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Orrock JL, Ward PA, McNarry AF. Routine Use of Videolaryngoscopy in Airway Management. Int Anesthesiol Clin 2024; 62:48-58. [PMID: 39233571 DOI: 10.1097/aia.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Tracheal intubation is a fundamental facet of airway management, for which the importance of achieving success at the first attempt is well recognized. Failure to do so can lead to significant morbidity and mortality if there is inadequate patient oxygenation by alternate means. The evidence supporting the benefits of a videolaryngoscope in attaining this objective is now overwhelming (in adults). This has led to its increasing recognition in international airway management guidelines and its promotion from an occasional airway rescue tool to the first-choice device during routine airway management. However, usage in clinical practice does not currently reflect the increased worldwide availability that followed the upsurge in videolaryngoscope purchasing during the coronavirus disease 2019 pandemic. There are a number of obstacles to widespread adoption, including lack of adequate training, fears over de-skilling at direct laryngoscopy, equipment and cleaning costs, and concerns over the environmental impact, among others. It is now clear that in order for patients to benefit maximally from the technology and for airway managers to fully appreciate its role in everyday practice, proper training and education are necessary. Recent research evidence has addressed some existing barriers to default usage, and the emergence of techniques such as awake videolaryngoscopy and video-assisted flexible (bronchoscopic) intubation has also increased the scope of clinical application. Future studies will likely further confirm the superiority of videolaryngoscopy over direct laryngoscopy, therefore, it is incumbent upon all airway managers (and their teams) to gain expertise in videolaryngoscopy and to use it routinely in their everyday practice..
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Affiliation(s)
- Jane Louise Orrock
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
| | | | - Alistair Ferris McNarry
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK
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2
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Kanazawa T. Investigation of the effectiveness of preoperative intubation simulation using a custom-made simulator for pediatric patients with difficult airway: a pilot study. J Anesth 2024:10.1007/s00540-024-03407-4. [PMID: 39279020 DOI: 10.1007/s00540-024-03407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 09/02/2024] [Indexed: 09/18/2024]
Abstract
The purpose of this study is to investigate whether preoperative intubation simulation using custom-made simulator is useful during anesthesia induction for the children who have difficult airway. We included the children under 15 years of age who have difficult airway which had been already known. Prior to the scheduled surgery, CT imaging was performed and a 3D reconstruction of the face from the chest was performed. Then custom-made airway simulator was made. We tried to intubate custom-made simulator of patients preoperatively. We planned how to intubate the patient for anesthesia induction from the result of intubation simulation. The findings of direct laryngoscopy were compared with the findings during intubation. Three patients were included in this study. It took up to 3 weeks to create a simulator, which was difficult due to time constraints to accommodate emergency surgeries. Simulation findings correlated well with findings during anesthesia induction. There were no cases of severe hypotension or hypoxia during induction of anesthesia with the planned intubation method. In conclusion, preoperative intubation simulation using custom-made simulator may be useful for the patients who have difficult airway.
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Affiliation(s)
- Tomoyuki Kanazawa
- Department of Pediatric Anesthesia, Okayama University Hospital, 2-5-1 Shikatachou, Kitaku, Okayama, 700-8558, Japan.
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3
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Jotaki S, Taniguchi H, Miyakawa H, Hiraki T. The Assessment of Airway Compression Due to Cervical Fusion in Klippel-Feil Syndrome Patients: A Report of Two Cases. Kurume Med J 2024; 70:73-75. [PMID: 38763739 DOI: 10.2739/kurumemedj.ms7012009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
In general anesthesia for Klippel-Feil syndrome (KFS) patients, there is a potential risk of difficult intubation. However, airway assessment to predict difficult intubation for KFS patients is not known. In Patient 1, cervical spine computed tomography (CT) revealed airway compression due to cervical fusion. For airway assessment, bronchofiberscopy, three-dimensional (3-D) CT, and virtual bronchoscopic image (VBI) construction were performed. Based on these images, fiberoptic nasotracheal awake intubation was performed. In Patient 2, magnetic resonance imaging and bronchofiberscopy showed no airway compression due to cervical fusion; therefore, tracheal intubation was performed using a video laryngoscope after anesthetic administration. Airway compression due to cervical fusion is considered one of the risk factors for difficult intubation in KFS patients.
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Affiliation(s)
- Shosaburo Jotaki
- Department of Anesthesiology, Kurume University School of Medicine
| | - Hiroko Taniguchi
- Department of Anesthesiology, Kurume University School of Medicine
| | - Haruka Miyakawa
- Department of Anesthesiology, Kurume University School of Medicine
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine
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4
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Yoshida K, Takizuka A, Kakinouchi K, Inoue S. Pros and cons of using rapid sequence induction in all cases requiring general anesthesia. JA Clin Rep 2024; 10:37. [PMID: 38842775 PMCID: PMC11156823 DOI: 10.1186/s40981-024-00720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/26/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Affiliation(s)
- Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima, 960-1295, Japan.
| | - Atsushi Takizuka
- Department of Anesthesiology, Yamashita Hospital, Ichinomiya, Aichi, Japan
| | - Ko Kakinouchi
- Department of Anesthesiology, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Satoki Inoue
- Department of Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikariga-Oka, Fukushima, 960-1295, Japan
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5
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Wylie NW, Durrant EL, Phillips EC, De Jong A, Schoettker P, Kawagoe I, de Pinho Martins M, Zapatero J, Graham C, McNarry AF. Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic: The report of the VL-iCUE survey with responses from 96 countries. Eur J Anaesthesiol 2024; 41:296-304. [PMID: 37962353 DOI: 10.1097/eja.0000000000001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The potential benefit of videolaryngoscopy use in facilitating tracheal intubation has already been established, however its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and after the early phases of the pandemic, whether institutions had acquired new devices during the COVID-19 pandemic, and whether there had been teaching on the devices acquired. DESIGN We designed a survey with 27 questions made available via the Joint Information Scientific Committee JISC online survey platform in English, French, Spanish, Chinese, Japanese and Portuguese. This was distributed through 18 anaesthetic and airway management societies. SETTING The survey was open for 54 to 90 days in various countries. The first responses were logged on the databases on 28 October 2021, with all databases closed on 26 January 2022. Reminders to participate were sent at the discretion of the administering organisations. PARTICIPANTS All anaesthetists and airway managers who received the study were eligible to participate. MAIN OUTCOME MEASURES Videolaryngoscopy use before the COVID-19 pandemic and at the time of the survey. RESULTS We received 4392 responses from 96 countries: 944/4336 (21.7%) were from trainees. Of the 3394 consultants, 70.8% (2402/3394) indicated no change in videolaryngoscopy use, 19.9% (675/3394) increased use and 9.3% (315/3393) reduced use. Among trainees 65.5% (618/943) reported no change in videolaryngoscopy use, 27.7% (261/943) increased use and 6.8% (64/943) reduced use. Overall, videolaryngoscope use increased by 10 absolute percentage points following the pandemic. CONCLUSIONS Videolaryngoscopy use increased following the early phase of the COVID-19 pandemic but this was less than might have been expected.
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Affiliation(s)
- Nia W Wylie
- From the South East Scotland School of Anaesthesia, NHS Lothian, Edinburgh UK (NWW, ELD, ECP), Department of Anesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France (ADJ), Department of Anesthesiology, Lausanne University Hospital, Switzerland (PS), Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Graduate School of Medicine, Japan (IK), Department of Anesthesia, Critical Care and Pain Medicine, Central Hospital of the Military Police of Rio de Janeiro, Rio de Janeiro, Brazil (MP), Hospital Clínic de Barcelona, Spain (JZ), Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, UK (CG), Western General and St Johns Hospitals, NHS Lothian, Edinburgh UK (AFMN)
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6
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Law JA, Kovacs G. Airway guidelines: Addressing the gaps. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:137-140. [PMID: 38272352 DOI: 10.1016/j.redare.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- J A Law
- Department of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - G Kovacs
- Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, QEII Health Sciences Centre, Halifax Infirmary Site, Halifax, Nova Scotia, Canada
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7
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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8
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Fritz C, Monos S, Ng J, Romeo D, Xu K, Moreira A, Rajasekaran K. Management of the Difficult Airway: An Appraisal of Clinical Practice Guidelines. Otolaryngol Head Neck Surg 2024; 170:112-121. [PMID: 37538005 DOI: 10.1002/ohn.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Management of the difficult airway can be a challenging process, which necessitates actionable recommendations from well-established guidelines. Herein, clinical practice guideline (CPG) quality is evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. STUDY DESIGN A systematic literature search was performed using Scopus, EMBASE, and MEDLINE via PubMed. SETTING Literature database. METHODS Data were abstracted from relevant guidelines and appraised by 4 expert reviewers in the 6 domains of quality defined by AGREE II. Intraclass correlation coefficients (ICC) were calculated across domains to quantify interrater reliability. RESULTS Twelve guidelines met the inclusion criteria. With a mean quality score of 83.1%, the highest quality guideline was authored by the American Society of Anesthesiologists (ASA). Low-quality content was observed in CPGs authored by the Japanese Society of Anesthesiologists (JSA) and the Chinese Collaboration Group for Emergency Airway Management (CCGEAM). Overall, deficits were most pronounced in domains describing the involvement of stakeholders, developmental rigor, and editorial independence. These findings were consistent among the panel of independent reviewers, with high ICC inter-rater reliability scores of 58.0% to 70.0% for the referenced domains. CONCLUSION By providing a comprehensive appraisal of guidelines, this report may serve as a reference for clinicians seeking to understand and improve upon the developmental quality of difficult airway management resources. According to AGREE II criteria for the quality of the guideline creation process, the 2022 ASA guideline outperforms its predecessors.
