This study compared the McGrath VL, Airtraq OL, and Macintosh laryngoscope for tracheal intubation in a simulated difficult airway scenario using a semi-rigid neck collar. The Airtraq and McGrath devices provided improved glottic views, fewer intubation attempts, and faster intubation times compared to the Macintosh laryngoscope. Both videolaryngoscopes were found to be more effective and safe for airway management in patients with cervical spine immobilization compared to the Macintosh laryngoscope. The study recommends using videolaryngoscopes in difficult airway situations involving neck immobilization.
airway management by comparative study beyween Airtraq and McGrath Videolaryngoscope and Classical Macintosh in neutral neck position (stimulated cervical injury scenarios)
Aim: To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the
nerves which at risk are the superficial branch of the radial
nerve (SBRN) and the Lateral Antebrachial Cutaneous
Nerve (LABCN).
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Endoscopic Endonasal Transclival Approach to the Ventral BrainstemDr. Shahnawaz Alam
Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation
Post-Thyroidectomy Laryngeal Diplegia in Mali: What Therapeutic Challenge? by Kone Fatogoma Issa in Experiments in Rhinology & Otolaryngology
Post-thyroidectomy laryngeal diplegia is the most common and most feared complication [1]. It occurs following a recurrent nerve lesion in 26 to 59% of cases [1,2]. Tracheotomy was considered until 1922 as the only reference treatment [3,4]. Therapeutic approaches have evolved over time, ranging from convention altranslaryngeal or extralaryngeal therapy to endoscopic laser approaches [5]. These endoscopic methods emphasized endoscopicary tenoidectomy and posterior transverse cordotomy [4,6]. Laser transverse posterior cordotomy has proved its efficacy, illustrated by the work of Denis and Kashima and Laccoureye & Merite Drancy [4,7].
airway management by comparative study beyween Airtraq and McGrath Videolaryngoscope and Classical Macintosh in neutral neck position (stimulated cervical injury scenarios)
Aim: To determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the
nerves which at risk are the superficial branch of the radial
nerve (SBRN) and the Lateral Antebrachial Cutaneous
Nerve (LABCN).
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Endoscopic Endonasal Transclival Approach to the Ventral BrainstemDr. Shahnawaz Alam
Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation
Post-Thyroidectomy Laryngeal Diplegia in Mali: What Therapeutic Challenge? by Kone Fatogoma Issa in Experiments in Rhinology & Otolaryngology
Post-thyroidectomy laryngeal diplegia is the most common and most feared complication [1]. It occurs following a recurrent nerve lesion in 26 to 59% of cases [1,2]. Tracheotomy was considered until 1922 as the only reference treatment [3,4]. Therapeutic approaches have evolved over time, ranging from convention altranslaryngeal or extralaryngeal therapy to endoscopic laser approaches [5]. These endoscopic methods emphasized endoscopicary tenoidectomy and posterior transverse cordotomy [4,6]. Laser transverse posterior cordotomy has proved its efficacy, illustrated by the work of Denis and Kashima and Laccoureye & Merite Drancy [4,7].
Call for action :expanding Cancer care in india Earnest and Young report Healthcare consultant
The context of cancer care in India is characterized by high incidence, late detection, lack of access to quality affordable care to majority of the populace and hence high mortality. It is agonising to observe high percentage of late detection owing to issues of access, affordability and awareness given that both the cost and success of treatment is favourably skewed towards earlier detection in a significant manner, leave alone the anguish of the family that has to negotiate with the reality of losing their loved one knowing that it is a travesty, not tragedy, of destiny. Further, it is of great concern to observe increasing deterioration of the key risk factors that contribute to the sickness, viz. use of alcohol/tobacco, obesity, environmental pollution etc. It is imperative for the stakeholders of Indian healthcare to address this growing menace before it becomes a national catastrophe.
An analysis of wrong practices among pharmacies and pharmacists in India-• Disadvantages of Self Medications Adverse Drug Reactions.Lack of knowledge about dose.Chances of using wrong medication.Risk of disease aggravation Drug interactions.
Using Microsoft Excel’s powerful logical formulas to filter job applicants th...Healthcare consultant
For Human Resource Professionals, hiring is undoubtly one of the most important and time consuming tasks. As much as hiring the right person for the right job is of paramount importance, screening and filtering CV could be quite daunting task, especially when you have a lot of applicants to choose from.However,you can use Microsoft excel amazingly powerful formulas to filter job applicants and multiple criteria you have set. This word book shows you exactly how it is done.
