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J Adam Law

Publications and source records attributed to J Adam Law.

6 recordsLinked to original sources
PubMed2006

Laryngoscopic evaluation with the Airway Cam.

PURPOSE: The Airway Cam is a head-mounted direct laryngoscopy video system which uses a prismatic sighting system that aligns with the operator's line of sight. This study evaluated intra- and inter-observer consistency in laryngoscopy grading comparing direct laryngoscopy to the laryngoscopy grade obtained with the Airway Cam. METHODS: Twenty-seven patients receiving a general anesthetic for elective surgery had laryngoscopy performed by an anesthesiologist wearing the Airway Cam. Each video was duplicated, then randomized and reviewed in a blinded fashion by the original laryngoscopist and a second anesthesiologist. Intra- and inter-observer correlations were identified. RESULTS: There was good intra-observer agreement of the Cormack-Lehane scale between direct laryngoscopy and laryngoscopy recorded with the Airway Cam (kappa = 0.63). The corresponding intra-observer correlation of the percentage of glottic opening score was strong at r = 0.83. There was good inter-observer agreement of the Cormack-Lehane scale between direct laryngoscopy and that observed by the second anesthesiologist during Airway Cam video review (kappa = 0.70). There was moderate correlation of the inter-observer percentage of glottic opening scores (r = 0.73). CONCLUSION: This study validates that the view recorded by the Airway Cam reflects the view of the laryngoscopist. The Airway Cam may introduce an additional level of objectivity into airway management research and teaching.

Adult↗
PubMed2004

Acute airway management in the emergency department by non-anesthesiologists.

PURPOSE: The responsibility of acute airway management often falls into the hands of non-anesthesiologists. Emergency physicians now routinely use neuromuscular blockade to facilitate intubation. The literature in support of this practice has almost exclusively been published in emergency medicine (EM) journals. This body of literature is presented and issues of educational support are discussed. SOURCE: A narrative review of the literature on the practice of airway management by non-anesthesiologists. PRINCIPAL FINDINGS: A significant proportion of acute airway management occurring outside the operating room is being performed by non-anesthesiologists. Rapid sequence intubation (RSI) is recognized as a core procedure within the domain of EM. RSI is being performed routinely by emergency physicians practicing in larger centres. Anesthesiologist support for the practice of RSI by non-anesthesiologists has been weak. Formal educational support outside of postgraduate training in the form of dedicated programs for advanced airway management are now being offered. The majority of the literature on the use of RSI by non-anesthesiologists represents retrospective case series, observational studies and registry data published in EM journals. The reported success rates for RSI performed by non-anesthesiologists is high. Complication rates are significant, however reporting consistency has been poor. CONCLUSIONS: The role of non-anesthesiologists in acute airway management is significant. Despite shortcomings in methodology, current evidence and practice supports the use of RSI by trained emergency physicians. Constructive collaborative efforts between anesthesiology and EM need to occur to ensure that educational needs are met and that competent airway management is provided.

Anesthesiology↗
PubMed2003

Laryngoscopic intubation: learning and performance.

BACKGROUND: Many healthcare professionals are trained in direct laryngoscopic tracheal intubation (LEI), which is a potentially lifesaving procedure. This study attempts to determine the number of successful LEI exposures required during training to assure competent performance, with special emphasis on defining competence itself. METHODS: Analyses were based on a longitudinal study of novices under training conditions in the operating room. The progress of 438 LEIs performed by the 20 nonanesthesia trainees was monitored by observation and videotape analysis. Eighteen additional LEIs were performed by experienced anesthesiologists to define the standard. A generalized linear, mixed-modelling approach was used to identify key aspects of effective training and performance. The number of tracheal intubations that the trainees were required to perform before acquiring expertise in LEI was estimated. RESULTS: Subjects performed between 18 and 35 laryngoscopic intubations. However, statistical modeling indicates that a 90% probability of a "good intubation" required 47 attempts. Proper insertion and lifting of the laryngoscope were crucial to "good" or "competent" performance of LEI. Traditional features, such as proper head and neck positions, were found to be less important under the study conditions. CONCLUSIONS: This study determined that traditional LEI teaching for nonanesthesia personnel using manikin alone is inadequate. A reevaluation of current standards in LEI teaching for nonanesthesia is required.

Adult↗