Sunday, April 21, 2013

How Long Does It Take To Intubate Somebody?

That is a question that has crossed my mind several times. When we're intubating a patient, it feels like time stands still. I've never held up a stopwatch and timed myself. Usually by the time I've induced the patient, intubated, checked for proper positioning, and secured the tube, a few minutes have passed. But how long it takes for me to actually insert the endotracheal tube is a mystery. Sometimes it can feel like an eternity when there is an unexpected difficult airway.

Now there is a study comparing the time it takes to intubate a difficult airway using a GlideScope video laryngoscope versus direct visualization with a Macintosh blade. Published in Anesthesiology News, the study is from the University of Toronto by Daniel Cordovani, M.D. and was presented as an abstract at the Society for Airway Management. The article also answers the key question of how much time is required to place an endotracheal tube in a normal airway.

The researchers identified difficult airway patients based on a Mallampati class of 3, small mouth opening of less than 3.5 cm, and short neck. They found that the GlideScope required a median time of 30 seconds to intubate their patients. A direct laryngoscope only took 18 seconds. A different study comparing intubation times in normal airways showed that a GlideScope needed 19 seconds versus 14 seconds for a Macintosh blade.

However the GlideScope had fewer patient who needed laryngeal pressure to bring the cords into view, 14% vs. 36%.  VL also afforded a better view of the cords 55% of the time. And VL failed to intubate the patient only 12% of the time vs. 25% for DL.

It may seem surprising that it took longer to intubate a difficult airway when using a video laryngoscope when compared to a direct laryngoscope. As anybody who has ever used a VL knows, it takes a little getting used to. It still takes me just a longer to insert the VL blade into the mouth then adjust the blade while looking at a tiny video monitor to find the laryngeal cords. With DL, most of the time the cords usually pops into view and I can insert the tube quickly.

But regardless of the method, it's good to know that in general only a few seconds are needed to intubate a patient. With so much new research and technology, there may come a day when failure to intubate will no longer be a risk of anesthesia.

1 comment:

  1. Why would it take an experienced Anesthesiologist an hour and a half to intubate a routine OR surgery. Patient told him prior to surgery,she was difficult to intubate. 2 other Anesthesiologist had to be called in.