1
|
Feinleib J, Baron EL. Airway Management Education for the Nonairway Specialist. Int Anesthesiol Clin 2024; 62:8-20. [PMID: 39041794 DOI: 10.1097/aia.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Affiliation(s)
- Jessica Feinleib
- West Haven, Connecticut
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, and West Haven VHA/VHA National Simulation Center
| | - Elvera L Baron
- Department of Anesthesiology and Perioperative Medicine, Case Western Reserve University School of Medicine at Louis Stokes Cleveland VAMC, Cleveland, Ohio
| |
Collapse
|
2
|
Chaverra Kornerup S, Parotto M. Extubation-Related Complications. Int Anesthesiol Clin 2024; 62:82-90. [PMID: 39233574 DOI: 10.1097/aia.0000000000000454] [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
Extubation represents an essential component of airway management. While being a common procedure in anesthesiology and critical care medicine, it is accompanied by a significant risk of morbidity and mortality. Safe extubation requires considerable skills, risk stratification and advanced planning. It is important to emphasize that intentional extubation is always an elective procedure, and as such should only be executed when conditions are optimal. The purpose of this review is to discuss the complications associated with planned extubation in the adult patient, including risk factors and management strategies, mainly focusing on the postoperative setting.
Collapse
Affiliation(s)
- Santiago Chaverra Kornerup
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Liu B, Wang Y, Li L, Xiong W, Feng Y, Liu Y, Jin X. The effects of laryngeal mask versus endotracheal tube on atelectasis after general anesthesia induction assessed by lung ultrasound: A randomized controlled trial. J Clin Anesth 2024; 98:111564. [PMID: 39089119 DOI: 10.1016/j.jclinane.2024.111564] [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: 10/09/2023] [Revised: 03/05/2024] [Accepted: 07/21/2024] [Indexed: 08/03/2024]
Abstract
STUDY OBJECTIVE This study aims to evaluate the impact of Supreme™ laryngeal masks versus endotracheal tubes on atelectasis during general anesthesia using lung ultrasound (LUS), and provide evidence for respiratory management. DESIGN A single-center, double-blind, randomized controlled trial was conducted. SETTING The study was conducted in both the operating room and the post-anesthesia care unit, with follow-up assessments performed in the ward. PATIENTS Enrollment included 180 cases undergoing non-laparoscopic surgeries in gynecology, urology, and orthopedic limb surgeries. INTERVENTIONS Patients were randomly assigned 1:1 to the endotracheal intubation or laryngeal mask group. MEASUREMENTS LUS scores were recorded across 12 lung regions at baseline, 15 min after airway establishment, at the end of surgery, and 30 min following airway removal. Outcome measures encompassed the oxygenation index, dynamic lung compliance, incidence of postoperative pulmonary complications, throat pain, and other postoperative complications assessed at 24 and 48 h postoperatively. The primary outcome focused on the LUS score in all 12 lung regions at 15 min after airway establishment. MAIN RESULTS Intention-to-treat analysis of 177 subjects revealed endotracheal intubation led to significantly higher LUS scores at 15 min {P < 0.001, mean difference 4.15 ± 0.60, 95% CI [2.97, 5.33]}, end of surgery (P < 0.001, mean difference 3.37 ± 0.68, 95% CI [2.02, 4.72]), and 30 min post-removal (P < 0.001, mean difference 2.63 ± 0.48, 95% CI [1.68, 3.58]). No major complications occurred in the two groups. CONCLUSIONS Compared to endotracheal intubation, laryngeal masks effectively reduce atelectasis formation and progression in gynecological, urological non-laparoscopic, and orthopedic limb surgeries. However, caution is warranted when generalizing these findings to surgeries with a higher risk of laryngeal mask leakage or obese patients. Additionally, the efficacy of laryngeal masks in reducing postoperative atelectasis remains uncertain when comprehensive monitoring of muscle relaxation and reversal therapy is employed.
Collapse
Affiliation(s)
- Bin Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yaxin Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ling Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Wei Xiong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yifan Feng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xu Jin
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Anesthesiology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100191, China.
| |
Collapse
|
4
|
Athanassoglou V, O'Sullivan EP, van Zundert A, Pandit JJ. New guidelines for research in airway device evaluation: time for an updated approach (ADEPT-2) to the Difficult Airway Society's 'ADEPT' strategy? J Clin Monit Comput 2023; 37:345-350. [PMID: 36125636 PMCID: PMC9486783 DOI: 10.1007/s10877-022-00911-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022]
Abstract
In this article we present the learning from a clinical study of airway device evaluation, conducted under the framework of the Difficult Airway Society (DAS, UK) 'ADEPT' (airway device evaluation project team) strategy. We recommend a change in emphasis from small scale randomised controlled trials conducted as research, to larger-scale observational, post-marketing evaluation audits as a way of obtaining more meaningful information.
