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Payne E, Ragheb J, Jewell ES, Huang BP, Bailey AM, Fritsch LM, Engoren M. Are physician assistant and patient airway assessments reliable compared to anesthesiologist assessments in detecting difficult airways in general surgical patients? Perioper Med (Lond) 2017; 6:20. [PMID: 29201360 PMCID: PMC5700753 DOI: 10.1186/s13741-017-0077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
Background Airway management remains one of the most important responsibilities of anesthesiologists. Prediction of difficult airway allows time for proper selection of equipment, technique, and personnel experienced in managing patients with difficult airway. Face to face preoperative anesthesia interviews are difficult to conduct as they necessitate patients traveling to the clinics, and, in practice, are usually conducted in the morning of the procedure by the anesthesiologist, when identification of predictors of difficult intubation may lead to schedule delays or case cancelations. We hypothesized that an airway assessment tool could be used by patients or physician assistants to accurately assess their airways. Methods We administered an airway assessment tool, which had been constructed in consultation with a psychometrician and revised after non-medical layperson feedback, to 215 patients presenting to the preoperative clinic for evaluation. Separately, patients had the airway exam performed by a physician assistant and an anesthesiologist. Agreement was compared using kappa. Results We found good agreement between observers only on "can you put three fingers in your mouth?" (three-way kappa = .733, p < 0.001) and poor agreement on Mallampati classification (three-way kappa = .195, p < 0.001) and "Can you fit three fingers between your chin and your Adam's Apple?" (three-way kappa = .216, p < 0.001). The agreements for the other questions were mostly fair. Agreements between patients and anesthesiologists were similar to those between physician assistants and anesthesiologists. Conclusions Neither the patients' self-assessments nor the physician assistants' assessments were adequate to substitute for the anesthesiologists' airway assessments.
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Affiliation(s)
- Erin Payne
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Jacqueline Ragheb
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Elizabeth S Jewell
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Betsy P Huang
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Angela M Bailey
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Laura M Fritsch
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, 4383 Cardiovascular Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5861 USA
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L'Hermite J, Wira O, Castelli C, de La Coussaye JE, Ripart J, Cuvillon P. Tracheal extubation with suction vs. positive pressure during emergence from general anaesthesia in adults: A randomised controlled trial. Anaesth Crit Care Pain Med 2017; 37:147-153. [PMID: 28882741 DOI: 10.1016/j.accpm.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/30/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND After general anaesthesia (GA) in adults, the optimal tracheal extubation technique (positive pressure or suctioning) remains debated. The primary endpoint of this study was to assess the effects of these techniques on onset time of desaturation (SpO2<92%). METHODS Sixty-nine patients with a body mass index<30 scheduled for elective orthopaedic surgery were allocated to positive pressure (PP) or suctioning (SUC) group. GA was standardised with propofol and remifentanil via target-controlled infusion. A morphine bolus of 0.15mg/kg was administered 20-30mins before the end of surgery. The effect of extubation technique on onset time of desaturation (T92) was assessed during the first 10mins after extubation during the spontaneous air breathing. Secondary endpoints included: frequency of desaturation, respiratory complications, need to use oxygen therapy and SpO2 at the end of the first hour while breathing in air (ClinicalTrials.gov identifier: NCT01323049). RESULTS Baseline patient characteristics and intraoperative management data for the 68 patients included had no relevant clinical difference between groups. T92 (sec) after tracheal extubation was 214 (168) vs. 248 (148) in the PP and SUC groups, respectively (P=0.44). In the PP and SUC groups, 50 and 43% reached a SpO2<92% within the first 10mins after extubation respectively (P=0.73). There were no statistically significant differences between groups for any secondary endpoints. CONCLUSIONS Positive pressure extubation as compared with suctioning extubation did not seem to delay onset time of desaturation after GA in standard weight adult patients.
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Affiliation(s)
- Joël L'Hermite
- Faculté de médecine, université Montpellier I, place du Pr-Debré, 30029 Nîmes cedex 9, France; Division of Anaesthesia Intensive Care Pain and Emergency, University Hospital of Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - Olivier Wira
- Faculté de médecine, université Montpellier I, place du Pr-Debré, 30029 Nîmes cedex 9, France; Division of Anaesthesia Intensive Care Pain and Emergency, University Hospital of Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - Chritel Castelli
- Department of Biostatistics and Clinical Epidemiology, Nimes University Hospital, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - Jean-Emmanuel de La Coussaye
- Faculté de médecine, université Montpellier I, place du Pr-Debré, 30029 Nîmes cedex 9, France; Division of Anaesthesia Intensive Care Pain and Emergency, University Hospital of Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - Jacques Ripart
- Faculté de médecine, université Montpellier I, place du Pr-Debré, 30029 Nîmes cedex 9, France; Division of Anaesthesia Intensive Care Pain and Emergency, University Hospital of Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - Philippe Cuvillon
- Faculté de médecine, université Montpellier I, place du Pr-Debré, 30029 Nîmes cedex 9, France; Division of Anaesthesia Intensive Care Pain and Emergency, University Hospital of Nîmes, place du Pr-Debré, 30029 Nîmes cedex 9, France
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Huang HB, Peng JM, Xu B, Liu GY, Du B. Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis. Chest 2017; 152:510-517. [PMID: 28629915 DOI: 10.1016/j.chest.2017.06.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/21/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. METHODS We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95% CIs. RESULTS Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = .003), use of VL did not result in a significant increase in the first-attempt success rate (RR = 1.08; 95% CI, 0.92-1.26; P = .35) compared with DL. In addition, time to intubation (MD = 4.12 s; 95% CI, -15.86-24.09; P = .69), difficult intubation (RR = 0.72; 95% CI, 0.30-1.70; P = .45), mortality (RR = 1.02; 95% CI, 0.84-1.25; P = .83), and most other complications were similar between the VL and DL groups. CONCLUSIONS The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.
