Difficult airway management and the novice physician


J Emerg Trauma Shock, 2010 vol. 3(1) pp. 9-12

Difficult airway management and the novice physician
Aikins, NL; Ganesh, R; Springmann, KE; Lunn, JJ; Solis-Keus, J

BACKGROUND: Selection of the ideal airway device in patients with difficult airways (DA) or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP) who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5) patients who may be more difficult to intubate than normal weight patients.
MATERIALS AND METHODS: In this prospective randomized experimental study the author investigates a novice physician’s use of the Bullard, Fiberoptic, Fastrach and Trachlight comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device.
RESULTS: The Fastrach was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic. A success rate of 20% (one of five) was achieved with the Trachlight on first attempt after 95 seconds. The Bullard was successful in 40 % (two of five) of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively.
CONCLUSIONS: In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach demonstrated the highest success rate.

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