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A noninferiority trial comparing left paratracheal pressure versus cricoid pressure on tracheal intubation conditions using the Pentax Airway Scope.

ABSTRACT: There are no studies evaluating the effect of left paratracheal pressure (PP) on difficulty of intubation using Pentax Airway Scope (Pentax), so we conducted this study to show that PP was not inferior to cricoid pressure (CP) in intubation time using the Pentax. Patients aged 19-70 years, with an American Society of Anesthesiologists physical status 1 or 2, and undergoing otorhinolaryngological, gynecological surgery, and cholecystectomy at a single university hospital were enrolled. Intubation was performed using the Pentax under PP or CP of 30 N. The primary outcome was intubation time, and the secondary outcomes were tube advancement difficulty and glottis view. The mean difference in intubation time (PP group - CP group) was - 4.19 s (95% CI - 8.24 to - 0.15), which was within the non-inferiority margin of 6.5 s, thus proving non-inferiority of the PP compared with the CP group. However, the score for tube advancement difficulty was significantly lower in the PP group than in the CP group (p = 0.02). PP did not prolong the intubation time and showed comparable intubation conditions to CP in intubation using the Pentax. Therefore, PP may be a good alternative maneuver to prevent gastric regurgitation during intubation using the Pentax.

SUBMITTER: Kim HY

PROVIDER: S-EPMC9519916 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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A noninferiority trial comparing left paratracheal pressure versus cricoid pressure on tracheal intubation conditions using the Pentax Airway Scope.

Kim Ha Yeon HY Moon Jee Hwan JH Park Hee Yeon HY Min Sang Kee SK Kim Jong Yeop JY

Scientific reports 20220928 1

There are no studies evaluating the effect of left paratracheal pressure (PP) on difficulty of intubation using Pentax Airway Scope (Pentax), so we conducted this study to show that PP was not inferior to cricoid pressure (CP) in intubation time using the Pentax. Patients aged 19-70 years, with an American Society of Anesthesiologists physical status 1 or 2, and undergoing otorhinolaryngological, gynecological surgery, and cholecystectomy at a single university hospital were enrolled. Intubation ...[more]

PMID: 36171474

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Project description:BACKGROUND:During an emergency endotracheal intubation, rapid sequence induction intubation (RSII) with cricoid pressure (CP) is frequently implemented to prevent aspiration pneumonia. We evaluated the CVS in endotracheal intubation in RSII with CP, in comparison with a direct laryngoscope (DL). METHODS:One hundred fifty patients were randomly assigned to one of three groups: the CVS as a video stylet (CVS-V) group, the CVS as a lightwand (CVS-L) group and DL group. Primary outcomes were to assess the power of the CVS, compared with DL, regarding the first attempt success rate and intubation time in simulated RSII with CP. Secondary outcomes were to examine hemodynamic stress response and the incidence of complications. RESULTS:The first attempt success rates within 30 s and within 60 s were higher in CVS-V and DL group than those in CVS-L group (p = 0.006 and 0.037, respectively). The intergroup difference for intubation success rate within 30 s was nonsignificant and almost all the patients were successfully intubated within 60 s (98% for CVS-L and DL group, 96% for CVS-L group). Kaplan-Meier estimator demonstrated the median intubation time was 10.6 s [95% CI, 7.5 to 13.7] in CVS-V group, 14.6 s [95% CI, 11.1 to 18.0] in CVS-L group and 16.5 s [95% CI, 15.7 to 17.3] in DL group (p = 0.023 by the log-rank test). However, the difference was nonsignificant after Sidak's adjustment. The intergroup differences for hemodynamic stress response, sore throat and mucosa injury incidence were also nonsignificant. CONCLUSIONS:The CVS-D and DL provide a higher first attempt intubation success rate within 30 and 60 s in intubation with CP; the intubation time for the CVS-V was nonsignificantly shorter than that for the other two intubation methods. Almost all the patients can be successfully intubated with any of the three intubation methods within 60 s. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT03841890 , registered on February 15, 2019 (retrospectively registered).

Project description:IntroductionWhile awake tracheal intubation (ATI) is regarded as the gold standard for difficult airway management according to current guidelines, there seems to be a reluctance in its application. This retrospective cohort study, conducted at a German tertiary hospital over a 2-year period, aimed to demonstrate that integrating awake tracheal intubation using flexible bronchoscopy (ATI:FB) into routine airway management makes it a successful and safe approach.Materials and methodsIn 2019 and 2020, records from the data acquisition system (DAQ) and archived anesthesia records were screened to evaluate the specifics of ATI:FB procedures, focusing on overall success and safety. Analysis included complications, time required for ATI:FB, and potential influencing factors such as patient characteristics, indication, medical/operative specialty, sedation technique, route and experience of anesthesiologist. Logistic regression assessed the impact of various variables on occurrence of complications and linear regression, with log(time) as the dependent variable, evaluated median time required to perform ATI:FB.ResultsATI:FB constituted 4.3 % (n = 1,911) of all airway management procedures, predominantly observed in dental, oral, and maxillofacial surgery (46.5 %) and otorhinolaryngology (38.4 %). The success rate for ATI:FB was notably high at 99.6 %, with only 5.4 % of cases experiencing complications, including technical issues, agitation, and visibility obstruction due to mucous secretion. Complication risk was influenced by the medical specialty and the experience of the anesthesiologist. A strong effect was observed in otorhinolaryngology (OR = 4.54, 95 % CI [1.64; 14.06]). The median time required for ATI:FB was 16 minutes (IQR: 11 to 23), with factors such as indication (p < 0.0001), experience of anesthesiologist (p < 0.0001), sedation technique (p = 0.0408), priority of the procedure (p = 0.0134), and medical/operative specialty (p < 0.0001) affecting the duration. The median time required for ATI:FB differed significantly based on the experience of the anesthesiologist (p < 0.0001).ConclusionATI:FB proves successful and safe, with low complications and manageable procedural time. Experience of the anesthesiologist is a modifiable factor enhancing safety, emphasizing the need for ATI:FB integration into routine airway management.

Dataset Information

A noninferiority trial comparing left paratracheal pressure versus cricoid pressure on tracheal intubation conditions using the Pentax Airway Scope.

Publications

A noninferiority trial comparing left paratracheal pressure versus cricoid pressure on tracheal intubation conditions using the Pentax Airway Scope.

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