aScope
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aScope Ambu aScope 1: a New Disposable Flexible Video Laryngoscope Author Source Schirin M. Missaghi et al Internet Journal of Airway Management, Homepage, Volume 6 (January 2010 to December 2011) Framework Evaluation of the aScope for orotracheal intubation in 10 patients with apparently normal airways. Main endpoints Comparators Conclusion None Cost Benefits Working channel The start-up investment of the aScope is significantly lower than that of alternative products It eliminates time and costs of hygienic reprocessing associated with standard flexible laryngoscopes, requiring a special automatic endoscopy washing machine, and repair costs. The aScope eliminates any risks of cross infection and is always available for use in other patients. Experienced endoscopists had regularly problems with fogging of the camera system and the presence of secretions obscuring the view due to the working channel cannot be used for suctioning. The manufacturer should redesign the current model of the aScope (1)and provide this device with a larger sized working channel and the facility for suctioning aScope A cost analysis of reusable and disposable flexible optical scopes for intubation Author Source Tvede MF et al Acta Anaesthesiol Scand. 2012 May;56(5):577-84. doi: 10.1111/j.1399-6576.2012.02653.x. Epub 2012 Feb 16. PMID: 22338623 http://www.ncbi.nlm.nih.gov/pubmed/22338623 Framework • The costs incurred during intubations using FOSs at a large anaesthesia department were identified, and a series of intubations using a disposable scope were analyzed for comparison Main endpoints • • • • • • • • Cost per intubation Cost per intubation per device Cost per intubation with a fixed no. of intubations/mth Procedures performed by the staff when using the applicable device Initial expenditure Repair cost/ year Wages cost /year Operating cost/procedure/intubation using reusable scope Comparators • • • • • aScope Flexible optical scope(reusable) Total cost of an intubation is greater when using disposable compared with reusable equipment (€204.4 vs. €177.7) If video equipment with an external monitor is considered mandatory, the expenses are of equal magnitude. The cost analysis is particularly sensitive to the actual number of flexible optic intubations performed; with fewer intubations, the total cost will begin to favor disposable equipment. Conclusion aScope Preliminary Evaluation of Ambu aScope 2 for Endoscopic Guidance During Percutaneous Dilatational Tracheostomy Author Jamadarkhana S et al Source ICS 2011 Framework 10 patients underwent PDT Main endpoints Comparators None Ease of use Quality of image Ventilatory parameters Cardiovascular parameters Conclusion Easy handling and maneuvrability Clarity and quality of endoscopic view was 8-10 (1-10, 10 being the best) No significant cardiovascular and ventilatory changes during the procedure No complications were reported aScope is an alternative to reusable bronchoscopes for PDT on ICU, and the single use design eliminates the risk of cross contamination and delays with sterilization. AuraOnce Comparison between LMA-Classic and AMBU AuraOnce laryngeal mask airway in patients undergoing elective general anaesthesia with positive pressure ventilation Author Suzanna AB et al Source Med J Malaysia. 2011 Oct;66(4):304-7. PMID: 22299547 http://www.ncbi.nlm.nih.gov/pubmed/22299547 Framework • • 180 patients allocated into two groups ASA I and II patients undergoing elective general anaesthesia Main endpoints • • • Ease of insertion Adequacy of seal intraoperatively Postoperative complications Comparators • • Ambu LMA Classic LMA Conclusion • • • First attempt success rate was comparable between the two groups (Classic LMA 87% versus Ambu LMA 83%) Time of insertion was significantly shorter in the Ambu LMA group (Seal performance)Nitrous oxide level was comparable between the two groups up to 20 minutes of operation. At 40 and 60 minutes, the Ambu LMA showed a significant lower nitrous oxide leak compared to the Classic LMA. Postoperatively, incidence of blood stains was comparable between the two groups, however the incidence of sore throat was lower in the Ambu LMA group The Ambu LMA was comparable to the Classic LMA in terms of the ease of insertion, but provided better seal during positive pressure ventilation with less postoperative sore throat. • • AuraOnce Randomised Comparison of the AMBU AuraOnce Laryngeal Mask and the LMA Unique Laryngeal Mask Airway in Spontaneously Breathing Adults Author Source Framework Main endpoints Comparators Conclusion Williams DL et al Anesthesiol Res Pract. 