Posture used by anaesthetists during laryngoscopy

Walker, J. D.

doi:10.1093/bja/aef252

Cited by 11 publications

(3 citation statements)

References 1 publication

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“…[ 4 ] To facilitate glottic visualisation, anaesthesiologists often adopt various postures such as flexing the neck, bending forward, stooping, bending their knees, standing on their toes or exerting their arms. [ 5 ] Although these positions are held for short periods during laryngoscopy and intubation, repeated performance in these stressful positions may have long-term impacts on joint performance. [ 6 ] Therefore, it is crucial to consider ergonomics and adopt proper techniques to minimise the risk of long-term injury from the performer's standpoint and ensure optimal patient care.…”

Section: Discussionmentioning

confidence: 99%

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

Mookambika,

Hemanth Kumar,

Areti

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods: The study included 48 patients aged 18–60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist’s posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student’s t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results: Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack–Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion: Anaesthesiologists’ posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.

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Section: Discussionmentioning

confidence: 99%

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

Mookambika,

Hemanth Kumar,

Areti

et al. 2024

Indian Journal of Anaesthesia

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“…The trajectories of vertical head movement and head tilting in novices correspond to our previous study using ML 8) . Other authors demonstrated that novices who used ML were crouching and getting their faces close to the face of the mannequin during tracheal intubation 2,[5][6][7] . Therefore, lowering the head by bending the body and bringing the face closer to the face of the patient by turning the face more downward is a typical posture for novices during tracheal intubation, regardless of the type of laryngoscope.…”

Section: Discussionmentioning

confidence: 99%

“…Whitten stated in her textbook that novices crouch and take the wrong posture with their head close to the mouth of patients during tracheal intubation 2) . Several authors have shown that the posture during tracheal intubation using ML in simulation settings differs between the novices and experts, and novices tend to lean their back and neck more forward and head closer to the mouth [3][4][5][6][7] . Our previous study using motion capture and eye-tracking systems in the simulation setting also showed that the novices who used ML lowered their heads more, turned their faces more downwards, and their eyes turned upward during tracheal intubation 8) .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intubation Time, Head Movements, and Gaze Distribution during Tracheal Intubation Using a Video Laryngoscope between Experts and Novices

Nomura

Yoshikawa

Hamabe

et al. 2022

J St. Marianna Univ

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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.

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Reducing musculoskeletal pain in the operating theatre

et al. 2022

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Posture used by anaesthetists during laryngoscopy

Abstract: Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back.

Cited by 11 publications

References 1 publication

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial

Comparison of Intubation Time, Head Movements, and Gaze Distribution during Tracheal Intubation Using a Video Laryngoscope between Experts and Novices

Reducing musculoskeletal pain in the operating theatre

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