Yoshiroh Kaminoh

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 tracheal intubation by the Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study.

To compare tracheal intubation with the Pentax Airway Scope (AWS) and the Macintosh laryngoscope (McL) during chest compression, 25 anesthesiologists (including 12 specialists having >5xa0years of experience and 13 trainees having <2xa0years of experience) performed tracheal intubation using either the McL or the AWS, with or without chest compression, on a manikin. Using the McL, both specialists and trainees took a significantly longer time (Pxa0<xa00.01) to secure the airway with chest compression (17.3xa0±xa03.7xa0and 22.5xa0±xa08.0, respectively)xa0and than without chest compression (11.3xa0±xa02.9 and 13.9xa0±xa04.4xa0s, respectively). No significant difference was observed in time needed to secure the airway using the AWS with or without chest compression in both groups. From the standpoint of experience, time to complete intubation for specialists using the McL during chest compression was significantly shorter than that for trainees. In contrast, the difference in time to complete intubation with the AWS during chest compression was not significantly different between the two groups. Based on these results, we conclude that the use of the AWS may reduce the time needed to secure the airway during chest compression.

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

BACKGROUNDnRecent 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.nnnMETHODSnTwenty staff doctors in intensive care and emergency medicine performed tracheal intubation on an infant manikin with Mil and ATQ with or without chest compression.nnnRESULTSnIn 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.nnnCONCLUSIONnWe 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

BACKGROUNDnRecent 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.nnnMETHODSnTwenty-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.nnnRESULTSnTwo 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.nnnCONCLUSIONnWe 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.

Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study

PurposeThe 2010 American Heart Association or European Resuscitation Council guidelines for cardiopulmonary resuscitation emphasize that rescuers should minimize interruption of chest compressions, even for endotracheal intubation. Cervical stabilization should also be maintained during traumatic cardiac arrest. The utility of the Pentax-AWS Airwayscope (AWS) video laryngoscope and Airtraq (ATQ) optic laryngoscope for airway management has been reported under cervical stabilization. We first evaluated ATQ utility during chest compression with or without cervical stabilization and then compared the AWS, ATQ, and Macintosh laryngoscope (McL) during chest compressions under cervical stabilization in a manikin.MethodsIn the first trial, 19 novice doctors performed tracheal intubation with ATQ during chest compression with or without cervical stabilization. In the second trial, 21 novice doctors performed tracheal intubation on a manikin with cervical stabilization using AWS, ATQ, and McL with or without chest compression in a manikin. The rate of successful intubation, time to intubation, and subjective difficulty of use (visual analog scale) were recorded.ResultsIn the first trial, intubation time during chest compression was significantly shortened under cervical stabilization compared to without cervical stabilization (Pxa0<xa00.05). In the second trial, using McL, 3 participants failed to perform tracheal intubation without chest compression and 11 failed during chest compression (Pxa0<xa00.05). Using ATQ, all intubations were successful without chest compression, but 5 failed during chest compression (Pxa0<xa00.05). Intubation time was significantly prolonged by chest compression using McL or ATQ (Pxa0<xa00.05). All participants successfully secured the airway with AWS regardless of chest compression, and chest compression did not prolong intubation time. Chest compression worsened the score on the visual analog scale of laryngoscopy in the McL trial (Pxa0<xa00.05), but not in ATQ or AWS trials. Difficulty of tube passage through the glottis increased with chest compression with the McL and ATQ (Pxa0<xa00.05) but not with AWS.ConclusionThe AWS was superior to McL and ATQ for endotracheal intubation during simulated cervical stabilization and chest compression.

