GlideScope Video Laryngoscope - Coursework Example

GlideScope Video Laryngoscope Introduction One of the leading causes of anaesthesia related injury is the inability to intubate the patient in order to secure the airway (Karen et al.1999). Currently, the use of laryngoscope has made it easy to perform laryngoscope views. It is a common device worldwide and used in anaesthetic practices (karsli et al.2010). This device should be studied extensively since it is an essential device in intubation trolley at the anaesthesia department in Saudi Arabia. The author is currently practicing in Saudi Arabia. The subject of laryngoscope is of high importance and requires evaluation as it has raised the question of laryngoscope view by use of other devices like Macintosh devices and GlideScope. A great number of medical professionals have shown interest in learning usage of better devices to perform successful laryngoscope views and also to minimize intubation complications. This also increases the rate of successful intubation and secure patient airway (Cooper, 2003). Evidence based practice can be developed by writing research critiques. In this assignment, the University of the West of England (Moule et al. 2003) critical frame work will be used to conduct the critique. Search strategy The research got conducted in Cardiff University databases: using these key words: GlideScope, laryngoscope, Intubate, pediatric patient. GlideScope is an instrument designed to be used in a diversity of clinical settings. A number of patients ranging from morbidly obese to preterm can also be diagnosed using the device. In Scopus, there were no hits, 17 hits in Cochrane library, 229 hits in Pub med, but after limiting research to a human being, time limitation, full text and English language between 20002 and 2011 the search came up with 47 hits. This study was latter chosen after comprehensive scan of titles and abstracts. Kim conducted a randomized clinical trial to access and evaluates the usefulness of GVL compared to direct laryngoscope (DL) with a view and time taken for intubation in children. However, it has been noted that the title do not relate to study focus since the research should be exceedingly clear and reflecting on the purpose of the research (Hicks, 2009). Key words like comparison or Macintosh device for laryngoscope should be used to make the articles purpose clearer (Yentis and Smith, 2009). This article has a comprehensive abstract. Research specialists have inferred that an abstract should provide a clearer indication of the methods adopted for the research. Hicks stated that an article should give an indication of the research methods, findings and conclusion. Polit and Beck also supports this by emphasizing that the objective of the research should be made clear in the abstract. Although, Polit and Beck stated that word count of the abstract should not exceed 150 they exceeded 200. An introduction to the study is considered as an important section, as it provides a brief introduction to the phenomenon and concepts reported within the framework of the study (Burns and Grove, 2005). The introductory paragraph of the article allows readers to build an understanding of the issues and the background of the research study (Parahoo, 2006). The introduction of this article clearly sets out the issues that the researchers were aware of, the fact that the data on the uses of the device for children got limited. However, it has been noted that the hypothesis has not been set out in the introductory paragraph. The hypothesis is clear from the abstract, but it should have been added to the introductory paragraph (Parahoo, 2006). One of the problematic aspects of this article is that there is no literature review. The authors have not introduced the basic definition of the concepts and models used in the research and analysis section of the article. Polit and Beck stated that it is extremely relevant to include a literature review in an article. This allows the reader to make use of the article as a reference because it provides a literature review of relevant work by other researchers. It must be taken into account that the researchers are professionals and have an appreciation of the concepts and phenomenon. According to Kim, it is assumed that lack of literature is mainly due to the limitations on the word count required for this article. This problem has added a limitation to the report of this research. Accuracy of the research has become easy to understand for a general audience because it lacks literature review (Parahoo, 2006). The methods section of a research article can be helpful for researchers to develop a thorough structure for their research (Gerrish and Lacey, 2006). The research methodology chosen by the authors in this instance gathered data from studying 203 children who got admitted for surgery. The study got approved by the hospital ethics committee, and written consent for researchers to recruit children to the study was obtained from the children’s parents. The sample included in this study was children aged between 3 months to 16 months. This was after the committee in charge of hospital ethics approved and informed written approval from guardians or parents. The ones with risk of high intracranial pressure or pulmonary aspirations got excluded. Before induction, the neck extension degree and mallampatti classification got evaluated. The researchers excluded the children with high risk of pulmonary aspiration or increased intracranial pressure, participants who are suitable in comparison with the studies that have been conducted in the same field of subject matter. Author clearly states that, there were three different anaesthetists who performed the intubations. These anaesthetists had used Glidescope for not less than 20 times. They also had skills on conventional laryngoscopy. It must be noted that the assigning of participants is a significant aspect of a research study and using a randomized clinical trial is considered to be the gold standard to evaluate the effectiveness of practice (Parahoo, 2006). This allows researchers to obtain the results in the most effective way. This research has accurate measures of allocation of research. Computer-generated randomization got used in the study. The two distinctive groups as selected in this research were the DL using a Macintosh blade Welch Allyn laryngoscope group and the laryngoscopy by GVL group. The first group got given the title DL group and the second, the title GS group. BURP manoeuvre got also used to ease the intubation process. Its effectiveness came out clearly as it improved laryngoscopic views by use of both devices. Since BURP manoeuvred effectively, it improved the C&L