Kannaujia Ashish, Haldar Rudrashish, Shamim Rafat, Mishra Prabhakar, Agarwal Anil
Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Saudi J Anaesth. 2021 Apr-Jun;15(2):86-92. doi: 10.4103/sja.sja_1062_20. Epub 2021 Apr 1.
Protection of anaesthesiologists from contaminated aerosols of COVID 19 patients during endotracheal intubation has spurred the development of barrier devices like aerosol boxes and clear transparent plastic sheets and usage of videolaryngoscopes in COVID 19 patients. However, the efficiency, feasibility and difficulties faced by anaesthesiologist while performing endotracheal intubations under barrier devices require scientific validation. This manikin-based pilot study aims to assess the laryngoscopic performances of experienced anaesthesiologists under two different barrier enclosures.
53 anaesthesiologists (14 Consultants and 39 Senior Residents) who were undergoing an airway training module as a part of preparedness for handling the COVID 19 pandemic were recruited. Using an aerosol box over a manikin, the participants attempted intubation using a Glidescope Videolaryngoscope and Macintosh laryngoscopes (GA and MA Groups). Subsequently, intubation was attempted under a transparent plastic sheet using both laryngoscopes (GP and MP groups). Time required for intubation, first pass success rates, subjective ease of intubation and the feedback obtained from the participants were recorded and analysed.
Time required for accomplishing successful intubation was 38.55 ± 12.16 seconds, 26.58 ± 5.73 seconds, 46.89 ± 15.23 seconds and 37.26 ± 8.71 seconds for GA, MA, GP and MP groups respectively. Time for intubation and difficulty (VAS) was least for Macintosh group with aerosol box (MA) and maximum time was taken in Glidescope group with transparent polythene drape (GP). First attempt success rate for Glidescope groups (GP and GA) were 100% and in MA and MP group was 98% and 96% respectively. Restriction in hand movement and stylet removal were the major difficulties reported.
Longer intubation times were observed while using Glidescope Videolaryngoscopes with either of the two barrier devices in place compared to Macintosh laryngoscopes.
在对新型冠状病毒肺炎（COVID-19）患者进行气管插管期间，保护麻醉医生免受其污染气溶胶的影响，促使了气溶胶箱和透明塑料薄膜等屏障设备的研发，以及在COVID-19患者中使用视频喉镜。然而，麻醉医生在屏障设备下进行气管插管时所面临的效率、可行性和困难需要科学验证。这项基于人体模型的初步研究旨在评估经验丰富的麻醉医生在两种不同屏障罩下的喉镜操作表现。
招募了53名正在接受气道训练模块的麻醉医生（14名顾问医生和39名高级住院医生），作为应对COVID-19大流行准备工作的一部分。在人体模型上使用气溶胶箱，参与者使用Glidescope视频喉镜和Macintosh喉镜尝试插管（GA组和MA组）。随后，使用两种喉镜在透明塑料薄膜下尝试插管（GP组和MP组）。记录并分析插管所需时间、首次通过成功率、插管主观难易程度以及参与者的反馈。
GA组、MA组、GP组和MP组成功完成插管所需时间分别为38.55±12.16秒、26.58±5.73秒、46.89±15.23秒和37.26±8.71秒。使用带气溶胶箱的Macintosh组（MA）插管时间和难度（视觉模拟评分法）最小，而使用带透明聚乙烯单布的Glidescope组（GP）耗时最长。Glidescope组（GP和GA）首次尝试成功率为100%，MA组和MP组分别为98%和96%。报告的主要困难是手部活动受限和管芯取出困难。
与Macintosh喉镜相比，在使用两种屏障设备之一的情况下使用Glidescope视频喉镜时，观察到插管时间更长。