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Affiliation(s)
- Christian Fritz
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stylianos Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jinggang Ng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Matsuyama H, Hara M, Seto A, Hiraki T. Predictive underestimation of difficult direct laryngoscopy in a patient with rheumatoid arthritis-associated immobilized craniocervical junction. JA Clin Rep 2023; 9:85. [PMID: 38051390 DOI: 10.1186/s40981-023-00679-9] [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: 09/06/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for direct laryngoscopy, is lacking. Herein, we present a case of RA with Cormack-Lehane grade IV, which was not predicted by preoperative examination. CASE PRESENTATION A 66-year-old woman with RA was scheduled for a right total knee arthroplasty and right elbow synovectomy. She had a long history of RA without symptoms related to the cervical spine or spinal cord. Although physical examination suggested moderate risk of difficult intubation with preserved cervical retroflexion, her Cormack-Lehane classification was grade IV under muscle relaxation. Bony integration of the occiput to axis was considered to be the main cause of difficult direct laryngoscopy, and restricted neck rotation was found postoperatively. CONCLUSIONS RA patients may have limited upper cervical spine motion despite normal cervical retroflexion.
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Affiliation(s)
- Hirotaka Matsuyama
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masato Hara
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Atsushi Seto
- Nagata Orthopedic Hospital, 1-6-3 Shiranui-Machi, Omuta, Fukuoka, 836-0843, Japan
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
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10
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Kitaura A, Fukuda I, Yuasa H, Tsukimoto S, Nakajima Y. Difficult ventilation due to an undetected mask crack. JA Clin Rep 2023; 9:80. [PMID: 37971603 PMCID: PMC10654299 DOI: 10.1186/s40981-023-00672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Affiliation(s)
- Atsuhiro Kitaura
- Department of Anesthesiology, Facility of Medicine, Kindai University, 377-2 Ohonohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Issei Fukuda
- Department of Anesthesiology, Facility of Medicine, Kindai University, 377-2 Ohonohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Haruyuki Yuasa
- Department of Anesthesiology, Facility of Medicine, Kindai University, 377-2 Ohonohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Shota Tsukimoto
- Department of Anesthesiology, Facility of Medicine, Kindai University, 377-2 Ohonohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Facility of Medicine, Kindai University, 377-2 Ohonohigashi, Osakasayama, Osaka, 589-8511, Japan
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11
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Wollner EA, Nourian MM, Bertille KK, Wake PB, Lipnick MS, Whitaker DK. Capnography-An Essential Monitor, Everywhere: A Narrative Review. Anesth Analg 2023; 137:934-942. [PMID: 37862392 DOI: 10.1213/ane.0000000000006689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests that its use improves outcomes in operating rooms, intensive care units, and emergency departments, as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic derangements. In addition to being useful for diagnosing and managing esophageal intubation, capnography provides crucial information when used for monitoring airway patency and hypoventilation in patients without instrumented airways. Despite its ubiquitous use in high-income-country operating rooms, deaths from esophageal intubations continue to occur in these contexts due to incorrect use or interpretation of capnography. National and international society guidelines on airway management mandate capnography's use during intubations across all hospital areas, and recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless, capnography's use across high-income-country intensive care units, emergency departments, and postanesthesia recovery units remains inconsistent. While capnography is universally used in high-income-country operating rooms, it remains largely unavailable to anesthesia providers in low- and middle-income countries. This lack of access to capnography likely contributes to more frequent and serious airway events and higher rates of perioperative mortality in low- and middle-income countries. New capnography equipment, which overcomes cost and context barriers, has recently been developed. Increasing access to capnography in low- and middle-income countries must occur to improve patient outcomes and expand universal health care. It is time to extend capnography's safety benefits to all patients, everywhere.
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Affiliation(s)
- Elliot A Wollner
- From the Department of Anaesthesia and Perioperative Medicine, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - Maziar M Nourian
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ki K Bertille
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Pauline B Wake
- School of Medicine and Health Sciences, University of Papua New Guinea
| | - Michael S Lipnick
- Department of Anesthesia and Perioperative Medicine, Center for Health Equity in Surgery and Anesthesia (CHESA), University of California, San Francisco, California
| | - David K Whitaker
- Department of Anaesthesia and Intensive Care, Manchester Royal Infirmary, United Kingdom
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12
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Sekimoto S, Kiyama S, Uezono S. Successful reversal of remimazolam anesthesia in a "cannot intubate, can ventilate" situation: a case report. JA Clin Rep 2023; 9:46. [PMID: 37482584 PMCID: PMC10363519 DOI: 10.1186/s40981-023-00638-4] [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: 06/28/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Compared to other intravenous anesthetics, availability of a specific antagonist flumazenil is a clear advantage of remimazolam. We report a patient who could be rapidly woken up when laryngoscopy and tracheal intubation were unexpectedly difficult. CASE PRESENTATION A 62-year-old man was scheduled to have resection of a small gingival tumor. Preoperative airway examination was unremarkable except for an omega-shaped epiglottis. Anesthesia was induced with remifentanil/remimazolam infusion and rocuronium. A small omega-shaped edematous epiglottis precluded identification of glottis. Consciousness and spontaneous ventilation were rapidly restored after administration of flumazenil and sugammadex. Tracheostomy was done under local anesthesia while the patient breathed spontaneously. CONCLUSIONS Remimazolam can be a reasonable induction agent when there are concerns regarding airway management. Avoiding repeated airway manipulations is extremely important to prevent deterioration into a "cannot intubate, cannot ventilate (CICV)" emergency.
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Affiliation(s)
- Shota Sekimoto
- Department of Anesthesiology, School of Medicine, The Jikei University, Nishi-Shimbashi 3-25-8, Minato-Ku, Tokyo, 105-8461, Japan
| | - Shuya Kiyama
- Department of Anesthesiology, School of Medicine, The Jikei University, Nishi-Shimbashi 3-25-8, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Shoichi Uezono
- Department of Anesthesiology, School of Medicine, The Jikei University, Nishi-Shimbashi 3-25-8, Minato-Ku, Tokyo, 105-8461, Japan
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13
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Nagaura M, Saitoh K, Tsujimoto G, Yasuda A, Shionoya Y, Sunada K, Kawai T. Usefulness of preoperative computed tomography findings for airway management in patients with acute odontogenic infection: a retrospective study. Odontology 2023; 111:499-510. [PMID: 36279070 DOI: 10.1007/s10266-022-00756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Odontogenic infection is more likely to affect the airway and interfere with intubation than non-odontogenic causes. Although anesthesiologists predict the difficulty of intubation and determine the method, they may encounter unexpected cases of difficult intubation. An inappropriate intubation can cause airway obstruction due to bleeding and edema by damaging the pharynx and larynx. This study was performed to determine the most important imaging findings indicating preoperative selection of an appropriate intubation method. This retrospective study included 113 patients who underwent anti-inflammatory treatment for odontogenic infection. The patients were divided into two groups according to the intubation method: a Macintosh laryngoscope (45 patients) and others (video laryngoscope and fiberscope) (68 patients). The extent of inflammation in each causative tooth, the severity of inflammation (S1-4), and their influence on the airway were evaluated by computed tomography. The causative teeth were mandibular molars in more than 90%. As the severity of inflammation increased, anesthesiologists tended to choose intubation methods other than Macintosh laryngoscopy. In the most severe cases (S4), anesthesiologists significantly preferred other intubation methods (33 cases) over Macintosh laryngoscopy (9 cases). All patients with S4 showed inflammation in the parapharyngeal space, and the airway was affected in 41 patients. The mandibular molars were the causative teeth most likely to affect the airway and surrounding region. In addition to clinical findings, the presence or absence of inflammation that has spread to the parapharyngeal space on preoperative computed tomography was considered an important indicator of the difficulty of intubation.
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Affiliation(s)
- Madoka Nagaura
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan.
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan.
| | - Keisuke Saitoh
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Gentaro Tsujimoto
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Asako Yasuda
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
| | - Taisuke Kawai
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan
- Division of Oral Diagnosis, Dental and Maxillofacial Radiology and Oral Pathology Diagnostic Services, The Nippon Dental University Hospital, 2-3-16 Fujimi, Chiyoda-Ku, Tokyo, 102-8158, Japan
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14
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Chrimes N, Higgs A, Hagberg CA, Baker PA, Cooper RM, Greif R, Kovacs G, Law JA, Marshall SD, Myatra SN, O'Sullivan EP, Rosenblatt WH, Ross CH, Sakles JC, Sorbello M, Cook TM. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia 2022; 77:1395-1415. [PMID: 35977431 DOI: 10.1111/anae.15817] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 01/07/2023]
Abstract
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occur in the hands of both inexperienced and experienced practitioners. Current evidence shows that unrecognised oesophageal intubation occurs sufficiently frequently to be a major concern and to merit a co-ordinated approach to address it. Harm from unrecognised oesophageal intubation is avoidable through reducing the rate of oesophageal intubation, combined with prompt detection and immediate action when it occurs. The detection of 'sustained exhaled carbon dioxide' using waveform capnography is the mainstay for excluding oesophageal placement of an intended tracheal tube. Tube removal should be the default response when sustained exhaled carbon dioxide cannot be detected. If default tube removal is considered dangerous, urgent exclusion of oesophageal intubation using valid alternative techniques is indicated, in parallel with evaluation of other causes of inability to detect carbon dioxide. The tube should be removed if timely restoration of sustained exhaled carbon dioxide cannot be achieved. In addition to technical interventions, strategies are required to address cognitive biases and the deterioration of individual and team performance in stressful situations, to which all practitioners are vulnerable. These guidelines provide recommendations for preventing unrecognised oesophageal intubation that are relevant to all airway practitioners independent of geography, clinical location, discipline or patient type.
