INTRODUCTION: The anesthetic management for pediatric patients undergoing direct laryngoscopy and/or bronchoscopy (DLB) is administered based on the anesthesiologist’s preference. Objectives: The preliminary analysis of this study aims to identify variables that decrease surgical end-to-transport (SET) time and directly impacts patient outcomes. SET time is defined as the time of surgery end to the time of patient exit from the operating room. METHODS: After IRB approval, all DLBs performed at Boston Children’s Hospital (Boston, MA) by the Otolaryngology Department from June 2012 to December 2014 (n= 2419) were obtained from the Anesthesia Information Management System. With a 0.05 level of significance, a multivariate logistic regression was performed in SAS v9.3 with SET time as the dependent variable and surgery duration, age, gender, ASA status, airway device and extubation status as the independent variables. Airway device and extubation status were found to be moderately predictable of each other, so separate models were conducted. Spearman correlation testing was performed to evaluate the relationship between SET time and post-anesthesia care unit (PACU) duration. RESULTS: We excluded cases having ASA classification >2, age >21 years, regional nerve blocks, tracheostomy, nasal cannula, or unknown airway or extubation status. Remaining cases (n = 967) were arranged by SET times and dichotomized by the median value (14 minutes) into two groups (≤14 minutes and >14 minutes). After adjusting for other variables, we found that patients with an endotracheal tube (ETT) were 4.85 times more likely to have a SET time higher than the median, as compared with to those having with a laryngeal mask airway (LMA) (p = 0.0023, 95% CI: 1.76, 13.33). We also found that patients with an ETT were 2.89 times more likely to have a SET time higher than the median compared with those having a mask airway device. (p < 0.0001, 95% CI: 2.09, 3.98). In addition, there was a weak positive correlation between SET time and PACU duration (r = 0.09406, p = 0.0069). DISCUSSION: Preliminary analysis indicates that airway management has a significant impact on SET time after adjusting for surgery duration, age, gender, and ASA status. The use of either a mask or an LMA resulted in a lower SET time than the use of an ETT. The correlation of SET time and PACU duration suggests that reducing SET time does not negatively impact post-operative outcomes and may even be positively, though weakly, correlated. This study is limited by its retrospective nature. Future analysis will include the evaluation of commonly used perioperative anesthetics with dosage and timing variables and their correlation with SET time and patient outcomes.

Bakgrund Endotrakeal intubation används i många olika situationer där det finns ett behov av att skapa en säker luftväg. Den manipulation av luftvägarna som krävs i samband med en intubation kan bland annat orsaka postoperativ halssmärta och heshet, vilket kan ha negativa konsekvenser för patienten. För att försöka undvika komplikationer vid intubering har det utvecklats olika intubationshjälpmedel, där ett av hjälpmedlen är videolaryngoskop, som minskar den kraft som behövs för att skapa en fri insyn i larynx. Syfte Syftet med studien var att jämföra Macintosh direktlaryngoskopi mot McGrath videolaryngoskopi, för att undersöka om någon av metoderna ger minskad förekomst av halssmärta och heshet postoperativt. Metod För att besvara syftet antogs en kvantitativ ansats. Studien utfördes sedan som en förberedande undersökning med en induktiv metod. Datainsamlingen utfördes på en operationsavdelning i Västra Götaland, totalt deltog 24 patienter, varav 12 patienter intuberades med direktlaryngoskopi och 12 patienter intuberades med videolaryngoskopi. Deltagarna fick postoperativt svara på validerade enkätfrågor, och gradera eventuell förekomst av halssmärta och heshet enligt validerade fyrgradiga skalor. Resultat Resultatet visade att det eventuellt kan finnas en viss skillnad gällande postoperativ halssmärta beroende på om man intuberas med Macintosh direktlaryngoskopi eller McGrath videolaryngoskopi. Presenterat i absoluta och relativa mått visar det på att endast 1 deltagare (8%) som videolaryngoskoperades graderade lindrig halssmärta postoperativt, medan det var 3 deltagare (25%) som direktlaryngoskoperades som graderade lindrig halssmärta. Dock var skillnaden inte signifikant (p=0,56). Skillnaderna gällande heshet var större, där 9 deltagare (75%) som videolaryngoskoperades graderade sig helt besvärsfria postoperativt och 3 (25%) graderade en lindrig heshet. Ingen av deltagarna som direktlaryngoskoperades graderade sig som besvärsfri postoperativt, 9 (75%) graderade lindrig heshet och 3 (25%) graderade måttlig heshet. Skillnaden mellan grupperna var signifikant (p=0,001). Slutsats Skillnad verkar föreligga gällande framför allt heshet beroende på vilken intubationsmetod som används. Det kan även finnas en eventuell skillnad gällande halssmärta, dock är denna ej signifikant i pilotstudiens resultat. Studiepopulationen är begränsad i sitt antal, och det finns få studier att jämföra resultatet med. Det finns ett behov av fler och större studier för att finna evidens för den bästa metoden. / Background Endotracheal intubation is used in many different situations where there is a need to create a safe airway. The airway manipulation force that is required when an endotracheal intubation is needed may cause postoperative sore throat and hoarseness. This can adversely affect the patient. To avoid complications of an endotracheal intubation, different intubation aids have been developed, one of which is a videolaryngoscope, which reduces the force needed to create a free laryngeal insight. Aim The purpose of the study was to compare Macintosh direct laryngoscopy to McGrath videolaryngoscopy, to investigate whether either method reduces the incidence of sore throat and hoarseness postoperatively. Method To answer the purpose, a quantitative approach was adopted. The study was then conducted as a preliminary study with an inductive method. The data collection was carried out in an operation theatre in Västra Götaland, Sweden. A total of 24 patients participated, where 12 patients were intubated with direct laryngoscopy and 12 patients with videolaryngoscopy. Postoperatively the participants responded to validated questionnaires, and evaluated any occurrence of sore throat and hoarseness according to validated four-dimensional scales. Result There was a difference in postoperative sore throat depending on intubation with Macintosh direct laryngoscopy or McGrath videolaryngoscopy. Presented in absolute and relative terms, the result show that only 1 participant (8%) that was intubated with videolaryngoscopy graded mild sore throat postoperatively, while there 3 participants (25%) who were intubated with the use of direct laryngoscopy graded mild sore throat. However, the difference was not significant (p=0.56). The differences in hoarseness were greater, where 9 participants (75%) that was intubated with the use of videolaryngoscopy graduated no hoarseness post-operatively and 3 (25%) graded a mild hoarseness. None of the participants who were intubated with the use of direct laryngoscopy graded no hoarseness, 9 (75%) participants graded mild hoarseness and 3 (25%) graded moderate hoarseness. The difference between the groups was significant (p=0.001). Conclusions A difference exists in advance of hoarseness depending on the intubation method that is used. There may also be a difference regarding sore throat, but this result remained non-significant. However, in this pilot study the population was limited in its number, and there are few other studies in this field available for comparison. Therefore, more, and larger studies are needed to find evidence for the best intubation method.