If a little bit is wrong, how much is alright? Interpreting the significance of small numerators in clinical trials

Beach, Michael L.; Sites, Brian D.

doi:10.1111/anae.12980

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Moreover, ours was a more challenging patient population with distorted airway anatomy. Larger studies would refine the confidence intervals for failure .…”

Section: Discussionmentioning

confidence: 99%

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope

et al. 2016

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Airway management in patients with periglottic tumour is a high-risk procedure with potentially serious consequences. There is no consensus on how best to secure the airway in this group of patients. We conducted a feasibility study of awake tracheal intubation using a King Vision videolaryngoscope with a channelled blade in a cohort of 25 patients, with a periglottic tumour requiring diagnostic or radical surgery. We used 10% and 4% lidocaine to topicalise the airway and midazolam and remifentanil for sedation. We recorded the success rate, number of attempts, time to obtain glottic view, time to intubation and complications. Twenty-three of the 25 patients (92%, 95%CI 75-98%) were intubated with the awake videolaryngoscope-assisted technique, with 17/23 (74%, 95%CI 54-87%) intubations achieved at the first attempt. Five patients required two and one patient, three attempts at intubation. Two patients (8%, 95%CI 2-25%) could not tolerate the procedure due to inadequate topical anaesthesia. Median (IQR [range]) times to obtain glottic view and to intubate were 19 (17-22 [10-30]) s and 49 (42-71 [33-107]) s, respectively. Traces of blood in the airway were observed in 4/25 (16%, 95%CI 6-35%) patients. Although airway management in this group of patients was expected to be difficult, successful awake intubation with the King Vision videolaryngoscope was achieved in the majority of patients within less than a minute. This study highlights a number of potential advantages of awake videolaryngoscope-assisted intubation over other awake methods of securing the airway in patients with upper airway obstruction due to periglottic mass.

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“…Moreover, ours was a more challenging patient population with distorted airway anatomy. Larger studies would refine the confidence intervals for failure .…”

Section: Discussionmentioning

confidence: 99%

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope

et al. 2016

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“…Two thirds of the TT caseload had their TT removed awake. It is reassuring that no deaths were reported under GA but the upper 95% confidence interval of zero in this series is 3 (of 2695) which equates to approximately 1.1 per thousand (9).…”

Section: Discussionmentioning

confidence: 60%

“…Almost 90% of children (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) year) were classed as ASA 1 or 2 and, in these, the substantial majority underwent routine nonurgent ENT, dental, orthopedics & trauma, or general surgery procedures; 65% were 'day cases'. One in six children were managed outside operating theater sites compared with one in 12 adults.…”

Section: Discussionmentioning

confidence: 99%

The state of UK pediatric anesthesia: a survey of National Health Service activity

Sury

Arumainathan

Belhaj

et al. 2015

Pediatric Anesthesia

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This secondary analysis of the 2013 United Kingdom National Health Service (NHS) Anaesthesia Activity Survey of the Fifth National Audit Project (of the Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland) shows pediatric anesthesia activity in detail. A local coordinator (LC) in every NHS hospital collected data on patients undergoing any procedure managed by an anesthetist. Questionnaires had 30 question categories. Each LC was randomized to a 2-day period. The pediatric age groups were infants, (<1 year), preschool age (1-5 year), and school age children (6-15 year). The median questionnaire return rate was 98%. The annual caseload was estimated to be 486 900 children: 36 500 infants, 184 700 preschool age, and 265 800 school age children. Almost 90% of children (1-15 year) were ASA 1 or 2 and the substantial majority underwent routine nonurgent ear nose and throat, dental, orthopaedics, or general surgery procedures; 65% were 'day cases'. One in six children were managed outside operating theater sites compared with one in 12 adults. Forty one per cent was in district general hospitals. Almost all ASA 4 and 5 children (89%) and infants (92%) were managed in specialist hospitals. 'Awake' cases and sedation accounted for only 2% of cases. There were notable differences in demography and anesthetic care compared with adults and between different age groups of children. These data enable analysis of the current state of UK pediatric anesthetic practice and highlight differences between pediatric and adult services.

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“…(1/317 soit 0,31 %) et proches de l'incidence de douleurs thoraciques (six cas de douleurs thoraciques sur 240 patientes incluse dans trois études soit 2,5 %) rapportées par l'équipe de Toronto. [8][9][10] En utilisant l'approximation proposée par Beach et Sites dans le calcul de la borne supérieure de l'intervalle de confiance (IC)95 % en cas d'événement rares, 20 nous retrouvons un IC95 % de 3/295 (1,01 %), proche de 3/317 (0,95 %) chez Dansereau et 3/240 (1,25 %) dans l'équipe de Toronto. Même si ce seul cas rapporté dans notre établissement sur un an prête à discussion, car des phénomènes mineurs de douleurs thoraciques transitoires peuvent avoir été négligées par d'autres anesthésistes, le fait d'attirer l'attention sur ce sujet peut participer au renforcement de la vigilance des praticiens et des autorités sanitaires dans le suivi des effets secondaires induits par les nouvelles molécules mises sur le marché.…”

Section: Commentaireunclassified

Syndrome coronarien aigu après injection de carbétocine 100 µg au cours d’une césarienne en urgence

Jacquenod¹,

Cattenoz²,

Canu³

et al. 2015

Can J Anesth/J Can Anesth

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If a little bit is wrong, how much is alright? Interpreting the significance of small numerators in clinical trials

Cited by 8 publications

References 25 publications

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope

The state of UK pediatric anesthesia: a survey of National Health Service activity

Syndrome coronarien aigu après injection de carbétocine 100 µg au cours d’une césarienne en urgence

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If a little bit is wrong, how much is alright? Interpreting the significance of small numerators in clinical trials

Cited by 8 publications

References 25 publications

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision® videolaryngoscope

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision® videolaryngoscope

The state of UK pediatric anesthesia: a survey of National Health Service activity

Syndrome coronarien aigu après injection de carbétocine 100 µg au cours d’une césarienne en urgence

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Product

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A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope

A feasibility study of awake videolaryngoscope‐assisted intubation in patients with periglottic tumour using the channelled King Vision^® videolaryngoscope