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Affiliation(s)
- N Chrimes
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - A Higgs
- Department of Anaesthesia and Intensive Care, Warrington Teaching Hospitals NHS Foundation Trust, Cheshire, UK
| | - C A Hagberg
- Department of Anaesthesiology and Peri-operative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P A Baker
- Department of Anaesthesiology, University of Auckland, New Zealand
- Department of Anaesthesiology, Starship Children's Hospital, Auckland, New Zealand
| | - R M Cooper
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - R Greif
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland
- Department of Medical Education, Sigmund Freud University, Vienna, Austria
| | - G Kovacs
- Departments of Emergency Medicine, Anesthesia, Medical Neurosciences and Division of Medical Education, Dalhousie University, Halifax, Canada
| | - J A Law
- Department of Anesthesia, Pain Management and Peri-operative Medicine, Dalhousie University, Halifax, Canada
| | - S D Marshall
- Department of Critical Care, University of Melbourne, VIC, Australia
- Department of Anaesthesia and Peri-operative Medicine, Monash University, Melbourne, VIC, Australia
| | - S N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - E P O'Sullivan
- Department of Anaesthesiology, St James's Hospital, Dublin, Ireland
| | - W H Rosenblatt
- Department of Anesthesia, Yale School of Medicine, New Haven, CT, USA
| | - C H Ross
- Department of Emergency Medicine, Mercy Health, Javon Bea Hospital, Rockton and Riverside Campuses, Rockford, IL, USA
- Department of Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - J C Sakles
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - M Sorbello
- Anesthesia and Intensive Care, AOU Policlinico San Marco University Hospital, Catania, Italy
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- School of Medicine, University of Bristol, Bristol, UK
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15
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Standard of anesthesia care: possible dissociation from recommendations made by clinical practice guidelines. J Anesth 2022; 36:642-647. [PMID: 35997835 DOI: 10.1007/s00540-022-03098-9] [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: 03/25/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
A medical malpractice lawsuit may be brought against health care providers, if there was a possibility of a negligence, or failure to meet the standard of care. Recently, clinical practice guidelines have increasingly been used as evidence of the standard of care. Nevertheless, it is not clear whether these guidelines can be used as evidence of the standard of care. We carried out a snapshot study to know whether or not there were dissociations between the current standard of anesthesia care and recommendations made by clinical practice guidelines. We asked all the 80 heads of Anesthesiology departments of Japanese public and private Universities, to answer questions related to difficult airway management after induction of anesthesia, postoperative monitoring of breathing, and of the presence or the absence of neuropathy of the lower legs after regional anesthesia. The response rate was 71% (57/80). The majority of anesthesiologists had little experience with front-of-neck access in patient, and responders might frequently make repeated attempts at tracheal intubation. Postoperative monitoring was frequently not routinely performed. In conclusion, this study has shown that there may be various degrees of dissociations between the current standard of anesthesia care and the recommendations made by clinical practice guidelines that had been used as evidence of the standard of care in medical malpractice lawsuit cases in Japan.
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16
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Ide A, Nozaki-Taguchi N, Sato S, Saito K, Sato Y, Isono S. Rocuronium versus saline for effective facemask ventilation during anesthesia induction: a double-blinded randomized placebo-controlled trial. BMC Anesthesiol 2022; 22:173. [PMID: 35659538 PMCID: PMC9164462 DOI: 10.1186/s12871-022-01717-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mask ventilation progressively improves after loss of consciousness during anesthesia induction possibly due to progression of muscle paralysis. This double-blinded randomized placebo-controlled study aimed to test a hypothesis that muscle paralysis improves mask ventilation during anesthesia induction.
Methods
Forty-four adults patients including moderate to severe obstructive sleep apnea undergoing scheduled surgeries under elective general anesthesia participated in this study. Randomly-determined test drug either rocuronium or saline was blinded to the patient and anesthesia provider. One-handed mask ventilation with an anesthesia ventilator providing a constant driving pressure and respiratory rate (15 breaths per minute) was performed during anesthesia induction, and changes of capnogram waveform and tidal volume were assessed for one minute. The needed breaths for achieving plateaued-capnogram (primary variable) within 15 consecutive breaths were compared between the test drugs.
Results
Measurements were successful in 38 participants. Twenty-one and seventeen patients were allocated into saline and rocuronium respectively. The number of breaths achieving plateaued capnogram did not differ between the saline (95% C.I.: 6.2 to 12.8 breaths) and rocuronium groups (95% C.I.: 5.6 to 12.7 breaths) (p = 0.779). Mean tidal volume changes from breath 1 was significantly greater in rocuronium group than saline group (95% C.I.: 0.56 to 0.99 versus 3.51 to 4.53 ml kg-IBW−1, p = 0.006). Significantly more patients in rocuronium group (94%) achieved tidal volume greater than 5 mg kg-ideal body weight−1 within one minute than those in saline group (62%) (p = 0.026). Presence of obstructive sleep apnea did not affect effectiveness of rocuronium for improvement of tidal volume during one-handed mask ventilation.
Conclusions
Use of rocuronium facilitates tidal volume improvement during one-handed mask ventilation even in patients with moderate to severe obstructive sleep apnea.
Trial registration
The clinical trial was registered at (05/12/2013, UMIN000012495): https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000014515
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17
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Yamochi S, Kinoshita M, Sawa T. Anesthetic management of a severely obese patient (body mass index 70.1 kg/m 2) undergoing giant ovarian tumor resection: a case report. J Med Case Rep 2022; 16:164. [PMID: 35468828 PMCID: PMC9040208 DOI: 10.1186/s13256-022-03383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Giant ovarian tumors are rarely seen with severe obesity. There are few reports of perioperative management of giant ovarian tumors and severe obesity. Here, we report the perioperative management of physiological changes in massive intraabdominal tumors in a patient with severe obesity. CASE PRESENTATION A 46-year-old Japanese woman (height 166 cm, weight 193.2 kg; body mass index 70.1 kg/m2) was scheduled to undergo laparotomy for a giant ovarian tumor. The patient was placed in the ramp position. Preoxygenation was performed using a high-flow nasal cannula, and awake tracheal intubation was performed using a video laryngoscope. Mechanical ventilation using a limited tidal volume with moderate positive end-expiratory pressure was applied during the surgical procedure. The aspiration speed for 15 L of tumor aspirate was set to under 1 L/minute, and the possibility of reexpansion pulmonary edema was foreseen by conventional monitoring. CONCLUSIONS We successfully completed anesthetic management in a patient with concomitant severe obesity and giant ovarian tumors.
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Affiliation(s)
- Shoko Yamochi
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
| | - Mao Kinoshita
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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18
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Nagabuchi R, Minami H, Sakikawa M, Onodera Y, Kanao-Kanda M, Kanda H. Awake Intubation for a Case of Giant Parapharyngeal Space Tumor Using McGrath MAC® Video Laryngoscopeq. Int Med Case Rep J 2022; 15:19-22. [PMID: 35125893 PMCID: PMC8807866 DOI: 10.2147/imcrj.s345763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Intubation and ventilation cannot be performed in cases of parapharyngeal space tumors as the enlargement of the upper airway leads to the obstruction and hindrance of the intubation procedure. However, there is limited literature on anesthetic management, including the airway, in this disease. Herein, we report a successful case of awake intubation in a patient with parapharyngeal space tumor. Case Presentation A 64-year-old man with a history of giant parapharyngeal space tumor was scheduled for bilateral endoscopic sinus surgery and nasal septoplasty. We performed awake intubation using the McGrath® video laryngoscope, which resulted in excellent laryngeal deployment and a smooth procedure. Conclusion We report the anesthetic management of a giant parapharyngeal space tumor with the potential for difficult airway management to maintain spontaneous breathing. Awake intubation was useful in maintaining ventilation and intubation in this case. The preparation of a cricothyroid puncture is needed in cases of intubation failure.
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Affiliation(s)
- Ririko Nagabuchi
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hikari Minami
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Makoto Sakikawa
- Department of Dentistry and Oral Surgery, Rinseikai Yoshida Hospital, Nayoro, Japan
| | - Yoshiko Onodera
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Megumi Kanao-Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan
- Correspondence: Hirotsugu Kanda, Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka-higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan, Tel +81-166-68-2583, Fax +81-166-68-2589, Email
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19
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Fuchs A, Haller M, Riva T, Nabecker S, Greif R, Berger-Estilita J. Translation and application of guidelines into clinical practice: A colour-coded difficult airway trolley. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Iliff HA, El-Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan-Pak-Kee V, O'Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia 2021; 77:82-95. [PMID: 34545943 PMCID: PMC9291554 DOI: 10.1111/anae.15585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 12/16/2022]
Abstract
Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri‐operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high‐quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post‐thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post‐haematoma evacuation care; day‐case thyroid surgery; training; consent and pre‐operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.
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Affiliation(s)
- H A Iliff
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - J Davis
- Department of Otolaryngology Head and Neck Surgery, Medway NHS Foundation Trust, Gillingham, UK
| | - A Harris
- Patient Representative, London, UK
| | - S Khan
- Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Lan-Pak-Kee
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - J O'Connor
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
| | - L Powell
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, UK
| | - G Rees
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK
| | - T S Tatla
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
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21
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Farid AM, Taman HI. The Impact of Sevoflurane and Propofol Anesthetic Induction on Bag Mask Ventilation in Surgical Patients with High Body Mass Index. Anesth Essays Res 2021; 14:594-599. [PMID: 34349326 PMCID: PMC8294424 DOI: 10.4103/aer.aer_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: Obesity is associated with restrictive ventilatory pattern which causes rapid oxygen desaturation. Although obesity is considered as a risk factor for difficult airway management, failure to achieve effective bag mask ventilation (BMV) can be catastrophic. This study tried to assess the effect of both propofol and sevoflurane on the efficacy of BMV during anesthetic induction in obese patients. Patients and Methods: A total of 200 cases were included, and they were randomly divided into two equal groups; Group S which included 100 cases who underwent sevoflurane induction, and Group P which included the remaining 100 cases who underwent propofol induction. Results: No statistically significant difference was detected between the two groups regarding patient and air way characteristics (P > 0.05). Difficult BMV (DBMV) was encountered in 19% and 37% of cases in Groups S and P, respectively. The incidence of DBMV was significantly increased in the P group (P = 0.005). Furthermore, the severity of difficulty was more marked in the P group. Logistic regression analysis revealed that thyromental distance, presence of macroglossia, presence of beard, lack of teeth, history of snoring, as well as propofol induction were risk factors for DBMV. Conclusion: Sevoflurane can facilitate BMV and provide better intubation conditions in comparison to propofol during anesthetic induction in morbidly obese patients. Moreover, decreased thyromental distance, presence of macroglossia and beard, lack of teeth, and history of snoring are considered preoperative indicators of DBMV.
