Shinji Kusunoki

Tracheal intubation of a difficult airway using Airway Scope, Airtraq, and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel.

BACKGROUND:The Airway Scope (AWS) (Pentax-AWS®, Hoya Corp., Tokyo, Japan) and the Airtraq® (ATQ) (Prodol, Vizcaya, Spain) have similarities in the novel structures of their blades. In this study, we evaluated the ease of use of the AWS and ATQ compared with the Macintosh laryngoscope (ML) by inexperienced personnel in a simulated manikin difficult airway. METHODS:Twenty-four fifth-year medical students with no previous experience in tracheal intubation participated in this study. We used an advanced patient simulator (SimMan®, Laerdal Medical, Stavanger, Norway) to simulate difficult airway scenarios including cervical spine rigidity, limited mouth opening, and pharyngeal obstruction. The sequences in selecting devices and scenarios were randomized. Success rates for tracheal intubation, and the time required for visualization of the glottis, tracheal intubation, and inflation of the lungs, and the number of optimization maneuvers and dental click sounds were analyzed. The 3 different intubation devices were tested in 4 different scenarios by 24 students. RESULTS:Both the AWS and ATQ had very high success rates of tracheal intubation compared with the ML (AWS 100%*; ATQ 98%*; and ML 89%; *P < 0.05 AWS, ATQ versus ML). The time to intubation with the AWS was significantly shorter than with the ATQ and ML (AWS 11 ± 6 seconds; ATQ 16 ± 12 seconds; and ML 16 ± 11 seconds; *P < 0.05 AWS versus ATQ, ML). The number of optimization maneuvers with the AWS was significantly lower than with the ATQ and ML. There were significantly more audible dental click sounds with the ML than with the AWS and ATQ. CONCLUSION:Both the AWS and ATQ may be suitable devices for difficult intubation by inexperienced personnel in this manikin simulated scenario. Further studies in a clinical setting are necessary to confirm these findings.

Safety of the inter-nipple line hand position landmark for chest compression.

BACKGROUND No previous study has investigated the safety of hand position during chest compression determined by the inter-nipple line, in which the heel of one hand is positioned on the centre of the chest between the nipples, from the standpoint of prevention of organ injury. METHODS We measured the distance from the xiphisternal junction to the inter-nipple line (dN) in 1000 surgical patients and the heel length (H) of hands in 100 healthy volunteers, then used the formula H/2-dN to determine the amount of deviation when the heel of the rescuers hand extended to the xiphoid process (D). Next, 100 surgical patients were randomly assigned to 18 anaesthesiologists, who placed the heels of their hands on the sternum for validation. RESULTS The D value was positive in 551 patients, indicating that the heel may extend to the xiphoid process during chest compression in those individuals. Multivariate logistic-regression analyses showed that deviations beyond the xiphoid process to the epigastric region were more likely to occur in female (OR 3.52), elderly (OR 2.00), and short-statured (OR 2.09) patients, and with male rescuers (OR 2.81). During actual positioning, deviation occurred in 51 patients and extended to the epigastric region in 5 females. CONCLUSIONS Simulation of hand position determined by the inter-nipple line resulted in placement of the rescuers hands over the xiphoid process in nearly half of the patients. Hand deviation to the epigastric region may occur when the patient is a short-statured or elderly female, and when the rescuer is male.

Video laryngoscopy for emergency tracheal intubation during chest compression

0300-9572/

Latent myofascial trigger points in paraspinal muscles of patients with chronic pain

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Airway Scope(R) for Emergency lntubations : Usefulness of a New Video-laryngoscope

AbstractWe have found a unique type of latent myofascial trigger point in the paraspinal muscles of patients with various chronic pain conditions, which has not been described previously. The myofascial trigger points are located in paraspinal muscles that shared the same or adjacent spinal nerves with the primary lesion causing the chronic pain condition. We also investigated the efficacy of trigger point injections to those points to alleviate the original pain. We reviewed 11 patients with such latent myofascial trigger points. Diagnosed chronic pain conditions included postthoracotomy pain syndrome, postherpetic neuralgia, cancer pain, radiculopathy, chronic abdominal wound pain, and chronic pancreatitis. Injections of local anesthetics to latent myofascial trigger points in the paraspinal muscles immediately reduced the intensity of the original pain in all patients. After the series of treatments, a visual analog scale showed a significant decrease of pain.