Solutions

Solutions- Facteurs identifiésJimson et al. Predicting difficult endotracheal intubation in surgical patients scheduled for generalanesthesia. Anesth Analg 1995- Sociétés savantesGene et al. Management of the difficult airway, a closed claims analysis. Anesthesiology 2005

Solutions- Facteurs identifiésJimson et al. Predicting difficult endotracheal intubation in surgical patients scheduled for generalanesthesia. Anesth Analg 1995- Sociétés savantesGene et al. Management of the difficult airway, a closed claims analysis. Anesthesiology 2005

Solutions- Facteurs identifiésJimson et al. Predicting difficult endotracheal intubation in surgical patients scheduled for generalanesthesia. Anesth Analg 1995- Sociétés savantesGene et al. Management of the difficult airway, a closed claims analysis. Anesthesiology 2005Morbi-mortalité liée à l’intubation reste élevée

Les LaryngoscopesMacintoshMiller

EvolutionMasque LaryngéBullard LaryngoMac CoyFasttrachLMA CTrach

Pourquoi se limiter ?2012

Pourquoi se limiter ?Jonathan Berall (1997)Camera Screen Laryngoscope

GLOTTISCOPEVIDÉOLARYNGOSCOPEVideoAirtraqGlideScopeMac GrathPentax AWSC-Mac with D-BladeTruview EVO2

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Points positifs- GlideScope : 51 % intubation vs 90 % par desmanipulateurs inexpérimentés ; 89sec vs63sec.Nouruzi-Sedeh P et al.Laryngoscopy via macintosh blade versus GlideScope : sucess rate and time forendotracheal intubation in untrained medical personnel. Anesthesiology 2009- GlideScope pour intubation difficile prévue :98 % de succès et rattrape 94 % si laryngodirect inefficaceAziz MF et al. Routine clinical practice effectiveness of the GlideScope in difficult airway managemement : ananalysis of 2400 GlideScope intubations, complications, and failures from two institutions. Anesthesiology 2011

Points positifs- Améliore vue patients aux ATCD Cormack 3/4Cooper RM et al; Use of a new videolaryngoscope (GlideScope) in the management of adifficult airway. Can J Anesth 2003- Moins traumatique et meilleure vueRussel T et al. A comparaison of the forces applied to a manikin during laryngoscopywith the GlideScope and Macintosh laryngoscopes. Anesth Intensive Care 2011

Points positifs- Améliore vue patients aux ATCD Cormack 3/4Cooper RM et al; Use of a new videolaryngoscope (GlideScope) in the management of adifficult airway. Can J Anesth 2003- Moins traumatique et meilleure vueRussel T et al. A comparaison of the forces applied to a manikin during laryngoscopywith the GlideScope and Macintosh laryngoscopes. Anesth Intensive Care 2011

Points positifs- Moins traumatique sur les dentsRussel et al. Measurement of forces applied during Macintosh direct laryngoscopy compared withGlideScope videolaryngoscopy, Anaesthesia 2012.- Moins de mouvement du rachis cervicalYoshihiro et al. Distorsion of anterior airway anbatomy during laryngoscopy withthe GlideScope videolaryngoscope. J Anesth 2010.

Macintosh- Difficile à enseigner et pratique longuePlummer JL et al. Learning endotracheal intubation in a clinical skills learning center : aquantitative study. Anesth Analg 2001- Seul le manipulateur voit- 50 % de succès sur les 10 premieres IOT.- 18 % aide nécessaire après 80 IOT.Konrad C et al. Learning manual skills in anesthesiology. Aneth Analg 1998

- 37 novices (expérience < 6 laryngoscopies)- 2 groupes : V/T et T/V- Patients faciles (Cormack 1 ou 2)

Laryngoscopie video-assistée seraitmoins traumatisante (mais nonsignificatif)

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005- TruViewLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007- Pentax AWS- AirtraqEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008Maharaj CH et al. Evaluations of intubation using the Airtraq orMacintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005MEILLEURE VUE- TruViewLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007- Pentax AWS- AirtraqEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008Maharaj CH et al. Evaluations of intubation using the Airtraq orMacintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005MEILLEURE VUE- TruView- Pentax AWS- AirtraqLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007MEILLEURE VUE, SURTOUT C&L > 1Enomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008Maharaj CH et al. Evaluations of intubation using the Airtraq orMacintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005MEILLEURE VUE- TruView- Pentax AWS- AirtraqLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007MEILLEURE VUE, SURTOUT C&L > 1Enomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008MEILLEURE VUE, SUCCESMaharaj CH et al. Evaluations of intubation using the Airtraq orMacintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005MEILLEURE VUE- TruView- Pentax AWS- AirtraqLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007MEILLEURE VUE, SURTOUT C&L > 1Enomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008MEILLEURE VUE, SUCCESMaharaj CH et al. Evaluations of intubation using the Airtraq orMacintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006FACILE UTILISATION, SUCCÈS, MOINS TRAUMATIQUE, PLUS RAPIDE