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Affiliation(s)
- Ahmed M Farid
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hani I Taman
- Department of Anesthesia, Surgical Intensive Care and Pain Management, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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22
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Kuwana K, Obara S, Tanaka S, Sato Y, Yoshida K, Hanayama C, Hakozaki T. The use of the Sanuki airway™ in three patients with suspected difficult airway. SAGE Open Med Case Rep 2021; 9:2050313X211031311. [PMID: 34290870 PMCID: PMC8273519 DOI: 10.1177/2050313x211031311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
The Sanuki airway is a single-use intubation oral airway designed for fiberoptic bronchoscope intubation. Sanuki airway has a bite block function and a wide lumen for the tracheal tube to pass through. Here, three cases are reported in which Sanuki airway was used for oral fiberoptic bronchoscope intubation. Case 1 is a patient who presented with reduced mouth opening and intraoral edema due to facial bone fracture. Case 2 is a patient who suffered from severe neck stiffness and had reduced mouth opening due to systemic psoriatic arthritis. Case 3 is a patient who suffered from multiple facial traumas and was in a full-stomach state. In all patients, advancing the tip of the bronchofiber into the larynx using Sanuki airway was possible under dexmedetomidine sedation, which contributed to the successful tracheal intubation. Using Sanuki airway may be considered an option for oral fiberoptic bronchoscope intubation in patients anticipated with difficult airways.
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Affiliation(s)
- Keisuke Kuwana
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Shinju Obara
- Surgical Operation Department, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Shiori Tanaka
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Yuki Sato
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Chie Hanayama
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Takahiro Hakozaki
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
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23
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Yasuda A, Miyazawa N, Inoue E, Imai T, Shionoya Y, Nakamura K. Anesthetic Management of a Juvenile Hyaline Fibromatosis Patient With Trismus and Cervical Movement Limitation. Anesth Prog 2021; 68:117-118. [PMID: 34185859 PMCID: PMC8258748 DOI: 10.2344/anpr-68-01-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/31/2019] [Indexed: 11/11/2022] Open
Abstract
Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease characterized by the presence of tissue nodules, joint contractures, and gingival hyperplasia. With a 1-year-9-month-old female patient scheduled for a gingivectomy and excision of a lower lip mass under general anesthesia, it was anticipated that airway management would be difficult because of trismus and limited cervical movement. Intubation with video-laryngoscopic assistance could not be achieved because gingival hyperplasia and trismus prevented blade insertion and manipulation. Therefore, 2 endotracheal tubes were used: 1 used as a nasopharyngeal airway for assisted ventilation, and 1 used for intubation along with a flexible fiberoptic scope. This case demonstrated a useful method for managing ventilation and intubation in patients with JHF, particularly when the use of oral airway devices is difficult.
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Affiliation(s)
- Asako Yasuda
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Noriko Miyazawa
- Department of Anesthesiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Emiko Inoue
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Tomoaki Imai
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Yoshiki Shionoya
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
| | - Kiminari Nakamura
- Department of Dental Anesthesia, The Nippon Dental University Hospital, Tokyo, Japan
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24
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Tang ZH, Chen Q, Wang X, Su N, Xia Z, Wang Y, Ma WH. A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation. Medicine (Baltimore) 2021; 100:e25324. [PMID: 33832107 PMCID: PMC8036033 DOI: 10.1097/md.0000000000025324] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Awake fiberoptic endoscope intubation (AFOI) is the primary strategy for managing anticipated difficult airways. Adequate sedation, most commonly being achieved with remifentanil and dexmedetomidine, is integral to this procedure. This meta-analysis aimed to compare the safety and efficacy of these 2 sedatives. METHODS We conducted electronic searches in Embase, Web of Science, PubMed, Google Scholar, Medline, Springer, and Web of Science with no language restrictions. Studies comparing safety and efficacy between the sole use of remifentanil and dexmedetomidine among patients who underwent AFOI were included. Eight randomized controlled trials, comprising 412 patients, met the inclusion criteria. The primary outcomes were first attempt intubation success rate and incidence of hypoxia. The secondary outcomes were the Ramsay Sedation Scale score at intubation, memory recall of endoscopy, and unstable hemodynamic parameters during intubation. RESULTS Dexmedetomidine significantly reduced the incidence of hypoxemia during AFOI (risk ratio: 2.47; 95% confidence [CI]: 1.32-4.64]) compared with remifentanil; however, the first intubation success rates were equivalent (risk ratio: 1.12; 95% CI: 0.87-1.46]. No significant differences between the 2 sedatives were found for the Ramsay Sedation Scale score at intubation (mean difference: -0.14; 95% CI: -0.66-0.38) or unstable hemodynamic parameters during intubation (risk ratio: 0.83; 95% CI: 0.59-1.17). Dexmedetomidine reduced memory recall of endoscopy (risk ratio: 1.39; 95% CI: 1.13-1.72). CONCLUSIONS While both remifentanil and dexmedetomidine are effective for AFOI and well-tolerated, dexmedetomidine may be more effective in reducing the incidence of hypoxemia and memory recall of endoscopy. PROSPERP REGISTRATION NUMBER CRD42020169612.
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Affiliation(s)
- Zhi-hang Tang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Qi Chen
- Anesthesiology Department of Chongqing University Cancer Hospital/Chongqing Cancer institute, Chongqing
| | - Xia Wang
- Guangzhou University of Chinese Medicine, Guangzhou
| | - Nan Su
- Inner Mongolia People's Hospital, Inner Mongolia
| | - Zhengyuan Xia
- Department of Anesthesiology, the University of Hong Kong, Hong Kong, China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Wu-hua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
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Clark CM, Morgan BT, Schmitt D, Harman RJ, Goode V. Improving Emergency Cricothyroidotomies: Simulation-Based Training for Critical Care Providers. Crit Care Nurs Q 2021; 44:203-213. [PMID: 33595967 DOI: 10.1097/cnq.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses skill proficiency of providers related to emergency cricothyroidotomies. Various techniques to improve procedural skills were studied. Accurate identification of the cricothyroid membrane via palpation remained consistently inadequate. High-fidelity simulation including the use of human cadavers may be the preferred method of skill training for crisis management. The authors emphasize that additional research is needed regarding a method for rapid cricothyroid membrane identification as well as needle cricothyroidotomy versus surgical airway on cadavers. More consistent training will enable emergency care providers to perform this rare but lifesaving skill.
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Affiliation(s)
- Clayton M Clark
- Duke University Nurse Anesthesia Program, Duke University School of Nursing, Durham, North Carolina (Drs Clark, Morgan, and Goode); Department of Evolutionary Anthropology, Duke University, Durham, North Carolina (Dr Schmitt); Department of Anesthesiology, Duke University Hospital, Durham, North Carolina (Dr Harman); and Johns Hopkins University School of Nursing, Baltimore, Maryland (Dr Goode)
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26
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Abrons RO, Ten Eyck P, Sheffield ID. The Articulated Oral Airway as an aid to mask ventilation: a prospective, randomized, interventional, non-inferiority study. BMC Anesthesiol 2021; 21:94. [PMID: 33781212 PMCID: PMC8006343 DOI: 10.1186/s12871-021-01315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background Oropharyngeal airways are used both to facilitate airway patency during mask ventilation as well as conduits for flexible scope intubation, though none excel at both. A novel device, the Articulated Oral Airway (AOA), is designed to facilitate flexible scope intubation by active displacement of the tongue. Whether this active tongue displacement also facilitates mask ventilation, thus adding dual functionality, is unknown. This study compared the AOA to the Guedel Oral Airway (GOA) in regards to efficacy of mask ventilation of patients with factors predictive of difficult mask ventilation. The hypothesis was that the AOA would be non-inferior to the GOA in terms of expiratory tidal volumes by a margin of 1 ml/kg, thus demonstrating dual functionality. Methods In this randomized controlled clinical trial, fifty-eight patients with factors predictive of difficult mask ventilation were mask ventilated with both the GOA and the AOA. Video of the anesthetic monitors were evaluated by a blinded member of the research team, noting inspiratory and expiratory tidal volumes and expiratory CO2 waveforms. Results The AOA was found to be non-inferior to the GOA at a margin of 1 ml/kg with a mean weight-standardized expiratory tidal measurement 0.45 ml/kg lower (CI: 0.34–0.57) and inspiratory tidal measurement 0.109 lower (CI: − 0.26-0.04). There was no significant difference in expiratory waveforms (p = 0.2639). Conclusions The AOA was non-inferior to the GOA for mask ventilation of patients with predictors of difficult mask ventilation and there was no significant difference in EtCO2 waveforms between the groups. These results were consistent in the subset of patients who were initially difficult to mask ventilate. Trial registration ClinicalTrials.gov, NCT03144089, May 2017.