EPIDEMIC INTELLIGENCE SERVICE PROGRAMME by Dr.Mahboob ali khan Phd Healthcare consultant
The Changing Paradigm of Health.A nation in transition; major improvements in last 50 years but progress uneven .Old and new challenges (epidemiological transition); factors driving ill-health (poverty, inequities) persist; also new opportunities (partnerships, technology) National capacity building & international collaboration are critical for responding to these challenges
A clinic may be defined as a place of professional practice with facilities for outdoor consultation and treatment during scheduled hours by one or more physicians and staff and equipment essential for the services provided. It may or may not have the facilities for limited investigations specific to the scope of services provided.
A large percentage of the population, in rural as well as urban areas, is dependent on private clinics and, therefore, the quality of healthcare services provided by them is very important. At present there is no system of registration of private clinics by health authorities in India. The Clinical Establishments (Registration and Regulation) Bill, 2007 is still pending in the parliament.
Call for action :expanding Cancer care in india Earnest and Young report Healthcare consultant
The context of cancer care in India is characterized by high incidence, late detection, lack of access to quality affordable care to majority of the populace and hence high mortality. It is agonising to observe high percentage of late detection owing to issues of access, affordability and awareness given that both the cost and success of treatment is favourably skewed towards earlier detection in a significant manner, leave alone the anguish of the family that has to negotiate with the reality of losing their loved one knowing that it is a travesty, not tragedy, of destiny. Further, it is of great concern to observe increasing deterioration of the key risk factors that contribute to the sickness, viz. use of alcohol/tobacco, obesity, environmental pollution etc. It is imperative for the stakeholders of Indian healthcare to address this growing menace before it becomes a national catastrophe.
An analysis of wrong practices among pharmacies and pharmacists in India-• Disadvantages of Self Medications Adverse Drug Reactions.Lack of knowledge about dose.Chances of using wrong medication.Risk of disease aggravation Drug interactions.
Using Microsoft Excel’s powerful logical formulas to filter job applicants th...Healthcare consultant
For Human Resource Professionals, hiring is undoubtly one of the most important and time consuming tasks. As much as hiring the right person for the right job is of paramount importance, screening and filtering CV could be quite daunting task, especially when you have a lot of applicants to choose from.However,you can use Microsoft excel amazingly powerful formulas to filter job applicants and multiple criteria you have set. This word book shows you exactly how it is done.
EPIDEMIC INTELLIGENCE SERVICE PROGRAMME by Dr.Mahboob ali khan Phd Healthcare consultant
The Changing Paradigm of Health.A nation in transition; major improvements in last 50 years but progress uneven .Old and new challenges (epidemiological transition); factors driving ill-health (poverty, inequities) persist; also new opportunities (partnerships, technology) National capacity building & international collaboration are critical for responding to these challenges
A clinic may be defined as a place of professional practice with facilities for outdoor consultation and treatment during scheduled hours by one or more physicians and staff and equipment essential for the services provided. It may or may not have the facilities for limited investigations specific to the scope of services provided.
A large percentage of the population, in rural as well as urban areas, is dependent on private clinics and, therefore, the quality of healthcare services provided by them is very important. At present there is no system of registration of private clinics by health authorities in India. The Clinical Establishments (Registration and Regulation) Bill, 2007 is still pending in the parliament.
4. Presented by
Alaa Elsayed Goma Falogy
M.Sc. of Anaesthesia and surgical intensive care
Faculty of medicine
Zagazig university
2016
5. Under supervision of
Prof; Ayman Abdel El-Salam Hassan
Professor of Anesthesia and surgical Intensive Care
Prof; Ahmed Abd El-Hakim Balata
Professor of Anesthesia and surgical Intensive Care
Prof; Khaled Mohammed El-Sayed
Professor of Anesthesia and surgical Intensive Care
6. Research question
If
used by [experienced anesthiologists] managing a
model of a difficult airway in form of neck
immobilization by semi- rigid neck collar
Do [ the Airtraq OL and the McGrath VL]
Are
[more safe and more effective in tracheal
intubation ] when compared to [Classic Macintosh
laryngoscope]?
8. INTRODUCTION:
• Airway management is a major challenge for
the anaesthesiologists in their everyday
operative practice using direct laryngoscopy.
