Repeated attempts improve tracheal tube insertion time using the intubating laryngeal airway in a mannequin

Study Objective: To determine if repeated performance of endotracheal tube insertion via the intubating laryngeal airway (ILA) would shorten insertion time in mannequins. Design: Prospective study. Setting: Clinical Skills Laboratory, Department of Anesthesia, Toronto Western Hospital. Participants: 65 department anesthesiologists. Measurements: After a video training session, anesthesiologists with no previous experience with the ILA performed 5 consecutive ILA-guided tracheal tube intubations on a mannequin. Each participant completed Task 1: insertion of an ILA; Task 2: blind insertion of a tracheal tube through the ILA, and Task 3: removal of the ILA. The time required for each task and the total intubation time for the three tasks over the 5 attempts were recorded. These times were compared using repeated-measures analysis of variance. The success rate among the 5 attempts was compared using Chi-Square analyses. Main Results: A total of 65 anesthesiologists performed 5 ILA-guided tracheal intubations each. Total intubation time decreased from the first to the fifth attempt (92.6 +/- 22.7 sec, 74.5 +/- 19.2 sec, 66.5 +/- 16.5 sec, 65.9 +/- 19.9 sec, and 60.8 +/- 16.3 sec; P < 0.001). Significant differences in intubation times were noted between the first and second, and the second and third attempts (P < 0.001 and P = 0.02, respectively). The success rate did not change over the 5 attempts (84.6%, 89.2%, 84.6%, 89.2%, and 90.8%; P = 0.737). Conclusions: Total intubation time decreased by 34% (92.6 to 60.8 sec) over the 5 attempts in mannequins. The success rate ranged from 84.6% to 90.8% and did not differ significantly over the 5 attempts. (C) 2010 Elsevier Inc. All rights reserved.