Download - Airway management data show
![Page 1: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/1.jpg)
![Page 2: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/2.jpg)
![Page 3: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/3.jpg)
Airway Management: A Comparative Study
Using McGrath® Video laryngoscope versus
Airtraq® and Macintosh Laryngoscope in Neutral Position.
![Page 4: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/4.jpg)
Presented byAlaa Elsayed Goma Falogy
M.Sc. Assistant lecturer of Anaesthesia and Surgical Intensive care
Faculty of medicineZagazig University
![Page 5: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/5.jpg)
Under supervision of Prof. Dr. Ayman Abdel El-
Salam HassanProfessor of Anesthesia and surgical
Intensive Care
Prof. Dr. Ahmed Abd El-Hakim Balata
Professor of Anesthesia and surgical Intensive Care
Prof. Dr. Khaled Mohammed
El-Sayed Professor of Anesthesia and surgical
Intensive Care
![Page 6: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/6.jpg)
I would like to thank….
Prof, Dr.: Salah A. Fattah Ismail
For his sincere effort to travel all this distance to give us this honor to be with us this special day
![Page 7: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/7.jpg)
I would like to thank….
Prof, Dr.: Ahmed M. Salama
For his pleased acceptance to share us this discussion
![Page 8: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/8.jpg)
I would like to thank….
to my precious family;you mean the world to meyou'll always be my strength, my power, thank you for being a part of me...
![Page 9: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/9.jpg)
Research questionIfused by [experienced anesthiologists] who is managing a model of a difficult airway in form of neck immobilization by semi- rigid neck collarDo [ the Airtraq OL and the McGrath VL] Are more safe and more effective in tracheal intubation when compared to [Classic Macintosh laryngoscope]?
![Page 10: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/10.jpg)
Introduction
![Page 11: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/11.jpg)
• Airway management is a major challenge for the anaesthesiologists in their everyday operative practice using direct laryngoscopy.
• During this direct laryngoscopy, positioning of the head and neck in neutral position
• will decrease chance of optimal laryngeal visualization which impair the line of sight between laryngeal , pharyngeal and oral axes.
![Page 12: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/12.jpg)
Concept of line of sight during direct laryngoscopy
![Page 13: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/13.jpg)
• patients with cervical spine instability who necessitate neck immobilization , airway management implies upon a high risk of neurological damage related to head and neck manipulation, so semi-rigid neck collar is applied in trail to control neck movement.
• Such immobilisation technique can turn intubation process under the direct laryngoscopy into more difficult situation (Impair the line of sight) .
![Page 14: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/14.jpg)
• These concerns have aroused the idea to develop number of alternatives to classical Macintosh laryngoscope such as Airtraq® Optical Laryngoscope, McGrath® Video laryngoscope.
• These laryngoscopes do not require the arrangement of pharyngeal, laryngeal and oral axis in one line of sight and thus do not require modulation of neutral position.
• During difficult airway situations, both Airtraq optical laryngoscope and McGrath Video laryngoscope sound to be better than Macintosh laryngoscope
![Page 15: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/15.jpg)
AIM OF THE WORK To evaluate the efficacy and safety of
in stimulated difficult intubation situations in patients with their cervical spine kept in
neutral position by semi-rigid neck collar as an
immobilization techniques .
VS
![Page 16: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/16.jpg)
Neck extension During intubation may badly affects the cervical instability and this is may imply upon risk of spinal cord injury
NECK EXTENSION
![Page 17: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/17.jpg)
Cervical spine stability Cervical stability: is the ability of the
spine to maintain strong relationships between vertebrae, so as not to damage the neural structures contained within the spinal column
Cervical instability: Excess translational
or rotational motion of any vertebra and means that the odontoid process is no longer firmly held against the back of the anterior arch of C1.
![Page 18: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/18.jpg)
Concept of Videolaryngoscopy Video laryngoscopy (VL) is an
update of high resolution micro-cameras systems that improves the success rate of intubation.
There is a hypothesis that improved lighting and a better view can increase the chance of intubation success.
Anaesthesia had used the miniature camera for many years but for only bronchial endoscopy .
![Page 19: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/19.jpg)
Video Laryngoscopy in difficult Airway management
VIDEO ASSISTED LARYNGOSCOPY
AS AN INTIAL APPROACH TO
INTUBATION
![Page 20: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/20.jpg)
McGrath Video-Laryngoscope
![Page 21: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/21.jpg)
The McGrath Video Laryngoscope:
(Aircraft Medical, Edinburgh, United Kingdom) • A video-based system for tracheal
intubation that utilizes a video camera embedded into a camera stick.
• The unit is a battery powered Features a single electronic control
• Offers the user an image of the Glottis and the surrounding anatomy on a LCD screen.