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Affiliation(s)
- Hui-Bin Huang
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China; Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Biao Xu
- Critical Care Medicine Center, the PLA 302 Hospital, Fengtai District, Beijing, People's Republic of China
| | - Guang-Yun Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, People's Republic of China.
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Basavaraju A, Slade K. Dental damage in anaesthesia. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dental injury associated with anaesthesia: An 8-year database analysis of 592 claims from a major French insurance company. Anaesth Crit Care Pain Med 2017; 37:49-53. [PMID: 28838826 DOI: 10.1016/j.accpm.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dental injury is the most common incident associated with anaesthesia. Regarding recent recommendations on informed consent and changes in airway management practices, a large series of claims related to dental injury has not been recently described. The aim of this study was to analyse a recent database in order to describe the characteristics of dental injury in France. METHODS A database that prospectively collected claims reported to Le Sou Médical-MACSF between January 2003 and December 2010, was analysed. Five hundred and ninety-two cases were reported. The following characteristics were analysed: number and type of teeth injured, mechanism of injury, anaesthetic procedure, risk factors and dental outcome after injury. RESULTS Amongst the 1514 claims related to anaesthesia, 592 (39.2%) were classified as dental damage. Preoperative informed consent concerning possible perioperative dental injury was documented in only 34.8% of patients. Only one tooth was affected in 65.2% of patients, dental bridge injury in 12.8% of cases and damage to two or more teeth in 14% of patients. Incisors were involved in 50% of cases. Fracture was the most common type of injury (64.2%). Poor dentition was the most common risk factor (23.1%) followed by difficult intubation (15.4%). Both risks were combined in only 7.6% of cases. Tracheal intubation was the highest risk procedure (41.6%). CONCLUSION Dental injury remains the most common anaesthesia-related claim. Dental examination and documentation in patient medical files requires improvement and better informed consent on dental injury risk needs to be provided to patients.
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Fornebo I, Simonsen KA, Bukholm IRK, Kongsgaard UE. Claims for compensation after injuries related to airway management: a nationwide study covering 15 years. Acta Anaesthesiol Scand 2017; 61:781-789. [PMID: 28556897 DOI: 10.1111/aas.12914] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/25/2017] [Accepted: 05/08/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement. METHODS All claims to The Norwegian System of Compensation to Patients from 1 January 2001 to 31 December 2015 within the medical specialty of anaesthesiology were studied. Data were extracted from this database for patients and coded by airway management procedures. RESULTS Of 400 claims for injuries related to airway management, 359 were classified as 'non-severe' and 41 as 'severe'. Of the severe cases, 37% of injuries occurred during emergency procedures. Eighty-one claims resulted in compensation, and 319 were rejected. A total of €1,505,344 was paid to the claimants during the period. Claims of dental damage contributed to a numerically important, but financially modest, proportion of claims. More than half of the severe cases were caused by failed intubation or a misplaced endotracheal tube. CONCLUSION Anaesthesia procedures are not without risk, and injuries can occur when securing the airway. The most common injury was dental trauma. Clear patterns of airway management that resulted in injuries are not apparent from our data, but 37% of severe cases were related to emergency procedures which suggest the need for additional vigilance. Guidelines for difficult intubation situations are well established, but adherence to such guidelines varies. Good planning of every general anaesthesia should involve consideration of possible airway problems and assessment of pre-existing poor dentition.
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Affiliation(s)
- I. Fornebo
- Medical Faculty; Oslo University; Oslo Norway
| | - K. A. Simonsen
- Department of Medical Experts; The Norwegian system of Compensation to Patients (NPE); Oslo Norway
| | - I. R. K. Bukholm
- Medical Faculty; Oslo University; Oslo Norway
- The Norwegian system of Compensation to Patients (NPE); Oslo Norway
| | - U. E. Kongsgaard
- Medical Faculty; Oslo University; Oslo Norway
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
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Pakize Özyürek AK. The effect of periuretral care and follow-up on bacteriuria in patients with urinary catheter: A comparison of three solutions. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2017. [DOI: 10.5799/10.5799/ahinjs.01.2015.01.0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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59
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Evaluation of pH on removed tracheal tubes after general anesthesia: a prospective observational study. J Clin Anesth 2016; 35:346-349. [DOI: 10.1016/j.jclinane.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022]
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60
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61
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Jaber S, Monnin M, Girard M, Conseil M, Cisse M, Carr J, Mahul M, Delay JM, Belafia F, Chanques G, Molinari N, De Jong A. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med 2016; 42:1877-1887. [DOI: 10.1007/s00134-016-4588-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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62
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. [Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]. Rev Bras Anestesiol 2016; 67:6-14. [PMID: 27692805 DOI: 10.1016/j.bjan.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Espanha
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madri, Espanha; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madri, Espanha
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Espanha; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madri, Espanha
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Espanha
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha.
