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Scottish Paediatric Anaesthetic Network April 2008. The Berci Kaplan video-laryngoscope increases paediatric tracheal intubation success by non-anaesthetists L. Walker, G. Wilson, T.Engelhardt, J.Morse Dept of Anaesthesia, Royal Aberdeen Childrens Hospital. Background.

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scottish paediatric anaesthetic network april 2008

Scottish Paediatric Anaesthetic Network April 2008

The Berci Kaplan video-laryngoscope increases paediatric tracheal intubation success by

non-anaesthetists

L. Walker, G. Wilson, T.Engelhardt, J.Morse

Dept of Anaesthesia, Royal Aberdeen Childrens Hospital

background
Background

Paediatric tracheal intubation is a vital and life saving skill in the emergent setting

background1
Background
  • Tracheal intubation is a core skill in anaesthesia
  • Paediatric airway provides particular challenges to both to acquisition and teaching of this skill
video laryngoscopy
Video-Laryngoscopy
  • Provides a view of airway anatomy which is not dependant on laryngoscopists direct line of sight
  • Berci Kaplan video-laryngoscope projects image from tip of blade onto a screen remote from patient
video laryngoscopy1
Video-Laryngoscopy
  • Advantages

Increases angle of view from 150 to 800

Shared point of view for teacher and learner

Similar design and technique to Macintosh laryngoscope

video laryngoscopy2
Video-Laryngoscopy
  • Disadvantages

Need for coordination between hand movements and screen

video laryngoscopy3
Video-Laryngoscopy
  • Berci Kaplan video-laryngoscope has been studied both for airway management and as a teaching tool
  • Has been shown to be of use in management of difficult airways
  • Greater incidence of successful tracheal intubation by novice practitioners in adult setting

Low D. Healy D. Rasburn N. The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia. 63(2):195-201, 2008 Feb.

hypothesis
Hypothesis

We hypothesised that the familiar design and intuitive technique of video-laryngoscopy would result in a shorter time to visualise the glottis and intubate the trachea, with a higher rate of success for novices in the paediatric setting

methods
Methods
  • Research Ethics Committee approval
  • 70 non-anaesthesia staff recruited (nursing staff, theatre ODPs, medical students, non-anaesthesia medical trainees)
  • Any previous tracheal intubation experience recorded
methods1
Methods
  • Given baseline training in laryngoscopy and intubation with direct and video-laryngoscopes
  • Standardised description and practical demonstration
methods3
Methods
  • Laerdal SimBaby manikin used
  • Realistic, airway anatomy
  • Reproducible environment
methods4
Methods
  • Volunteers asked to view the glottis of manikin and if possible, intubate using both direct and video-laryngoscopes, in a random order
  • Time to view glottis, time to intubation and placement of tube recorded
results
Results

Time to view glottis

  • Direct Laryngoscopy 11.5 seconds

(Range of 2-78 seconds)

  • Video-Laryngoscopy 8 seconds

(Range of 1-48 seconds)

results1
Results

Success of intubation

  • Direct Laryngoscopy 53%
  • Video-Laryngoscopy 84%
results2
Results

Time to intubation

  • Direct Laryngoscopy 40.5 seconds

(Range of 8-100 seconds)

  • Video-Laryngoscopy 34.5 seconds

(Range of 8-104 seconds)

results3
Results
  • 43/70 volunteers stated that the video-laryngoscopy was easier to use, stating factors such as improved view of glottis and greater certainty of tube position
  • 6/70 volunteers commented on difficulties coordinating hand and screen movements during video-laryngoscopy
discussion
Discussion
  • Marked increase in incidence of successful tracheal intubation by novices using video-laryngoscopy
  • Straightforward to teach and critique
discussion1
Discussion
  • Potential uses of video-laryngoscopy

-Teaching paediatric airway skills

-Use by personnel with little paediatric intubation experience in emergency setting