Summary We compared the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope in a simulated difficult airway, using manual in‐line stabilisation in 88 anaesthestised patients of ASA physical status 1‐2. The primary outcome was laryngoscopic view. Secondary outcomes included rates of successful tracheal intubation and complications. A Cormack and Lehane grade‐1 or ‐2 view was found in all patients when using the McGrath compared with 45 (51%, p < 0.0001) using the Macintosh laryngoscopes. The mean (SD) percentage of glottic opening was 82 (23)% using the McGrath compared with 13 (23)% using the Macintosh (p < 0.0001). In 66 out of 88 patients (75%), the McGrath improved the glottic view by one to three grades compared with the Macintosh (p < 0.001). Intubation of the trachea was successful in all patients using the McGrath, while the Macintosh was successful in 26 (59%, p < 0.001). There was no significant difference in the complication rates between the devices.
This study determined that traditional LEI teaching for nonanesthesia personnel using manikin alone is inadequate. A reevaluation of current standards in LEI teaching for nonanesthesia is required.
P Pu ur rp po os se e: : The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed.S So ou ur rc ce e: : A narrative review of the literature on the practice of airway management by non-anesthesiologists.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by nonanesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. C Co on nc cl lu us si io on ns s: : The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided. Objectif : La responsabilité de l'assistance respiratoire d'urgence revient souvent à des médecins non-anesthésiologistes. Les urgentistes utilisent maintenant de routine le bloc neuromusculaire pour faciliter l'intubation. La documentation à l'appui de cette pratique a été publiée presque exclusivement dans les journaux de médecine d'urgence (MU). Nous présentons l'ensemble de ces documents et exposons les questions de formation. Source : Une revue traditionnelle de la documentation sur la pratique de l'assistance respiratoire par des non-anesthésiologistes. Constatations principales : Une proportion significative de l'assistance respiratoire d'urgence, réalisée à l'extérieur de la salle d'opéra-tion, relève de non-anesthésiologistes. L'intubation en séquence rapide (ISR) est reconnue comme une intervention centrale dans le domaine de la MU. L'ISR est généralement réalisée par des urgentistes dans les grands centres. Le soutien anesthésiologique pour la pratique de l'ISR
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