Application of Research of the Glidescope Video Laryngoscope - Report Example

Running Head: Critical evaluation and application of a research article GlideScope® video laryngoscope: a randomized clinical trial in 203 pediatric patients Introduction The researchers must provide valid statements about the concerns of a sustained inquiry into the given subject of interest. Application of research elements is essential in supporting the researchers’’ opinion. “A good research involves the provision of a certified and a precise thesis statement”. This research on a GlideScope® video laryngoscope in a randomized clinical trial in 203 pediatric patients provides a clear statement about the GlideScope® video laryngoscope, a device used in laryngeal view and endotracheal intubation in difficult airways. It enables the viewing of glottis without aligning oral, pharyngeal and tracheal axes. The researchers in their own dimension to establish the advantages of VGL over the direct laryngoscopy, have connected their knowledge of previous studies, which demonstrated that in adults, VGL can provide a laryngoscopic view that is same as or better than that of direct laryngoscope view, and that it is of the research besides just stating the GVL provides little data in children. They needed to have provided a cross-cutting limitation that evaluates its usefulness against its disadvantages. The difficulties incurred during the study have not only been shown at the conclusion of the results. Literature Review The materials used by the researchers are up to the year 2007, with the majority of resources published or drafted between 2005 and 2006. The oldest resource or work that is cited is that of 1997. In this regard, the choice of materials the researchers said is fairly contemporal but need to be more current may be at least up to 2010. Some of these include among others books, journals and articles. The main aim of the investigator is to establish the effectiveness of GlideScope® video laryngoscope over the direct laryngoscope in the pediatrics. In the analysis of their references to other works, it proves that their scope is merely specific to the subject matter, giving a narrow perspective to general body of knowledge. “Among those stated is only the intubation of larynges in patients with difficulties in their airway, which is just but the primary concern of investigating GVL against other laryngoscopic gadgets”. Conclusively, their link to a wider body of knowledge is minimal. Theoretical questions about the efficiency of GlideScope® video laryngoscope and direct or Macintosh laryngoscope are the subject of the researchers’ investigation. The subject is the evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anesthetists in simulated easy and difficult laryngoscopy. The research then, therefore, revolves around the GVL and the Macintosh laryngoscopes. They have tried to link the subject topic and theoretical questions that this investigation induces. The formulation of this research is a result of the literature that discusses the distinction that emanates from the use of Macintosh laryngoscopes and the GlideScope® video laryngoscope. Clearly, the motive to prove the admissibility of the theories aligned to justify that GVL is more efficient than direct or Macintosh laryngoscope, is cause of the research. Due to this, all research preparations, procedure and the actual study and analysis must be in line to justify or disagree with the subject hypotheses. However, the research questions are not clearly stated. What is presented however, is a working hypothesis that seeks to prove the efficiency of GVL in the intubation of patients with difficult airway. The method selection The research involved 203 patients (children). Their parents or guardians’ consent was sought after getting the research approval from the hospital ethics committee. The sample age ranged from 3 months to 17 years old. There is no statement of the sex proportion of these patients. These are patients presented for surgery under general anesthesia. Those excluded involved, those with risks of pulmonary aspirations and intracranial pressure. A computer-generated randomization to allocate the patients in laryngoscopy was done with a Macintosh bladed Welch, after the evaluation of the degree of neck extension and mallampatti classification. Three different anesthetists knowledgeable in the use of GlideScope® video laryngoscope performed the intubation. The laryngoscopic view was done using both the GVL and Macintosh laryngoscopes with Cormack and Lehane (C & L) grades. From this description of the method used during the research, it is therefore evident that the researchers managed to describe their research design and method, although there is a missing link on the causal relationship between the population sample and the method selected. It is very clear that the use of VGL on children does not provide sufficient device affectivity. That not withstanding however, the research method is appropriate to the topic under investigation albeit simplistic; The GlideScope® video laryngoscope on the randomized clinical trial on 203 pediatric patients. In addition, the researchers have failed on the standardized research method statement by not acknowledging the strength and weakness of the design. As described through the method or the research design, the researchers adequately identified those who participated in the research. The type of their research subjects, authorities involved and the researchers themselves are indicated. For instance, they selected 203 children who patients presented for surgery under general anesthesia. There is mention of hospital ethics committee and the parents and/or guardians of the children. What is mentioned about the selection of participants is the exclusion of categories of the research ‘specimen’. Otherwise, the researchers have not exclusively identified their participants’ selection criteria, and their basis on age specification. The participants in this research are relevant to the study hence appropriate for the research design selected. In addition, there is a statement of the number of participants’ i.e. 203 children-patients and their parents or guardians. Data collection and analysis The researchers did not specify the types of Cormack and Lehane grades used, whether grade ii, iii or iv and/or if they used laparoscopic assistance with both the Glidescope® and Macintosh laryngoscopes, in the collection of scores in the laryngoscopic view in 203 children. The trachea was intubated using direct laryngoscopy (Group DL, n=100) or the GlideScope® (Group GS, n=103). They compared Cormack and Lehane grades for two views in every patient and recorded the time of intubation for each group. The paired C&L grade and the change of