Scottish Paediatric Anaesthetic Network April 2008

1. 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

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

3. Background • Tracheal intubation is a core skill in anaesthesia • Paediatric airway provides particular challenges to both to acquisition and teaching of this skill

4. 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

5. Berci Kaplan video-laryngoscope

6. 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

7. Video-Laryngoscopy • Disadvantages Need for coordination between hand movements and screen

8. Angle of view, direct vs. video-laryngoscopy

9. 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.

10. Berci Kaplan video-laryngoscope

11. 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

12. 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

13. Methods • Given baseline training in laryngoscopy and intubation with direct and video-laryngoscopes • Standardised description and practical demonstration

14. Methods

15. Methods • Laerdal SimBaby manikin used • Realistic, airway anatomy • Reproducible environment

16. 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

17. Methods

18. Results Time to view glottis • Direct Laryngoscopy 11.5 seconds (Range of 2-78 seconds) • Video-Laryngoscopy 8 seconds (Range of 1-48 seconds)

19. Results Success of intubation • Direct Laryngoscopy 53% • Video-Laryngoscopy 84%

20. Results Time to intubation • Direct Laryngoscopy 40.5 seconds (Range of 8-100 seconds) • Video-Laryngoscopy 34.5 seconds (Range of 8-104 seconds)

21. 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

22. Discussion • Marked increase in incidence of successful tracheal intubation by novices using video-laryngoscopy • Straightforward to teach and critique

23. Discussion • Potential uses of video-laryngoscopy -Teaching paediatric airway skills -Use by personnel with little paediatric intubation experience in emergency setting