This thesis will cover the principle, design, and construction of an automatic esophageal intubation detector. This device uses a giant magneto recitative sensor to and a magnetized stylet to automatically measure the position of an ET tube in a person's throat. This method is less subjective than currently used methods such as end tidal CO2, as it does not rely on user interpretation of data or physiological state of the patient. The device developed during this project was tested on an anatomical mockup, a porcine airway model, and an intubation training dummy. In all three tests, the device performed well, accurately indicating tracheal intubation when the tube was placed in the trachea. Only one instance of a false positive indication of tracheal intubation was recorded and this occurred in an atypical and avoidable situation. As of now, the device functions in non-obese adult male patients, but plans are in place to increase usability for the entire population. / Master of Science

Background: Careful airway management, including tracheal intubation, is important when performing anaesthesia in order to achieve safe tracheal intubation. Aim: To study airway management in anaesthesia care from both the professional and patient perspectives. Methods: 11 RNAs performed three airway tests in 87 patients, monitored in a study-specific questionnaire. The tests usefulness for predicting an easy intubation was analysed (Study I). 68 of 74 anaesthesia departments in Sweden answered a self-reported questionnaire about the presence of airway guidelines (Study II). 20 anaesthesiologists were interviewed; a phenomenographic analysis was performed to describe how anaesthesiologists' understand algorithms for management of the difficult airway (Study III). 13 patients were interviewed; content analysis was performed to describe patients' experiences of being awake fiberoptic intubated (Study IV). Results: The Mallampati classification is a good screening test for predicting easy intubation and intubation can be safely performed by RNAs (Study I). The presence of airway guidelines in Swedish anaesthesia departments is poorly implemented (Study II). Algorithms can be understood as law-like rules, a succinct plan to follow in difficult airway situations, an action plan kept in the back of one's mind while creating flexible and versatile personal algorithms, or as consensus guidelines based on expert opinion in order to be followed in clinical practice (Study III). One theme emerged describing experiences of being awake intubated; feelings of being in a vulnerable situation but cared for in safe hands, described in five categories: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation (Study IV). Conclusions: The Mallampati classification is a good screening test for predicting easy intubation, when the airway assessment is performed in a structured manner by RNAs. The presence of airway guidelines in Swedish anaesthesia departments was poorly implemented and should receive higher priority. Algorithms need to be simple and easy to follow and based on the best available scientific evidence. Tailored information about what to expect, ensuring eye contact, and giving breathing instructions during the procedure may reduce patients' feeling distress.

Abstract Background: Hypoxaemia during tracheal intubation in obstetrics remains a lifethreatening complication. This study aimed to identify common clinical preinduction predictors of difficult intubation. Methods: A retrospective analysis was performed of data pertaining to tracheal intubation in patients requiring general anaesthesia for caesarean delivery, with a gestational age from 20 weeks, and until 7 days post-delivery, obtained from an obstetric airway management registry (ObAMR) at the University of Cape Town. Data was entered anonymously into a secure UCT REDCap database. Data categories were: patient and pregnancy characteristics, airway characteristics, details of management, and operator experience. The primary aim of the study was to identify anatomical and physiological risk factors for hypoxaemia. The primary outcome was defined as arterial desaturation to < 90% during obstetric airway management. For this purpose, multivariable binary logistic regression was performed. Hypoxaemia was thus used as a composite indicator of anatomical and physiological difficulty. Results: Data was collected for 1095 general anaesthetics in the ObAMR. Overall, 143/1091 of patients (13.1%, 95%CI 11.1 to 15.4%) experienced peripheral oxygen saturation below 90%. Univariate analysis showed that 91/142 (64.1%) of patients who desaturated were obese (body mass index [BMI]> 30 kg/m2 ), compared with 347/915 (37.9%) who were obese and did not experience desaturation (p< .001). A receiver operating curve (ROC) was constructed post hoc, which showed a cut-point for BMI of 29.76, and a sensitivity of 0.66, and specificity 0.62 for the prediction of hypoxaemia. Desaturation occurred in 17.0% of patients with hypertensive disorders of pregnancy, versus 11.0 % without (p=0.005). Increasing Mallampati class was associated with an increased incidence of hypoxaemia. The incidence of hypoxaemia was 25.8% for interns, compared with 8.0 % for consultant anaesthesiologists (p=0.005). In the multivariate analysis of factors associated with hypoxaemia, body mass index (p< 0.001), room air saturation prior to preoxygenation (p=0.008), and the presence of airway oedema (p=0.027), were independently associated with hypoxaemia. Conclusions: In this study, both anatomical and physiological predictors of hypoxaemia were identified. Using this concept, a predictive tool could be developed to aid in the identification of a difficult airway in obstetrics. Simple interventions such as face mask ventilation and the use of high flow nasal oxygenation, could be introduced to protect the parturient from the consequences of life-threatening hypoxaemia.