• During this direct laryngoscopy, positioning of
the head and neck in
NEUTRAL POSITION
will decrease chance of optimal laryngeal
visualization which impair the line of sight
between laryngeal , pharyngeal and oral axes.
10. INTRODUCTION:
• patients with cervical spine instability who
necessitate neck immobilization , airway
management implies upon a high risk of
neurological damage related to head and neck
manipulation, so semi-rigid neck collar is
applied in trail to control neck movement.
• Such immobilisation technique can turn
intubation process under the direct
laryngoscopy into more difficult situation
(Impair the line of sight) .
INTRODUCTION:
11. INTRODUCTION:
• These concerns have aroused the idea to develop
number of alternatives to classical Macintosh
laryngoscope such as Airtraq ® OL, McGrath® Video
laryngoscope.
• These laryngoscopes do not require the arrangement of
pharyngeal, laryngeal and oral axis in one line of sight
and thus do not require modulation of neutral position.
• During difficult airway situations, both Airtraq optical
laryngoscope and McGrath Video laryngoscope sound
to be better than Macintosh laryngoscope
12. in stimulated difficult intubation
situations
in patients with their cervical spine kept
in neutral position
by semi-rigid neck collar as an
immobilization techniques.
VS
14. Cervical spine stability:
Cervical Stability:
is the ability of the
spine to maintain
strong relationships
between vertebrae,
so as not to
damage the neural
structures contained
within the spinal
column
Cervical instability:
Excess translational
or rotational motion
of any vertebra and
means that the
odontoid process is
no longer firmly
held against the
back of the anterior
arch of C1.
15. Concept of
Videolaryngoscopy: Video laryngoscopy (VL) is an
update of high resolution
micro-cameras systems that
improves the success rate of
intubation.
There is a hypothesis that
improved lighting and a better
view can increase the chance
of intubation success.
Anaesthesia had used the
miniature camera for many
years but for only bronchial
endoscopy .
18. The McGrath Video Laryngoscope:
(Aircraft Medical, Edinburgh, United
Kingdom)
• A video-based system for tracheal intubation
that utilizes a video camera embedded into a
camera stick.
• The unit is a battery powered Features a
single electronic control
• Offers the user an image of the Glottis and
the surrounding anatomy on a LCD screen.
• The unit which is used as a part of much the
same way as common as Macintosh
laryngoscope
19. Concept of the improved glottic
view
Based upon the hypothesis that improved glottic view
leads the better chance of successful intubation
21. AIRTRAQ Optical Laryngoscope
based on refraction prism principle to give an angular
view of the glottic area.
The blade of the Airtraq consists of two side by side
channels.
One channel act as housing for the ETT, and the other
channel terminates in terminal lenses and transmit back
the image.
The viewed image is then been transmitted to a proximal
eye piece viewfinder employing a prisms system and lenses
not as basic concepts of usual fiberoptics.
23. METHODOLOGY
This was a prospective, randomized clinical trial.
group assignments (C, A and M)
age group of 20-50 years, ASAps Grades I or II
undergoing elective surgery requiring general
Anaesthesia
three groups of 50 patients each , of either sex.
All patients will receive standard monitoring
according to ASA guidelines.
24. INTUBATION PROCEDURE
Intubation process was performed by one
anesthesiologist with accepted experience in two
recent video laryngoscopes under study.
A malleable stylet was used in both groups
(Classical Macintosh and McGrath VL).
The technique was considered failed if tracheal
intubation was not achieved within 120 seconds
or within a maximum of three intubation
attempts.
26. INTUBATION PROCEDURE
Intubation time was separated into T1 and T2.
T1 is the time between insertions of the allocated
laryngoscope in the mouth until optimal glottic view
including optimization maneuvers.
T2 is the time from optimal glottic view till
confirmation of tracheal intubation (by vision)
including removal of the device.
28. Intubation sequence by McGrath VL
With the patient in neutral position, Use left hand to
introduce the VL into the midline of the oropharynx.
Push the blade tip till it past the posterior portion of the
tongue.
Now, move eyes to the video screen in order to obtain the
best view of the glottis.
The video image of the glottis now is representing
Cormack – Lehane view.
Using video visualization, the ETT is then advanced on a
smooth curve through the glottis mediated by styllet.
