BACKGROUND: Many parameters are being used today to assess difficulty of intubation. This study was done to determine the validity of a new device, the Lee Thyromental Ruler (LTR), in the prediction of degree of difficult intubation. METHODS: A prospective, single-blinded cross sectional study was used. 187 patients scheduled for elective surgery under general endotracheal anesthesia were enrolled in the study. All residents of the Department of Anesthesiology of the Veterans Memorial Medical Center were taught how to use the LTR. Preoperative assessments were done on each patient using the following stepwise evaluation plan: (1) thyromental distance measurement in terms of fingerbreadths, (2) airway asseSsment using the Mallampati classification, (3) assessment of range of neck flexion and extension, and (4) thyromental distance measurement using the LTR. These were correlated with the number of attempts to intubate and the degree of glottic exposure during laryngoscopy by Cormack and Lehane as measures for difficulty of intubation RESULTS: The study showed that TMD by LTR using 5.3 cm had higher sensitivity (90 percent) and specificity (83.6 percent) than TMD by fingerbreadth for prediction of degree of difficulty of intubation as measured by the number of attempts to intubate. There was no significant difference in the number of attempts among patients distributed according to Mallampati classification and range of neck flexion and extension. Only the Mallampati classification showed a significant difference among the distribution of subjects according to the Cormack and Lehane grading of glottic exposure during laryngoscopy. CONCLUSION: The Lee Thyromental Ruler is therefore a more valid measure of the thyromental distance as compared to use of fingerbreadths. It is inexpensive, reliable, easy to use and its design allows its use in patients with different anatomical variations. It would thus aid in the prediction of difficult intubation and avoid the complications associated with multiple intubation attempts and failed intubation. (Author)
Human ; INTUBATION ; ANESTHESIA ; ENDOTRACHEAL ; SURGERY ; ELECTIVE, ANESTHESIOLOGY

BACKGROUND: The image and status of anesthesiology as a medical specialty in the eyes of the general public has been a problem. This study assessed the patients' thoughts on anesthesiologists and their preoperative concerns and examined the influence of any previous anesthetic experience on their apprehension. METHODS: One hundred thirty-nine patients undergoing elective surgical procedures were surveyed with a questionnaire regarding their thoughts on anesthesiologists and their preoperative concerns at preoperative visits. The results were analyzed in terms of a previous experience with anesthesia. RESULTS: Sixty-five patients had previous experience with anesthesia (Group 1), and 74 patients had none (Group 2). Seventy-one percent of patients in Group 1 and 80% in Group 2 reported that a physician-anesthesiologist was in charge of their anesthesia. Regarding the responsibility for the patients' safety during the surgical procedures, 83% of patients in Group 1 and 82% in Group 2 reported that the anesthesiologists were responsible for the patients' well-being. Fifty-seven percent of patients in Group 1 and 58% in Group 2 reported that the anesthesiologists were responsible for their safe recovery from the anesthesia. The most frequent preoperative apprehensions were postoperative pain (57% in Group 1 and 62% in Group 2) and the risk of not waking up from the anesthesia (60% in Group 1 and 57% in Group 2). There were no significant differences between the two groups. CONCLUSIONS: Passive learning from previous anesthetic experience does not affect the patients' thoughts on the anesthesiologists and their preoperative concerns.
Anesthesia* ; Anesthesiology ; Humans ; Learning ; Pain, Postoperative ; Surveys and Questionnaires ; Surgical Procedures, Elective

INTRODUCTIONAnaesthetists may be called upon to emergently secure the airway of a laterally positioned patient. Intubating a patient's trachea in the lateral position may be difficult due to unfamiliarity. This exploratory study aimed to investigate the success rate of lateral intubation performed by novices in a controlled setting.

METHODSIn this observational study, all patients who presented for elective surgery requiring the lateral position with planned lateral intubation at Singapore General Hospital were included. The trainee assigned to each patient had no prior indication of the proposed lateral intubation until the start of the case. Verbal instructions were given before the start of and during the procedure. The consultant anaesthetist in attendance could intervene at any point to prevent patient harm or if the trainee requested assistance. Time to intubation, adjuncts used and complications encountered were recorded.

RESULTSA total of 44 consecutive patients were included in this study. The trainees completed 42 of the 44 lateral intubations, with 41 being successfully performed on the first attempt. All patients were intubated successfully in a lateral position within two attempts. The mean duration of intubation was 57.3 ± 36.4 seconds. There was no difference between left and right lateral intubation. Other than one episode of transient desaturation on pulse oximetry, there were no complications.

CONCLUSIONLateral intubation by trainees had a high success rate when supervised by an experienced operator. Intubation of patients in unconventional positions using routine airway equipment should be included in airway training for trainees.

Anesthesia ; Anesthesiology ; education ; Elective Surgical Procedures ; Humans ; Intubation, Intratracheal ; Laryngoscopy ; education ; Patient Positioning ; Posture ; Singapore ; Trachea ; pathology

INTRODUCTIONProduction pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore.

METHODSA random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure.

RESULTSDemographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively.

CONCLUSIONProduction pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.

Anesthesia ; methods ; Anesthesiologists ; Anesthesiology ; methods ; Elective Surgical Procedures ; Humans ; Operating Rooms ; Patient Safety ; Prevalence ; Singapore ; Stress, Physiological ; Surveys and Questionnaires ; Tertiary Care Centers ; Treatment Outcome ; Workload

Direct laryngoscopy and endotracheal intubation cause increased arterial blood pressure and heart rates. These cirulatory effects are due to mechanical stimulation of the laryngopharynx and traches via efferent cervical sympathestic fibers. And various cardiac arrhythmias, even-cardiac arrest may occur by stimulation of the vague nerve during intubation. The present study observed the ECG and circulatory changes following i.v. injection of meperidine, 50 mg, and diazepam, 10mg, as primary i.v. anesthetic agents, for the purpose of the prevention of circulatory stimulation before laryngoscopy and tracheal intubation. This study was undertaken on eight-eight, ASA class l-ll patients of either sex undergoing elective surgical procedures in the Department of Anesthesiology at Ewha Womans University hospital. The results were as follows: 1) The increases of systolic blood pressure following intubation were markedly reduced in the pre-treated groups for both normotensive and hypertensive individuals. 2) Heart rates following intubation were markedly increased in all groups. 3) Transient abnormal findings in the ECG appeared in sixty-nine cases(78.4%) following intubation and the majority showed sinus tachycardia. 4) pH, PaCO2, and PaO2 values were within normal range following intubation in all groups.
Anesthesiology ; Anesthetics ; Arrhythmias, Cardiac ; Arterial Pressure ; Blood Pressure ; Diazepam* ; Electrocardiography ; Female ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Hypopharynx ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy* ; Meperidine* ; Reference Values ; Surgical Procedures, Elective ; Tachycardia, Sinus