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Affiliation(s)
- Ron O Abrons
- Associate Professor, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Patrick Ten Eyck
- Assistant Director for Biostatistics and Research Design, Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Isaac D Sheffield
- Resident in Anesthesiology, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Choudhry DK, Brenn BR, Sacks K, Lutwin-Kawalec M, Aaronson NL, Rahman T. Comparative evaluation of one-handed versus two-handed mask holding techniques in children during inhalational induction of anesthesia: A randomized crossover study. Paediatr Anaesth 2021; 31:338-345. [PMID: 33340185 DOI: 10.1111/pan.14111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to evaluate if two-handed mask airway is superior to one-handed mask airway during inhalational induction of anesthesia in children. METHODS A randomized, two period, crossover study was performed on 60 children aged 1-8 years, with obstructive sleep apnea due to adenotonsillar hypertrophy, scheduled for adenotonsillectomy. Children were assigned to two study sequences and one control sequence of 20 subjects each. A control sequence was added to evaluate the effect of anesthetic depth. Sequence 1: One-handed followed by two-handed airway, 30 seconds each; Sequence 2: two-handed followed by one-handed airway, 30 seconds each and Sequence 3: two-handed airway, for 60 seconds. The work of breathing indices, phase angle, and labored breathing index were recorded using respiratory inductance plethysmography. Additional outcome measures were tidal volume, minute ventilation, and respiratory rate. A straight comparison and a crossover analysis was performed. RESULTS The initial comparison revealed that one-handed airway had greater phase angle (mean diff. 17.4; 95% confidence interval [CI] 1.07-33.68; P = .034), greater labored breathing index (mean diff. 0.56; 95% CI 0.16-1.04; P = .004),lower minute ventilation (mean diff. -1567; 95% CI -2695 to -5.4; P = .004),and lower tidal volume (mean diff. -39; 95% CI -2.7 to -5.4; P = .02) than two-handed airway. On crossover analysis, within-subject difference in the phase angle was greater during one-handed than two-handed airway (34.3; 95% CI 8.46-60.14; P = .01) as was labored breathing index (mean diff. 1.2; 95% CI 0.39-2.00; P < .0046).Minute ventilation was lower during one-handed than two-handed airway (mean diff. -3359; 95% CI -4363 to -2355, P < 0.0001) as was tidal volume(mean diff. -78; 95% CI -110.4 to -45.8; P < .0001). CONCLUSION In children with obstructive sleep apnea due to adenotonsillar hypertrophy, two-handed airway provides superior airway patency that was not influenced by the anesthetic depth.
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Affiliation(s)
| | - B Randall Brenn
- Shriners Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Karen Sacks
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | | | - Nicole L Aaronson
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Tariq Rahman
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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28
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Grigonytė M, Kraujelytė A, Januškevičiūtė E, Šėmys G, Bružytė-Narkienė G, Kriukelytė O, Kontrimavičiūtė E, Valevičienė NR. Current Recommendations for Airway Management Techniques in COVID-19 Patients without Respiratory Failure Undergoing General Anaesthesia: A Nonsystematic Literature Review. Acta Med Litu 2021; 28:19-30. [PMID: 34393625 PMCID: PMC8311853 DOI: 10.15388/amed.2021.28.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022] Open
Abstract
Summary Background Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first emerged, many articles have been published on airway management for coronavirus disease 2019 (COVID-19) patients. However, there is a lack of clear and concise conceptual framework for working with infected patients without respiratory failure undergoing general anaesthesia compared to noninfected patients. The aim of this article is to review current literature data on new challenges for anaesthesia providers, compare standard airway management techniques protocols with new data, and discuss optimisation potential. Materials and methods Literature search was performed in Google Scholar and PubMed databases using these keywords and their combinations: anaesthesia, preoxygenation, airway management, difficult airway, SARS-CoV-2, COVID-19. The following nonsystematic review is based on a comprehensive literature search of available data, wherein 41 articles were chosen for detailed analysis. Summarised and analysed data are presented in the article. Results SARS-CoV-2 has unique implications for airway management techniques in patients without respiratory failure undergoing general anesthesia. Main differences with the standard practice include: institutional preparedness, team composition principles, necessary skills, equipment, drugs, intubation and extubation strategies. Failed or difficult intubation is managed with predominance of emergency front of neck access (FONA) due to increased aerosol generation. Conclusions Airway management techniques in COVID-19 patients without respiratory failure are more challenging than in noninfected patients undergoing general anaesthesia. Safe, accurate and swift actions avoid unnecessary time delay ensuring the best care for patients, and reduce risk of contamination for staff. Appropriate airway strategy, communication, minimisation of time for aerosol generating procedures and ramped-up position aid to achieve these goals. During the pandemic, updated available literature data may change clinical practice as new evidence emerges.
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Affiliation(s)
| | | | | | - Giedrius Šėmys
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Greta Bružytė-Narkienė
- Faculty of Medicine, Vilnius University, Vilnius, LithuaniaCentre of Anaesthesiology, Intensive Therapy and Pain Management, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Oresta Kriukelytė
- Faculty of Medicine, Vilnius University, Vilnius, LithuaniaCentre of Anaesthesiology, Intensive Therapy and Pain Management, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eglė Kontrimavičiūtė
- Centre of Anaesthesiology, Intensive Therapy and Pain Management, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Nomeda Rima Valevičienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Morimatsu H. Incidence of accidental events during anesthesia from 2012 to 2016: survey on anesthesia-related events by the Japanese Society of Anesthesiologists. J Anesth 2021; 35:206-212. [PMID: 33566155 DOI: 10.1007/s00540-021-02898-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The Japanese Society of Anesthesiologists (JSA) has conducted surveys on life-threatening accidental events during anesthesia and reported results since 1992. This report describes the incidence of these life-threatening accidental events in the survey period between 2012 and 2016. METHODS JSA conducts an annual survey on accidental events. Each participating facility reports life-threatening accidental events that occurred each year. Facilities accredited by the JSA can electronically report events using the JSA Perioperative Information Management System (JSA-PIMS) software program that interfaces with the electronic anesthesia record system. RESULTS The number of cardiac arrest events per 10,000 anesthesia cases gradually decreased from 2.97 in 2012 to 2.30 in 2016 (odds ratio OR 0.77 95% CI 0.68-0.88). The number of severe hypotension events per 10,000 anesthesia cases gradually decreased from 4.63 in 2012 to 4.24 in 2016 (OR 0.92, 95% CI 0.83-1.01). The number of severe hypoxia events per 10,000 anesthesia cases gradually decreased from 2.01 in 2012 to 1.59 in 2016 (OR 0.79, 95% CI 0.68-0.92). The number of life-threatening arrhythmia events per 10,000 anesthesia cases was 1.14 in 2012. Thereafter, it tended to decrease slightly to 0.88 in 2016 (OR 0.77, 95% CI 0.63-0.95). CONCLUSION The incidence of cardiac arrest during this period was 2.63/10,000, which was lower the incidence reported in other countries. While no change was observed in the incidence of severe hypotension over the survey period, the incidence of severe hypoxia and life-threatening arrhythmia decreased by 20-25% during those 5 years.
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Affiliation(s)
- Hiroshi Morimatsu
- Okayama University Hospital, 2-5-1, Kitaku, Shikatacho, Okayama, Japan.
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30
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Konda M, Inoue S, Naito Y, Egawa J, Kawaguchi M. Life-threatening airway obstruction caused by angioedema in a morbidly obese postoperative patient: a case report. JA Clin Rep 2021; 7:1. [PMID: 33398469 PMCID: PMC7782656 DOI: 10.1186/s40981-020-00408-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background We report a case of a morbidly obese patient who developed life-threatening airway obstruction due to angioedema. Case presentation A 50-year-old Japanese morbidly obese female was treated with enalapril for 10 years, with no history of angioedema. After 3 h of completion of breast cancer resection under general anesthesia with tracheal intubation, she developed airway obstruction and respiratory arrest. Her oral cavity was occupied with a swollen tongue. It was extremely difficult to determine the airway anatomical orientation although tracheal intubation was attempted using a videolaryngoscope. At this time, she probably started gasping respiration, which generated a faint bubble and revealed a possible airway. Her airway was established using a tracheal tube without confirming the glottis or the vocal cord. Conclusions Angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is rare; however, once it occurs, it can be potentially life threatening, especially for patients with possible difficult airway. Considering the risk–benefit ratio, we must be careful in administering ACE inhibitor therapy in morbidly obese patients.
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Affiliation(s)
- Makiko Konda
- Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Satoki Inoue
- Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yusuke Naito
- Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Junji Egawa
- Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Jones PM, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Kovacs G. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth 2021; 68:1373-1404. [PMID: 34143394 PMCID: PMC8212585 DOI: 10.1007/s12630-021-02007-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider "exit strategy" options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a "cannot ventilate, cannot oxygenate" emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as "airway lead" to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.
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Affiliation(s)
- J. Adam Law
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Room 5452, Halifax, NS B3H 3A7 Canada
| | - Laura V. Duggan
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Mathieu Asselin
- grid.23856.3a0000 0004 1936 8390Département d’anesthésiologie et de soins intensifs, Université Laval, 2325 rue de l’Université, Québec, QC G1V 0A6 Canada ,grid.411081.d0000 0000 9471 1794Département d’anesthésie du CHU de Québec, Hôpital Enfant-Jésus, 1401 18e rue, Québec, QC G1J 1Z4 Canada
| | - Paul Baker
- grid.9654.e0000 0004 0372 3343Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Edward Crosby
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Suite CCW1401, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Andrew Downey
- grid.1055.10000000403978434Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Orlando R. Hung
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Philip M. Jones
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Rd., London, ON N6A 5A5 Canada
| | - François Lemay
- grid.417661.30000 0001 2190 0479Département d’anesthésiologie, CHU de Québec – Université Laval, Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, QC G1R 2J6 Canada
| | - Rudiger Noppens
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Matteo Parotto
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Interdepartmental Division of Critical Care Medicine, University of Toronto, EN 442 200 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Roanne Preston
- grid.413264.60000 0000 9878 6515Department of Anesthesia, BC Women’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Nick Sowers
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Kathryn Sparrow
- grid.25055.370000 0000 9130 6822Discipline of Anesthesia, St. Clare’s Mercy Hospital, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John’s, NL A1B V6 Canada
| | - Timothy P. Turkstra
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - David T. Wong
- grid.17063.330000 0001 2157 2938Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St, Toronto, ON M5T2S8 Canada
| | - George Kovacs
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
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Chrimes N, Higgs A, Law JA, Baker PA, Cooper RM, Greif R, Kovacs G, Myatra SN, O'Sullivan EP, Rosenblatt WH, Ross CH, Sakles JC, Sorbello M, Hagberg CA. Project for Universal Management of Airways - part 1: concept and methods. Anaesthesia 2020; 75:1671-1682. [PMID: 33165958 PMCID: PMC7756721 DOI: 10.1111/anae.15269] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2020] [Indexed: 12/17/2022]
Abstract
Multiple professional groups and societies worldwide have produced airway management guidelines. These are typically targeted at the process of tracheal intubation by a particular provider group in a restricted category of patients and reflect practice preferences in a particular geographical region. The existence of multiple distinct guidelines for some (but not other) closely related circumstances, increases complexity and may obscure the underlying principles that are common to all of them. This has the potential to increase cognitive load; promote the grouping of ideas in silos; impair teamwork; and ultimately compromise patient care. Development of a single set of airway management guidelines that can be applied across and beyond these domains may improve implementation; promote standardisation; and facilitate collaboration between airway practitioners from diverse backgrounds. A global multidisciplinary group of both airway operators and assistants was assembled. Over a 3-year period, a review of the existing airway guidelines and multiple reviews of the primary literature were combined with a structured process for determining expert consensus. Any discrepancies between these were analysed and reconciled. Where evidence in the literature was lacking, recommendations were made by expert consensus. Using the above process, a set of evidence-based airway management guidelines was developed in consultation with airway practitioners from a broad spectrum of disciplines and geographical locations. While consistent with the recommendations of the existing English language guidelines, these universal guidelines also incorporate the most recent concepts in airway management as well as statements on areas not widely addressed by the existing guidelines. The recommendations will be published in four parts that respectively address: airway evaluation; airway strategy; airway rescue and communication of airway outcomes. Together, these universal guidelines will provide a single, comprehensive approach to airway management that can be consistently applied by airway practitioners globally, independent of their clinical background or the circumstances in which airway management occurs.
