Background and aim COVID-19 pandemic has resulted in an unprecedented increased usage of Personal protective equipment (PPE) by healthcare-workers. PPE usage causes headache in majority of users. We evaluated changes in cerebral hemodynamics among healthcare-workers using PPE. Methods Frontline healthcare-workers donning PPE at our tertiary center were included. Demographics, co-morbidities and blood-pressure were recorded. Transcranial Doppler (TCD) monitoring of middle cerebral artery was performed with 2-MHz probe. Mean flow velocity (MFV) and pulsatility index (PI) were recorded at baseline, after donning N95 respirator-mask, and after donning powered air-purifying respirator (PAPR), when indicated. End-tidal carbon-dioxide (ET-CO2) pressure was recorded for participants donning PAPR in addition to the N95 respirator-mask. Results A total of 154 healthcare-workers (mean age 29 ± 12 years, 67% women) were included. Migraine was the commonest co-morbidity in 38 (25%) individuals while 123 (80%) developed de-novo headache due to N95 mask. Donning of N95 respirator-mask resulted in significant increase in MFV (4.4 ± 10.4 cm/s, p < 0.001) and decrease in PI (0.13 ± 0.12; p < 0.001) while ET-CO2 increased by 3.1 ± 1.2 mmHg (p < 0.001). TCD monitoring in 24 (16%) participants donning PAPR and N95 respirator mask together showed normalization of PI, accompanied by normalization of ET-CO2 values within 5-min. Combined use of N95 respirator-mask and PAPR was more comfortable as compared to N95 respirator-mask alone. Conclusion Use of N95 respirator-mask results in significant alterations in cerebral hemodynamics. However, these effects are mitigated by the use of additional PAPR. We recommend the use of PAPR together with the N95 mask for healthcare-workers doing longer duties in the hospital wards.

EditordThe 2019 novel coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, profoundly impacting the lives of anaesthesiologists, intensivists, and nurses caring for the critically ill. Such high-acuity patient care imposes a significant physical and cognitive burden, which is further compounded by increased workloads, staffing deficiencies, and equipment shortages. Participation in aerosol-generating procedures and frequent direct patient contact may increase risk of infection. Government-imposed containment measures may lead to social isolation and restrict access to usual coping mechanisms. Exposure to contagion may also engender concerns from staff living with older people and young children. The previous severe acute respiratory syndrome outbreak of 2003 saw emotional exhaustion, anxiety, depression, and burnout afflicting healthcare workers. 1,2 Similarly, studies on healthcare workers from China and Italy have described stress-related anxiety and depression during the COVID-19 pandemic. 3,4 These studies did not specifically examine intensive care providers, who may constitute a highrisk subgroup. We sought to determine the prevalence and severity of psychological distress amongst anaesthesiologists and nurses working in ICUs during this pandemic, and identify potential risk factors. We also studied their main concerns, perceptions of pandemic preparedness, training adequacy, and staff protection. This observational, cross-sectional study was conducted at a 1240-bed tertiary academic medical centre in Singapore. During this pandemic, anaesthesiologists were rostered into ICUs in our hospital. Ethics approval was obtained from the institutional domain-specific review board (2020/00648) before commencement of the study. All anaesthesiologists (including trainees) and nurses working in ICUs were invited to participate with a one-time self-administered online questionnaire. The sampling period was June 11e15, 2020, during which Singapore saw 400 to 500 new cases daily, with a cumulative total exceeding 40 000 cases for a population of~5.8 million. Two survey completion reminders were issued. All participants completed a 46question, closed-ended, self-reporting questionnaire (Supplementary Appendix 1). No identifying information was collected. The anonymised questionnaire collected participant characteristics, medical history, and workplace characteristics, such as redeployment outside normal professional boundaries, direct COVID-19 patient care, workload during the pandemic,

Failure to secure the airway is an important cause of morbidity and mortality during resuscitations. We compared the rate of successful intubation of the King Vision™ aBlade™ channeled and non-channeled video laryngoscopes, and McGRATH™ MAC video laryngoscope when used by junior doctors to intubate a simulated difficult airway in an out-of-hospital setting. 105 junior doctors were recruited in a crossover study to perform tracheal intubation with the three video laryngoscopes on a simulated difficult airway using the SimMan® 3G manikin. Primary outcome was the rate of successful intubations. Secondary outcomes were time-to-visualization, time-to-intubation and ease of use. Rates of successful intubations were higher for King Vision channeled and McGrath compared to the King Vision non-channeled (85.7% and 82.9% respectively versus 24.8%; p<0.001). Amongst the participants who had successful intubations, King Vision channeled and McGrath had shorter mean time-to-intubation compared to the King Vision non-channeled (41.3±20.3s and 38.5±18.7s respectively versus 53.8±23.8s, p<0.004;). There was no significant difference in the rate of successful intubation and mean time-to-intubation between King Vision channeled and McGrath. The King Vision channeled and McGrath video laryngoscopes demonstrated superior intubation success rates compared to King Vision non-channeled laryngoscope when used by junior doctors for intubating simulated difficult airway in an out-of-hospital setting. We postulated that the presence of a guidance channel in the King Vision channeled laryngoscope and the familiarity of the blade curvature and handling of the McGrath could have accounted for their improved intubation success rates.

No abstract

Background This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method One hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s. Conclusion Military medical officers with 2–3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

Introduction This study shed light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes.Method133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study.ResultsThe medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s.ConclusionMilitary medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.