Effects of a simulation-based sedation training course on non-anesthesiologists' attitudes toward sedation and analgesia

AbstractnThe purpose of this study was to conduct a survey of emergency or complication during sedation and change of attitude toward sedation by simulation-based sedation training course (SEDTC) hosted by the Japanese Association of Medical Simulation. We used a questionnaire survey to non-anesthesiologists who participated in the 1st to 13th SEDTCs from 2011 to 2012. Survey contents included emergencies or complications during sedation and impressions of the Sedation and Analgesia guidelines for non-anesthesia doctors developed by the American Society of Anesthesiologists. Of 84 non-anesthesiologists, 81 have encountered patient respiratory suppression. More than 70xa0% non-anesthesiologists have encountered patient respiratory arrest. All non-anesthesiologists have encountered patient cardiac suppression; 20–30xa0% of non-anesthesiologists have encountered patient anaphylaxis, asthma attack, and cardiac arrest; and all non-anesthesiologists have encountered patient vomiting and about 80xa0% aspiration. Non-anesthesiologists largely accepted the guidelines. SEDTC attendance improved significantly 13 points of 18 important suggestions. As non-anesthesiologists experience several complications during sedation, SEDTC may be useful for the improvement of their attitude toward the safety management of sedation.

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 Pentax-AWS Airwayscope, Airtraq and Miller laryngoscope for tracheal intubation by novice doctors during infant cardiopulmonary resuscitation simulation: a randomized crossover trial

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 Airway Scope (AWS) with an infant-sized Intlock (AWS-I), Airtraq laryngoscope (ATQ) and Miller laryngoscope during chest compressions on an infant manikin. Twenty-three novice doctors performed tracheal intubation on an infant manikin using the AWS-I, ATQ and Miller laryngoscope, with or without chest compressions. In Miller laryngoscope trials, one participant failed to secure the airway without chest compressions, while nine failed with compressions (Pxa0<xa00.05). In ATQ trials, none of the participants failed without compressions, while six failed with compressions (Pxa0<xa00.05). In AWS-I trials, all participants succeeded regardless of chest compressions. Intubation time was significantly longer with chest compressions with the Miller laryngoscope and ATQ, but not with the AWS-I. The AWS-I is an effective device for endotracheal intubation during chest compressions in infant simulations managed by novice doctors.

Backboard insertion in the operating table increases chest compression depth: a manikin study.

The quality of chest compression (CC) is influenced by the surface supporting the patient. The present study compared chest compression depth with and without a rigid backboard on an operating table with a pressure-distributing mattress. We hypothesized that the presence of a backboard would result in an increased depth of chest compression on the operating table with a pressure-distributing mattress. In a randomized crossover trial, we simulated in-hospital cardiac arrest in a Resusci Anne SkillReporter model placed on a standard operating table with a 6-cm-thick pressure-distributing mattress. A total of 25 male doctors performed CC 30 times, with or without the rigid backboard. Mean chest compression depth increased from 4.9xa0±xa00.4 to 5.4xa0±xa00.3xa0mm (Pxa0<xa00.0001) when a backboard was present. Mean proportion of compressions >50xa0mm increased significantly with the presence of a backboard (53.6%xa0±xa032.3%–81.8%xa0±xa015.0%, Pxa0<xa00.0001). Applying a backboard significantly increased CC depth during cardiopulmonary resuscitation of a manikin model on an operating table with a pressure-distributing mattress.

Comparison of Laryngeal Mask Supreme® and Soft Seal® for airway management in several positions

PurposeIn emergency situations, rescuers occasionally must secure the airway while the patient is in a position other than the ideal supine position. We hypothesized that the laryngeal mask airway Supreme® (Supreme) may be useful for emergent airway management in several positions and compared the utility of the Supreme with that of the conventional Soft Seal® (Soft Seal) device.MethodsNineteen novice doctors in our anesthesia department attempted insertion of the Supreme or Soft Seal device on a simulated manikin in the supine, left lateral decubitus (left-LT), right lateral decubitus (right-LT), prone, and sitting positions. For each device, successful ventilation attempts, mean time to secure the airway, and difficulty of use [using the visual analog scale (VAS)] were evaluated.ResultsThe success rate of ventilation was significantly higher with the Supreme than the Soft Seal in the prone and sitting positions (Pxa0<xa00.05). Compared with the Soft Seal, time to secure the airway was significantly shorter with the Supreme when the manikin was in the sitting position but not in the other four positions. VAS scores for Supreme use were significantly higher than those for Soft Seal use in the right-LT, prone, and sitting positions.ConclusionAirway management attempts by novice doctors were more successful with the Supreme than the Soft Seal in the right-LT, prone, and sitting positions in the manikin. The Supreme may therefore be useful for emergent airway management.