No description available.

No description available.

Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.

UA Open Access Publishing Fund / Background: Noninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV compared to patients intubated primarily in the medical intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of 235 patients intubated between 1 January 2012 and 30 June 2013 in a medical ICU of a university medical center. A total of 125 patients were intubated after failing NIPPV, 110 patients were intubated without a trial of NIPPV. Intubation-related data were collected prospectively through a continuous quality improvement (CQI) program and retrospectively extracted from the medical record on all patients intubated on the medical ICU. A propensity adjustment for the factors expected to affect the decision to initially use NIPPV was used, and the adjusted multivariate regression analysis was performed to evaluate the odds of a composite complication (desaturation, hypotension, or aspiration) with intubation following failed NIPPV versus primary intubation. Results: A propensity-adjusted multivariate regression analysis revealed that the odds of a composite complication of intubation in patients who fail NIPPV was 2.20 (CI 1.14 to 4.25), when corrected for the presence of pneumonia or acute respiratory distress syndrome (ARDS), and adjusted for factors known to increase complications of intubation (total attempts and operator experience). When a composite complication occurred, the unadjusted odds of death in the ICU were 1.79 (95% CI 1.03 to 3.12). Conclusions: After controlling for potential confounders, this propensity-adjusted analysis demonstrates an increased odds of a composite complication with intubation following failed NIPPV. Further, the presence of a composite complication during intubation is associated with an increased odds of death in the ICU.

Ofri luftväg kan uppstå på grund av bakåtfallen tunga hos den medvetslösa patienten eller om luftvägen blir tilltäppt av sekret, blod, maginnehåll eller främmande kropp. Att kunna säkerställa fri luftväg hos den medvetandesänkta patienten är en kompetens som varje anestesisjuksköterska måste behärska för att kunna säkerställa adekvat ventilation. Syftet med studien var att beskriva om larynxmask (LMA) är en patientsäker metod för att skapa fri luftväg och upprätthålla adekvat ventilation. Studien genomfördes som en litteraturstudie där 19 vetenskapliga artiklar analyserades. Resultatet av de granskade artiklarna gav följande fem teman; LMA är en säker metod för att skapa fri luftväg, LMA är en säker metod för att upprätthålla adekvat ventilation, personalens kompetens vid användning av LMA, aspirationsrisk vid användning av LMA med undertema LMA vid övervikt samt LMA vid elektiva- och akuta situationer. Litteraturstudiens resultat visar att LMA är en säker metod för att skapa fri luftväg och upprätthålla adekvat ventilation. Framtida studier skulle kunna belysa om LMA kan användas vid kirurgi till patienter med ökad aspirationsrisk, till exempel vid sectio och obesitaskirurgi. Studier skulle också kunna fokuseras på patienternas postoperativa upplevelser av att ha haft LMA jämfört med trakeal intubation. / Airway obstruction can in the case of an unconsciousness patient be caused by the tounge that falls back in the throat or by secretion, blood, stomach fluid or foreign body. The knowledge of airway management of the unconsciousness patient is a necessary qualification in every nurse anesthetist. The purpose of this study was to describe if laryngeal mask airway is a safe method to establish a secure airway and adequate ventilation. The study was performed as a literature study in which 19 articles were analysed. During the analyse five themes occurred: LMA is a secure way for airway management, LMA is a secure way to maintain adequate ventilation, the staff competence when using LMA, the risk of aspiration when using LMA with subtheme LMA in overweight and LMA in elective and acute situations. The result of the study shows that LMA is a secure way to establish a safe airway and adequate ventilation. Further studies could study if LMA can be used to elective patients with increased risk of aspiration, for example in cesarean and obesity surgery. Studies could also focuse on the patients´ postoperative experiences between LMA and tracheal intubation.

