Zehra İpek Arslan

Effect of Cricoid Pressure on Laryngeal View During Macintosh, McGrath MAC X-Blade and GlideScope Video Laryngoscopies.

Objective Cricoid pressure is useful in fasted patients requiring emergency intubation. We compared the effect of cricoid pressure on laryngeal view during Macintosh, McGrath MAC X-Blade and GlideScope video laryngoscopy. Methods After obtaining approval from the Human Research Ethics Committee and written informed consent from patients, we enrolled 120 patients (American Society of Anesthesiologists I-II, age 18-65 years) undergoing elective surgery that required endotracheal intubation in this prospective randomised study. Patients were divided into three groups (Macintosh, McGrath MAC X-Blade and GlideScope). Results Demographic and airway variables were similar in the groups. Cormack-Lehane grades were improved or unchanged on using cricoid pressure in Macintosh and McGrath MAC X-Blade groups. However, laryngeal views worsened in 12 patients (30%), remained unchanged in 26 patients (65%) and improved in 2 patients (5%) in the GlideScope group (p<0.001). Insertion and intubation times for Macintosh and McGrath MAC X-Blade video laryngoscopes were similar. Insertion times for GlideScope and Macintosh video laryngoscopes were similar, but were longer than those for the McGrath MAC X-Blade video laryngoscope (p=0.02). Tracheal intubation took longer with the GlideScope video laryngoscope than with the other devices (p<0.001 and p=0.003). Mean arterial pressures after insertion increased significantly in Macintosh and GlideScope groups (p=0.004 and p=0.001, respectively) compared with post-induction values. Heart rates increased after insertion in all three groups compared with post-induction values (p<0.001). Need for optimisation manoeuvres and postoperative minor complications were comparable in all three groups. Conclusion Although all three devices are useful for normal or difficult intubation, cricoid pressure improved Cormack-Lehane grades of Macintosh and McGrath MAC X-Blade video laryngoscopes but statistically significantly worsened that of the GlideScope video laryngoscope.

Intubation of a Paediatric Manikin in Tongue Oedema and Face-to-Face Simulations by Novice Personnel: a Comparison of Glidescope, Airtraq and Direct Laryngoscopy.

OBJECTIVE Glidescope and Airtraq were designed for facilitating intubation and for teaching regarding the airway anatomy. We aimed to evaluate their efficacy in normal airway, tongue oedema and face-to-face orotracheal intubation models when used by novice personnel. METHODS After the local human research ethics committee approval, 36 medical students who were in the beginning of their third year were enrolled in this study. After watching a video regarding intubation using one of these devices, the students intubated a paediatric manikin with a Glidescope or Airtraq via the normal airway, tongue oedema and face-to-face approach. RESULTS Although the insertion and intubation times were similar among the groups, the intubation success rate of the Glidescope was higher in the normal airway (100% vs 67%) and tongue oedema (89% vs. 50%) compared with the Airtraq (p=0.008 and p=0.009). The success rates with the paediatric manikin by the face-to-face approach were similar among the groups (50%) (p=0.7). The need for manoeuvres in the Glidescope was lower in the normal and tongue oedema models (p=0.02 and p=0.002). In addition, oesophageal intubation was low in the control and tongue oedema models with the Glidescope (p=0.03 and p<0.001). CONCLUSION Novice personnel could more easily intubate the trachea with the Glidescope than with the Airtraq. Intubation with the Glidescope was superior to that with the Airtraq in the normal and tongue oedema models. The face-to-face intubation success rates were both low with both the Glidescope and Airtraq groups.

Intubation of a Pediatric Manikin in Tongue Edema and Face-to-Face Simulations by Emergency Medical Staff: A Comparison of the Glidescope, Airtraq and Direct Laryngoscopy

ABS TRACT Objective: Trauma victims occasionally cannot be intubated by emergency staff via conventional techniques. We sought to evaluate the efficacies of the application of the Glidescope and Airtraq in normal airway, tongue edema and face-to-face tracheal intubation models as used by emergency medical staff. Material and Methods: Following approval from the local human research ethics committee, 14 emergency medical staff enrolled in this study. The participants attempted to intubate pediatric manikins in three different airway models (in a random order) with a Glidescope, Airtraq and Direct Laryngoscope. Results: All emergency medical staff intubated the normal and tongue edema models successfully with the three devices. The intubation success rates for the Airtraq and Glidescope were 93% with the face-to-face approach (entrapped). The intubation time with the Glidescope was longer than that for the other devices in three models (p=0.001, p=0.02, p=0.02). When compared within groups, the intubation time for the Glidescope was increased relative to the normal face-to-face approach (16 [14.0-21.5] seconds vs. 31 [18.8-34.3] seconds, 57 [43.0-71.0] seconds; p<0.001). This was not the case when we examined the other devices. Conclusion: The emergency medical staff was able to intubate the pediatric manikin in the tongue edema and face-to-face models with the Glidescope and Airtraq with similar rates of success. In the Glidescope group, tracheal intubation required much more time, but this prolongation was clinically negligible. This study has been registered at www.clinicaltrials.gov.tr (NCT02478203).