• The unit which is used as a part of much the same way as common as Macintosh laryngoscope
![Page 22: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/22.jpg)
Concept of the improved glottic view
Based upon the hypothesis that improved glottic view leads the better chance of successful intubation
![Page 23: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/23.jpg)
Airtraq Optical-
Laryngoscope
![Page 24: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/24.jpg)
based on refraction prism principle to give an angular view of the glottic area.
The blade of the Airtraq consists of two side by side channels.
One channel act as housing for the ETT, and the other channel terminates in terminal lenses and transmit back the image.
The viewed image is then been transmitted to a proximal eye piece viewfinder employing a prisms system and lenses not as basic concepts of usual fiberoptics.
AIRTRAQ Optical Laryngoscope:
![Page 25: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/25.jpg)
PATIENTS AND
METHODS
![Page 26: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/26.jpg)
METHODOLOGY This was a prospective, randomized
clinical trial. group assignments (C, A and M) age group of 20-50 years, ASAps
Grades I or II undergoing elective surgery requiring general Anaesthesia
three groups of 50 patients each , of either sex.
All patients received standard monitoring according to ASA guidelines.
![Page 27: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/27.jpg)
INTUBATION PROCEDURE
Intubation process was performed by one anesthesiologist with accepted experience in two recent video laryngoscopes under study.
A malleable stylet was used in both groups (Classical Macintosh and McGrath VL).
The technique was considered failed if tracheal intubation was not achieved within 120 seconds or within a maximum of three intubation attempts.
![Page 28: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/28.jpg)
CORMACK - LEHANE SCORE
![Page 29: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/29.jpg)
INTUBATION PROCEDURE
Intubation time was separated into T1 and T2.
T1 is the time between insertions of the allocated laryngoscope in the mouth until optimal glottic view including optimization maneuvers.
T2 is the time from optimal glottic view till confirmation of tracheal intubation (by vision) including removal of the device.
![Page 30: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/30.jpg)
McGrath VL;INTUBATION TECHNIQUE
AND SEQUENCE
![Page 31: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/31.jpg)
Intubation sequence by McGrath VL
With the patient in neutral position, use left hand to introduce the VL into the midline of the oropharynx.
Push the blade tip till it past the posterior portion of the tongue.
Then turn eyes to the video screen in order to obtain the best view of the glottis.
The video image of the glottis now is representing Cormack – Lehane view.
Using LCD screen, the ETT is then advanced on a smooth curve through the glottis mediated by stylet.
![Page 32: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/32.jpg)
Intubation sequence by McGrath VL
introduce the VL into the midline of mouth and Push the blade tip till posterior portion of the tongue.
![Page 33: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/33.jpg)
Intubation sequence by McGrath VL
turn eyes to the video screen in order to obtain the best Cormack – Lehane view.
![Page 34: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/34.jpg)
Intubation sequence by McGrath VL
By use of LCD screen, the ETT is then advanced on a smooth curve through the glottis by stylet.
![Page 35: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/35.jpg)
AIRTRAQ OL;INTUBATION TECHNIQUE
AND SEQUENCE
![Page 36: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/36.jpg)
Intubation sequence by Airtraq OL
Add lubricant to outer surface of the endotracheal tube and hosting channel of Airtraq OL.
Embed the tube into the side holding channel of the Airtraq so that the tip of the endotracheal tube is at the tip of the side channel.
Turn on the light for about 30-60 seconds before the procedure.
![Page 37: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/37.jpg)
Intubation sequence by Airtraq OL
The device is held in the mouth in the midline by right hand .
Then advanced by sliding over the tongue.
The image on view finder is optimized by moving the blade as necessary by left hand.
The laryngeal inlet must be in the centre of viewfinder just before pushing the ETT forward by right hand .
![Page 38: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/38.jpg)
Intubation sequence by Airtraq OL
Loading ETT to hosting channel
Introduction into oral cavity
![Page 39: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/39.jpg)
Intubation sequence by Airtraq OL
Sliding over the tongue
Checking the viewfinder and ETT insertion
![Page 40: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/40.jpg)
Intubation sequence by Airtraq OL
Unholding the ETT from the
Airtraq Removal of the Airtraq
![Page 41: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/41.jpg)
RESULTS
![Page 42: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/42.jpg)
PARAMETERS TO BE COMPARED BETWEEN ALL
GROUPS Demographic data and Airway assessment data. Intubation Conditions:
Numbers of Attempts. Optimization Procedures. Cormack - Lehane score. Intubation Difficulty Score.
Success Rate of Intubation. Time To Intubation. Hemodynamics (HR and MAP). Complications.