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Affiliation(s)
- N. Chrimes
- Department of AnaesthesiaMonash Medical CentreMelbourneAustralia
| | - A. Higgs
- Department of Anaesthesia and Intensive CareWarrington Hospitals NHS Foundation TrustCheshireUK
| | - J. A. Law
- Department of AnesthesiaPain Management and Peri‐operative MedicineDalhousie UniversityHalifaxCanada
| | - P. A. Baker
- Department of AnaesthesiologyUniversity of AucklandAucklandNew Zealand
- Department of AnaesthesiologyStarship Children's HospitalAucklandNew Zealand
| | - R. M. Cooper
- Department of Anesthesiology and Pain MedicineUniversity of TorontoTorontoCanada
| | - R. Greif
- Department of Anesthesiology and Pain MedicineBern University HospitalBernSwitzerland
- Sigmund Freud University ViennaViennaAustria
| | - G. Kovacs
- Departments of Emergency MedicineAnesthesiaMedical Neurosciences and Division of Medical EducationDalhousie UniversityHalifaxCanada
| | - S. N. Myatra
- Department of AnaesthesiologyCritical Care and PainTata Memorial HospitalHomi Bhabha National InstituteMumbaiIndia
| | | | | | - C. H. Ross
- Department of Emergency MedicineMercy HealthJavon Bea HospitalRockton and Riverside CampusesRockfordILUSA
- Department of SurgeryUniversity of Illinois College of MedicineChicagoILUSA
| | - J. C. Sakles
- Department of Emergency MedicineUniversity of Arizona College of MedicineTucsonAZUSA
| | - M. Sorbello
- Anesthesia and Intensive CareAOU Policlinico San Marco University HospitalCataniaItaly
| | - C. A. Hagberg
- AnesthesiologyCritical Care and Pain MedicineBud Johnson Clinical Distinguished ChairDepartment of Anaesthesiology and Peri‐operative MedicineUniversity of Texas MD Anderson Cancer CenterHoustonTXUSA
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Wong P, Lim WY. Aligning difficult airway guidelines with the anesthetic COVID-19 guidelines to develop a COVID-19 difficult airway strategy: a narrative review. J Anesth 2020; 34:924-943. [PMID: 32642840 PMCID: PMC7341705 DOI: 10.1007/s00540-020-02819-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/20/2020] [Indexed: 12/17/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is caused by a coronavirus that is transmitted primarily via aerosol, droplets or direct contact. This may place anesthetists at higher risk of infection due to their frequent involvement in aerosol-generating airway interventions. Many anesthethetic COVID-19 guidelines have emerged, whose underlying management principles include minimizing aerosol contamination and protecting healthcare workers. These guidelines originate from Australia and New Zealand, Canada, China, India, Italy, Korea, Singapore, the United States and the United Kingdom. Hospitalized COVID-19 patients may require airway interventions, and difficult tracheal intubation secondary to laryngeal edema has been reported. Pre-pandemic difficult airway guidelines include those from Canada, France, Germany, India, Japan, Scandinavia, the United States and the United Kingdom. These difficult airway guidelines require modifications in order to align with the principles of the anesthetic COVID-19 guidelines. In turn, most of the anesthetic COVID-19 guidelines do not, or only briefly, discuss an airway strategy after failed tracheal intubation. Our article identifies and compares pre-pandemic difficult airway guidelines with the recent anesthetic COVID-19 guidelines. We combine the principles from both sets of guidelines and explain the necessary modifications to the airway guidelines, to form a failed tracheal intubation airway strategy in the COVID-19 patient. Valuing, and a greater understanding of, these differences and modifications may lead to greater adherence to the new COVID-19 guidelines.
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Affiliation(s)
- Patrick Wong
- Duke-National University of Singapore Medical School, Yong Loo Lin School of Medicine (National University of Singapore), Singapore, Singapore
- Division of Anesthesiology and Perioperative Sciences, Sengkang General Hospital, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Wan Yen Lim
- Division of Anesthesiology and Perioperative Sciences, Sengkang General Hospital, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
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Tanaka S, Yoshida K, Muramatsu K, Yamagishi S, Obara S, Watanabe K. An experience of subglottic airway foreign body removal in a patient under tracheal intubation: a case report. JA Clin Rep 2020; 6:76. [PMID: 33011931 PMCID: PMC7533046 DOI: 10.1186/s40981-020-00382-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background Removal of an airway foreign body is challenging to anesthesiologists. We report successful removal of an extremely rare foreign body between a tracheal tube and the trachea in patients under tracheal intubation. Case presentation A 57-year-old male received total aortic arch replacement and postoperative mechanical ventilation. An airway foreign body was detected just below the glottis, outside the tracheal tube during mechanical ventilation after surgery in the intensive care unit. Before the removal procedure, we planned multiple strategies to cope with unexpected airway and breathing troubles. As a result, the foreign body was successfully removed orally by using a bronchial fiber, without extubation of the tracheal tube, under general anesthesia with dexmedetomidine and ketamine. Conclusions We reported the successful removal of a foreign body in the subglottic airway of a patient under tracheal intubation.
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Affiliation(s)
- Shiori Tanaka
- Department of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakamatsu, Fukushima, 965-8611, Japan. .,Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, Fukushima, 960-1297, Japan.
| | - Keisuke Yoshida
- Department of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakamatsu, Fukushima, 965-8611, Japan.,Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, Fukushima, 960-1297, Japan
| | - Kenichi Muramatsu
- Department of Cardiovascular Surgery, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakamatsu, Fukushima, 965-8611, Japan
| | - Shigeki Yamagishi
- Department of Pulmonology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakamatsu, Fukushima, 965-8611, Japan
| | - Shinju Obara
- Department of Anesthesiology, Fukushima Medical University, 1, Hikariga-oka, Fukushima, Fukushima, 960-1297, Japan
| | - Kazuhiro Watanabe
- Department of Anesthesiology, Aidu Chuo Hospital, 1-1, Tsuruga-machi, Aizuwakamatsu, Fukushima, 965-8611, Japan
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Comparison of the MultiViewScope Stylet Scope and the direct laryngoscope with the Miller blade for the intubation in normal and difficult pediatric airways: A randomized, crossover, manikin study. PLoS One 2020; 15:e0237593. [PMID: 32790734 PMCID: PMC7425958 DOI: 10.1371/journal.pone.0237593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/30/2020] [Indexed: 12/26/2022] Open
Abstract
Background Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized crossover study, we compared the effectiveness of the MVS Stylet Scope to a standard direct laryngoscope with Miller #1 blade in simulated normal and difficult airways. Methods Fifteen expert anesthesiologists and Fifteen anesthesiology residents participated in the study. Participants were asked to perform intubation with the Airsim Baby manikin first, and then with the Airsim Pierre Robin manikin. Participants in each group used the intubation devices in a randomized order. The primary outcome was the time of successful intubation. The secondary outcomes were the force exerted on the incisors during intubation, Cormack–Lehane scale, the difficulty of intubation. Results There were no differences between MVS Stylet Scope and Direct laryngoscope in the time of successful intubation by the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved the force exerted on the incisors during intubation in the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved Cormack–Lehane scale, and the difficulty of intubation with difficult pediatric airway situation in both expert anesthesiologists and anesthesiology residents. Conclusions Although less forces on the incisors and improved view of glottis were observed with the MVS Stylet Scope, MVS Stylet Scope did not shorten the time of intubation. The results of this study mean that the MVS Stylet Scope may be a less invasive airway devise than the direct laryngoscope with the Miller blade in the pediatric airway management. For the next step, we need to evaluate the MVS Stylet Scope in the real patients as an observational study.
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A learning curve of LMA® ProSeal™ insertion: a prospective analysis of cumulative sum method. J Anesth 2020; 34:554-560. [DOI: 10.1007/s00540-020-02790-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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Saito T, Asai T. A new scoring system to predict failed facemask ventilation: a reply to the letter of Professor Priebe. J Anesth 2020; 34:636-637. [DOI: 10.1007/s00540-020-02794-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
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Smith C, McNarry AF. Airway Leads and Airway Response Teams: Improving Delivery of Safer Airway Management? CURRENT ANESTHESIOLOGY REPORTS 2020; 10:370-377. [PMID: 32837344 PMCID: PMC7369438 DOI: 10.1007/s40140-020-00404-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Airway management remains a source of significant morbidity and mortality. This review considers recent summaries of complications and looks toward strategies to improve practice using a coordinated approach. Recent Findings A safety gap can exist between national recommendations and local practice. A lack of attention to end tidal carbon dioxide has repeatedly contributed to airway mismanagement. Clinicians must be trained in newer airway devices (videolaryngoscopes or supraglottic airways) to use them effectively. Time must be found to teach rarely performed skills (e.g., front-of-neck access). Both larger and smaller hospitals have benefitted from an airway lead or response team, coordinating education programs, ensuring the adoption of guidelines, standardizing equipment, and recognizing the role of human factors and ergonomics. Summary Even in the twenty-first century, the incidence of airway-related morbidity and mortality can be reduced, by an institutionally supported, coordinated approach to the whole process of airway care.
