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A comparison of two new devices for emergency airway management: Laryngeal tube and airway management device
Correspondence A COMPARISON OF TWO NEW DEVICES FOR EMERGENCY AIRWAY MANAGEMENT: LARYNGEAL TUBE AND AIRWAY MANAGEMENTDEVICE To the Editor:--In this letter, 2 new devices for airway management are compared: the Airway Management Device (AMD) and the Laryngeal Tube (LT). 1,2.3 The A M D (Fig 1) is a single slim silicone tube, with 2 cuffs provided with pilot balloons (the pharyngeal, inflated with 50 to 80 mL of air, and the esophageal with 5 to 8 mL) and an oval hole that, placed between the cuffs, permits ventilation. The main characteristic of this device lies in its special channel designed to be opened only when the esophageal cuff is partially deflated. It allows the passage of a suction catheter into the esophagus to permit gastric aspiration. The LT (Fig 2) is a silicone curved device, provided with 2 cuffs connected to one pilot balloon. The oval aperture, between the cuffs, is the route for ventilation. Both devices are inserted blindly as the Combitube. Six medical students and 4 nurses inserted both devices blindly in a new airway simulator manikin (Air-Man manikin, Laerdal, Stavanger, Norway) twice. The following parameters were recorded: ease of insertion, number of attempts, and insertion time. Data were recorded for insertion in normal conditions and in simulated cervical spine rigidity. Ease of insertion was evaluated with a score ranging from 0 to 3 (0 = very easy, 1 = easy, 2 = difficult, 3 = impossible). In normal conditions and in simulated cervical rigidity, both the A M D and the LT were inserted at the first attempt in all cases. Mean insertion time for the A M D was 7.8 _+ 1.1 sec in normal conditions and 8.5 _+ 2.1 sec in simulated cervical rigidity. These figures for the LT were 4.4 _+ 1.4 sec in normal conditions, and 5.2 _+ 1.7 sec in cervical rigidity. Both in normal conditions and in simulated cervical rigidity the insertion of the A M D was considered very easy in 8/10 (80%) and easy in 2/10 (20%), whereas the insertion of the LT was very easy in 10/10 (100%). In a manikin, both the A M D and the LT prove to be easy and rapid to insert. The use of the LT seems to be simpler and quicker than the AMD. Further studies are needed to evaluate the exact place of these 2 devices in airway m a n a g e m e n t in patients.
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FELICE AOR~), MD RITA CATALDO,MD ALESSANDRAALFANO BENEDETrA GALL]
Department of Anaesthesia Universi~ School of Medicine Campus Bio-Medico Rome, Italy PATRICK RAVUSSIN,MD
Department of Anaesthesiology and Critical Care Sion Hospital Sion, Italy
Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1902-0016535.00/0 doi: 10.1053/ajem.2001.21355
FIGURE 1.
Airway management device.
163
164
AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 19, Number 2 • March 2001
FIGURE 2. Laryngeal tube.