![Page 43: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/43.jpg)
DEMOGRAPHIC AND AIRWAY ASSESSMENT
DATADemographic data Group C Group A Group M
p-value (Sig.) (N=50) (N=50) (N=50)
Age (in years) 35.90±7.65 35.92±7.70 35.16±7.72 0.856** (NS)
Male / Female 62 / 38 % 66 / 34 % 60 / 40 % 0.892* (NS)
Height (cm) 171.48±3.71 171.62±3.54 171.6±3.8 0.981** (NS)
Weight (Kg) 77.96±7.22 77.62±6.25 76.86±6.93 0.619** (NS)
BMI (Kg/m2) 26.84±2.29 27.06±2.05 26.14±2.13 0.095** (NS)
ASAps I / II 14 / 86 % 16 / 84 % 10/ 90 % 0.668* (NS)
MS I / II 56 / 44 % 48 / 52 % 62 / 38 % 0.369* (NS) TMD (cm) 7.18±0.34 7.12±0.34 7.17±0.32 0.766** (NS)
NON-SIGNIFICA
NT
![Page 44: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/44.jpg)
NUMBERS OF ATTEMPTS
Macintosh group
Airtraq group
McGrath group
Most of patients in VL need 1 attempt for successful intubation
About 1/3 patients needed 2nd and 3rd attempt in Macintosh group
HS
![Page 45: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/45.jpg)
OPTIMIZATION PROCEDURE
Highly Significant
![Page 46: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/46.jpg)
CORMACK-LEHANE SCORE
46
Airtraq almost get C&L I
Mac
into
sh le
ast i
n C
&LI
PER
SIS
T
Most views of McGrath C&L II
Macintosh most C&L II
HIGHLY- SIGNIFICANT
![Page 47: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/47.jpg)
IDS DISTRIBUTION
Airt
raq
max
IDS
is 2
McG
rath
max
IDS
is
4
Mac
into
sh r
each
ed
IDS
7
HIGHLY- SIGNIFICAN
T
![Page 48: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/48.jpg)
SUCCESS RATE OF INTUBATION
Mac
into
sh h
as 4
fa
ilure
s
NON-SIGNIFICAN
T
![Page 49: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/49.jpg)
SAFETY AND EFFECTIVENESS
INTER-GROUP ANALYSIS
49
BETTER IMAGE
CONCEPT THOERY SA
ME
VID
EOSC
OPE
EF
FIEN
CY
FAMILARITY
NO NEED FOR
ALIGNMENT
![Page 50: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/50.jpg)
AIRTRAQ LEAST
MACINTOSH MOST
HEMODYNAMICS (HR)
NO
N-
SIG
NIF
ICAN
T
HS
HIG
H
SIG
NIF
ICAN
T
HIG
H S
IGN
IFIC
ANT
![Page 51: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/51.jpg)
ALL Increased MAP
ALL return to basal level
HEMODYNAMICS (MAP)
NO
N-
SIG
NIF
ICAN
T
![Page 52: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/52.jpg)
Time to Intubation
52
Familiarity and same technique
HIG
H
SIG
NIF
ICAN
T
3 2 1 3 1 2
![Page 53: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/53.jpg)
Complications
Sharp tip for both devices produce
more trauma
as primary insult more than
secondary injury
Styl
et
man
ipul
atio
n??
Primary > secondary
Secondary is more than primary
![Page 54: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/54.jpg)
LIMITATIONS DESIGN
Operator knows the devices, which may also introduce bias. (solved by closed envelopes
basis (lottery technique)). STIMULATIVE
Not on real cervical trauma patients. FURTHERMORE,
Inter-incisor distance may be added in airway assessment parameters as pre and post
insertion of neck collar especially because it affects primary insertion of Airtraq OL.
![Page 55: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/55.jpg)
SUMMARY AND
CONCLUSION
![Page 56: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/56.jpg)
Research questionAre McGrath® Video laryngoscope versus
Airtraq more safe and more effective in
tracheal intubation when compared to Classic Macintosh laryngoscope in
patients with neck collar inserted?
Yes
![Page 57: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/57.jpg)
Airtraq OL and McGrath VL showed the prove beyond doubt to be safer and more effective than Macintosh Laryngoscope in managing stimulated difficult intubation situation in form of cervical spine immobilization.
![Page 58: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/58.jpg)
RECOMMENDATIONS
![Page 59: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/59.jpg)
The use of videolaryngoscopes in our daily practice is recommended specially in difficult airway scenarios and similar studies need to be done upon real cervical trauma patients for better assessment of its advantages and disadvantages.
![Page 60: Airway management data show](https://reader035.vdocument.in/reader035/viewer/2022062503/58ee5cce1a28ab2c768b456f/html5/thumbnails/60.jpg)
THANK YOU