Anesth Pain Med.  2017 Jul;12(3):271-274. 10.17085/apm.2017.12.3.271.

Learning curve of skilled anesthesiologists for endotracheal intubation using Optiscopeâ„¢

• Park SK
• Yun SH
• Park JC
• Kim HJ

• KMID: 2388846
• DOI: http://doi.org/10.17085/apm.2017.12.3.271

Abstract

BACKGROUND
Optiscopeâ„¢ is a semi-rigid fiberscope for endotracheal intubation. A camera attached to the distal end of the stylet shows the laryngeal view through an adjustable LCD-monitor attached at the handle. The aim of this study was to evaluate the learning curve of skilled anesthesiologists in the use of Optiscopeâ„¢.
METHODS
Eighty-patients with normal airways were randomly assigned to four anesthesiologists, who did not have previous experience of intubation with Optiscopeâ„¢. After induction of general anesthesia, the four investigators performed 20 intubations each, using the Optiscopeâ„¢. Time to intubation (TTI), number of intubation attempts, and reasons of prolonged TTI were evaluated.
RESULTS
The success rate of intubation was 98.8%. The TTI was significantly faster in 16th-20th patients (35.0 s, interquartile range 27.3-41.4) than in the first 10 patients (54.1 s, interquartile range 31.2-75.5) (P = 0.006). All patients after the 16th intubation were intubated at the first attempt. Frequent problems encountered were difficulty in getting the stylet tip under the epiglottis, and mucous secretion obscuring the laryngeal anatomy.
CONCLUSIONS
Optiscopeâ„¢ is an effective device for endotracheal intubation. About 15 intubations in patients with normal airways provided clinically adequate experience to the skilled anesthesiologists. Additional maneuver of airway opening such as jaw thrust and sufficient removal of oral secretion, are suggested to reduce TTI.

Keyword

Airway management; Intubation; Laryngoscope; Learning curve

MeSH Terms

Airway Management
Anesthesia, General
Epiglottis
Humans
Intubation
Intubation, Intratracheal*
Jaw
Laryngoscopes
Learning Curve*
Learning*
Research Personnel

Figure

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  Fig. 1 Change of time to intubation in twenty consecutive patients intubated by four anesthesiologists. The time to intubation decreased with experience (Spearman’s rank correlation coefficient [Rho] = −0.323, P = 0.003). TTI: Time to intubation.

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  Fig. 2 Time to intubation according to the groups. Cases with unusual long time to intubation were happened in group A and group B. Group A: first–10th patients, Group B: 11th–15th patients, Group C: 16th–20th patients intubated by four anesthesiologists. *P < 0.05/3 (Bonferroni correction) compared with group A.

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