Singhal S K, Kaur Kiranpreet, Yadav Pushpa
Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India.
J Anaesthesiol Clin Pharmacol. 2021 Jul-Sep;37(3):469-474. doi: 10.4103/joacp.JOACP_133_19. Epub 2021 Oct 12.
To evaluate the role of experience in acquisition of skill of orotracheal intubation in adults.
A prospective randomized study was conducted on 307 patients of either sex, belonging to ASA grade I and II (aged 18-60 years) posted for surgery under general anaesthesia. The patients were subjected to DL and ETI procedure, which was performed by five different groups of participants. Group 1 consisted of first-year resident of anaesthesiology with experience of less than 10 intubations, group 2 for second-year resident, group 3 for third-year resident, group 4 for senior resident and group 5 for consultant. Ease of mask ventilation, time taken for intubation, number of attempts, success rate, and ease of intubation were assessed for all the groups.
Categorical variables were analysed using Chi-square test. For all statistical tests, a value less than 0.05 was taken as a significant difference. Maximum difficulty in mask ventilation was encountered by group 1 anaesthesiologist, that is, in 69.2% of the patients. Group 1 took maximum time to intubate, that is, 47.98 ± 31.54 sec and least time was taken by group 5 anaesthesiologist (9.55 ± 6.93) sec. First attempt success rate was least in group (80.0%). Group 1 had success rate of 96.9%, whereas rest all groups had 100% success.
Skill of mask ventilation and intubation and time taken for intubation grossly improves with increasing experience. Minimum of 25 intubation attempts should be required by an anaesthesiologist resident in elective scenario to achieve 100% success rate in our study.
评估经验在成人经口气管插管技能习得中的作用。
对307例拟行全身麻醉手术的ASA I级和II级成年患者(年龄18 - 60岁,性别不限)进行一项前瞻性随机研究。患者接受直接喉镜检查(DL)和经口气管插管(ETI)操作,由五组不同的参与者进行。第1组由麻醉学一年级住院医师组成,插管经验少于10次;第2组为二年级住院医师;第3组为三年级住院医师;第4组为高年资住院医师;第5组为顾问医师。评估所有组的面罩通气难易程度、插管时间、尝试次数、成功率及插管难易程度。
分类变量采用卡方检验进行分析。对于所有统计学检验,P值小于0.05被视为有显著差异。第1组麻醉医师在面罩通气时遇到的困难最大,即69.2%的患者存在该情况。第1组插管耗时最长,为47.98±31.54秒,第5组麻醉医师耗时最短(9.55±6.93)秒。第1组首次尝试成功率最低(80.0%)。第1组成功率为96.9%,而其余所有组成功率均为100%。
随着经验增加,面罩通气和插管技能以及插管时间显著改善。在我们的研究中,择期手术场景下麻醉科住院医师至少需要进行25次插管尝试才能达到100%的成功率。