Background: Endotracheal intubation is a core skill for airway management. With regard to the expertise of endotracheal intubation among physicians using a rigid laryngoscope, the body movement, the head movement, and movement of the gaze during the intubation procedure vary for each physician. This study aimed to test the hypothesis that the duration of endotracheal intubation, head movement, and movement of gaze intra-procedurally differ between experts and novices and assessed these factors using both a motion capture system and eyetracking system in a medical simulation setting. Methods: After obtaining institutional approval, individuals who were either novices or experts at endotracheal intubation using Macintosh laryngoscopes were recruited. Body motion and gaze distribution during endotracheal intubation of a mannequin were recorded and analyzed using a motion capture system and eye-tracking system. The values obtained were compared between the novices and experts. Results: The endotracheal intubation time was significantly shorter in experts (21.6 ± 7.6 sec vs 30.4 ± 8.3 sec, p=0.002), and the range of vertical head movement was smaller in experts (13.1 ± 7.7 cm vs 39.2 ± 8.1 cm, p<0.001), with significantly different trajectory, than those in novices. The ratio of downward gazing was significantly higher in experts (99.6 [96.7-100]% vs 32.4[18.8-43.4]%, p<0.001), and that of proximal gazing was significantly higher in novices (78.1 [67.9-85.6]% vs 37.2 [6.4-82.1]%, p=0.011). Conclusion: Body movement and gaze dynamics during endotracheal intubation with rigid laryngoscope differed between novices and experts. This system is a potential and feasible tool for evaluating the practice of endotracheal intubation.
Background: Video analysis of body and gaze movements has recently become widespread, mainly in the field of engineering, however, few medical studies have used motion capture and eye-tracking systems. The aim of this study was to test the hypothesis that head movements and gaze distribution during tracheal intubation differ between practitioners who are expert at tracheal intubation and those who are novice at tracheal intubation as a secondary analysis of our previous study. Methods: Practitioners who were either novices or experts at tracheal intubation using Macintosh laryngoscopes were recruited. Head movement and gaze distribution during tracheal intubation into a mannequin were recorded using motion capture and eye-tracking systems and analyzed according to 3 phases: phase A (mouth opening), B (obtaining vocal cord view), and C (tracheal intubation). The values obtained were compared between novices and experts. Results: Intra-group comparison showed significant differences in the height of the head and forward-backward head tilt during tracheal intubation in the experts and novices, respectively. Inter-group comparison showed significant differences at each phase except for the height of the head at phase A
Background: Video laryngoscopy (VL) is an attractive airway management device; however, its userʼs motion during tracheal intubation (TI) has not been evaluated. Therefore, this study aimed to investigate the differences in head and eye movement during TI using VL, McGRATH ® , between experts and novices. Methods: Time for TI, head movements, and gaze distribution during TI in a mannequin with McGRATH ® were recorded using motion capture and eye-tracking systems. TI was divided into three phases: A) from mouth opening to laryngoscope insertion, B) from the insertion into the mouth to enable visualization of the vocal cords, and C) from holding a constant vocal cord view to the finish of intubation. Data were compared between the experts and novices according to the phases. Results: In the experts, total TI time was significantly shorter (17.5 vs. 20.5 sec, p<0.001), and the duration of Phases A and C were significantly shorter (A: 5.0 vs. 6.4 sec, p<0.001; C: 8.1 vs. 9.2 sec, p=0.031). The intra-group comparison showed the head height in both groups significantly decreased until the Phase B and significantly increased in Phase C. Inter-group comparison showed the head heights in the Phases B and C were significantly lower in the novices (B: 152.2 vs. 142.6 cm, p<0.001; C: 157.4 vs. 145.9 cm, p<0.001). The height differences between the occipital and temporal regions indicated both groups turned their faces down from Phase A to B and upward in Phase C. The extent of head tilting in each phase was significantly larger in the novices. Gaze analysis indicated that while the experts continued looking down and further throughout TI, the novices looked up during Phases B and C. Conclusion: Posture and gaze distribution during TI using McGRATH® were different between the novices and experts. These results should be considered in instructing and learning TI.
Background: Carotid ultrasonography can be used as a minimally invasive method of evaluating systemic hemodynamics. We investigated carotid artery flow velocity during one-lung ventilation (OLV) to test our hypothesis that the measured values from carotid ultrasonography would positively correlate with global hemodynamic values, blood pressure, and arterial pressure-based cardiac output (APCO). Methods: The study group comprised 43 consecutive patients who underwent pulmonary surgery between April and September 2017. Common carotid artery measurements on the same side as the non-dependent lung were obtained at 8 time points: before induction of general anesthesia, after tracheal intubation, after positional change, at 15, 30, 60, and 90 minutes after initiation of OLV, and 15 minutes after OLV. We measured peak systolic velocity (PSV) of the common carotid artery. Non-invasive systolic blood pressure (NISBP), non-invasive mean blood pressure (NIMBP), non-invasive diastolic blood pressure (NIDBP), systolic arterial pressure (SAP), mean arterial pressure (MAP), and diastolic arterial pressure (DAP), and APCO were recorded at the same points. Results: PSV increased significantly after a change to the lateral decubitus position. Multiple regression analysis showed PSV was affected by APCO, SAP, age, and history of hypertension (R 2 = 0.23). APCO was the most affective factor (β = 8.35, SE = 1.60, t = 5.22, P < 0.0001). The second was SAP (β = -0.37, SE = 0.08, t = -4.75, P < 0.0001). Conclusions: Carotid ultrasonography may be useful for evaluating systemic hemodynamics during pulmonary surgery.
Among patients with aortic valve stenosis (AS) , left ventricular outflow tract obstruction (LVOTO) due to myocardial hypertrophy and left ventricular outflow tract obstruction (LVOTO) after aortic valve replacement (AVR) , there are cases in which systolic anterior movement (SAM) remains in the systolic mitral valve. In addition to AVR in consultation with the surgeon in cases with cardiac muscle hypertrophy due to AS, Morrow surgery was added in case 1, and papillary muscle bundle resection was added in case 2. As there are no clear standard indications for Morrow surgery and papillary muscle bundle resection, accurately determining flow velocity of the left ventricular outflow tract on preoperative transthoracic echocardiography (TTE) and intraoperative transesophageal echocardiography (TEE) is important for predicting the risk of LVOTO and SAM. Decisions regarding the type of operation should be made in consultation with the surgeon based on the findings in the hypertrophic myocardium.
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