References 1. Agr6 F, Cataldo R, Alfano A, et al: A new prototype for airway management in an emergency: The Laryngeal Tube. Resuscitation 1999;41:284-286 2. Genzwuerker HV, Hilker T, Hohner E, et al: The laryngeal tube: A new adjunct for airway management. Prehosp Emerg Care 2000; 4:168-t72 3. Dorges V, Ocker H, Wenzel V, et al: The laryngeal tube: A new simple device. Anesth Analg 2000;90:1220-1222
BONY PROMINENCE PAIN CAUSED BY ELEVATED WHEELCHAIR SEATING PRESSURES To the Editor.'--The purpose of this report is to describe a patient with bony prominence pain caused by elevated wheelchair seating pressures. The patient, a 60-year-old man with a relapsing and remitting form of multiple sclerosis (MS), used a 3-wheeled scooter for mobility in his home and workplace? During the last 7 days, he complained of pain over his fight ischial tuberosity, precipitated by sitting on a fluid pad cushion (Jay Cushion, Sunrise
Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1902-0017535.00/0 doi:l 0.1053/ajem.2001.21336
Home Healthcare Group, Logmont, CO) which he purchased 1 month ago. His pain was relieved only by being transferred to his bed. His pain worsened considerably during the weekend, causing him to come to the emergency department for pain relief. The patient had normal vital signs and was afebrile. The emergency physician confirmed the presence of paraplegia with evidence of reduced sensory perception in his lower extremities. Increased motor tone (spasticity, hyperreflexia, and extensor plantar response) were detected. He had no evidence of loss of visual acuity or vertigo. The emergency physician bad the patient transferred to a stretcher for examination of the perineum. Within 5 minutes after transfer to the stretcher, the patient noted a significant reduction in discomfort over his fight ischial tuberosity. Visualization of the skin of the buttocks revealed no evidence of skin damage or pressure ulceration. Gentle palpation of the fight ischial tuberosity elicited some discomfort. Because the emergency physician believed that the patient's pain was precipitated by elevated seating pressures, the patient was admitted to the hospital to prevent the development of pressure ulcers. His hospital care was coordinated by an interdisciplinary team, involving a physiatrist, physical therapist, and rehabilitation engineer, to maintain his muscle strength and extensibility and search for the cause of his pain. Approximately 30 minutes after initiation of his exercise program, he repeatedly complained about pain around his fight ischial tuberosity that precipitated muscle spasms of his fight leg. The discomfort in his fight buttocks that precipitated these muscle spasms had been present since purchasing the new fluid pad cushion. Because the cushion is a self-contained fluid and foam cushion, it could not be easily reconfigured to relieve the patient's pain. Consequently, an individualized wheelchair seating evaluation was initiated to identify a cushion that encountered lower seating pressures for the patient. An individualized wheelchair seating evaluation was accomplished using a pressure monitoring system, Oxford Pressure Monitor (OPM) MK 2 (Talley Medical, United Kingdom) that judges interface pressure between the seat and the patient's buttocks. 2 The individualized seating evaluation was first accomplished by measuring the interface pressures in sites of the right anterior and posterior buttocks. The anterior sensor was positioned near the fight ischial tuberosity, while the posterior sensor was positioned approximately 5 cm posterior to the fight ischial tuberosity at a site beneath the gluteus maximus muscle. The pressures were recorded as average pressure values of the 12 sensors in the pads. The average pressure was expressed as the mean and standard deviation of the 12 sensor measurements. The patient was allowed to remain in this position for approximately 5 minutes so that the interface pressure measurement could be correlated with the patient's level of discomfort. When the patient was seated on the Jay cushion, he continually complained of pain around his fight ischial tuberosity. The magnitude of pain discomfort was correlated with the average pressure measurements. The average pressure measurements near the ischial tuberosity (110_+ 20 mmHg) were always higher than those encountered at a site posterior to the ischial tuberosity (60_+20 mmHg).
.....
..............:,, :,::
i ii,iili i ii:ii:, i ili iliads!!!ii:iiiii:iiiiiii,ii
ii:i%i
FELICE AOR~), MD RITA CATALDO,MD ALESSANDRAALFANO BENEDETrA GALL]
Department of Anaesthesia Universi~ School of Medicine Campus Bio-Medico Rome, Italy PATRICK RAVUSSIN,MD
Department of Anaesthesiology and Critical Care Sion Hospital Sion, Italy
Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1902-0016535.00/0 doi: 10.1053/ajem.2001.21355
FIGURE 1.
Airway management device.
163
164
AMERICAN JOURNAL OF EMERGENCY MEDICINE • Volume 19, Number 2 • March 2001
FIGURE 2. Laryngeal tube.
