Difficult airway management and the novice physician

Abstract

Background:Selection of the ideal airway device in patients with difficult airways (DA) or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP) who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5) patients who may be more difficult to intubate than normal weight patients.Materials and Methods:In this prospective randomized experimental study the author investigates a novice physician's use of the Bullard™, Fiberoptic™, Fastrach™ and Trachlight™ comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device.Results:The Fastrach™ was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic™. A success rate of 20% (one of five) was achieved with the Trachlight™ on first attempt after 95 seconds. The Bullard™ was successful in 40 % (two of five) of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively.Conclusions:In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach™ demonstrated the highest success rate.

Styletubation in Bariatric Surgery: A Case Report

“…Various alternative intubation tools have been reported other than DL and VL [ 35 ]. Those tracheal intubating modalities include rigid Bullard TM laryngoscope, flexible fiberoptic bronchoscope (FOB), optical stylet [ 36 , 37 , 38 , 39 ], or combined FOB with VL [ 40 ]. The video-assisted intubating stylet technique has recently been termed “styletubation”, in contrast to the concept of the conventional laryngoscopy [ 41 ].…”

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial

“…Novice physicians could ventilate and also intubate obese patients (BMI > 30) with ILMA in 55 ± 6.6 seconds and a 100% intubation rate in the first attempt. 22 It is a useful tool for out-of-hospital procedures as well. 23 In obese patients with lingual tonsillar hyperthropy, ILMA was used as a rescue device after failed tracheal intubation using Trachlight.…”

The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review

“…VL, along with supraglottic airway devices and flexible scopes, are recommended for unanticipated difficult airways, underscoring the importance of enhancing the success rates of VL [ 10 53 ]. Current guidelines suggest that when individual techniques prove challenging, a combination of methods can be used [ 10 54 ]. One such technique includes VL combined with optical/video stylets, flexible intubation scopes, airway exchange catheters, retrograde-placed guidewires, and supraglottic airway placement.…”