A randomised comparative study of Miller laryngoscope blade versus Oxiport<sup>®</sup> Miller laryngoscope blade for neonatal and infant intubations

Dias, Raylene; Dave, Nandini; Chhabria, Rachana; Shah, Harick; Garasia, Madhu

doi:10.4103/ija.ija_86_17

Cited by 11 publications

(3 citation statements)

References 14 publications

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“…The possibility of supplying oxygen via a laryngoscope is not entirely new and has been described by others. Using a Miller-shaped blade in neonates has shown to decrease the incidence of severe desaturation during neonatal and infant intubations in a study by Dias et al [ 15 ] However, the use of Miller-shaped blades outside the neonatological and pediatric setting is extremely rare. Since the Macintosh blade type is standard and the by far most widespread laryngoscope type in Europe, we decided to create a modified Macintosh blade.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

et al. 2023

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Background Recently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation. Methods In this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade. Results Oxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups). Conclusions In this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway. Trial registration Not applicable.

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Section: Discussionmentioning

confidence: 99%

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

et al. 2023

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“…Based on the actual study, the base of the tongue may be described as a turning point for oxygen insufflation in the human airway, completely avoiding any ambient air from entering the airway. This effect may be reached by different devices such as an oxygenation laryngoscope or a special oropharyngeal oxygenation airway device [3,4,17,18]. The value of the placement of these devices at the base of the tongue must be evaluated both in animal and clinical studies in the future.…”

Section: Discussionmentioning

confidence: 99%

Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation

Wetsch

Schroeder

Herff

et al. 2022

JCM

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Background: In a cannot-ventilate-cannot-intubate situation, careful preoxygenation with high FiO2 allowing subsequent apneic oxygenation can be life-saving. The best position for an oxygen supply line within the human airway at which oxygen insufflation is more effective than standard preoxygenation with a face mask is unknown. Methods: In this experimental study, we compared the effectiveness of preoxygenation by placing an oxygen cannula at the nose entrance, through the nose at the soft palatine, or at the base of the tongue; as a control we used ambient air. We connected a fully preoxygenated test lung on one side to an oximeter with a flow rate of 200 mL/min simulating the oxygen consumption of a normal adult on the other side of the trachea of an anatomically correctly shaped airway manikin over a 20 min observation period five times for each cannula placement in a random order. Results: The oxygen percentage in the test lung dropped from 100% in all groups to 53 ± 1% in the ambient air control group, to 87 ± 2% in the nasal cannula group, and to 96 ± 2% in the soft palatine group; it remained at 99 ± 1% in the base of the tongue group (p = 0.003 for the soft palatine vs. base of the tongue and p < 0.001 for all other groups). Conclusions: When simulating apneic oxygenation in a preoxygenated manikin, oxygen insufflation at the base of the tongue kept the oxygen percentage at baseline values of 99%, demonstrating a complete block of ambient air flowing into the airway of the manikin. Oxygen insufflation at the soft palatine or insufflation via a nasal cannula were less effective regarding this effect.

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“…Evidence summary: Five RCTs have shown that supplemental oxygen increases the safe apnoea time in neonates and infants and reduces the incidence of hypoxaemia during tracheal intubation (Supplementary Table S6, http://links.lww.com/EJA/A891). [45][46][47][48][49] Supplemental oxygen can be delivered directly via the airway instrumentation device AirTraq (Prodol Meditec S.A., Vizcaya, Spain), Truview (Truphatek International Ltd, Netanya, Israel), Oxiport (Truphatek International j , Israel), nasopharyngeal airway or via nasal cannula.…”

Section: Pico 3 Tracheal Intubation Is Direct Laryngoscopy or Videola...mentioning

confidence: 99%

Airway management in neonates and infants

Disma,

Asai,

Cools

et al. 2023

European Journal of Anaesthesiology

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Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong ‘1’ or weak ‘2’ recommendation with high ‘A’, medium ‘B’ or low ‘C’ quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).

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A randomised comparative study of Miller laryngoscope blade versus Oxiport^® Miller laryngoscope blade for neonatal and infant intubations

Cited by 11 publications

References 14 publications

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation

Airway management in neonates and infants

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A randomised comparative study of Miller laryngoscope blade versus Oxiport® Miller laryngoscope blade for neonatal and infant intubations

Cited by 11 publications

References 14 publications

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation

Airway management in neonates and infants

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A randomised comparative study of Miller laryngoscope blade versus Oxiport^® Miller laryngoscope blade for neonatal and infant intubations