33. Intubation sequence by Airtraq OL
Add lubricant to outer surface of the
endotracheal tube and hosting channel of
Airtraq OL.
Embed the tube into the side holding channel of
the Airtraq so that the tip of the endotracheal
tube is at the tip of the side channel.
Turn on the light for about 30-60 seconds
before the procedure.
34. Intubation sequence by Airtraq OL
Hold the device in the mouth in the midline by
right hand .
advance by sliding the device over the tongue.
check the image on view finder to optimize the
view by moving the blade as necessary by left
hand.
Be sure that the laryngeal inlet is in the centre of
viewfinder just before pushing the ETT forward
by right hand .
39. COMPARISON BETWEEN GROUPS
ARE DONE ACCORDING TO:
INTUBATION CONDITIONS
NUMBERS OF ATTEMPTS
Optimization Procedures
Cormack and Lehane score
IDS
SUCCESS RATE OF INTUBATION
TIME TO INTUBATION
HEMODYNAMICS
COMPLICATIONS
40. DEMOGRAPHIC AND
AIRWAY ASSESSMENT DATA
Demographic data Group C Group A Group M
p-value (Sig.)
(N=50) (N=50) (N=50)
Age (in years) 35.90±7.65 35.92±7.70 35.16±7.72 0.856** (NS)
Male / Female 62 / 38 % 66 / 34 % 60 / 40 % 0.892* (NS)
Height (cm) 171.48±3.71 171.62±3.54 171.6±3.8 0.981** (NS)
Weight (Kg) 77.96±7.22 77.62±6.25 76.86±6.93 0.619** (NS)
BMI (Kg/m2
) 26.84±2.29 27.06±2.05 26.14±2.13 0.095** (NS)
ASAps I / II 14 / 86 % 16 / 84 % 10/ 90 % 0.668* (NS)
MS I / II 56 / 44 % 48 / 52 % 62 / 38 % 0.369* (NS)
TMD (cm) 7.18±0.34 7.12±0.34 7.17±0.32 0.766** (NS)
42. RESULTS OF THE STUDY
numbers of attempts
Macintosh group Airtraq group McGrath group
HS
43. RESULTS OF THE STUDY
Cormack-Lehane score in each group
43
Airtraq almost get C&L I
MacintoshleastinC&LI
Most views of McGrath C&L II
Macintosh most C&L II
HIGHLY-
SIGNIFICANT
44. RESULTS OF THE STUDY
IDS DISTRIBUTION
AirtraqendinIDS2
McGrathendsinIDS4
MacintoshendsinIDS7
HIGHLY-
SIGNIFICANT
45. RESULTS OF THE STUDY
SUCCESSFULNESS
45
Macintoshhas4failures
NON-
SIGNIFICANT
46. RESULTS OF THE STUDY
SUCCESSFULNESS
FAMILARITY
&
ADAPTATION
50. When it comes to intubation
time?
50
Again..Familiarity
51. RESULTS OF THE STUDY
Complications Occurrence
Sharp tip for
both devices
produce
more trauma
as primary
insult more
than
secondary
injury
Stylet
manipulation
52. LIMITATIONS
DESIGN
operator knows the devices, which may also introduce bias.
(solved by closed envelopes basis).
STIMULATIVE
not on real cervical trauma patients.
FURTHERMORE………
inter-incisor distance may be added in airway assessment
parameters as pre and post insertion of neck collar especially
because it affects primary insertion of Airtraq OL.
54. The conclusion of this study proves
that Airtraq OL and McGrath VL
are: MORE EFFECTIVE AND SAFE
Than Macintosh Laryngoscope
in managing stimulated difficult
intubation situation in form of
cervical spine immobilization by
semi-rigid neck collar
56. This study recommends use of
videolaryngoscopes in our daily practice
specially in difficult airway scenarios such
as neck immobilization situations because
it provide better airway management even
without extensive training, and it is needed
to conduct similar studies upon real
cervical trauma patients for better
assessment of its advantages and
disadvantages.
57. I would like to thank….
Prof, Dr.: Salah A. Fattah Ismail
For his sincere effort to travel all
this distance to give us this honor
to be with us this special day
58. I would like to thank….
Prof, Dr.: Ahmed M. Salama
For his pleased acceptance to share
us this discussion
59. I would like to thank….
My family that suffered a
lot through all this period
of Ph.D. journey
And they deserve all love
and care