Bakgrund: Övervikt och fetma är ett globalt växande problem. Specialistsjuksköterskor med inriktning anestesisjukvård måste ha god kännedom om de anatomiska, fysiologiska och psykologiska förändringar som fetma medför för att kunna erbjuda säker vård till denna patientgrupp. Syfte: Att identifiera svårigheter vid hantering av luftvägen hos vuxna patienter med obesitas. Metod: En systematisk litteraturöversikt med syntes utfördes. Analysen av insamlad data har skett enligt mall av Statens beredning för medicinsk och social utvärdering (SBU). Syntesen och analysen har genererat två huvudområden. Resultat: Två huvudsakliga områden som alla har betydelse och påverkas av obesitas har identifierats.  De områden som framkommit är maskventilation och intubation, Under dessa kategorier presenteras försvårande faktorer vid anestesi till patienten med obesitas, som stort nackomfång, minskad rörlighet i käken samt hög mallampatiklass. Konklusion: Den här litteraturstudien har identifierat svårigheter som anestesisjuksköterskan i sitt dagliga arbete kan ställas inför i mötet med den obesa patienten. Med kännedom om dessa svårigheter kan anestesisjuksköterskan skapa strategier för en anpassad och säker vård till även den obesa patienten. / Background: Obesity and obesity are a global growing problem. Specialist nurses with anesthetic care focus need to have a good knowledge of the anatomical, physiological and psychological changes that obesity causes to provide safe care to this patient group. Purpose: To identify difficulties in managing the airway in adults patients with obesity. Method: A systematic literature review with synthesis was performed. The analysis of collected data has been carried out according to the template of the Swedish Medical and Social Assessment (SBU) preparation. The synthesis of the analysis has generated two main areas. Results: Two main areas all of which are important and affected by obesity have been identified. The areas identified are mask ventilation and intubation. Under these categories, aggravating factors in anesthesia are presented to the patient with obesity, such as high neck circumference, reduced jaw movement, and high mallampathy class. Conclusion: This literature study has identified difficulties that the anesthetist nurse in his daily work can face in the meeting with the obese patient. Knowing these difficulties, the anesthesia nurse can create strategies for a customized and safe care to the obese patient.

Bakgrund. Bilden av svensk ambulanssjukvård idag visar att vissa regioner ökat kraven på legitimerad kompetens i ambulanserna, samt att vissa också kräver specialistsjuksköterskeutbildning. I samband med den utvecklingen har även kraven på den medicinska nivån på omhändertagandet höjts. Sjuksköterskor i ambulans verkar ofta i miljöer som skiljer sig tydligt från sjukhusen. Detta kan medföra stressade situationer, påverka beslutsfattandet och det medicinska omhändertagandet. Kunskap inom luftvägshantering är en av de viktigaste kompetenserna för patientens fortsatta överlevnad. Att säkerställa fri luftväg kan vara en uppgift på tio sekunder till en livshotande faktor under hela uppdraget och därför viktig att bedöma och åtgärda. Syfte. Att beskriva specialistsjuksköterskors erfarenhet av prehospital luftvägshantering. Metod. En kvalitativ studiedesign med induktiv forskningsansats. Datainsamlingen genomfördes genom tio stycken semistrukturerade intervjuer med specialistsjuksköterskor som är verksamma i prehospital verksamhet i Mellersta Norrland. Dataanalysen genomfördes med en manifest kvalitativ innehållsanalys. Resultat. I analysen framkom två kategorier: Prehospitala erfarenheter för luftvägshantering och förutsättningar för trygghet i luftvägshantering prehospitalt samt åtta subkategorier. Dessa var erfarenhet har betydelse för luftvägshantering, erfarenhet av enkla luftvägshjälpmedel, erfarenhet av avancerade luftvägshjälpmedel, hantering av stress, vikten av kollegial kompetens vid luftvägshantering, utbildning och mängdträning skapar trygghet och bristande stöd vid upprätthållande av kompetens. Majoriteten ansåg att de enkla luftvägshjälpmedlen oftast skapar mest trygghet, men att erfarenhet och kollegors kompetens har stor betydelse för lyckat resultat samt ökad trygghet. Bristande stöd vid upprätthållande av luftvägskompetens visades och förslag för ökad trygghet och erfarenhet var att få öva luftvägshantering på anestesin. Slutsats. Erfarenhet ger ökad trygghet hos samtliga specialistsjuksköterskor oavsett typ av luftvägshjälpmedel. Dock visar resultatet att utbildning och upprätthållande av kompetens är av vikt för minskad stress.