Computer-generated laryngoscopy profiles to assess competence in airway management

• Restricted to UC San Diego use only

• 2012

• Moitoza, Jennifer

Background : A method to discern a trainee's expertise with direct laryngoscopy would be useful for following progress and determining readiness for call or advanced assignments. We have developed methodology to record laryngoscopy motion and performance. The goal of this study was to determine whether laryngoscopy skill could be evaluated by electronic assessment of technique. Methods : Three anesthesia faculty with three to 23 years experience performed laryngoscopy five times each on a Medical Plastics Intubation Mannequin. Blade path and force were measured with a Mini-Bird magnetic position sensor (Ascension) and a 6-axis force transducer (ATI), respectively, attached to the laryngoscope handle and recorded on a Dell laptop computer. A Matlab (Mathworks) program digitally aligned the separate laryngoscopy trajectories and a virtual curvilinear tube was calculated within the mannequin airway that encompassed all the expert trajectories. Twelve residents were studied on the first day of their anesthesia residency. They performed laryngoscopy three times on the same mannequin with the instrumented handle. The percentage of the trajectory that fell within the expert tube was measured for each laryngoscopy. Residents were divided into high and low experience groups, high being > 20 previous laryngoscopy attempts in an airway model, and into upper and lower 50th percentiles based on laryngoscopy success in their first 10 patient attempts. Trajectory percentages, force, torque, and jerks were compared between groups by T-test. Results : A trajectory from one expert generally fell within the tube derived from the other two experts. Resident laryngoscopies fell within the expert tube an average 74% ± 6% (mean ± SE) of the path length (P < 0.001 vs. 100%). Conformity to the expert path was greater in the upper third of the airway (93% ± 3%) than near the larynx (61% ± 10%, P < 0.01). Conformity did not appear to differ among residents as a function of previous experience or patient laryngoscopy success. The average number of jerks for expert laryngoscopy trajectories was 16.5 ± 1.8 jerks per laryngoscopy, while residents averaged 45.8 ± 11.8 (P = 0.01). Laryngoscopy duration averaged 3.6 ± 0.3 seconds for experts and 8.0 ± 0.6 seconds for residents (P = 0.01). There was a trend towards significance for expert vs. resident trajectory path lengths, and laryngoscopy force and torque did not differ among the groups. None of the motion parameters differed among the residents as a function of experience or success. Discussion : Digital analysis of laryngoscopy trajectories with engineering technology is a novel and objective way to measure skill. Beginners and experts can be differentiated with the methods described here. Cross sectional and longitudinal studies will be necessary to determine whether assessment of technique can distinguish finer differences in skill as trainees progress in developing expertise. Supported by APSF

1 online resource ([21] p.)

• Academic Dissertations

• Dissertations, Academic--School of Medicine. (Discipline)--UCSD

• text

Thesis (M.D.)--University of California, San Diego, 2012

Forms part of the UCSD School of Medicine independent study projects, Class of 2012

Includes bibliographical references (p. [21])

• Jennifer Moitoza

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2020-10-28