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Huitink JM, Lie PP, Heideman I, Jansma EP, Greif R, van Schagen N, Schauer A. A prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre. Anaesthesia 2016; 72:42-48. [DOI: 10.1111/anae.13640] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2016] [Indexed: 12/18/2022]
Affiliation(s)
- J. M. Huitink
- VU University Medical Center; Amsterdam the Netherlands
| | - P. P. Lie
- VU University Medical Center; Amsterdam the Netherlands
| | - I. Heideman
- VU University Medical Center; Amsterdam the Netherlands
| | - E. P. Jansma
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam the Netherlands
| | - R. Greif
- Department of Anesthesiology and Pain Therapy; Bern University Hospital; University of Bern; Bern Switzerland
| | | | - A. Schauer
- VU University Medical Center; Amsterdam the Netherlands
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Komasawa N, Mihara R, Kido H, Minami T. Possibility of lip pulling method not only for prevention of soft tissue injury but also for improved laryngoscopy and tracheal intubation. Am J Emerg Med 2016; 34:1694. [PMID: 27210729 DOI: 10.1016/j.ajem.2016.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | - Haruki Kido
- Department of Anesthesiology, Osaka Medical College
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Suppiah RK, Rajan S, Paul J, Kumar L. Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation. Anesth Essays Res 2016; 10:212-7. [PMID: 27212749 PMCID: PMC4864687 DOI: 10.4103/0259-1162.174469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Traditional awake extubation leads to respiratory complications and hemodynamic response which are detrimental in neurosurgery, ENT surgery and patients with comorbidities. AIMS The primary objective was to compare the respiratory complications and hemodynamic stress response between traditional awake extubation of a endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA). SETTINGS AND DESIGN This prospective randomized study was conducted in a Tertiary Care Centre in 60 American Society of Anesthesiologists I and II patients coming for general surgery. MATERIALS AND METHODS Patients were randomized by permuted blocks into traditional awake extubation group and exchange extubation group. At the end of surgery in traditional group, awake extubation of ETT was done. In exchange group, 0.3 mg/kg propofol was administered, and the ETT was exchanged for a LMA. Awake extubation of LMA was then performed. Respiratory complications such as bucking, coughing, desaturation and the need for airway maneuvers and hemodynamic response were noted in both groups. ANALYSIS TOOLS Chi-square test, independent sample t- and paired t-tests were used as applicable. RESULTS Incidence of respiratory complication was 93.3% in traditional extubation while it was only 36.7% in exchange extubation group (P < 0.001). Hemodynamic response measured immediately at extubation in terms of heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure, and rate pressure product were all significantly lesser in exchange group when compared to traditional extubation. CONCLUSION Exchange extubation with LMA decreases respiratory complications and hemodynamic stress response when compared to traditional awake extubation.
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Affiliation(s)
- Ramanathan Kannan Suppiah
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sunil Rajan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Gómez-Ríos MÁ. Can fiberoptic bronchoscopy be replaced by video laryngoscopy in the management of difficult airway? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:189-191. [PMID: 26778672 DOI: 10.1016/j.redar.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- M Á Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Head of the Anaesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, Spain.
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67
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation. Braz J Anesthesiol 2016; 67:6-14. [PMID: 28017172 DOI: 10.1016/j.bjane.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Spain
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madrid, Spain; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Spain; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madrid, Spain
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Spain
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain.
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Anastasian ZH, Kim M, Heyer EJ, Wang S, Berman MF. Attending Handoff Is Correlated with the Decision to Delay Extubation After Surgery. Anesth Analg 2016; 122:758-764. [DOI: 10.1213/ane.0000000000001069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kido H, Komasawa N, Imajo Y, Ueno T, Minami T. Evaluation of double-lumen endotracheal tube extubation force by extraction angle: a prospective randomized clinical trial. J Clin Anesth 2016; 29:40-5. [PMID: 26897446 DOI: 10.1016/j.jclinane.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/17/2015] [Accepted: 10/08/2015] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE Gentle and noninvasive double-lumen tracheal tube (DLT) extubation is important for both airway and circulatory management, especially after lung resection. We performed a prospective randomized clinical trial comparing DLT extubation force based on 2 different extraction angles. DESIGN Randomized clinical trial. SETTING Operating room. PATIENTS Sixty adult patients scheduled for elective surgery under general anesthesia using DLT with ASA physical status 1 to 3. INTERVENTIONS Sixty patients who underwent lung resection with a DLT were randomly assigned to extraction angles of 60° (30 patients) and 90° (30 patients) relative to the ground. MEASUREMENTS Extubation forces and changes in vital signs were compared between groups. Results were analysed with the Mann-Whitney U test, non-paired t test, and χ(2) test. P<.05 was considered significant. MAIN RESULTS Less extraction force was needed at 60° compared to 90° (90°, 13.9±2.3 N; 60°; 7.1±2.1 N; P<.001). The rate of increase in systolic and diastolic blood pressure (post-extubation/pre-extubation) was significantly smaller at 60° than at 90° (systolic blood pressure, P<.001; diastolic blood pressure, P=.002). CONCLUSIONS Our findings suggest that DLT extubation at 60° requires less force than at 90° and was accompanied by a smaller increase in blood pressure. Thus, extraction at 60° may be less invasive and beneficial for patients undergoing DLT extubation.
