暂无摘要。

BACKGROUND: Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression.
METHODS: This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute.
RESULTS: A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants.
CONCLUSIONS: The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings.
BACKGROUND: Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.

OBJECTIVE: There are 26 teaching hospitals in Taiwan that provide anesthesia residency training programs (one program per hospital), and only an average of 40 medical graduates are accepted for residency training per year. The aim of this study is to understand how this situation affects the learning and working conditions of anesthesia residents in Taiwan.
METHODS: A self-structured survey was mailed to all 178 anesthesia residents receiving training in Taiwan in April 20, 2012. Survey questions included resident characteristics, working and learning conditions, satisfaction with resident training programs, and reasons for choosing anesthesiology as a career. In addition to descriptive statistics, linear regression was used to test correlation between working conditions and satisfaction with training programs.
RESULTS: The survey was completed by 136 residents. Although the residents\' expected optimal working time was 54.1 ± 12.2 h per week, their actual working time was an average of 64.0 ± 15.7 h per week. In addition, the workload included managing 4.2 ± 1.3 operating rooms simultaneously. The ratio of working vs. learning time was 2.2 ± 1.1. Less than 40 % of the residents were satisfied with their training in critical care and pain management. Anesthesia residents with heavier workloads and higher ratios of work vs. learning time had significantly lower satisfaction with their training programs, especially with training environments (R (2) = 0.169). General interest in anesthesiology and related work (66.1 %) was the main factor in choosing anesthesia as their career.
CONCLUSIONS: Anesthesia residents in Taiwan are treated as an integral part of hospital manpower. This may limit the effectiveness of their learning and cause dissatisfaction with their training environment. To improve the current status, anesthesia residents should perform anesthesia in one operating room at a time and some of the anesthesia training hospitals should be suggested for removal.