Airway Management Meeting "New Perceptions and Teaching Methods" in Goettingen (March 2001)
Ulrich Braun, MD
Professor of Anesthesia, Department of Anesthesia and Intensive Care, Georg-August University of Goettingen, Goettingen, Germany
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Published: June 30, 2001.
The correct citation of this report of a scientific meeting for reference is:
Ulrich Braun. Airway management meeting "new perceptions and teaching methods" in Goettingen (March 2001). Internet Journal of Airway Management
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The Department of Anesthesia and Intensive Care at the Georg-August University of Goettingen and the Society of Airway Management (SAM) organized an airway management meeting in Goettingen (Germany) from March 16 to 17, 2001. The topic was “New Perceptions and Teaching Methods“ with Dr U Braun (Goettingen, Germany) as program chairman, president of SAM at the time of the meeting. The goal of this meeting was to bring together the German speaking airway management community from Germany, Austria, and Switzerland, to focus interest on the latest developments and new teaching methods, and to spread the information about SAM and gain some new members for the society. There were altogether 386 participants (among them 49 from Austria and 8 from Switzerland), mostly anesthesiologists, but also some surgeons, pediatricians, neurologists, and ENT physicians, and a few nurses and students.
The main topics were: teaching methods, the value of the flexible fiberscope, the pharyngeal and laryngeal airway, rapid-sequence induction, tracheostomy, and emergency medicine. There was general agreement, that teaching activities should be improved (Dr R Georgi, Stuttgart, Germany) and that manikins and airway simulation (Dr J Schaefer, Pittsburgh, Pennsylvania, USA; member of SAM), airway rotation (Dr C Eich, Goettingen, Germany), and video-assisted intubation techniques (Dr M Weiss, Zuerich, Switzerland) should be employed.
It became clear, that the most valuable instrument for mastering the airway is the flexible fiberscope. This is valid for every discipline to cope with the airway and also for anesthesiology. If the anesthesiologist wants to become the airway expert, he can only do this by generating the preconditions to be able to apply the instrument in a very broad range. This was put forward by Dr A Ovassapian (Chicago, Illinois, USA; executive director of SAM). Dr U Klein (former Jena and now Nordhausen, Germany) described the value of the flexible instrument for lung separation and Dr W Wilhelm (Homburg/Saar, Germany) for the intensive care ward. Drs U Braun and A Timmermann (Goettingen, Germany) showed the benefit of the flexible fiberscope for “difficult tracheal intubation” in patients undergoing surgical treatment of Noma disease (cancrum oris). This is an infectious disease of children in the Subsaharan region; it is caused by poverty and malnutrition, and leaves monstrous scars and open wounds in the face if it can be survived.
Another big step forward is the option to provide ventilation from the pharynx and larynx. Dr A Brain (Reading, England, UK) presented the Proseal-LMA, which is the latest development of the inventor of the Laryngeal Mask Airway (LMA). It improves the position check of the LMA and provides access to the stomach. Clinical studies are under way. The device is for sale now in Germany.
Dr M Frass (Vienna, Austria) described the value of the Combitube. The esophageal-tracheal double-lumen tube is effective and safe for resuscitation, and can also be used for general anesthesia. Dr F Semjen (Bordeaux, France) introduced the new Laryngeal Tube. This device has been shown to provide ventilation for resuscitation. It is available in the German speaking countries, but further testing is necessary. The new Glottic Aperture Seal Airway was brought before the audience by the inventor Dr S Augustine (Minneapolis, Minnesota, USA) and Dr R Greif (Vienna, Austria). The seal of the instrument is provided in close proximity to the glottic folds. The development is promising so far and beta-testing before clinical introduction is under way.
State of the art was presented concerning rapid-sequence induction and aspiration risk. The speakers (all from Germany) were Dr KH Fuchs (Wuerzburg), Dr C Diefenbach (Koeln), Dr GF Schwarzmann (Wuerzburg), and Dr A Deller (Trier).
Percutaneous tracheostomy is well established in intensive care wards in German speaking countries. Three methods were introduced, which are named after the inventors: Ciaglia (Dr M Walz, Essen, Germany), Fantoni (Dr J Rathgeber, Hamburg, Germany) and Griggs (Dr J Plazejak, Krefeld, Germany). All of these methods can be performed safely with guidance of the flexible fiberscope, and have excellent cosmetic and functional post-tracheostomy results, but it must be kept in mind, that there is a mortality risk which may be around 0.1 percent in the intensive care environment for all methods. Percutaneous and surgical tracheostomy (Dr P Dost, Essen, Germany) do not compete with each other but are complementary.
Preclinical emergency medicine is performed mostly by physicians in Germany, but much remains to be done to improve documentation (Drs A Timmermann and W Panzer, Goettingen, Germany) and teaching (Dr V Doerges, Luebeck, Germany). The intubating laryngeal mask airway is a valuable tool for ventilatory resuscitation (Dr K Goldmann, Boston, Massachusetts, USA).
The workshop with twenty workstations was well attended. All methods presented in the lectures could be practiced. Dr J Henderson (Glasgow, Scottland, UK; Henderson laryngoscope blade), Drs C Verghese (Oxford, England, UK) and A Brain (all currently available laryngeal mask airways), and Dr M Frass (Combitube) contributed to the workshop. Drs J Schaefer and A Timmermann introduced the new Laerdal airway simulators Simman and Airman. These simulators are available now. It is the first time, that airway simulation is possible with a purchased simulator. There is a great teaching potential offered by these new devices.
Much positive response for the meeting was received from the participants. It is believed that it makes sense to organize an airway symposium of this size in Germany every two years.
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