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Affiliation(s)
- Haruki Kido
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | | | - Yukihiro Imajo
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | - Takeshi Ueno
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Osaka, Japan
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Cho K, Kim MH, Lee W, Lee JH, Lim SH, Lee KM, Kim YJ, Kim JH, Choi DN, Chang HY. The oropharyngeal bleeding after esophageal stethoscope insertion -A case report-. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.1.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kwangrae Cho
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myoung-hun Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wonjin Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong Han Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Hun Lim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kun Moo Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Jae Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong Han Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Deul-nyuck Choi
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho-young Chang
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Tracheal Intubation with a McGrath® Series 5 Video Laryngoscope by Novice Personnel in a Cervical-immobilized Manikin. J Emerg Med 2016; 50:61-6. [DOI: 10.1016/j.jemermed.2015.06.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/25/2015] [Accepted: 06/12/2015] [Indexed: 11/20/2022]
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72
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Soft tissue injuries after direct laryngoscopy. J Clin Anesth 2015; 27:668-71. [DOI: 10.1016/j.jclinane.2015.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/19/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022]
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73
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Brandão Ribeiro de Sousa JM, de Barros Mourão JI. Tooth injury in anaesthesiology. Braz J Anesthesiol 2015; 65:511-8. [DOI: 10.1016/j.bjane.2013.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022] Open
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74
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Pascall E, Trehane SJ, Georgiou A, Cook T. Litigation associated with intensive care unit treatment in England: an analysis of NHSLA data 1995–2012. Br J Anaesth 2015; 115:601-7. [DOI: 10.1093/bja/aev285] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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75
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Mihara R, Komasawa N, Matsunami S, Minami T. The effect of extraction angle on endotracheal tube extubation force: Simulation and randomized clinical trial. J Int Med Res 2015; 43:653-60. [PMID: 26347545 DOI: 10.1177/0300060515592904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/29/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the extraction force generated at different extubation angles using a manikin simulation and a randomized clinical trial. METHODS Simulations were performed on a manikin to assess the force generated at extubation angles of 0°, 30°, 45°, 60°, 90° and 120° relative to the ground. The trial compared extraction force and changes in vital signs in patients undergoing general anaesthesia with tracheal intubation followed by extubation at 60° or 90°. RESULTS The simulation study found that the extubation force was significantly lower at 45° and 60° than at all other extraction angles. In the trial, extubation at 60° resulted in significantly lower extraction force and systolic blood pressure elevation (n = 23) than extubation at 90° (n = 23). CONCLUSION Findings in a manikin simulation were confirmed by those of a randomized clinical trial, where extubation at 60° required less force than 90°, and was accompanied by less SBP elevation. Extubation at 60° is less invasive than extubation at 90°.
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Affiliation(s)
- Ryosuke Mihara
- Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan
| | | | - Sayuri Matsunami
- Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan
| | - Toshiaki Minami
- Department of Anaesthesia, Osaka Medical College, Takatsuki, Japan
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76
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White V, Nath A, Stansby G. Litigation claims relating to venous thromboembolism in the NHS. Phlebology 2014; 30:389-96. [DOI: 10.1177/0268355514537487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Litigation costs for clinical negligence in the management of venous thromboembolism have escalated in the last five years. The National Health Service Litigation Authority estimates these claims have cost in excess of £112 million. Our aim is to identify the areas of practice where these claims are most likely to arise to help improve patient outcome. Methods The National Health Service Litigation Authority provided de-identified data on individual medical negligence claims against the NHS since 2007. We subcategorised the data into (a) the nature of the venous thromboembolism event, (b) the area of specialist practice and (c) the damages incurred. Inter-group differences were evaluated using ANOVA, Kruskal–Wallis test and Mann–Whitney U Test. Results Failure to prevent and to diagnose pulmonary emboli and deep vein thrombosis occurs across the spectrum of clinical specialties. In the study period 189 claims were made. The majority of claims were in surgical specialties and the financial burden was significantly greater than in the medical specialities (£3,257,394 vs. £1,532,996). The amounts paid out by specialty was not significantly different but had significant variance ( p < 0.0001). Conclusions The National Institute of Clinical Excellence provides comprehensive guidelines on venous thromboembolism risk assessment. Poor compliance has contributed to morbidity and mortality while the cost has continued to escalate. A multimodal approach to education is needed to improve patient outcome. Improved venous thromboembolism prevalence data are also needed.