References 1. Agr6 F, Cataldo R, Alfano A, et al: A new prototype for airway management in an emergency: The Laryngeal Tube. Resuscitation 1999;41:284-286 2. Genzwuerker HV, Hilker T, Hohner E, et al: The laryngeal tube: A new adjunct for airway management. Prehosp Emerg Care 2000; 4:168-t72 3. Dorges V, Ocker H, Wenzel V, et al: The laryngeal tube: A new simple device. Anesth Analg 2000;90:1220-1222
BONY PROMINENCE PAIN CAUSED BY ELEVATED WHEELCHAIR SEATING PRESSURES To the Editor.'--The purpose of this report is to describe a patient with bony prominence pain caused by elevated wheelchair seating pressures. The patient, a 60-year-old man with a relapsing and remitting form of multiple sclerosis (MS), used a 3-wheeled scooter for mobility in his home and workplace? During the last 7 days, he complained of pain over his fight ischial tuberosity, precipitated by sitting on a fluid pad cushion (Jay Cushion, Sunrise
Copyright © 2001 by W.B. Saunders Company 0735-6757/01/1902-0017535.00/0 doi:l 0.1053/ajem.2001.21336
Home Healthcare Group, Logmont, CO) which he purchased 1 month ago. His pain was relieved only by being transferred to his bed. His pain worsened considerably during the weekend, causing him to come to the emergency department for pain relief. The patient had normal vital signs and was afebrile. The emergency physician confirmed the presence of paraplegia with evidence of reduced sensory perception in his lower extremities. Increased motor tone (spasticity, hyperreflexia, and extensor plantar response) were detected. He had no evidence of loss of visual acuity or vertigo. The emergency physician bad the patient transferred to a stretcher for examination of the perineum. Within 5 minutes after transfer to the stretcher, the patient noted a significant reduction in discomfort over his fight ischial tuberosity. Visualization of the skin of the buttocks revealed no evidence of skin damage or pressure ulceration. Gentle palpation of the fight ischial tuberosity elicited some discomfort. Because the emergency physician believed that the patient's pain was precipitated by elevated seating pressures, the patient was admitted to the hospital to prevent the development of pressure ulcers. His hospital care was coordinated by an interdisciplinary team, involving a physiatrist, physical therapist, and rehabilitation engineer, to maintain his muscle strength and extensibility and search for the cause of his pain. Approximately 30 minutes after initiation of his exercise program, he repeatedly complained about pain around his fight ischial tuberosity that precipitated muscle spasms of his fight leg. The discomfort in his fight buttocks that precipitated these muscle spasms had been present since purchasing the new fluid pad cushion. Because the cushion is a self-contained fluid and foam cushion, it could not be easily reconfigured to relieve the patient's pain. Consequently, an individualized wheelchair seating evaluation was initiated to identify a cushion that encountered lower seating pressures for the patient. An individualized wheelchair seating evaluation was accomplished using a pressure monitoring system, Oxford Pressure Monitor (OPM) MK 2 (Talley Medical, United Kingdom) that judges interface pressure between the seat and the patient's buttocks. 2 The individualized seating evaluation was first accomplished by measuring the interface pressures in sites of the right anterior and posterior buttocks. The anterior sensor was positioned near the fight ischial tuberosity, while the posterior sensor was positioned approximately 5 cm posterior to the fight ischial tuberosity at a site beneath the gluteus maximus muscle. The pressures were recorded as average pressure values of the 12 sensors in the pads. The average pressure was expressed as the mean and standard deviation of the 12 sensor measurements. The patient was allowed to remain in this position for approximately 5 minutes so that the interface pressure measurement could be correlated with the patient's level of discomfort. When the patient was seated on the Jay cushion, he continually complained of pain around his fight ischial tuberosity. The magnitude of pain discomfort was correlated with the average pressure measurements. The average pressure measurements near the ischial tuberosity (110_+ 20 mmHg) were always higher than those encountered at a site posterior to the ischial tuberosity (60_+20 mmHg).