Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial

Background Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tub...

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Main Authors: Rahendra Rahendra, Fajar Sesario, Andi Ade Wijaya Ramlan, Raihanita Zahra, Christopher Kapuangan, Arif Hari Martono Marsaban, Aries Perdana
Format: Article
Language:English
Published: Korean Society of Anesthesiologists 2024-10-01
Series:Anesthesia and Pain Medicine
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Online Access:http://anesth-pain-med.org/upload/pdf/apm-24018.pdf
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author Rahendra Rahendra
Fajar Sesario
Andi Ade Wijaya Ramlan
Raihanita Zahra
Christopher Kapuangan
Arif Hari Martono Marsaban
Aries Perdana
author_facet Rahendra Rahendra
Fajar Sesario
Andi Ade Wijaya Ramlan
Raihanita Zahra
Christopher Kapuangan
Arif Hari Martono Marsaban
Aries Perdana
author_sort Rahendra Rahendra
collection DOAJ
description Background Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. Methods This controlled trial randomized fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects. Results The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type. Conclusions Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.
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spelling doaj-art-0dd6a76b5d8a44efb7a9b143b97aaac62024-11-18T07:05:39ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772024-10-0119Suppl 1S113S12010.17085/apm.240181261Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trialRahendra Rahendra0Fajar Sesario1Andi Ade Wijaya Ramlan2Raihanita Zahra3Christopher Kapuangan4Arif Hari Martono Marsaban5Aries Perdana6 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas IndonesiaBackground Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. Methods This controlled trial randomized fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects. Results The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type. Conclusions Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.http://anesth-pain-med.org/upload/pdf/apm-24018.pdfadverse effectsdurationendotracheal intubationpediatricsplacement accuracyspiral endotracheal tube
spellingShingle Rahendra Rahendra
Fajar Sesario
Andi Ade Wijaya Ramlan
Raihanita Zahra
Christopher Kapuangan
Arif Hari Martono Marsaban
Aries Perdana
Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
Anesthesia and Pain Medicine
adverse effects
duration
endotracheal intubation
pediatrics
placement accuracy
spiral endotracheal tube
title Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
title_full Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
title_fullStr Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
title_full_unstemmed Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
title_short Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath video laryngoscope: a prospective randomized trial
title_sort endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a mcgrath video laryngoscope a prospective randomized trial
topic adverse effects
duration
endotracheal intubation
pediatrics
placement accuracy
spiral endotracheal tube
url http://anesth-pain-med.org/upload/pdf/apm-24018.pdf
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