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Affiliation(s)
- Victoria White
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Alexander Nath
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
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Abstract
Airway management is the most important clinical skill for anesthesiologist, emergency physician, and other providers who are involved in oxygenation and ventilation of the lungs. Rapid-sequence intubation is the preferred method to secure airway in patients who are at risk for aspiration because it results in rapid unconsciousness (induction) and neuromuscular blockade (paralysis). Application of cricoid pressure (CP) for patients undergoing rapid-sequence intubation is controversial. Multiple specialty societies have recommended that CP is not effective in preventing aspiration; rather it may worsen laryngoscopic view and impair bag-valve mask ventilation. Some experts think that CP should be applied in trauma and patients at risk for aspiration; however CP, if necessary, should be altered or removed to facilitate intubation.
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Affiliation(s)
- Joshua C Stewart
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sanjay Bhananker
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh Ramaiah
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
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78
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Pandit JJ. Volatile anaesthetic depression of the carotid body chemoreflex-mediated ventilatory response to hypoxia: directions for future research. SCIENTIFICA 2014; 2014:394270. [PMID: 24808974 PMCID: PMC3997855 DOI: 10.1155/2014/394270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
In assessing whether volatile anaesthetics directly depress the carotid body response to hypoxia it is necessary to combine in meta-analysis studies of when it is "functionally isolated" (e.g., recordings are made from its afferent nerve). Key articles were retrieved (full papers in English) and subjected to quantitative analysis to yield an aggregate estimate of effect. Results from articles that did not use such methodology were assessed separately from this quantitative approach, to see what could be learned also from a nonquantitative overview. Just 7 articles met the inclusion criteria for hypoxia and just 6 articles for hypercapnia. Within these articles, the anaesthetic (mean dose 0.75, standard deviation (SD) 0.40 minimum alveolar concentration, MAC) statistically significantly depressed carotid body hypoxic response by 24% (P = 0.041), but a similar dose (mean 0.81 (0.42) MAC) did not affect the hypercapnic response. The articles not included in the quantitative analysis (31 articles), assessed qualitatively, also indicated that anaesthetics depress carotid body function. This conclusion helps direct future research on the anaesthetic effects on putative cellular/molecular processes that underlie the transduction of hypoxia in the carotid body.
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Affiliation(s)
- J. J. Pandit
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK
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79
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Subramanyam R, Chidambaran V, Ding L, Myer CM, Sadhasivam S. Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012. Paediatr Anaesth 2014; 24:412-20. [PMID: 24417679 DOI: 10.1111/pan.12342] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although commonly performed, tonsillectomy is not necessarily a low-risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia- and opioid-related claims and their characteristics. METHODS Tonsillectomy-related malpractice claims and jury verdict reports from the United States (US) between 1984 and 2012 found in the LexisNexis MEGA™ Jury Verdicts and Settlements database were reviewed by two independent reviewers. LexisNexis database collects nationwide surgical, anesthesia, and other malpractice claims. Data including years of case and verdicts, surgical, anesthetic and postoperative opioid-related complications, details of injury, death, cause of death, litigation result, and judgment awarded were analyzed. When there were discrepancies between the two independent reviewers, a third reviewer (SS) was involved for resolution. Inflation adjusted monetary awards were based on 2013 US dollars. RESULTS There were 242 tonsillectomy-related claim reports of which 98 were fatal claims (40.5%) and 144 nonfatal injury claims (59.5%). Verdict/settlement information was available in 72% of cases (n = 175). The median age group of patients was 8.5 years (range 9 months to 60 years). Primary causes for fatal claims were related to surgical factors (n = 39/98, 39.8%) followed by anesthesia-related (n = 36/98, 36.7%) and opioid-related factors (n = 16/98, 16.3%). Nonfatal injury claims were related to surgical (101/144, 70.1%), anesthesia (32/144, 22.2%)- and opioid-related factors (6/144, 4.2%). Sleep apnea was recorded in 17 fatal (17.4%) and 15 nonfatal claims (10.4%). Opioid-related claims had the largest median monetary awards for both fatal ($1 625 892) and nonfatal injury ($3 484 278) claims. CONCLUSIONS Tonsillectomy carries a high risk from a medical malpractice standpoint for the anesthesiologists and otolaryngologists. Although surgery-related claims were more common, opioids- and anesthetic-related claims were associated with larger median monetary verdicts, especially those associated with anoxic, nonfatal injuries. Caution is necessary when opioids are prescribed post-tonsillectomy, especially in patients with sleep apnea.
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Affiliation(s)
- Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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80
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Abstract
BACKGROUND AND OBJECTIVES Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.
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81
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Bensghir M, Bouhabba N, Fjouji S, Haimeur C, Azendour H. [Difficult intubation: should follow the recommendations]. ACTA ACUST UNITED AC 2014; 33:181-4. [PMID: 24530085 DOI: 10.1016/j.annfar.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
Intubation and ventilation impossible mask is a dramatic situation with potentially serious consequences. We report the case of a patient of 43 years, followed for a goiter, which was scheduled for a total thyroidectomy under general anesthesia. Preoperative evaluation is not noted signs of compression or tracheal deviation, and there were no criteria predictive of intubation or difficult mask ventilation. The induction of anesthesia was standard. Mask ventilation was effective allowing paralysis. The standard laryngoscopy showed a score of Cormack and Lehane grade IV. Several attempts at intubation were made leading to a situation of intubation and ventilation impossible mask with deep desaturation. A tracheostomy was done urgently. The patient was operated on, six months later, with a fiber optic intubation. Through this case, the authors draw attention to the difficulty of achieving an emergency tracheotomy in the presence of goiter and emphasize the need for integration of different modes of learning and retention of management skills of the upper airway.
