Learning curves for fibreoptic nasotracheal intubation when using the endoscopic video camera

Abstract

SummaryWe have followed the progress of 12 anaesthetic trainees as they learnt how to perform fibreoptic nasotracheal intubation with the aid of an endoscopic video camera system. Each trainee had a structured teaching session on a bronchial tree model, viewed an instructional videotape and then performed 20 nasotracheal intubations on anaesthetised oral surgery patients. Trainees were required to perform the endoscopies under full visual control and to demonstrate airway anatomy as they advanced the fibrescope. They were allowed up to two 2 1 2 min periods to complete nasotracheal endoscopy. All 240 endoscopies were completed within the time limit: 228 were completed within 2 1 2 min and 12 (5%) were completed during the second 2 1 2 min period. We constructed a group learning curve from the pooled data. The half-life of the curve was nine endoscopies. The best fit value for the first endoscopy time was 132 s, and after the 18th (two halflives) it was 49 s. We analysed the theoretical basis for deriving a learning curve from raw data. This information could form a rational basis for the design of fibreoptic training programmes using video imaging systems.

Training in airway management

“…With learning objectives of intubation within 2 min and > 90% success rate on the first attempt, Johnson & Roberts [110] found that an acceptable level of expertise was reached by the tenth intubation. With more stringent objectives, Smith et al [111] found that after 18 intubations, 70-80% were completed in < 60 s. Using a mono-exponential model, their learning curve suggests that after 45 intubations (five half-lives) the trainee draws close to their 'expert' intubation time. It is clear that whilst these figures may go some way to help with the rational design of training programmes, numbers alone do not provide a basis on which to declare a trainee competent at a procedure.…”

Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management

“…Smith et al assessed the skills acquisition of 12 anesthetic trainees as they performed 20 nasotracheal intubations on anesthetized patients. 70 The half-life of the curve for the trainees was nine endoscopic intubations. The model inferred that the trainees would achieve successful intubations within the estimated expert time after five halflives (45 repetitions).…”

Awake tracheal intubation using the Sensascope™ in 13 patients with an anticipated difficult airway

“…However, Biro et al [1] showed that the learning curve for the SensaScope is quite small (< five uses) compared with the flexible fibrescope [8].…”