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Affiliation(s)
- Carolyn Smith
- South East Scotland School of Anaesthesia, St John’s Hospital, Livingston, EH54 6PP UK
| | - Alistair F. McNarry
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Crewe Road South, Edinburgh, EH4 2XU UK
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Maeda M, Chaki T, Kawaguchi R, Kimijima T, Yamakage M. Difficult airway management of a patient with limited range of motion in the temporomandibular joint and cervical extension caused by psoriatic arthritis: a case report. JA Clin Rep 2020; 6:44. [PMID: 32514697 PMCID: PMC7280384 DOI: 10.1186/s40981-020-00351-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psoriasis vulgaris, a chronic inflammatory skin disease, rarely causes temporomandibular arthritis. We report a case of difficult airway management of a patient with limited range of motion in the temporomandibular joint and cervical extension caused by psoriatic arthritis. CASE PRESENTATION A 33-year-old man was scheduled to undergo laparoscopic colectomy. On admission, he was diagnosed with psoriatic arthritis. After induction of general anesthesia, we attempted intubation using Pentax Airway Scope® with a thin intlock blade and using a bronchoscope, but it was impossible because of the limited oral space and mandibular elevation. Because of concerns about cannot intubate, cannot ventilate, we antagonized the neuromuscular block and he emerged from general anesthesia. Finally, we succeeded in awake intubation via the nasal cavity using a bronchoscope under spontaneous respiration. CONCLUSIONS Although psoriasis vulgaris is very rarely associated with temporomandibular arthritis, anesthesiologists should consider that it can cause perioperative difficult airways.
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Affiliation(s)
- Makishi Maeda
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan.
| | - Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Ryoichi Kawaguchi
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Tomohiko Kimijima
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
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López AM, Belda I, Bermejo S, Parra L, Áñez C, Borràs R, Sabaté S, Carbonell N, Marco G, Pérez J, Massó E, Soto JM, Boza E, Gil JM, Serra M, Tejedor V, Tejedor A, Roza J, Plaza A, Tena B, Valero R. Recommendations for the evaluation and management of the anticipated and non-anticipated difficult airway of the Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor, based on the adaptation of clinical practice guidelines and expert consensus. ACTA ACUST UNITED AC 2020; 67:325-342. [PMID: 32471791 DOI: 10.1016/j.redar.2019.11.011] [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: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Abstract
The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.
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Affiliation(s)
- A M López
- Hospital Clínic de Barcelona, Barcelona, España
| | - I Belda
- Hospital Clínic de Barcelona, Barcelona, España
| | - S Bermejo
- Consorci Mar Parc de Salut de Barcelona, Barcelona, España
| | - L Parra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - C Áñez
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - R Borràs
- Hospital Universitari Dexeus, Barcelona, España
| | - S Sabaté
- Fundació Puigvert (IUNA), Barcelona, España
| | - N Carbonell
- Hospital Universitari Dexeus, Barcelona, España
| | - G Marco
- Hospital Universitari Santa Maria de Lleida, Lleida, España
| | - J Pérez
- Hospital Universitari Parc Taulí, Sabadell, España
| | - E Massó
- Hospital Universitari Germans Trias i Pujol, Badalona, España
| | - J Mª Soto
- Hospital d' Igualada, SEM, Igualada, España
| | - E Boza
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, España
| | - J M Gil
- Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Serra
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - V Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - A Tejedor
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, España
| | - J Roza
- Hospital Universitari de Vic, Vic, España
| | - A Plaza
- Hospital Clínic de Barcelona, Barcelona, España
| | - B Tena
- Hospital Clínic de Barcelona, Barcelona, España
| | - R Valero
- Hospital Clínic de Barcelona, Barcelona, España.
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Myatra SN, Patwa A, Divatia JV. Critical language during an airway emergency: Time to rethink terminology? Indian J Anaesth 2020; 64:275-279. [PMID: 32489200 PMCID: PMC7259417 DOI: 10.4103/ija.ija_214_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 12/20/2022] Open
Abstract
Clear language should be used during emergency airway management to aid communication and understand the nature of the emergency. Unfortunately, during emergency airway management, there is no uniform language used for communication. Various difficult airway guidelines use different terminologies. Terminologies like “can't intubate, can't oxygenate” (CICO) and “can't intubate, can't ventilate” (CICV) have certain limitations. Though terminology like “Front of Neck Access” (FONA) is dominant in the literature,”emergency cricothyroidotomy” is used more often in clinical practice, suggesting a disconnect between the dominant terminology in the literature and in clinical practice. Terminology should not be used merely because it is catchy, simple and advocated by a few. It must accurately reflect the nature of the situation, convey a sense of urgency, and suggest an action sequence. An initiative to achieve consensus among existing terminologies is much needed. Leaders in the field should work towards refining airway terminology and replace poor phrases with ones that are more concise, precise and can be used universally in an airway emergency.
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Affiliation(s)
- Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Apeksh Patwa
- Kailash Cancer Hospital and Research Centre, Muni Ashram, Goraj, Vadodara, Gujarat, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Merchan-Galvis AM, Caicedo JP, Valencia-Payán CJ, Calvache JA. Methodological quality and transparency of clinical practice guidelines for difficult airway management using the appraisal of guidelines research & evaluation II instrument: A systematic review. Eur J Anaesthesiol 2020; 37:451-456. [PMID: 32205574 DOI: 10.1097/eja.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complications arising from airway management represent an important cause of morbidity and mortality. Clinical practice guidelines (CPGs) are systematically created documents that summarise knowledge and assist the delivery of high-quality medical care by identifying evidence that supports best clinical care. OBJECTIVE Using the Appraisal of Guidelines for Research & Evaluation II instrument, we aimed to evaluate the methodological rigour and transparency of unanticipated difficult airway management CPGs in adults. DESIGN Using PUBMED without language restrictions, we identified eligible CPGs between 1 January 1996 and 30 June 2019. All versions of a CPG were included as independent guidelines to assess improvements over time or the methodological limitations of each version. CPGs-related obstetrics or paediatrics or the management extubation in cases of difficult airway were excluded. RESULTS Fourteen CPGs were included. Of the six domains suggested by the Appraisal of Guidelines for Research & Evaluation II instrument, 'applicability' had the lowest score (23%) and 'scope and objectives' had the highest score (88%). The remaining domains (stakeholder involvement, editorial independence, rigour of development and clarity of presentation) had scores ranging between 56 and 81%. Overall, the highest scored CPG was the Difficult Airway Society 2015. CONCLUSION Future updates of CPGs for difficult airway management in adults and severely ill patients should consider more emphasis on the applicability of their recommendations to real clinical practice.
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Affiliation(s)
- Angela M Merchan-Galvis
- From the Department of Social Medicine and Family Health, Cochrane Affiliated Centre, Universidad del Cauca, Popayán, Colombia (AMM-G, CJV-P), Institute of Biomedical Research IIB, Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau (AMM-G), Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia (JPC, JAC), Grupo de Entrenamiento en Vía Aérea Latinoamérica (EVALA), Capítulo de Vía Aérea Difícil de La Confederación Latinoamericana de Sociedades de Anestesia (CLASA), Sociedad Colombiana de Anestesia y Reanimación (SCARE), Colombia (JPC) and Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands (JAC)
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Saito T, Asai T, Taguchi A, Sophia CTH, Liu W, Thinn KK, Ti LK. Prediction of failed facemask ventilation: new scoring system for difficult airway. J Anesth 2020; 34:367-372. [PMID: 32206918 DOI: 10.1007/s00540-020-02761-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/07/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND We previously have shown that there was a strong correlation between failed facemask ventilation, failed ventilation through a supraglottic airway, and difficult tracheal intubation. The primary aim of this study was to evaluate whether or not an established method to predict difficult ventilation through a supraglottic airway was also useful for predicting failed facemask ventilation. METHODS This was a single-center, retrospective observational study. We studied 28,081 anesthetized patients in whom ventilation through a facemask, and supraglottic airway was attempted as the initial technique during induction of anesthesia, between May 2011 and March 2016. For each patient, the score which had been validated to be useful for predicting difficult ventilation through a supraglottic airway was calculated. The score ranged between 0 and 7 points, and we defined a low risk when the score was 0-3, and a high risk when the score was 4-7. To measure and compare the predictive accuracy of the score, we generated a receiver operating characteristic curve and compared the area under the curve (AUC). RESULTS The incidence of failed facemask ventilation was significantly higher in patients with high-risk predictive score than in patients with low-risk predictive score [0.38% vs 0.056%, odds ratio 6.8 (95% CI 2.6-18.1, p value = 0.002)], and the sensitivity of the score was 25%, while the specificity was 95%, with a negative predictive value of 99%. The AUC of the score was 0.71 (95% CI 0.58-0.83). CONCLUSIONS The predictive score for difficult ventilation through a supraglottic airway is also useful to predict failed facemask ventilation.
