Easy-to-implement oral cavity modification to expand simulation-based training in airway management.
BACKGROUND
Injuries to the oral cavity and teeth can occur during routine intubation and general anesthesia but often occur in emergency situations when the priority of securing the airway supersedes preanesthetic evaluation. This study demonstrates the feasibility of modifying the oral cavity to increase the dental fidelity during emergency airway management.


METHODS
A Laerdal Manikin was used to manipulate the preexisting Polyester (hard) and the Vinyl (flexible) dentition sets that are interchangeable among the Laerdal family of manikins. Items easily available in a dental laboratory such as dental acrylic and dental impression material were used to create modifications.


RESULTS
Laerdal dentition sets were altered to simulate common dental (tooth-related) trauma encountered during intubation such as a fracture, luxation, or avulsion injuries. Anatomic variations such as carious (decayed) teeth, loose teeth, and class II malocclusion (overbite) were also fabricated. Tooth luxation was engineered to occur with pressure by a laryngoscope, and bleeding teeth were also created to demonstrate excessive pressure applied during direct laryngoscopy. It is feasible to improve the realism of the Laerdal family of manikins with simple modifications.


CONCLUSIONS
This project proves the concept of feasibly fabricating anatomic variations to increase the fidelity of existing simulation manikins. Other anatomic variations present challenges to airway management, and future research will aim at creating additional modifications. In addition, future research will seek to quantify the improvement in airway management skills by anesthesia and emergency medicine providers by training on manikins with variable oral cavity anatomy.
From the Department: Clinical Simulation Program, San Francisco VA Medical Center, University of California at San Francisco, San Francisco, CA.
Niyati N
NN
Mehta
Shelley H
SH
Miyasaki
Jan
J
Hirsch
Richard L
RL
Fidler
D058109:Airway Management / Q000379:methods*; D002983:Clinical Competence; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008348:Manikins; D009055:Mouth / Q000293:injuries*; D018677:Tooth Injuries / Q000517:prevention & control*