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Observational Study
. 2024 Feb 29;69(4):E151-E158.
doi: 10.24546/0100486397.

Sex Disparities in Applied Force on Maxillary Incisors Among Novices During Laryngoscopy Using a High-Fidelity Simulator: A Prospective Observational Study

Yuko Ono  1   2   3 , Kazuaki Shinohara  3 , Jiro Shimada  2 , Jun Sugiyama  1 , Shigeaki Inoue  1 , Joji Kotani  1
Affiliations
Observational Study

Sex Disparities in Applied Force on Maxillary Incisors Among Novices During Laryngoscopy Using a High-Fidelity Simulator: A Prospective Observational Study

Yuko Ono et al. Kobe J Med Sci. .

Abstract

Endotracheal intubation (ETI) is a common and crucial intervention. Whether the performance of ETI differs according to the sex of the laryngoscopist remains unclear. The aim of this study was to assess sex disparities in markers of ETI performance among novices using a high-fidelity simulator. This prospective observational study was conducted from April 2017 to March 2019 in a public medical university. In total, 209 medical students (4th and 5th grade) without clinical ETI experience were recruited. Of the 209 students, 64 (30.6%) were female. The participants used either a Macintosh direct laryngoscope or C-MAC video laryngoscope in combination with a stylet or gum-elastic bougie to perform ETI on a high-fidelity simulator. The primary endpoint was the maximum force applied on the maxillary incisors during laryngoscopy. The secondary endpoint was the time to ETI. The implanted sensors in the simulator automatically quantified the force and time to ETI. The maximum force applied on the maxillary incisors was approximately 30% lower in the male than female group for all laryngoscopes and intubation aids examined (all P < 0.001). Similarly, the time to ETI was approximately 10% faster in the male than female group regardless of the types of laryngoscopes and intubation aids used (all P < 0.05). In this study, male sex was associated with a lower maximum force applied on the maxillary incisors during both direct and indirect laryngoscopy performed by novices. A clinical study focusing on sex differences in ETI performance is needed to validate our findings.

Keywords: Airway-related adverse events; Definitive airway management; Laryngoscopy; Medical student; Sex gap.

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Figures

Figure 1
Figure 1. Participant flow diagram
DL, direct laryngoscope; ETI, endotracheal intubation; GEB, gum-elastic bougie; VL,video laryngoscope. aTo minimize the learning curve effect, the order of the ETI method was randomized for each participant.
Figure 2
Figure 2. Comparison of maximum applied force on maxillary incisors by sex of the laryngoscopists
The column scatter plots represent the data distribution (circles), median (horizontal bar), and interquartile range (vertical bar). The P values were derived from the Mann–Whitney U test. Male participants, n = 145; female participants, n = 64. DL, direct laryngoscope; GEB, gum-elastic bougie; VL, video laryngoscope.
Figure 3
Figure 3. Comparison of maximum applied force on tongue by sex of the laryngoscopists
The column scatter plots represent the data distribution (circles), median (horizontal bar), and interquartile range (vertical bar). The P values were derived from the Mann–Whitney U test. Male participants, n = 145; female participants, n = 64. DL, direct laryngoscope; GEB, gum-elastic bougie; VL, video laryngoscope.
Figure 4
Figure 4. Comparison of time to ETI by sex of the laryngoscopists
The time to ETI was defined as the time from the first contact with the device until the first successful lung ventilation. The column scatter plots represent the data distribution (circles), median (horizontal bar), and interquartile range (vertical bar). The P values were derived from the Mann–Whitney U test. Male participants, n = 145; female participants, n = 64. DL, direct laryngoscope; ETI, endotracheal intubation; GEB, gum-elastic bougie; VL, video laryngoscope.
Figure 5
Figure 5. Distribution of Cormack–Lehane laryngoscopic view by sex of the laryngoscopists
Error bar represents the 95% confidence interval. Male participants, n = 145; female participants, n = 64. The P values were derived from the Mann–Whitney U test. DL, direct laryngoscope; GEB, gum-elastic bougie; VL,video laryngoscope.
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