glade means that C&L glades can show high difficulty in laryngoscopy. It is considered as the least harmful way to apply pressure on the larynx. This help professionals carry out the incubation process (Karsli et al. 2010). Studies have been performed previously, but they lacked accuracy because of the models used for the allocation of participants into different groups (Leaper and Whitaker, 2010). In this regard, this research has made a mark as the careful methods used mean that its findings are reliable. Researchers did a pilot study, as a preliminary run, on the first 60 patients to reveal deficiencies that might arise during the study (Polit and Beck, 2010). Data distribution was evaluated by using the Kolmogrov-Smirnov test and the Wilcoxon signed Rank test to evaluate the hypothesis about a population mean. These detailed outlines of how the data got collected illustrated that the data collection process and mean were well employed. Moreover, it also shows the collection of the data was appropriate due to the delicate instruments employed. The findings and analysis section of the research should be explained briefly so that readers can gain knowledge of the analysis models. The research method becomes credible when the findings and analysis section allows an accurate conclusion to be reached (Polit and Beck, 2010). The authors have made use of effective analysis techniques and found out that GVL allowed equal and better laryngoscopic view. The results were based upon the view of different patients by using both GVL and Macintosh devices (Drummond, 2011). A difference was noted in terms of BURP application to ease the intubation process. This was a sub research outcome but only 5 of the patients having C&L grade 4 or 3 have direct laryngoscopy using BURP. This means that no conclusion can be drawn on the efficacy of Glidescope used in children with difficult airway in this study. The section of findings and analysis was relatively better at illustrating findings comparing to any other articles regarding the chosen subject matter. Very detailed information has been discussed in the analysis part, which allows this section to be much more useful and comprehensive. The discussion section has been backed up with analysis (Elliott and Smith, 2010). However, it has been noted that there are some sections that are not provided in article. It would have been better if the author was able to include an overview of the literature they had reviewed in preparation for undertaking this study (British National Formulary, 2010). Implications for practice Physiological implications GlideScope video laryngoscope (GVL) allows direct vision of the Vocal cord without any head movement, which could be an excellent option for patients with cervical spine injury (Timothy et al. 2005). Moreover, the GVL blade allows the user to see the anterior of the larynx clearly, even with the presence of secretions (Sakles 2006). In addition, there is a possibility of palatopharyngeal wall perforation during intubation by GVL (Leong et al. 2008). According to Aziz, lip or gum lacerations could have occurred during intubation by both of the GVL and DL devices. Management and introduction of change of practice According to Wayne and McDonnell, increasing the successful attempts of patient intubation with Glidescope video laryngoscope compared with direct laryngoscope and safe usage for patients with cervical Trauma injuries might suggest that hospitals should consider GLV as one of the essential air way management tools. To avoid malpractice guidelines need to be established for the use of GLV training programmes (Sakles, 2006). It should be established for clinicians on a regular basis, and competency tests should be introduced and reviewed annually. Moreover, clinicians should be provided with manufacturer’s instructions (Aziz et al. 2011). Kim stated that emergency doctors could use the GVL without experience or training. It also gives a wide area of research and study especially the use of BURP Improving the efficiency, diversity and competency of GVL. This greatly expands the area of study that can give promising and substantial results in the near future. Legal and ethical aspects Since there is a significant improvement in airway management in anaesthesia worldwide, the hospital should try to provide such equipment, where it reflects on patient safety regardless of cost effectiveness (Kim, 2003). Ethically hospitals should encourage studies that provide reliable evidence to enhance exemplary practice. (Gosselin et al. 2006) The use of either direct laryngoscope or Glidescope should be considering the experience of anaesthetists they have to be skilled and technically competent to practice the intubation. According to fun et al, the criteria of anaesthetist who are eligible to practice the intubation of new tools should be able to complete successful trial of minimum 30 cases. Legally, confidentiality of the information should be considered, and it is ethical that the researchers should thoroughly explain the study to all participants. Some hospitals do not allow access to the GVL due to the cost of it (Phipps, 2008). References Cooper, R.M., Pacey, J.A., Bishop, M. J. & McCluskey, S.A., 2005. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth, 52, 191–198. Doyle, D.J., 2005. The GlideScope video laryngoscope. Anaesthesia, 60, 414–415. Kaplan, M. B., Hagberg, C.A., Ward, D.S. & et al, 2006. Comparison of direct and video-assisted views of the larynx during routine intubation. J Clin Anesth, 18, 357–362. Kim, J. T., Na, H. S., Bae, J.Y., Kim, D. W., Kim*, H. S., Kim, C. S. & Kim, S. D., 2008. GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients. British Journal of Anaesthesia, 101 (4), 531–534. Lim, T. J., Lim, Y. & Liu, E. H., 2005. Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy. Anaesthesia, 60, 180–183. Lai, H.Y., Chen, I. H., Chen, A., Hwang, F.Y., & Lee, Y., 2006. The use of the GlideScope for tracheal intubation in patients with ankylosing spondylitis. Br J Anaesth, 97, 419–422. Milne, A. D., Dower, A. M. & Hackmann, T. 2007. Airway management using the pediatric GlideScope in a child with Goldenhar syndrome and atypical plasma cholinesterase. Paediatr Anaesth, 17, 484–487. Sun, D. A., Warriner, C. B., Parsons, D. G., Klein, R., Umedaly, H. S., & Moult, M. 2005. The GlideScope video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth, 94, 381–384. Takahata, O., Kubota, M., Mamiya, K. & et al. 1997. The efficacy of the ‘BURP’ maneuver during a difficult laryngoscopy. Anesth Analg, 84, 419–421. Trevisanuto, D., Fornaro, E., & Verghese, C. 2006. The GlideScope video laryngoscope: initial experience in five neonates. Can J Anaesth, 53,423–424. Read More