Where it started, where it going

A million of anything is….lots

Very proud

Jan is a clever bloke.
Here the relevant papers wot he wrote

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...

Summary

11/11

Responding to an article about consent for anaesthesia in children we analysed (all cause) PAEDIATRIC PERIOPERATIVE MORTALITY in NAP7

Really low for older children
Low for infants
High for neonates (80x)

(Small numbers & wide CIs)

www.bjanaesthesia.org/article/S000...

1/n

Yes …..except time to embrace “sustained exhaled CO2”

Time to move away from “no trace wrong place” as it is insufficient, cases may have poor but not ‘no trace’ & NTWP creates confusion

I constantly emphasise head & neck positioning: in flextension
-this flattens the (serpentine) curves of the airway & I believe improves angle of approach to the glottis & trachea

[this contrasts to the oft cited opinion that “with VL you don’t need to bother with positioning”]

4/7

We teach a technique of
-optimising view achieving a grade 1 view
- divide the screen into 3x3. Glottis should be in the middle box
-the styletted tube (I use 6.0-6.5 routinely for multiple reasons) is delivered ALONG the distal blade (tip sliding along it) & simple physics takes it to glottis

2/7

A manikin you say?
-we used trucorp difficult airway manikin to facilitate a consistent & difficult airway: D-blade Grade 2b
-this is impractical in a clinical study, so a manikin achieves what a clinical study cannot
-HAVL intubation is a physics issue so I hope data are (largely) transferable

4/4

-in a genuinely difficult intubation performance differences increased
-findings same for FPS, time to intubation, operator ease, success w/in 120s

3/4

The key findings of adjuncts for HAVL

-STYLETS BEST
-STATIC BOUGIES WORST (by a distance)
-dynamic bougies closer to stylet than bougie

This contrasts to recent studies so is notable.

2/4

Delighted that Ben Dallyn from @RUHBath won the 1st prize for oral presentation @dasairway

He presented A MANIKIN STUDY OF STYLETS & BOUGIES (static & dynamic)…..

1/4

DAS ORAL PRESENTATIONS

Great to see David Irwin & Sam Gunning 2nd
VL TO TEACH DL: SYSTEMATIC REVIEW & METANALYSIS

-VL improves FPS
-Point estimates of time & overall success favour VL (n/s)
-sensitivity analyses support VL
-the overall evidence is weak & further good quality study would be good

Great slide in the ETHICS section of #DAS2024 @dasairway from Catriona Ferguson

Lovely summary - including the inherent conflicts within the law

Celebrating the airway!
Difficult Airway Society 2024