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Acquiring Fiberoptic Skills in the Novice
Abstract Number: T-62
Abstract Type: Original Research
Introduction: Failed intubation occurs in the parturient at a rate of 1/250. The Accreditation Council for Graduate Medical Education (ACGME) reports that residents do 469 rigid laryngoscopies and only 33 flexible fiberoptics over the course of their training, all in the supine position. Parturients in respiratory distress compensate for the physiologic changes of pregnancy by sitting upright. Following topicalization with nebulized lidocaine, they can be intubated by facing the patient. We tested a program to improve the fiberoptic intubation skills in both the supine and upright position.
Methods: 40 medical students were enrolled. They completed 10 virtual reality intubations using the smart phone app, iLarynx oriented in either the supine or upright position. They then performed 20 intubations on a mannequin randomly oriented to either position. Time to carina was recorded by a research nurse unaware of training assignment. Students were re-tested a week later to measure the effect of practice with the app on their retention skills.
Results and Discussion: Learning curves showed that the upright position is definitely harder to master. Practice with a smart phone improved upright performance from 45 to 26 secs. It does not improve supine skills.
Reference: Anaesthesia. 2013 Oct;68(10):1053-8. doi: 10.1111/anae.12379. Epub 2013 Aug 19.