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Showing posts with the label Anesthesia

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial

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Journal Club SummaryMethodology Score: 4/5                    Usefulness Score:  3/5
Lascarrou JB, et al. JAMA. 2017 Feb 7;317(5):483-493. Abstract Link
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Pediatric Airway Management in the Emergency Department

By Rob Suttie
Pediatric endotracheal intubation is an uncommon procedure in the Emergency Department (ED); even in high volume tertiary pediatric centres the incidence has been reported at 8-10/10,000 patients. While infrequent, pediatric airway management is an essential and life-saving skill that all ER physicians must be prepared for.  Much of the knowledge and skill set from the adult world is applicable here, however there are several important differences that are unique to the pediatric population.

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Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine - The POKER Study: A Randomized Double-Blind Clinical Trial

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Journal Club SummaryMethodology Score: 4/5
Usefulness Score:  3.5/5

 Ferguson I, et al.
Ann Emerg Med. 2016 Nov;68(5):574-582.
Abstract Link

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Direct versus Video Laryngoscopy: Are they just as good?

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Did we get your attention? Good! This is one of the areas in Acute and Critical Care Medicine which is highly controversial. This post is a desire to explore the topic after this very interesting article below came out. I hope to get some feedback but please keep it friendly!
So I’m going to admit it right off the bat, I use direct laryngoscopy (DL) as my preferred means of intubation. It doesn’t mean I don’t use or like video laryngoscopy (VL), simply that I am more comfortable with DL. So when I initially saw this paper: Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults by D. Janz et. al in Critical Care Medicine I was excited.
Could it be that both methods are “just as good”? Would I finally not look like a Luddite using my old school DL technique with the residents wondering why I was holding on to a method dating back to the 19th century? Below is my breakdown of this paper and what I think it tells us about DL vs. VL.
Objective: To evaluat…
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Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill

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Journal Club Summary
 Methodology Score: 2.5/5       Usefulness Score:  3/5
Semler MW, et al. Am J Respir Crit Care Med.2015 Oct 1. [Epub ahead of print] Abstract Link
This randomized, open-label, pragmatic trial of 150 adults undergoing intubation in a medical ICU found that the median lowest arterial oxygen saturation was 92% with apneic oxygenation versus 90% with usual care (95% confidence interval for the difference -1.6% to 7.4%; P = .16). Unfortunately, the first RCT of apneic oxygenation versus usual care outside the operating room was underpowered for a clinically important outcome; the results of this small single centre trial should not impact the use of a cheap, low risk intervention that may yet have benefit in critically ill patients.   By: Dr. Nicholas Costain
Epi lessonIntention-to-treat (ITT) Analyses Intention-to-treat (ITT) analyses are widely recommended as the preferred approach to the analysis of most clinical trials. The basic intention-to-treat principle is that partici…
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