A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

T he criterion standard for management of the anticipated difficult tracheal airway is awake flexible fiberoptic intubation (FFI), an approach that was compared with the use of the McGrath video laryngoscope (MVL) (Aircraft Medical, Edinburgh, Scotland) in patients with expected difficult intubation. Researchers hypothesized that MVL intubation would be faster than FFI. Ninety-three adult patients with anticipated difficult intubation were randomly allocated to awake FFI or awake MVL. They were given glycopyrrolate, nasal oxygen, oral topical lidocaine, and a transtracheal injection of 100 mg lidocaine. Infusion of remifentanil was given intravenously to a Ramsay sedation score of 2 to 4. Time to tracheal intubation was recorded by independent observers. Intubation success on the first attempt, researchers' evaluation of the ease of the technique, and patient-reported intubation discomfort on a visual analog scale were also recorded. Eighty-four patients qualified for analysis. Time to tracheal intubation was a median of 80 seconds (interquartile range [IQR], 58Y117 seconds) with FFI and 62 seconds (IQR, 55Y109 seconds) with MVL. Success of intubation on the first attempt was 79% versus 71% for FFI and MVL, respectively. The median visual analog scale score for patients' assessment of discomfort for both techniques was 2 (FFI: IQR, 0Y3; MVL: IQR, 0Y4). No difference was found in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airways.

Head-to-head comparison in this large multicenter trial revealed that the newly introduced C-MAC D-Blade does not yield the same first-attempt intubation success as the GlideScope in patients with predicted difficult laryngoscopy except in the hands of attending anesthesiologists. Additional research would be necessary to identify potential causes for this difference. Intubation success rates were very high with both systems, indicating that acute-angle video laryngoscopy is an exceptionally successful strategy for the initial approach to endotracheal intubation in patients with predicted difficult laryngoscopy.

The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting, and this improvement is greatest in simulated difficult scenarios.

We performed a systematic search of the medical literature and reviewed the evidence examining success rates and incidence of complications of ultrasound (US) guidance relative to traditional techniques for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, and ilioinguinal/iliohypogastric. We included studies of sufficient methodologic quality for review and excluded poor-quality studies. We then rated the strength of evidence for US guidance for each block using a system developed by the United States Agency for Health Care Policy and Research. Although relatively few studies have compared US guidance with established techniques, the available evidence suggests that the use of US guidance is a safe and effective means to facilitate correct needle placement and adequate spread of local anesthetic for truncal blocks. Further studies are needed to directly compare US guidance to traditional techniques and to clarify potential benefits and limitations of US guidance for truncal blocks.

In patients with OHCA, we detected a slightly higher rate of CCF in patients for whom a SGA was inserted, both before and after insertion. However, the actual differences were so small, that in the context of this observational, secondary analysis, it is unclear if this represents a clinically significant difference.

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We evaluated the performance of tracheal intubation using video laryngoscopy in an obstetric unit. We analyzed airway management details during a 3-year period, and observed 180 intubations. All cases were managed with direct or video laryngoscopy. Direct laryngoscopy resulted in 157 out of 163 (95% confidence interval [CI], 92%-99%) first attempt successful intubations and failed once. Video laryngoscopy resulted in 18 of 18 (95% CI, 81%-100%) successful intubations on first attempt. The failed direct laryngoscopy was rescued with video laryngoscopy. The patients managed with video laryngoscopy frequently required urgent or emergency surgery and had predictors of difficult direct laryngoscopy in 16 of 18 cases. Video laryngoscopy may be a useful adjunct for obstetric airway management, and its role in this difficult airway scenario should be further studied.