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The Dexter® Endoscopic Dexterity Trainer improves fibreoptic bronchoscopy skills: preliminary observations

Felice Agrò, MD^*, Federica Sena, MD^*, Errol Lobo, MD PhD, Simone Scarlata, MD^*, Nicola Dardes, MD^* and Giorgio Barzoi, MD^*

^* Rome Italy
California, USA

To the Editor:

Fibreoptic intubation of the trachea is the gold standard for control of the known difficult airway. Nevertheless this technique is still under utilized in clinical practice.^1,2 Perhaps one reason for lack of use of awake fibreoptic intubation is a lack of training or confidence on the part of the anesthesiologist.³ Few teaching programs formally train their fellows in endoscopic techniques, and only some anesthesiologists actively maintain this psychomotor skill.⁴ We evaluated the efficacy of a training program using a new endoscopy training model (Figure), the Dexter® Endoscopic Dexterity Trainer (Replicant® Medical Simulator Ltd., Wellington, New Zealand).

View larger version (74K): [in this window] [in a new window]   FIGURE Dexter® Endoscopic Dexterity Trainer.

All participants showed improvement in accuracy and speed after the training program with the Dexter® Endoscopic Dexterity Trainer. The pretest average speed (duration of performance) in performing a standard exercise was 30.33 min:sec (P < 0.001). The post test average speed in performing the exercise was 12:30 min:sec (P < 0.001).

The pretest average number of errors in finding pictures and/or segments missed was 5 (P < 0.001). The post test average number of errors was 0 (P < 0.001).

These results were confirmed in the Laerdal^TM SimMan^TM universal patient simulator.

The pretest average speed (duration of performance) in performing a standard exercise was 30:24 min:sec. The post test average speed was 12:23 min:sec (P < 0.001).

The pretest average number of errors was 6.8 (P < 0.001). The post test average number of errors was 1.8 (P < 0.001).

Our preliminary data suggest that the Dexter® training program improves bronchoscopy skills. The configuration of the Dexter® enhances eye-hand coordination and aids in the recognition of images, their size, depth and distance. This skill is important in dealing with the difficult airway where the anatomical orientation of structures may be abnormal.

References

1 Caplan RA, Posner KL, Ward RJ, Cheney FW. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 1990; 72: 828–32.[Medline]

2 Ovassapian A. Fiberoptic Endoscopy and the Difficult Airway, 2nd ed. Lippincott-Raven; 1996.

3 Mason RA. Learning fibreoptic intubation: fundamental problems (Editorial). Anaesthesia 1992; 47: 729–31.[Medline]

4 Mason RA. Education and training in airway management (Editorial). Br J Anaesth 1998; 81: 305–7.[Free Full Text]

5 Agrò F, Giuliano I, Montecchia F. A new human-dynamic simulator (Air Man) for airway training in emergency situations (Letter). Am J Emerg Med 2002; 20: 495.[Medline]

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