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The Impact of Airway Technique on Anesthesia Control Time

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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.

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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

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA

    Matthew J. Rowland, Richard D. Urman, David A. Preiss & Joshua C. Vacanti

  2. Department of Anesthesia, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Xinling Xu

  3. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Jesse M. Ehrenfeld

Authors
  1. Matthew J. Rowland
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  2. Richard D. Urman
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  4. Jesse M. Ehrenfeld
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  5. David A. Preiss
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Correspondence to Richard D. Urman.

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Rowland, M.J., Urman, R.D., Xu, X. et al. The Impact of Airway Technique on Anesthesia Control Time. J Med Syst 43, 72 (2019). https://doi.org/10.1007/s10916-019-1191-y

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