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The Impact of Airway Technique on Anesthesia Control Time

  • Matthew J. Rowland
  • Richard D. UrmanEmail author
  • Xinling Xu
  • Jesse M. Ehrenfeld
  • David A. Preiss
  • Joshua C. Vacanti
Education & Training
Part of the following topical collections:
  1. Education & Training

Abstract

Few studies have examined the impact of video laryngoscopy (VL) on operating room efficiency. We hypothesized that VL reduces anesthesia control time (ACT), a metric of anesthesia efficiency, compared with fiberoptic intubation (FOI) in potentially difficult airways, but that direct laryngoscopy (DL) remains more efficient in routine cases. We performed a multi-institutional, retrospective chart review of anesthetic cases from 2015 to 2016. Cases were compared based on choice of airway technique (laryngeal mask airway [LMA], DL, VL or FOI) and ACT. Generalized linear models with gamma distribution and log link were then used to model the data to control for variables including ASA physical status (PS), Mallampati (MP) score, body mass index, and presence of a trainee. ACT was analyzed for 32,542 cases. LMA insertion was associated with a median ACT of 10 min (CI 8–14 min), DL 14 min (CI 11–18 min), VL 17 min (CI 13–21 min) and FOI 20 min (CI 14.5–26 min). Modeling confirmed these results when controlling for variables expected to increase the ACT. However, modeling also revealed that presence of a trainee minimizes the increase in ACT for cases using VL or FOI. Use of VL in patients with a high MP score may improve anesthesia efficiency in the operating room. ASA PS, MP score, and presence of a trainee are all associated with an increased ACT. Trainee presence with both FOI and VL was associated with reduced increases in ACT for these devices.

Keywords

Anesthesia control time Videolaryngoscopy Laryngoscopy Operating room Efficiency Fiberoptic Intubation 

Abbreviations

ACT

Anesthesia Control Time

FOI

Fiberoptic intubation

VL

Video laryngoscopy

DL

Direct laryngoscopy

BMI

Body mass index

LMA

Laryngeal mask airway

MP

Mallampati class

CI

Confidence interval

T1

In room to induction complete

T2

Induction start to induction complete

T3

Induction start to intubation

T4

In room to intubation

CRNA

Certified Registered Nurse Anesthetist

SRNA

Student Registered Nurse Anesthetist

Notes

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest relevant to this work.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Department of AnesthesiaBeth Israel Deaconess Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of AnesthesiologyVanderbilt University Medical CenterNashvilleUSA

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