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Affiliation(s)
- M Bensghir
- Service d'anesthésiologie, hôpital Militaire Med V Rabat, université Med V Souissi, B.P 8840 Rabat Agdal, Maroc.
| | - N Bouhabba
- Service d'anesthésiologie, hôpital Militaire Med V Rabat, université Med V Souissi, B.P 8840 Rabat Agdal, Maroc
| | - S Fjouji
- Service d'anesthésiologie, hôpital Militaire Med V Rabat, université Med V Souissi, B.P 8840 Rabat Agdal, Maroc
| | - C Haimeur
- Service d'anesthésiologie, hôpital Militaire Med V Rabat, université Med V Souissi, B.P 8840 Rabat Agdal, Maroc
| | - H Azendour
- Service d'anesthésiologie, hôpital Militaire Med V Rabat, université Med V Souissi, B.P 8840 Rabat Agdal, Maroc
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82
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The difficult airway with recommendations for management--part 1--difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth 2013; 60:1089-118. [PMID: 24132407 PMCID: PMC3825644 DOI: 10.1007/s12630-013-0019-3] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/13/2013] [Indexed: 12/14/2022] Open
Abstract
Background Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered.
Methods Nineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria. Conclusions The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.
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83
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Mourão J, Neto J, Luís C, Moreno C, Barbosa J, Carvalho J, Tavares J. Dental injury after conventional direct laryngoscopy: a prospective observational study. Anaesthesia 2013; 68:1059-65. [DOI: 10.1111/anae.12342] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - J. Neto
- Institute of Biomedical Sciences Abel Salazar; University of Oporto; Oporto; Portugal
| | - C. Luís
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - C. Moreno
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - J. Barbosa
- Center for Medical Education; University of Oporto; Oporto; Portugal
| | - J. Carvalho
- Faculty of Dental Medicine; University of Oporto; Oporto; Portugal
| | - J. Tavares
- Department of Surgery; Faculty of Medicine; University of Oporto; Oporto; Portugal
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Baker P, Moore C, Hopley L, Herzer K, Mark L. How do anaesthetists in New Zealand disseminate critical airway information? Anaesth Intensive Care 2013; 41:334-41. [PMID: 23659395 DOI: 10.1177/0310057x1304100310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The communication of information concerning patients with difficult airways is universally recognised as an important component in avoiding future airway management difficulties. A range of options is available to impart this information; little is known however, about the follow-up patterns of anaesthetists following the identification and management of a difficult airway. In this study, 158 anaesthetists were contacted and asked to comment on their follow-up patterns regarding a number of difficult airway scenarios. This was followed by a retrospective survey of 124 patients with known difficult airways. A wide discrepancy was found between stated follow-up preferences by anaesthetists and the actual use of options such as postoperative visits, notes in the clinical record, letters to the patient and family doctor, and entries in hospital, national and MedicAlert™ databases. Of the patients with an airway difficulty noted on their anaesthetic record, only 14% of them also had a pertinent comment on their clinical record; even fewer were referred to hospital warning systems (12%) or national (6%) and MedicAlert (7%) databases. Comments from our survey were critical of multiple difficult airway databases and alert systems, which are not linked and do not lead automatically to a single source of information. We suggest that a custom-designed MedicAlert New Zealand difficult airway/intubation registry could be established, with easy access for medical practitioners and patients. This registry could be accessed through the National Health Index database and linked to the MedicAlert international registry and their nine international affiliates.
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Affiliation(s)
- P Baker
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
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85
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Green MS, Hoffman CR. An unusual cause of nasotracheal tube cuff equipment failure. J Clin Anesth 2013; 24:600-1. [PMID: 23101780 DOI: 10.1016/j.jclinane.2011.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/18/2011] [Accepted: 11/09/2011] [Indexed: 11/30/2022]
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86
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Yan Z, Tanner JW, Lin D, Chalian AA, Savino JS, Fleisher LA, Liu R. Airway trauma in a high patient volume academic cardiac electrophysiology laboratory center. Anesth Analg 2012; 116:112-7. [PMID: 23223101 DOI: 10.1213/ane.0b013e31826f9125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Providing anesthesia and managing airways in the electrophysiology suite can be challenging because of its unique setting outside of the conventional operating room. We report our experience of several cases of reported airway trauma including tongue and pharyngeal hematoma and vocal cord paralysis in this setting. METHODS We analyzed all of the reported airway trauma cases between December 2009 and January 2011 in our cardiac electrophysiology laboratories and compared these cases with those without airway trauma. Data from 87 cases, including 16 cases with reported airway trauma (trauma group) and 71 cases without reported airway trauma from the same patient population pool at the same period (control group), were collected via review of medical records. RESULTS Airway trauma was reported for 16 patients (0.7%) in 14 months among 2434 anesthetic cases. None of these patients had life-threatening airway obstruction. The avoidance of muscle relaxants during induction in patients with a body mass index less than 30 was found to be a significant risk factor for airway trauma (P = 0.04; odds ratio, 10; 95% confidence interval, 1.1-482). Tongue or soft tissue bite occurred in 2 cases where soft bite block was not used during cardioversion. No statistically significant difference was found between the trauma and the control groups for preprocedure anticoagulation, anticoagulation during the procedure, or reversal of heparin at the end of the procedure. CONCLUSIONS The overall incidence of reported airway trauma was 0.7% in our study population. Tongue injury was the most common airway trauma. The cause seems to have been multifactorial; however, airway management without muscle relaxant emerged as a potential risk factor. Intubation with muscle relaxant is recommended, as is placing a soft bite block and ensuring no soft tissue is between the teeth before cardioversion.