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Affiliation(s)
- Tomoyuki Saito
- Department of Anesthesia, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Takashi Asai
- Department of Anesthesia, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Asuka Taguchi
- Department of Anesthesia, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Chew Tsong Huey Sophia
- Department of Anesthesia, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Weiling Liu
- Department of Anesthesia, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Kyu Kyu Thinn
- Department of Anesthesia, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore
| | - Lian Kah Ti
- Department of Anesthesia, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore.,Department of Anesthesia, Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Road, Singapore, 119077, Singapore
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Howard I, Cameron P, Wallis L, Castrén M, Lindström V. Identifying quality indicators for prehospital emergency care services in the low to middle income setting: The South African perspective. Afr J Emerg Med 2019; 9:185-192. [PMID: 31890482 PMCID: PMC6933208 DOI: 10.1016/j.afjem.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/18/2019] [Accepted: 07/24/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Historically, performance within the Prehospital Emergency Care (PEC) setting has been assessed primarily based on response times. While easy to measure and valued by the public, overall, response time targets are a poor predictor of quality of care and clinical outcomes. Over the last two decades however, significant progress has been made towards improving the assessment of PEC performance, largely in the form of the development of PEC-specific quality indicators (QIs). Despite this progress, there has been little to no development of similar systems within the low- to middle-income country setting. As a result, the aim of this study was to identify a set of QIs appropriate for use in the South African PEC setting. METHODS A three-round modified online Delphi study design was conducted to identify, refine and review a list of QIs for potential use in the South African PEC setting. Operational definitions, data components and criteria for use were developed for 210 QIs for inclusion into the study. RESULTS In total, 104 QIs reached consensus agreement including, 90 clinical QIs, across 15 subcategories, and 14 non-clinical QIs across two subcategories. Amongst the clinical category, airway management (n = 13 QIs; 14%); out-of-hospital cardiac arrest (n = 13 QIs; 14%); and acute coronary syndromes (n = 11 QIs; 12%) made up the majority. Within the non-clinical category, adverse events made up the significant majority with nine QIs (64%). CONCLUSION Within the South Africa setting, there are a multitude of QIs that are relevant and appropriate for use in PEC. This was evident in the number, variety and type of QIs reaching consensus agreement in our study. Furthermore, both the methodology employed, and findings of this study may be used to inform the development of PEC specific QIs within other LMIC settings.
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Affiliation(s)
- Ian Howard
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lee Wallis
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Academic EMS, Stockholm, Sweden
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Ott T, Stracke J, Sellin S, Kriege M, Toenges G, Lott C, Kuhn S, Engelhard K. Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms. BMJ Open 2019; 9:e030430. [PMID: 31767584 PMCID: PMC6887030 DOI: 10.1136/bmjopen-2019-030430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES During a 'cannot intubate, cannot oxygenate' situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient's life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a 'cannot intubate, cannot oxygenate' situation. DESIGN Due to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study. SETTING We collected data in our institutional simulation centre between November 2016 and November 2017. PARTICIPANTS We included 40 experienced staff anaesthesiologists at our tertiary university hospital centre. INTERVENTION The participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records. PRIMARY OUTCOME MEASURES The difference in 'time to ventilation through cricothyrotomy' between the two situations was the primary outcome measure. RESULTS The results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3-40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time. CONCLUSION Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a 'cannot intubate, cannot oxygenate' situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Jascha Stracke
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Susanna Sellin
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Carsten Lott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
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Ahmad I, El-Boghdadly K, Bhagrath R, Hodzovic I, McNarry AF, Mir F, O'Sullivan EP, Patel A, Stacey M, Vaughan D. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2019; 75:509-528. [PMID: 31729018 PMCID: PMC7078877 DOI: 10.1111/anae.14904] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 12/13/2022]
Abstract
Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high‐quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post‐tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.
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Affiliation(s)
- I Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - R Bhagrath
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - I Hodzovic
- Department of Anaesthesia, Cardiff University School of Medicine, Cardiff, UK.,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - A F McNarry
- Department of Anaesthesia, NHS Lothian, Edinburgh, UK
| | - F Mir
- Department of Anaesthesia, St. George's University Hospital NHS Foundation Trust, London, UK
| | - E P O'Sullivan
- Department of Anaesthesia, St James's Hospital, Dublin, Ireland
| | - A Patel
- Department of Anaesthesia, Royal National Throat Nose and Ear Hospital and University College London Hospitals NHS Foundation Trust, London, UK
| | - M Stacey
- Department of Anaesthesia, Cardiff and Vale NHS Trust (HEIW), Cardiff, UK
| | - D Vaughan
- Department of Anaesthesia, Northwick Park Hospital, London, UK
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Bjurström MF, Persson K, Sturesson LW. Availability and organization of difficult airway equipment in Swedish hospitals: A national survey of anaesthesiologists. Acta Anaesthesiol Scand 2019; 63:1313-1320. [PMID: 31286467 DOI: 10.1111/aas.13448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/09/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Airway complications account for almost one third of anaesthesia-related brain damage and death. Immediate access to equipment enabling rescue airway strategies is crucial for successful management of unanticipated difficult airway situations. METHODS We conducted a nationwide survey of Swedish anaesthesiologists to analyse availability and organization of difficult airway trolleys (DATs), and multiple factors pertaining to difficult airway management, to highlight areas of potential improvement. RESULTS Six hundred and thirty-nine anaesthesiologists completed the 14-item survey. Whereas DATs were almost ubiquitous (95%) in main operating departments of hospitals, prevalence was low in remote anaesthetizing locations (20.3%) and electroconvulsive therapy units (26.6%). Approximately 60% of emergency departments had a DAT. Immediate (within 60 seconds) access to videolaryngoscopes in all units where general anaesthesia is conducted was reported by 56.8%. Almost half of anaesthesiologists reported that all DATs at their workplace were standardized. Forty-six per cent reported that the DATs were organized according to a difficult airway algorithm; almost 90% believe that such an organization can impact the outcome of a difficult airway situation positively. Only 36.2% of DATs contained second-generation supraglottic airway devices exclusively. Most Swedish anaesthesiologists use the Swedish Society of Anaesthesiology and Intensive care Medicine difficult airway algorithm, but almost one fifth prefer the Difficult Airway Society algorithm. Less than half of respondents underwent formal difficult airway training annually. CONCLUSION Our results motivate efforts to (a) increase availability of DATs in remote anaesthetizing locations, (b) increasingly standardize DATs and organize DATs according to airway algorithms, and (c) increase the frequency of difficult airway training.
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Affiliation(s)
- Martin F. Bjurström
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
| | - Karolina Persson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
| | - Louise W. Sturesson
- Department of Clinical Sciences Lund, Anaesthesiology and Intensive Care Lund University, Skåne University Hospital Lund Sweden
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Tsukamoto M, Taura S, Hitosugi T, Yokoyama T. Comparison of the Performance of Mask Ventilation Between Face Masks With and Without Air Cushion. J Oral Maxillofac Surg 2019; 77:2465.e1-2465.e5. [PMID: 31574262 DOI: 10.1016/j.joms.2019.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Mask ventilation is a basic technique for induction of anesthesia. In head and neck surgery, we have encountered difficulty in ventilation owing to facial deformities. Recently, a new type of face mask without an air cushion, the QuadraLite face mask (Intersurgical, Berkshire, UK), was developed. The aim of this study was to compare the performance of cases with predicted difficult mask ventilation between the new type of face mask and a traditional face mask. PATIENTS AND METHODS This study was a crossover prospective study. The participants were patients (aged > 18 years) who underwent oral-maxillofacial surgery under general anesthesia. The risk factors for a difficult airway were assessed. Patients were divided into 3 risk groups: low risk, 0 or 1 risk factor for predicted difficult mask ventilation; medium risk, 2 or 3 risk factors; and high risk, 4 or more risk factors. An air cushion face mask (Koo Medical, Shanghai, China) and the QuadraLite face mask were applied in turn under the setting of pressure-controlled ventilation. The expiratory tidal volumes were compared between these face masks. RESULTS A total of 48 patients were included: 16 in the low-risk group, 16 in the medium-risk group, and 16 in the high-risk group. Higher expiratory tidal volumes were observed with the QuadraLite face mask than with the air cushion face mask, although the differences did not reach the statistically significant level: 574.3 ± 62.7 mL versus 553.1 ± 60.6 mL in the low-risk group (P = .44), 553.1 ± 112.9 mL versus 536.4 ± 114.2 mL in the medium-risk group (P = .38), and 560.0 ± 98.6 mL versus 548.2 ± 07.1 mL in the high-risk group (P = .22). In all cases, a sufficient ventilation volume was obtained by the QuadraLite face mask. CONCLUSIONS The QuadraLite face mask is compact because there is no air cushion, and it can provide sufficient mask ventilation as well as a traditional face mask with an air cushion even in patients with a difficult airway.
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Affiliation(s)
- Masanori Tsukamoto
- Assistant Professor, Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan.
| | - Shiori Taura
- Graduate Student, Department of Dental Anesthesiology, Graduate School of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takashi Hitosugi
- Assistant Professor, Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Yokoyama
- Professor, Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Edelman DA, Perkins EJ, Brewster DJ. Difficult airway management algorithms: a directed review. Anaesthesia 2019; 74:1175-1185. [PMID: 31328259 DOI: 10.1111/anae.14779] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2019] [Indexed: 12/18/2022]
Abstract
The primary aim of this study was to identify, describe and compare the content of existing difficult airway management algorithms. Secondly, we aimed to describe the literature reporting the implementation of these algorithms. A directed search across three databases (MEDLINE, Embase and Scopus) was performed. All articles were screened for relevance to the research aims and according to pre-determined exclusion criteria. We identified 38 published airway management algorithms. Our results show that most facemask employ a four-step process as represented by a flow chart, with progression from tracheal intubation, facemask ventilation and supraglottic airway device use, to a rescue emergency surgical airway. The identified algorithms are overwhelmingly similar, yet many use differing terminology. The frequency of algorithm publication has increased recently, yet adherence and implementation outcome data remain limited. Our results highlight the lack of a single algorithm that is universally endorsed, recognised and applicable to all difficult airway management situations.
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Affiliation(s)
- D A Edelman
- Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - E J Perkins
- Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - D J Brewster
- Central Clinical School, Monash University, Melbourne, Vic., Australia
- Cabrini Hospital, Melbourne, Vic., Australia
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