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7 results

  • Chapter 17 - Videolaryngoscopy

  • from Section 1 - Airway Management: Background and Techniques
  • Edited by Tim Cook, Michael Seltz Kristensen
  • Book:
    Core Topics in Airway Management
    Published online:
    03 October 2020
    Print publication:
    03 December 2020, pp 153-160

  • Summary

    Videolaryngoscopes have been in existence for several decades but in the last decade have taken a central role in both difficult and routine airway management. During that time videolaryngoscopy has not only become embedded in most difficult airway algorithms but the technique has become part of core airway management skills and the use of awake videolaryngoscopy has increased. This chapter describes the various types of videolaryngoscopes, their roles, strengths and limitations. Strategies to optimise use of Macintosh and hyperangulated devices are described as well as which adjuncts are best suited to their use. The issue of ‘can see, cannot intubate’ is discussed along with techniques to overcome it. The role of videolaryngoscopy outside the operating theatre, in critical care, in the emergency department and in pre-hospital care is discussed in this and other chapters.

  • Variability of antithrombotics use in patients with hypoplastic left heart syndrome and its variants following first- and second-stage palliation surgery: a national report using the National Pediatric Cardiology Quality Improvement Collaborative registry

  • Preeti Ramachandran, Eileen King, Ashley Nebbia, Robert H. Beekman, 3rd, Jeffrey B. Anderson
  • Journal:
    Cardiology in the Young / Volume 27 / Issue 4 / May 2017
    Published online by Cambridge University Press:
    30 August 2016, pp. 731-738
  • Purpose

    Patients with hypoplastic left heart syndrome and its variants following palliation surgery are at risk for thrombosis. This study examines variability of antithrombotic practice, the incidence of interstage shunt thrombosis, and other adverse events following Stage I and Stage II palliation within the National Pediatric Cardiology Quality Improvement Collaborative registry.

    Methods

    We carried out a multicentre, retrospective review using the National Pediatric Cardiology Quality Improvement Collaborative registry including patients from 2008 to 2013 across 52 surgical sites. Antithrombotic medications used at Stage I and Stage II discharge were evaluated. Variability of antithrombotics use at the individual patient level and intersite variability, incidence of shunt thrombosis, and other adverse events such as cardiac arrest, seizure, stroke, and need for cardiac catheterisation intervention in the interstage period were identified. Antithrombotic strategies for hybrid Stage I patients were evaluated but they were excluded from the variability and outcomes analysis.

    Results

    A total of 932 Stage I and 923 Stage II patients were included in the study: 93.8% of Stage I patients were discharged on aspirin and 4% were discharged on no antithrombotics, and 77% of Stage II patients were discharged on aspirin and 17.5% were discharged on no antithrombotics. Only three patients (0.2%) presented with interstage shunt thrombosis. The majority of patients who died during interstage or required shunt dilation and/or stenting were discharged home on aspirin.

    Conclusion

    Aspirin is the most commonly used antithrombotic following Stage I and Stage II palliation. There is more variability in the choice of antithrombotics following Stage II compared with Stage I. The incidence of interstage shunt thrombosis and associated adverse events was rare.