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Affiliation(s)
- Zhe Yan
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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87
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Cook T. Litigation in anaesthesia: areas of high clinical risk and the National Audit Projects. Br J Anaesth 2012; 109:1005; author reply 1005-6. [DOI: 10.1093/bja/aes405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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88
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Cook T, MacDougall-Davis S. Complications and failure of airway management. Br J Anaesth 2012; 109 Suppl 1:i68-i85. [DOI: 10.1093/bja/aes393] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Ozer AB, Erhan OL, Demirel I, Keles E. Dental avulsion due to direct laryngoscopy during the induction of general anaesthesia and avulsed teeth in nasopharynx. BMJ Case Rep 2012; 2012:bcr-2012-006898. [PMID: 23001105 DOI: 10.1136/bcr-2012-006898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
General anaesthesia was induced to a 32-year-old female patient. During direct laryngoscopy, the four upper front incisors were avulsed and fell into the patient's oral cavity without fracture. After endotracheal intubation, her oral cavity was searched laryngoscopically but the teeth were not found. Radiological findings of her chest and abdomen obtained by the C-armed x-ray device and endoscopic findings of the oesophagus were normal. Her head and neck imaging revealed a radiopaque lesion in the nasopharyngeal area. Later, the nasopharyngeal area was examined endoscopically and the teeth were removed following adenoidectomy. We emphasise that preoperative evaluation is essential for dental injuries, and patients with a risk of dental injury must be detected before surgery. The localisation of the broken teeth must be identified and removed, and one must keep in mind that the dental fragments can travel to the nasopharynx.
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Affiliation(s)
- Ayse B Ozer
- Department of Anesthesiology and Reanimation, Firat University, Elazig, Turkey.
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Turillazzi E, Bello S, Bonsignore A, Neri M, Riezzo I, Fineschi V. Retrospective analysis of anaesthesia-related deaths during a 12-year period: looking at the data from a forensic point of view. MEDICINE, SCIENCE, AND THE LAW 2012; 52:112-115. [PMID: 22422787 DOI: 10.1258/msl.2011.011074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Anaesthesia-related death is one of the most complex events to be studied in forensic pathology because of its rarity and its doubtful presentation. Particularly, the difficulties in assessing the cause of deaths in such circumstances are underlined. A scale must be considered in order to determine the causal role of anaesthesia in the process leading to death. Indeed, beyond deaths exclusively explained by anaesthetic care, there are deaths that are not anaesthesia-related and deaths explained by surgery and co-morbidities in which the role of anaesthetic care has to be carefully investigated. A retrospective analysis of 3138 autopsies is presented with the aim of better understanding the patho-physiological process of anaesthesia-related mortality and to determine the causal role of anaesthesiological care in the process leading to death, thus assessing the real incidence of deaths due to anaesthesia (0.16%). In the present study, the number of deaths generically anaesthesia-related (33 cases) accounts for 2.06% of autopsies due to medical malpractice claims and 1.05% of all autopsies. The number of deaths totally related to anaesthesic care is rather low with 0.32% of autopsies due to medical malpractice claims and 0.16% of all autopsies. Anaesthesia-related deaths were due to lack of or delay in intubation (2 cases), acute cardio-respiratory failure (2 cases) and anaesthetic-induced hepatotoxicity (1 case). The importance of a careful forensic investigation (clinical and familial history, medical records, complete autopsy and toxicology), which can lead to a clear understanding of anaesthesia-related deaths, is also stressed.
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Affiliation(s)
- E Turillazzi
- Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Foggia, Italy
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91
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Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67:318-40. [PMID: 22321104 DOI: 10.1111/j.1365-2044.2012.07075.x] [Citation(s) in RCA: 297] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tracheal extubation is a high-risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri-operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post-extubation care.