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005- TruViewLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007- Pentax AWS- AirtraqEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008Maharaj CH et al. Evaluations of ease of intubation with the Airtraqor Macintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005INTUBATION PLUS LONGUE C&L FACILE- TruViewLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007- Pentax AWS- AirtraqEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008Maharaj CH et al. Evaluations of ease of intubation with the Airtraqor Macintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005INTUBATION PLUS LONGUE C&L FACILE- TruView- Pentax AWSLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007TEMPS D’INTUBATION PLUS LONGEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008- AirtraqMaharaj CH et al. Evaluations of ease of intubation with the Airtraqor Macintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005INTUBATION PLUS LONGUE C&L FACILE- TruView- Pentax AWS- AirtraqLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007TEMPS D’INTUBATION PLUS LONGEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008TEMPS D’INTUBATION IDENTIQUEMaharaj CH et al. Evaluations of ease of intubation with the Airtraqor Macintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006

Comparaisons 1 vs 1- GlideScopeSun DA et al. The GlideScope Video laryngoscope : randomizedclinical trial in 200 patients. Br J Anaesth 2005INTUBATION PLUS LONGUE C&L FACILE- TruView- Pentax AWS- AirtraqLi JB et al. An evaluation of TruView EVO2 laryngoscope. Anesthésia2007TEMPS D’INTUBATION PLUS LONGEnomoto Y et al. Pentax AWS, a new videolaryngoscope for trachealintubation in patients with restrictive neck movements : arandomized comparative study. Br J Anaesth 2008TEMPS D’INTUBATION IDENTIQUEMaharaj CH et al. Evaluations of ease of intubation with the Airtraqor Macintosh laryngoscope by anaesthesists in easy and simulateddifficult laryngoscopy. Anaesthesia 2006CARACTERISQUES IDENTIQUES SI INTUBATION FACILE

Points négatifs- 22 % de laryngo direct Cormack 3-4 restepareil avec VideoLaryngoscopieBrown CA et al. Improved glottic exposure with the video Macintosh laryngoscope inadult emergency department tracheal intubations. Ann Emerg Med 2010- 7,5 % echec avec C-Mac en préhospitalierCavus E et al. The C-Mac videolaryngoscope for prehospital emergency intubation :a prospective, multicentre, obsevational study. Emergency Med J 2011

Points négatifs- TechnologieRothfield KP et al. Comparison of GlideScope to conventional laryngoscopy for emergency intubation by nonanesthesia providers. Anesth Analg 2010- Video bien pour les débutants (1) mais paspour les initiés (2)Walker L et al. Randomized controlled trial ofintubation with the McGrath series 5viudeolaryngoscope by inexperiencedanesthesists. Br J Anesth 2012Griesdale DE et al. GlideScope videolaryngoscopyversus direct laryngoscopy for endotrachealintubation : a systemic review and meta-analysis.Can J Anesth 2012- Inventeur GlideScope et Pentax AWS sonttous les deux des chirurgiens…

Comparaison- Mieux que Macintosh ?- Lequel ?

-150 patients avec BMI > 35 kg/m2 randomisés-Laryngoscopie Macintosh primaire (C&L)

Nombre de tentatives nécessaire à IOT(liéau Cormack) :-2,6 +/-1,0 GlideScope-1,4 +/- 0,7 V-MAC-2,9 +/-0,9 Mc GrathUtilisation d’un mandrin-60 % GlideScope-10 % V-MAC-76 % Mc GrathTemps d’intubation :- 33 +/- 18 sec GlideScope- 17 +/- 9 sec V-MAC- 41 +/- 25 sec Mc GrathSatisfaction meilleur avec V-MAC

Nombre de tentatives nécessaire à IOT(liéau Cormack) :-2,6 +/-1,0 GlideScope-1,4 +/- 0,7 V-MAC-2,9 +/-0,9 Mc GrathSATISFACTION, VITESSE,Utilisation d’un mandrin-60 % GlideScope-10 % V-MAC-76 % Mc GrathMOINS DE MANDRINTemps d’intubation :- 33 +/- 18 sec GlideScope- 17 +/- 9 sec V-MAC- 41 +/- 25 sec Mc GrathSatisfaction meilleur avec V-MAC

- 35 anesthésistes expérimentés- Formation courte initiale- 4 scénarios : simple, rigidité cervicale,œdème de langue, rigidité cervicale +œdème de langue

Normal-100 % intubation-Pression dentaire : Pentax < ..

SATISFACTION, VITESSE,Normal-100 % intubation-Pression dentaire : Pentax < ..

- 42 seniors- Apprentissage d’utilisation des glottiscopes (théorie et pratique)- 2 situations : intubation standard et intubation difficile (mannequin)

- GlideScope vs Macintosh- 17 études- 1998 patients- Intubation simple ou difficile- Novice ou expert- Exposition / Succès / Vitesse

EXPOSITION AMELIOREE(SURTOUT SI C&L INITIAL >1)

SUCCES POUR LES NOVICESSEULEMENT

PLUS RAPIDE POUR LES NOVICESSEULEMENT

Vidéo laryngoscopeAvantages- Rapproche notre œil de lacible : meilleure vue- Enseignement : faciled’utilisation pour lesnovices avec courbeapprentissage courte- Moins traumatiqueInconvénients- Temps d’intubation souventplus long- Les limites de latechnologies- Prix- Place dans l’algorythme ?Mieux voir n’est pas synonyme de mieux intuber.

Intubation : quoi de neuf ?RIENPour l’instant…