Shunsuke Fujiwara

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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SHIFTS IN ENDOTRACHEAL TUBE POSITION DUE TO CHEST COMPRESSIONS: A SIMULATION COMPARISON BY FIXATION METHOD

BACKGROUND Endotracheal tube placement during resuscitation is important for definite tracheal protection. Accidental extubation due to endotracheal tube displacement is a rare event that can result in severe complications. OBJECTIVE This study evaluated how endotracheal tube displacement is affected by tape vs. tube holder fixation using a manikin and auto-chest compression machine simulation. METHODS The endotracheal tube was placed in either a shallow or a deep position, with the tube cuff at the center of the glottis or 26 cm from the incisors in an advanced lifesaving simulator. Trials were performed five times in each setting with: no fixation; Durapore® tape fixation; Multipore® tape fixation; and Thomas tube holder® fixation. After 10 min of automated chest compressions, endotracheal tube shift was measured. Statistical analysis was performed with one-way repeated analysis of variance or χ(2) test, with p < 0.05 considered significant. RESULTS In the shallow setting, endotracheal tube extubation occurred in all trials with no fixation, Durapore, and Multipore. In contrast, no extubation occurred in the Tube holder trials (p < 0.05). In the deep setting, no extubation was confirmed in any trial. Relative to no fixation (0.56 ± 0.11 cm), endotracheal tube shift was significantly less in the Durapore tape, Multipore tape, and Tube holder groups (p < 0.05). Of the three fixation methods, Tube holder (0.04 ± 0.05 cm) showed significantly less shift (p < 0.05) relative to Durapore (0.28 ± 0.04 cm) and Multipore (0.32 ± 0.08 cm). CONCLUSION Endotracheal tube displacement occurs less with Tube holder fixation than with Durapore tape or Multipore tape during simulation of continuous chest compressions.

Significance of debriefing methods in simulation-based sedation training courses for medical safety improvement in Japan

Based on the American Society of Anesthesiologists’ Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists (ASA-SED), a sedation training course aimed at improving medical safety was developed by the Japanese Association for Medical Simulation in 2011. This study evaluated the effect of debriefing on participants’ perceptions of the essential points of the ASA-SED.A total of 38 novice doctors participated in the sedation training course during the research period. Of these doctors, 18 participated in the debriefing group, and 20 participated in non-debriefing group. Scoring of participants’ guideline perceptions was conducted using an evaluation sheet (nine items, 16 points) created based on the ASA-SED.The debriefing group showed a greater perception of the ASA-SED, as reflected in the significantly higher scores on the evaluation sheet (median, 16 points) than the control group (median, 13 points; p < 0.05). No significant differences were identified before or during sedation, but the difference after sedation was significant (p < 0.05).Debriefing after sedation training courses may contribute to better perception of the ASA-SED, and may lead to enhanced attitudes toward medical safety during sedation and analgesia.

Pectral nerve blocks and serratus-intercostal plane block for intractable postthoracotomy syndrome

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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 fluid leakage from four different cuffed pediatric endotracheal tubes using a pediatric airway simulation model.

This study used an airway model to compare the ability of a pediatric endotracheal tube with a taper‐shaped cuff to prevent microaspiration relative to endotracheal tubes with conventional cuffs. Four different types of 5.0‐mm inner diameter cuffed pediatric endotracheal tubes (taper‐shaped cuff [Taper], high‐volume low‐pressure [Hi‐Lo], middle‐volume low‐pressure [Intermediate], and low‐volume low‐profile [Lo‐Pro]) were fixed within vertically placed acrylic tubes. The cuffs were maintained at 10, 20, or 30 cmH2O pressure and 3 mL of simulated stomach contents was added to the top of the cuffs. The volume of leakage around the cuffs after 5 min and 4 h was measured. After 5 min, the volume of leakage was significantly lower with the Taper than with the Hi‐Lo, Intermediate, or Lo‐Pro at all pressure settings. After 4 h, leakage was significantly lower with the Taper than with the other three tubes regardless of initial cuff pressure (P < 0.05).

Proteomic analysis of cerebrospinal fluid before and after intrathecal injection of steroid into patients with postherpetic pain.

Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster, and the risk of it increases with age. By comparing proteomes of the cerebrospinal fluid (CSF) before and after the treatment, it may be possible to identify proteins that play a role in PHN and to predict responses to various treatments. To address this issue, we enrolled eight outpatients with PHN over 55 years of age and treated them with intrathecal methylprednisolone and lidocaine four times every week, collecting CSF samples before the treatment at each visit. We used 2D DIGE to investigate differentially expressed proteins in the CSF before and after repetitive treatments individually. Of 145 differentially expressed spots, the levels of nine proteins were decreased by the treatment including lipocalin‐type prostaglandin D synthase (L‐PGDS), and five were increased by it. The time course of alterations in the L‐PGDS concentration in the CSF of each patient, detected by a pairwise and sandwich ELISA by SPR constructed here was well correlated with that by 1DE Western blots with anti‐L‐PGDS antibody, but was not related with that of the pain relief. The present study demonstrates that the real‐time ELISA was precise and sensitive enough to measure L‐PGDS in the CSF and that the steroid treatment decreased the L‐PGDS concentration in CSF.

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.