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92
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Nouette-Gaulain K, Lenfant F, Jacquet-Francillon D, Belbachir A, Bournigault-Nuquet A, Choquet O, Claisse A, Dujarric F, Francon D, Gentili M, Majoufre-Lefebvre C, Marciniack B, Péan D, Yavordios PG, Leone M. [French clinical guidelines for prevention of perianaesthetic dental injuries: long text]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2012; 31:213-23. [PMID: 22377414 DOI: 10.1016/j.annfar.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dental injuries represent the most common claims against the anaesthesiologists. Dental lesions are frequent complications of orotracheal intubation and major causal factors are, firstly, preexisting poor dentition, and, secondly, difficult laryngoscopy and tracheal intubation. The aim of this work was to prioritize propositions for prevention in perianaesthetic dental injury and for care in case of dental trauma. METHOD A GRADE consensus procedure consisting of three rounds was conducted. A purposively selected heterogeneous panel (n=15) of experts, comprising 10 practitioners in anesthesiology, one practitioner who is jurist and anaesthesiologist, two practitioners in maxillofacial surgery, and two practitioners in dentist surgery. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the board members. The guidelines represent the best current evidence based on literature search and professional opinion. RESULTS The entire panel completed all three rounds and 31 plus six propositions were written for adult and paediatric clinical practice in anaesthesiology, respectively. The experts highlight the interest of preoperative visit for minimizing dental injuries: the practitioner must identify risk factors for difficult intubation and ventilation, describe precisely patient's preoperative dental condition, including upper incisor most commonly involved teeth in dental trauma. Patients have to be informed by practitioner for risk dental injury and anaesthesiology staff must choose his anesthesia protocol before the induction of intubation narcosis, avoiding insufficient anaesthesia and lack of experience by the anaesthesiologist. The choice of accurate proceeding during laryngoscopy, tracheal intubation and extubation for example, can aid in the prevention of dental injury, reduce the number of claims and the cost of litigation process. DISCUSSION These guidelines delineate an approach for the prevention of perianaesthetic dental trauma and for the immediate or urgent care in case of perianaesthetic dental injury.
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Affiliation(s)
- K Nouette-Gaulain
- Pôle d'anesthésie réanimation, service d'anesthésie-réanimation III, université Bordeaux-Segalen, hôpital des enfants, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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93
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Abstract
In airway management, poor judgment, education and training are leading causes of patient morbidity and mortality. The traditional model of medical education, which relies on experiential learning in the clinical environment, is inconsistent and often inadequate. Curriculum change is underway in many medical organisations in an effort to correct these problems, and airway management is likely to be explicitly addressed as a clinical fundamental within any new anaesthetic curriculum. Competency-based medical education with regular assessment of clinical ability is likely to be introduced for all anaesthetists engaged in airway management. Essential clinical competencies need to be defined and improvements in training techniques can be expected based on medical education research. Practitioners need to understand their equipment and diversify their airway skills to cope with a variety of clinical presentations. Expertise stems from deliberate practice and a desire constantly to improve performance with a career-long commitment to education.
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Affiliation(s)
- P A Baker
- Department of Anaesthesiology, The University of Auckland, New Zealand.
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94
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Ward DS, Karan SB, Pandit JJ. Hypoxia: developments in basic science, physiology and clinical studies. Anaesthesia 2011; 66 Suppl 2:19-26. [DOI: 10.1111/j.1365-2044.2011.06930.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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95
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96
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Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 2011. [DOI: 10.1093/bja/aer058 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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97
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Norris A, Hardman J, Asai T. A firm foundation for progress in airway management. Br J Anaesth 2011; 106:613-6. [DOI: 10.1093/bja/aer088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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98
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Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 2011. [DOI: 10.1093/bja/aer058 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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99
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Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106:617-31. [PMID: 21447488 DOI: 10.1093/bja/aer058] [Citation(s) in RCA: 1150] [Impact Index Per Article: 88.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This project was devised to estimate the incidence of major complications of airway management during anaesthesia in the UK and to study these events. METHODS Reports of major airway management complications during anaesthesia (death, brain damage, emergency surgical airway, unanticipated intensive care unit admission) were collected from all National Health Service hospitals for 1 yr. An expert panel assessed inclusion criteria, outcome, and airway management. A matched concurrent census estimated a denominator of 2.9 million general anaesthetics annually. RESULTS Of 184 reports meeting inclusion criteria, 133 related to general anaesthesia: 46 events per million general anaesthetics [95% confidence interval (CI) 38-54] or one per 22,000 (95% CI 1 per 26-18,000). Anaesthesia events led to 16 deaths and three episodes of persistent brain damage: a mortality rate of 5.6 per million general anaesthetics (95% CI 2.8-8.3): one per 180,000 (95% CI 1 per 352-120,000). These estimates assume that all such cases were captured. Rates of death and brain damage for different airway devices (facemask, supraglottic airway, tracheal tube) varied little. Airway management was considered good in 19% of assessable anaesthesia cases. Elements of care were judged poor in three-quarters: in only three deaths was airway management considered exclusively good. CONCLUSIONS Although these data suggest the incidence of death and brain damage from airway management during general anaesthesia is low, statistical analysis of the distribution of reports suggests as few as 25% of relevant incidents may have been reported. It therefore provides an indication of the lower limit for incidence of such complications. The review of airway management indicates that in a majority of cases, there is 'room for improvement'.
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Affiliation(s)
- T M Cook
- Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
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100
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Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 2011. [DOI: 10.1093/bja/aer058 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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