Limited Experience in Using Videolaryngoscopes Clinical Trial
Official title:
A Comparison of Three Videolaryngoscopes for Double-lumen Tubes Intubation in Simulated Easy and Difficult Airways
The investigators hypothesized that the use of the King Vision™ and the Airtraq® VL would
reduce the time to DLT intubation compared with the GlideScope® and Macintosh in simulated
easy and difficult airways. The investigators have considered to assess the efficacy of each
device in manikins before considering to evaluate them in patients undergoing thoracic
procedures.
Twenty-one staff anaesthesiologists who had limited prior experience in using the VLs for
DLT intubation participated in this randomised crossover study. Following a brief
demonstration and two practice attempts, participants were volunteered to insert a DLT using
the Macintosh, GlideScope®, Airtraq®, and King Vision™ on two high-fidelity easy and
difficult airway simulators in a computer-generated randomized sequence. The primary
endpoint, time to DLT intubation, as well as, the views obtained at laryngoscopy, ease of
intubation, numbers of laryngoscopy attempts and optimisation manoeuvers, and failure to
intubation; defined as an attempt took longer than 150 seconds, were recorded.
Several regional surveys demonstrated that most thoracic anesthesiologists are using the
double-lumen endobronchial tubes (DLT) as the first-choice lung separation technique. DLT,
when compared with single lumen tracheal tube, can be more difficult to insert in patients
with difficult airways. The videolaryngoscopes (VL) have the potential to facilitate the
placement of the DLTs for lung separation in patients with predicted or unanticipated
difficult airway.
The use of GlideScope® (Verathon Inc., Bothell, WA, USA), a VL with an angulated blade, has
been associated with variable times to DLT intubation according to the prior experience of
the operators, despite superior visualization of the glottis The channeled Airtraq® (Prodol
Meditec S.A., Vizcaya, Spain) and standard non-channeled blade of the King Vision™ (Ambu,
Ballerup, Copenhagen, Denmark), may offer additional benefits for DLT intubation in patients
with limited mouth opening or restricted neck movement, in whom the use of traditional VL
like as the Glidescope® could be difficult. This is because of the larger outer diameter,
the distal curvature and the increased rigidity of the DLT. Of note, the longer times to DLT
intubation with the use of different VL could be shortened with building up the operator's
experience.
To the best of the investigators knowledge, the comparison of the effects of the Macintosh,
GlideScope®, Airtraq®, and King Vision™ VL on the time to DLT intubation in simulated easy
and difficult airways has not yet been studied.
Two high-fidelity simulators (Airway Management Trainer, model AA-3100, Laerdal, Kent, UK)
were prepared to simulate easy and difficult airway situations, as described by Marshall et
al. and Wang et al. The "easy" airway was established with the manikin in a neutral
position. The "difficult" airway setting was obtained by placing an Oasis Elite™ Prone Head
Rest, Adult (140 mm in height) (Covidien, Mansfield, MA) under the occiput and securing the
head position with adhesive tape, object to replicate cervical-collar use. Positioning was
confirmed after each attempt to ensure consistency.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Open Label