared using one-way repeated measures analysis of variance. Data are presented as mean ± SD. P b .05 was considered significant. There was no significant difference in subjective difficulty between BVM and SGD (P = .34), while TI was more difficult than BVM and SGD (P b .001) (BVM, 43.7± 23.2 mm; SGD, 44.7±19.3 mm; TI, 88.8±9.1 mm). As for laryngoscopy and tube passage through the glottis during TI, students found laryngoscopy significantly less difficult than tube passage through the glottis (laryngoscopy, 41.6±17.6; tube passage thorough the glottis, 87.2±9.1 mm, P b .001). Physicians often choose TI during resuscitation, which can lead to poor outcomes, and it may be difficult to

A rare case of accidental arterial local anesthetic injection under ultrasound-guided stellate ganglion block

A 43-year-old woman (60 kg, 158 cm) routinely visited our department for SGB to treat intractable left-side facial nerve paralysis. She had undergone USG SGB more than 10 times. Ultrasound also revealed enlarged thyroid but showed no associated symptoms. Most recently, although we confirmed major vessels by USG, arterial puncture by the block needle occurred when USG SGB was performed. After 5 minutes of astriction, we performed USG SGB again with maximum attention to avoid repuncture. Under USG SGB, the needle could be easily visualized, and no arterial leak was observed. We administered 2 mL of 1% mepivacaine, but the patient experienced convulsions and respiratory arrest immediately after injection; right carotid artery pulse was sufficient. Bag-valve-mask ventilation was initiated, and spontaneous breathing recovered within 5 minutes. After recovery of spontaneous breathing, 3 mg of midazolam was administered to control the convulsions, followed by intravenous fat emulsion (20%, 100 mL). Consciousness recovered after 20 minutes. After 5 hours, the patient recovered completely without any neurological complications and was discharged home.