2012;2012:405812. Epub 2012 Feb 29. PMID: 22505884 http://www.ncbi.nlm.nih.gov/pubmed/22505884 • 82 adult patients (ASA status I-IV) were randomly allocated to receive the LMAU or AMBU and were blinded to device selection • Comparison of two SGA in spontaneously breathing adult patients undergoing general anaesthesia • All airway devices were inserted by trained anesthetists • • • • • • • • • • • • Seal pressure Overall success rate Insertion time No of adjustments Airway morbidity LMA-Unique AuraOnce AMBU produced significantly higher airway sealing pressures (AMBU 20 ± 6; LMAU 15 ± 7 cm H(2)O) No statistical difference between the two devices for first time & overall success rate, AuraOnce (35/40) Unique(31/38) Insertion time AuraOnce (27s) Unique(32s) Blood-staining/sore throat, AuraOnce (4/3) Unique (3/4) The AuraOnce provided a higher oropharyngeal leak pressure compared to the LMA Unique in spontaneously breathing adult patients. AuraOnce Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptic laryngoscope findings Author Gupta D et al Source Middle East J Anesthesiol. 2011 Jun;21(2):283-7. PMID: 22435281 http://www.ncbi.nlm.nih.gov/pubmed/22435281 Framework 31 ASA I and II patients General anesthetic technique with AuraOnce or AuraFlex Disposable Laryngeal Mask Airways. The position of the SGA cuff was confirmed by transverse neck ultrasound (USG), and reconfirmed with intra-SGA fibreoptic laryngoscopy (FOL). Main endpoints SGA position after placement and prior to removal with the assistance of ultrasound scan Comparators None Conclusion Ultrasound examination can replace fibreoptic examination for confirmation of the correct placement of an LMA Ultrasound examination can further give insight into the cause of airway/ventilation events that may be interfering with the LMA placement and ventilation. AuraFlex Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptic laryngoscope findings Author Gupta D et al Source Middle East J Anesthesiol. 2011 Jun;21(2):283-7. PMID: 22435281 http://www.ncbi.nlm.nih.gov/pubmed/22435281 Framework 31 ASA I and II patients General anesthetic technique with AuraOnce or AuraFlex Disposable Laryngeal Mask Airways. The position of the SGA cuff was confirmed by transverse neck ultrasound (USG), and reconfirmed with intra-SGA fiberoptic laryngoscopy (FOL). Main endpoints SGA position after placement and prior to removal with the assistance of ultrasound scan Comparators None Conclusion Ultrasound examination can replace fiberoptic examination for confirmation of the correct placement of an LMA Ultrasound examination can further give insight into the cause of airway/ventilation events that may be interfering with the LMA placement and ventilation. Ambu Resuscitator An In-Vitro Evaluation of Aerosol Delivery Through Tracheostomy and Endotracheal Tubes Using Different Interfaces Author Ari A et al Source Respir Care. 2012 Jan 23. [Epub ahead of print] PMID: 22273459 http://www.ncbi.nlm.nih.gov/pubmed/22273459 Framework A manikin was intubated with either an ETT(Mallinckrodt) or an TT(tracheostomy), to compare aerosol delivery via tracheostomy tube (TT) and ETT using interfaces such as T-piece, tracheostomy collar, and Ambu bag. Main endpoints • Delivered nominal dose • • • T-piece Tracheostomy collar Ambu bag. • • • Use of Ambu bag with both TT and ETT increased lung dose more than three fold. Inhaled dose with tracheostomy collar was less than T-piece with either TT or ETT In an adult model of spontaneous ventilation, aerosol therapy through ETT is less efficient than TT, while the Ambu bag was more efficient than T-piece or tracheostomy collar. Comparators Conclusion Ambu Resuscitator Radio stethoscopes: an innovative solution for auscultation while wearing protective gear Author Candiotti KA et al Source Am J Disaster Med. 2011 Sep-Oct;6(5):285-8. PMID: 22235600 http://www.ncbi.nlm.nih.gov/pubmed/22235600 Framework Two blinded anesthesiologists using a radio stethoscope performed a total of 100 assessments (50 each) to evaluate endotracheal tube position on a human patient simulator(HPS) Four ventilation patterns (i.e., right lung ventilation only; left lung ventilation only; ventilation of both lungs; and an esophageal intubation or no breath sounds) were simulated. An Ambu bag was used for ventilation, and subjects had to identify the ventilation pattern. Participants later compared the two types of respirators and their ability to auscultate for breath sounds. Main endpoints Comparators Comparison of the two types of respirator (positive and negative) None Conclusion Subjects were able to verify the correct ventilation pattern in all attempts (100 percent Radio stethoscopes appear to provide a viable solution for the problem of patient auscultation while wearing protective gear Pentax - AWS Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomized trial in a simulated trapped car accident victim Author Wetsch WA et al Source Eur J Anaesthesiol. 2011 Dec;28(12):849-58. doi: 10.1097/EJA.0b013e32834c7c7f. PMID: 21986981 http://www.ncbi.nlm.nih.gov/pubmed/21986981 Framework • • 25 experienced anaesthetists An airway manikin was placed on the driver's seat of a compact car. Access was possible only through the opened driver's door. Main endpoints • • • Time to achieve glottic view Time of intubation Time for first ventilation & tracheal tube position Comparators • • • • • • • • Macintosh laryngoscope Glidescope Ranger Storz C-MAC Ambu-Pentax AWS Airtraq McGrath Video laryngoscope provides a better glottic view, but with significantly delays. Devices with a tube guide (Airtraq and Ambu Pentax AWS) enable tracheal intubation to be achieved significantly faster and with a lower failure rate than devices without a tube guide. No video laryngoscope outperformed direct laryngoscopy with a Macintosh laryngoscope in this simulation study. Conclusion • Pentax - AWS Intubation training survey using four types of laryngoscopes among medical students: a comparison of the Macintosh laryngoscopes, Miller laryngoscopes, Airtraq, and Pentax-AWS Airwayscope [Article in Japanese] Author Hayashi K et al Source Masui. 