the C&L grade with BURP were compared using the Wilcoxon signed ranks test. Data distribution was first evaluated using the Kolmogorov–Smirnov test. Time for intubation between the groups was compared using unpaired t-test. Correlations between Mallampatti classification vs. TTI and between C&L grades vs. TTI were evaluated using Pearson’s correlation coefficient. A P-value of 0.05 was considered statistically significant. This is a detailed outline of how the data was collected. It illustrates that, data collection procedure and medium was well attended to. However, they leave guessing on those who carried out the data collection given the sophistication of devices used. Quantitative The research has identified quantitative sample. The study investigates on 203 children-patients. The sample size was determined based on the first 60 patients collected for the pilot study (difference in means 0.12, SD 0.45). For 90% power to show a statistically significant difference, the required sample size for the Wilcoxon signed ranks test with an alpha error of 0.05 was approximately 187. There was the calculation of Pearson correlation co-efficient, Macintosh laryngoscope recorded 0.45, and the GlideScope® video laryngoscope resulted into 0.35. Each of the result indicated a linear relationship of P > 0.01. The TTI using the Macintosh laryngoscope was related to the Mallampatti classification (n=83, Pearson correlation coefficient 0.46, P, 0.05). From these results, it is convincing that the researchers employed quantitative evidence to prove that the GVL is more efficient than the Macintosh laryngoscope. However, should t-tests analysis of variance (ANOVA) be conducted, the minimal normal data distribution would be ascertained. There is a clear statement describing statement of the score of the laryngoscopic view. The types of the statistical methods used in this research are appropriate to both the Macintosh and GlideScope® video laryngoscope. The research design is more quantitative than qualitative hence relevant in the establishment of laryngoscopic score. The use statistical analysis package is however not much. The data collected is presented in simple evidence table that only require basic computer packages. For instance, table 3 TTI with direct laryngoscope and Glidescope as presented; DL group (n=100) GS group (n=103) Overall TTI (s) TTI foe C& L Grades 1 & 2 TTI for C & L Grades 3 & 4 23.8 (13.9) (11-130) 22.6 (8.9) (11-82) (n==82) 80.0 (70.7) (30-130).(21.2) (n=2) 36.0 (17.9) (15-110) 34.4 (16.5) (15– 110) (n=94) 52.8 (24.1) (25– 100) (n=9) Results provided are clear but only would require more interpretations. The tables provided are indicative of the sample data and results. The tables however require further explanations from the researching team, that is, they present difficulty in understanding. Qualitative The researchers did not provide clear reflexive statements regarding their roles in the whole process of study, apart from indicating that three of them who had used the GVL for more than 20 times were allocated the role to use it during the study. Data analysis indicated that GVL was better than Macintosh in the intubation process. This analysis enabled the conclusion that was also in line with the literature. However, as explained above, the research lacks adequate description of electronic analysis package and how the interpretations were validated. Little instrumental adjustments and mismatchment are thus provided. Ethics The researchers sought permission from the hospital’s ethics committee and the consent from the parents or guardians of the children. Conclusion During the research, both Glidescope and the traditional Macintosh were used. However, the researchers have not explained negative implications that are associated with the devices. For instance, Macintosh can lead to intraocular pressure with tachycardia and hypertension. They have not explained in details, the extent of anterior airway distortion in using Macintosh as compared to VGL and the cervical spine movement during laryngeal visualization. Data provided from the research is a reflection of the literature in the use of GlideScope® video laryngoscope in laryngoscopic view. However further research is advisable based on the sample age. This is because; the sample age selected here is very young. The implies that, the utility of the GlideScope® in children, there are little data on children and that, although the GlideScope® rarely worsens an easy laryngeal view in children, it makes tracheal intubation more awkward and slower with an increased first attempt failure rate and longer TTI, especially in patients with an easy laryngoscopic view. There is the recommendation on the choice of the blade to be used. There is no potential bias as the results were generated from the medical devices used though. From the results it is however that GVL is better mostly in reducing intraocular pressure, tachycardia and hypertension. However it should have indicated that GVL is applicable as the most preferred because, there is less anterior airway distortion and the spine movement. References Benumof J L (1999): Pre-oxygenation: Best method for both efficacy and efficiency (editorial). Anesthesiology; 91:603. Baraka AS, Taha SK, Aouad MT et al (1999): Preoxygenation: Comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology; 91:612-616. Barash P. (2000). Clinical Management of the Airway. In Clinical Anesthesia (4th Ed). Lippincott Williams & Wilkins Publishers, Philadelphia. Caplan RA, Posner KL, Ward RJ et al (1990).  Adverse respiratory events in anesthesia: A closed claims analysis. Anesthesiology; 72:828-833. Karsli C, J. Armstrong & J. John 2010). A comparison between the GlideScope VideoLaryngoscope and direct laryngoscope in paediatric patients with difficult airways – a pilot study. Anaesthesia, 2010, 65, p353–35 Cheney FW, Posner KL, Caplan RA (1991). 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GlideScope® video 1aryngoscope: a randomized clinical trial. British Journal of Anaesthesia, 101; 4: 531-4 Keenan RL, Boyan CP (1985). Cardiac Arrest due to Anesthesia: A study of incidence and causes. JAMA; 253:2373-2377. Mallampati RS, Gatt SP, Gugino LD et al (1985).  A clinical Sign to predict difficult tracheal Intubation: A prospective study. Can Anaesth Soc 1985; 32:429-434. Savva D (1994): Prediction of difficult tracheal intubation. Br J Anaesth 73:149-153 Stoelting R, Miller R. 2000. In Basics of Anesthesia 4th Ed.  Churchill Livingstone.  New York. Wilson WC (1996): Emergency airway management on the ward. In Hannowell LA, Waldron RJ (eds).  Airway Management, Lippincott-Raven Publishers, Philadelphia, PA, p443-450. more useful in adults with difficult airway. However, the research has not outlined the limitations Read More