A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

Introduction:The Glidescope video laryngoscope has been shown to be a useful tool to improve laryngeal view. However, its role in the daily routine of airway management remains poorly characterized. Methods: This investigation evaluated the use of the Glidescope at two academic medical centers. Electronic records from 71,570 intubations were reviewed, and 2,004 cases were indentified where the Glidescope was used for airway management. We analyzed the success rate of Glidescope intubation in various intubation scenarios. In addition, the incidence and character of complications associated with Glidescope use were recorded. Predictors of Glidescope intubation failure were determined using a logistic regression analysis. Results: Overall success for Glidescope intubation was 97% (1,944 of 2,004). As a primary technique, success was 98% (1,712 of 1,755), whereas success in patients with predictors of difficult direct laryngoscopy was 96% (1,377 of 1,428). Success for Glidescope intubation after failed direct laryngoscopy was 94% (224 of 239). Complications were noticed in

T he criterion standard for management of the anticipated difficult tracheal airway is awake flexible fiberoptic intubation (FFI), an approach that was compared with the use of the McGrath video laryngoscope (MVL) (Aircraft Medical, Edinburgh, Scotland) in patients with expected difficult intubation. Researchers hypothesized that MVL intubation would be faster than FFI. Ninety-three adult patients with anticipated difficult intubation were randomly allocated to awake FFI or awake MVL. They were given glycopyrrolate, nasal oxygen, oral topical lidocaine, and a transtracheal injection of 100 mg lidocaine. Infusion of remifentanil was given intravenously to a Ramsay sedation score of 2 to 4. Time to tracheal intubation was recorded by independent observers. Intubation success on the first attempt, researchers' evaluation of the ease of the technique, and patient-reported intubation discomfort on a visual analog scale were also recorded. Eighty-four patients qualified for analysis. Time to tracheal intubation was a median of 80 seconds (interquartile range [IQR], 58Y117 seconds) with FFI and 62 seconds (IQR, 55Y109 seconds) with MVL. Success of intubation on the first attempt was 79% versus 71% for FFI and MVL, respectively. The median visual analog scale score for patients' assessment of discomfort for both techniques was 2 (FFI: IQR, 0Y3; MVL: IQR, 0Y4). No difference was found in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airways.

Given the cancellation of all elective procedures with the coronavirus disease 2019 (COVID-19) crisis, many anaesthesiology learners are assigned to stay at home, limiting opportunities to learn in the clinical environment. We report on a novel use of existing resources to structure a daily nationwide learning experience, using Kotter's change management model (KCMM) to drive the process: (a) create urgency;(b) form a guiding coalition; (c) create a vision; (d) communicate the vision; (e) remove obstacles; (f) create short-term wins; (g) build on the change, and (h) institutionalise new approaches. In the field of anaesthesiology, we describe the use of the Anesthesia Education Toolbox, 1 an online learning management system with resources for in-person and asynchronous learning. | WHAT WA S TRIED?1. The COVID-19 pandemic created a clear sense of urgency to develop and collate shared educational resources to support non-clinical learning.2. Educational leaders of institutions subscribed to the toolbox were asked to join a task force to prioritise learning needs.3. We aimed to create an engaging virtual learning curriculum for anaesthesia residents that would provide at-home learning. 4. We promoted sessions and solicited participants, content experts and facilitators by email and posting to social media. 5. We were able to collaborate effectively using videoconferencing.6. We developed a daily virtual learning session, allowing residents from across the country to engage with peers and subject matter experts. We used existing resources in the toolbox and structured them into a schedule covering 1 hour of content per day, considering active learning, sequencing and Bloom's taxonomy. Content experts and facilitators could present their own material if desired. Participant engagement occurred by using the chat or polling feature, or asking questions via microphones. Participation has averaged from 40 to 160 people from more than 10 institutions in the USA and Canada. The sessions are recorded and catalogued in the toolbox for future use.7. We are in the process of expanding the daily content, with the goal of developing an enduring curriculum.8. This innovation is now a required part of the curriculum for our learners. | WHAT LE SSON S WERE LE ARNED?Rather than individual programmes transitioning their in-person teaching to an online platform, it is possible to quickly and efficiently restructure existing resources from multiple institutions to create an online synchronous educational experience. The innovation lies with coordinating multiple institutions to share resources to support resident learning. Doing so takes someone to assess available resources and resident needs, identify an accessible online platform, and organise the curriculum and faculty members. Presenters are encouraged to gain experience with the online platform prior to their lecture. Having an experienced moderator for each session helps them run smoothly.The time of 13.00 hours Pacific Standard Time has worked well for learners in all time zone...

The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting, and this improvement is greatest in simulated difficult scenarios.