Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attr...Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attributed to anesthetic care at the Penn State Hershey Medical Center. Methods: Data was collected from retrospective chart review of available dental injury records, incident reports, and filed dental claims from January 2008 to June 2014. Results: Forty seven dental injuries were documented amongst 247,323 general anesthetics representing an overall incidence of 0.019%. Seventy percent of injuries occurred in patients with documented pre-existing prosthodontics or poor dentition and largely involved maxillary teeth (68%). Dental fracture (40%) and avulsion (40%) were the most common types of injury. Direct laryngoscopy was used in 60% of cases reporting dental injury;more than one attempt at securing the airway was required in 36% of cases. Total costs related to the injuries were $24347.65. Conclusions: Dental injury is often attributed to the actions of the anesthesiologist. The injury may be unnoticed until after surgery, what makes it difficult to identify the time and mechanism of injury. Our results suggest that the number of attempts at securing an airway is a risk factor for dental injury. Proper preoperative documentation of poor dentition, discussion with the patient about the increased risk of dental injury and detailed documentation of dental injury when it occurs is advised.展开更多
Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the eso...Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the esophagus blindly or using a laryngoscope. Methods: Our study compared blind versus laryngoscopic-guided esophageal EasyTube insertion. Thirty two anesthesiologists inserted an EasyTube, size 41 Fr, into a mannequin, by using a blind and a laryngoscopic technique in a 2 × 2 crossover design. Results: No statistically significant difference in the time to achieve an effective airway was found: 23.9 ± 6 seconds for the blind and 29.5 ± 7.6 seconds for the laryngoscopic-guided technique. Conclusion: EasyTube insertion was equally successful with or without a laryn-goscope in a mannequin when used by anesthesia providers.展开更多
Background: This study assesses the effectiveness of the GlideScope? Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range o...Background: This study assesses the effectiveness of the GlideScope? Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation attempts, number of adjustment maneuvers, and number of failed intubations.展开更多
文摘Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attributed to anesthetic care at the Penn State Hershey Medical Center. Methods: Data was collected from retrospective chart review of available dental injury records, incident reports, and filed dental claims from January 2008 to June 2014. Results: Forty seven dental injuries were documented amongst 247,323 general anesthetics representing an overall incidence of 0.019%. Seventy percent of injuries occurred in patients with documented pre-existing prosthodontics or poor dentition and largely involved maxillary teeth (68%). Dental fracture (40%) and avulsion (40%) were the most common types of injury. Direct laryngoscopy was used in 60% of cases reporting dental injury;more than one attempt at securing the airway was required in 36% of cases. Total costs related to the injuries were $24347.65. Conclusions: Dental injury is often attributed to the actions of the anesthesiologist. The injury may be unnoticed until after surgery, what makes it difficult to identify the time and mechanism of injury. Our results suggest that the number of attempts at securing an airway is a risk factor for dental injury. Proper preoperative documentation of poor dentition, discussion with the patient about the increased risk of dental injury and detailed documentation of dental injury when it occurs is advised.
文摘Introduction: The EasyTube is a disposable, polyvinyl-chloride, double-lumen, supraglottic airway device, which allows ventilation in either esophageal or tracheal position. The EasyTube may be positioned into the esophagus blindly or using a laryngoscope. Methods: Our study compared blind versus laryngoscopic-guided esophageal EasyTube insertion. Thirty two anesthesiologists inserted an EasyTube, size 41 Fr, into a mannequin, by using a blind and a laryngoscopic technique in a 2 × 2 crossover design. Results: No statistically significant difference in the time to achieve an effective airway was found: 23.9 ± 6 seconds for the blind and 29.5 ± 7.6 seconds for the laryngoscopic-guided technique. Conclusion: EasyTube insertion was equally successful with or without a laryn-goscope in a mannequin when used by anesthesia providers.
文摘Background: This study assesses the effectiveness of the GlideScope? Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation attempts, number of adjustment maneuvers, and number of failed intubations.