2011 Mar;60(3):389-94. PMID: 21485114 http://www.ncbi.nlm.nih.gov/pubmed/21485114 Framework • • • • 66 medical students with no intubation experience A survey regarding medical students’ usefulness in intubation procedure on mannequin. A short instruction including practice for the four various devices before intubation procedure were commenced. Four intubation procedures (one for each device) to the mannequin (Laerdal airway trainer) were performed Main endpoints • • • • Time for intubation POGO score(percentage of glottic opening) Incidence of esophageal intubation Teeth click Comparators • • • • • • • • • Macintosh laryngoscope Miller laryngoscope Airtraq Ambu-Pentax AWS Time for intubation was significantly longer in ATQ POGO was significantly higher in AWS, but lower in MAC Complications were fewer in AWS 70% of the participants chose AWS as the best device. With minimal instruction including practice, the AWS seemed to achieve safer intubation with better laryngeal view for novice laryngoscopists Conclusion Pentax - AWS First robotic tracheal intubations in humans using the Kepler intubation system Author Hemmerling TM et al Source Br J Anaesth. 2012 Jun;108(6):1011-6. Epub 2012 Mar 28. PMID: 22457483 http://www.ncbi.nlm.nih.gov/pubmed/22457483 Framework • A pilot study with 12 patients enrolled in the first human testing of a robotic intubation system for oral intubation. • • Main endpoints The robotic intubation system consist of four main components whereas a Pentax AWS video laryngoscope is incorporated as part of the system. A joystick allows simulation of the wrist or arm movements of a human operator. • Success rate of intubation • Intubation times Comparators None Conclusion • The success rate was high at 91% • • Only one patient failed intubation due to fogging of the video laryngoscope Intubation time were 93 s(median) Pentax - AWS Parker Flex-Tip Tube(®) provides higher intubation success with the Pentax-AWS Airway scope(®) despite the AWS tip being inserted into the vallecula Author Suzuki A et al Source J Anesth. 2012 Mar 4. [Epub ahead of print] PMID: 22391671 http://www.ncbi.nlm.nih.gov/pubmed/22391671 Framework • • Forty patients were randomly assigned into either the standard or Parker tube group Examination of whether the Parker tube facilitates intubation when the AWS tip is inserted into the vallecula. Main endpoints • • Success rate for intubation Time needed for tube placement Comparators • • Parker tube Standard tube Conclusion • • • The Parker tube provided both a higher intubation success rate (17/20 vs. 4/20) The Parker tube provided a faster intubation time (17 ± 5 s vs. 25 ± 4 s) The Parker tube in combination with the AWS is an optional technique allowing the laryngoscopist to obtain more reliable intubation success despite insertion of the AWS tip into the vallecula. Pentax - AWS Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients Author Source Woo CH et al Korean J Anesthesiol. 2012 Feb;62(2):119-24. Epub 2012 Feb 20. PMID: 22379565 http://www.ncbi.nlm.nih.gov/pubmed/22379565 Framework • • ASA physical status 2 or 3 adult patients with major burn injury were assigned into two groups. To compare cardiovascular responses and general efficacy of the Pentax-AWS and Macintosh laryngoscopes in burn patients Main endpoints • • • • • • Hemodynamic data Grade of sore throat Intubation time Success rate of intubation Number of intubation attempts POGO ( percentage of glottic opening) Comparators • • • • Pentax-AWS Macintosh laryngoscopes A statistically significant increase in heart rate just after laryngoscopy was seen with Macintosh. The success rate of the first attempt (100%) was greater with the Pentax AWS (46%). POGO scores were higher with the Pentax AWS (97 ± 4%) The use of Pentax-AWS offers a reduced degree of heart rate elevation compared with the Macintosh laryngoscope and better intubation environments in major burn patients. Conclusion • Pentax - AWS Use of the Pentax-AWS in a patient with Cormack 3a difficult airway [Article in Japanese] Author Suzuki A et al Source Masui. 2007 Mar;56(3):341-4. PMID: 17366925 http://www.ncbi.nlm.nih.gov/pubmed/17366925 Framework Use of Pentax-AWS in a 68-year-old male patient with known (Cormack grade 3a) difficult airway. Patient was sedated. Main endpoints POGO ( percentage of glottic opening) Intubation attempts Comparators None Conclusion POGO score 70% Tracheal intubation was successful uneventfully, and the patient's airway was secured without any postoperative complication.
