Achieving proficiency in rigid bronchoscopy-a study in manikins.

Autor: Royds J; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland., Buckley MA; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland., Campbell MD; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland., Donnelly GM; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland., James MFM; University of Cape Town, Cape Town, South Africa., Mhuircheartaigh RN; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland.; Mater Misericordiae University Hospital, Dublin, Ireland., McCaul CL; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland. cmccaul@rotunda.ie.; Mater Misericordiae University Hospital, Dublin, Ireland. cmccaul@rotunda.ie.; University College Dublin, Dublin, Ireland. cmccaul@rotunda.ie.
Jazyk: angličtina
Zdroj: Irish journal of medical science [Ir J Med Sci] 2019 Aug; Vol. 188 (3), pp. 979-986. Date of Electronic Publication: 2018 Dec 14.
DOI: 10.1007/s11845-018-1944-5
Abstrakt: Background: Rigid bronchoscopy may be used to relieve acute airway obstruction following induction of anaesthesia and is a recommended option for management of the difficult airway. The ability of anaesthetists to perform rigid bronchoscopy has not been reported. We sought to explore the acquisition of procedural skill in rigid bronchoscopy by anaesthesiologists in a manikin.
Methods: In a prospective interventional study, participants were asked to perform 40 rigid bronchoscopies in a TruCorp AirSim Advance airway manikin, configured to a randomised sequence of easy or difficult laryngoscopic grades to which the participants were blinded. The primary outcome was stabilisation (the attempt after which no further reduction in procedural time occurred). Dental injury and oesophageal intubation were also recorded. Forty anaesthesiologists and 40 unskilled controls (without laryngoscopic skills) participated.
Results: In the easy model, stabilisation occurred at attempt 8 in the anaesthesiology group and 10 in the unskilled controls. In the difficult model, stabilisation occurred at attempt 10 in both groups. Dental injury was less common in the anaesthesiology group. The proportion of participants achieving procedural competency did not differ between groups in either the easy (35/40 vs. 30/40) or difficult model (32/40 vs. 25/40).
Conclusions: This study shows that the technical skill of rigid bronchoscopy can be acquired within 10 repetitions in a manikin model. As procedural competence and complication frequency vary with the laryngoscopic grade of the model, both easy and difficult configurations should be used for training. Advanced laryngoscopic skills are not required prior to training in this technique.
Databáze: MEDLINE
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