In reply: Comparing face-to-face intubation with different devices

1. Zhang JQ, Xue FS, Meng FM. Comparing face-to-face intubation with different devices. J Anesth. 2016;. doi:10.1007/ s00540-016-2156-7. 2. Arslan ZI, Alparslan V, Ozdal P, Toker K, Solak M. Face-toface tracheal intubation in adult patients: a comparison of the AirtraqTM, GlidescopeTM and FastrachTM devices. J Anesth. 2015;29:893–8. 3. Ueshima H, Asai T. Tracheal intubation in daylight and in the dark: a comparison of the Airway Scope, Airtraq, and Macintosh laryngoscope in a manikin. Anaesthesia. 2010;65:684–7.

In reply: Confirmation of tracheal intubation time in adults

1. Arslan ZI, Alparslan V, Ozdal P, Toker K, Solak M. Face-toface tracheal intubation in adult patients: a comparison of the AirtraqTM, GlidescopeTM and FastrachTM devices. J Anesth. 2015;29:893–8. 2. Amathieu R, Sudrial J, Abdi W, Luis D, Hahouache H, Combes X, Dhonneur G. Simulating face-to-face tracheal intubation of a trapped patient: a randomized comparison of the LMA FastrachTM, the GlidescopeTM and the AirtraqTM laryngoscope. Br J Anaesth. 2012;108:140–5. 3. Grosomanidis V, Amaniti E, Pourzitaki Ch, Fyntanidou V, Mouratidis K, Vasilakos D. Comparison between intubation through ILMA and Airtraq, in different non-conventional patient positions: a manikin study. Emerg Med J. 2012;29:32–6.

Treatment of Posterior Reversible Encephalopathy Syndrome that Occurred in a Patient with Systemic Lupus Erythematosus by Plasmapheresis

Posterior reversible encephalopathy syndrome is characterized by visual and mental disturbances, nausea and vomiting and generalized or focal convulsions and often represents itself with parietal and occipital oedema formation. We want to report the treatment of posterior reversible encephalopathy syndrome with plasmapheresis, which developed in a 35-year-old woman with systemic lupus erythematosus diagnosed by renal biopsy 3 years ago. She has been followed up in the intensive care unit three times. However, she had been transferred to the nephrology department of our university hospital because of her uncontrolled blood pressure. Oral antihypertensive therapy, corticosteroid 500 mg 1 × 1 and cyclophosphamide were started for the activation of lupus. After the detection of low complement levels, systemic lupus erythematosus activation was suspected. She developed mental deterioration after her first plasmapheresis treatment and was then consulted by the neurology and intensive care unit doctors. Diffusion cranial magnetic resonance imaging was found compatible with posterior reversible encephalopathy syndrome. The patient was transferred to our intensive care unit. The patient gained consciousness after her second plasmapheresis. After 5 days of follow-up in our intensive care unit and after significant regression was observed in the magnetic resonance imaging analysis, the patient was transferred to the nephrology service conscious, cooperated and orientated. At the nephrology service, after a total of 13 times of plasmapheresis, complement levels were increased and she was discharged with corticosteroid therapy. Posterior reversible encephalopathy syndrome can be observed in patients with systemic lupus erythematosus and intensive care unit treatment may be required. To control the hypertension, plasmapheresis should be kept in mind in addition to the multiple antihypertensive therapy in these patients.

Assessment of Some Public Hospitals in Turkey Regarding Anaesthetist, Anaesthesia and Intensive Care Equipment

OBJECTIVE Every year, 230 million patients undergo major general surgery with anaesthesia worldwide, and 7 million resulted with major complications. Monitorisation and equipment has a great role in increasing patient safety and safe surgery during anaesthesia. METHODS Turkey is divided into 12 Eurostut-NUTS regions and 26 subregions statistically. Totally, 303 hospitals that are included in these regions were enrolled in this descriptive trial. The hospitals were contacted by telephone between October 2012 and August 2013. Data collecting forms were e-mailed to any of the anaesthetists or anaesthesia technicians of the hospital and they were requested to fill the forms and forward them to one of the investigators. RESULTS Data were obtained from 221 of 303 hospitals (73%). Twenty-three hospitals were tertiary (university and education and research), 21 were city and 177 were county hospitals. No anaesthetist, operating rooms or intensive care units were available in 114 of the county hospitals. Anaesthetists were responsible for 61% of these active working theatres. Electrocardiogram, heart rate, non-invasive blood pressure and saturation could be monitored in 97% of them. End-tidal carbon dioxide could be monitored in 91% of at least one operating room in these hospitals. However, if the subject became to end-tidal carbon dioxide monitoring in every room, this ratio decreased to 63%. Defibrillators were absent in 6% of these rooms. Adult intensive care units were available in 33% of the hospitals and paediatric intensive care units were available in 32.4%; the responsibility of these intensive care units were carried out by anaesthetists at a 91.4% ratio. End-tidal carbon dioxide could be monitored in 54% of these units; invasive monitorisation could be applied in 68.4% if needed. CONCLUSION It was observed that hospitals have different standards according to their infrastructures of anaesthesia and intensive care unit equipment. We think that the elimination of these differences is an important step with respect to increasing patient safety and enhancement of the service quality in hospitals.