Collapse
Affiliation(s)
- V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - A van Zundert
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- The University of Queensland, Brisbane, QLD, Australia
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- University of Oxford, Oxford, UK.
- St John's College, Oxford OX1 3JP, Oxford, 01865-221590, UK.
| |
Collapse
|
5
|
Kluj P, Fedorczak A, Fedorczak M, Gaszyński T, Kułak C, Wasilewski M, Znyk M, Bartczak M, Ratajczyk P. Comparison of Three Video Laryngoscopes and Direct Laryngoscopy for Emergency Endotracheal Intubation While Wearing PPE-AGP: A Randomized, Crossover, Simulation Trial. Healthcare (Basel) 2023; 11:healthcare11060884. [PMID: 36981541 PMCID: PMC10048466 DOI: 10.3390/healthcare11060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Background: The COVID-19 pandemic has necessitated changes in the safety protocols of endotracheal intubation at every level of care. This study aimed to compare the first-pass success rates (FPS) and intubation times (IT) of three video laryngoscopes (VL) and direct laryngoscopy (DL) for simulated COVID-19 patient emergency intubation (EI). Methods: The study was a prospective, randomized, crossover trial. Fifty-three active paramedics performed endotracheal intubation with the I-viewTM VL, UESCOPE® VL, ProVu® VL and Macintosh direct laryngoscope (MAC) wearing personal protective equipment for aerosol-generating procedures (PPE-AGP) on a manikin with normal airway conditions. Results: The longest IT was noted when the UESCOPE® (29.4 s) and ProVu® (27.7 s) VL were used. The median IT for I-view was 17.4 s and for MAC DL 17.9 s. The FPS rates were 88.6%, 81.1%, 83.0% and 84.9%, respectively, for I-view, ProVu®, UESCOPE® and MAC DL. The difficulty of EI attempts showed a statistically significant difference between UESCOPE® and ProVu®. Conclusions: The intubation times performed by paramedics in PPE-AGP using UESCOPE® and ProVu® were significantly longer than those with the I-view and Macintosh laryngoscopes. The use of VL by prehospital providers in PPE did not result in more effective EI than the use of a Macintosh laryngoscope.
Collapse
Affiliation(s)
- Przemysław Kluj
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
- Correspondence:
| | - Anna Fedorczak
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 93-338 Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital-Research Institute, 93-338 Lodz, Poland
| | - Michał Fedorczak
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| | - Cezary Kułak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Mikołaj Wasilewski
- Clinic of Anesthesiology and Intensive Therapy, Medical University of Lodz, 92-213 Lodz, Poland
| | - Mateusz Znyk
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Maria Bartczak
- Medical Simulation Center, Medical University of Lodz, 92-213 Lodz, Poland (M.Z.)
| | - Paweł Ratajczyk
- Department of Anesthesiology and Intensive Care, Medical University of Lodz, 90-549 Lodz, Poland
| |
Collapse
|
6
|
Cailleau L, Geeraerts T, Minville V, Fourcade O, Fernandez T, Bazin JE, Baxter L, Athanassoglou V, Jefferson H, Sud A, Davies T, Mendonca C, Parotto M, Kurrek M. Is there a benefit for anesthesiologists of adding difficult airway scenarios for learning fiberoptic intubation skills using virtual reality training? A randomized controlled study. PLoS One 2023; 18:e0281016. [PMID: 36706107 PMCID: PMC9882961 DOI: 10.1371/journal.pone.0281016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023] Open
Abstract
Fiberoptic intubation for a difficult airway requires significant experience. Traditionally only normal airways were available for high fidelity bronchoscopy simulators. It is not clear if training on difficult airways offers an advantage over training on normal airways. This study investigates the added value of difficult airway scenarios during virtual reality fiberoptic intubation training. A prospective multicentric randomized study was conducted 2019 to 2020, among 86 inexperienced anesthesia residents, fellows and staff. Two groups were compared: Group N (control, n = 43) first trained on a normal airway and Group D (n = 43) first trained on a normal, followed by three difficult airways. All were then tested by comparing their ORSIM® scores on 5 scenarios (1 normal and 4 difficult airways). The final evaluation ORSIM® score for the normal airway testing scenario was significantly higher for group N than group D: median score 76% (IQR 56.5-90) versus 58% (IQR 51.5-69, p = 0.0039), but there was no difference in ORSIM® scores for the difficult intubation testing scenarios. A single exposure to each of 3 different difficult airway scenarios did not lead to better fiberoptic intubation skills on previously unseen difficult airways, when compared to multiple exposures to a normal airway scenario. This finding may be due to the learning curve of approximately 5-10 exposures to a specific airway scenario required to reach proficiency.
Collapse
Affiliation(s)
- Loic Cailleau
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Vincent Minville
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Olivier Fourcade
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
| | - Thomas Fernandez
- Department of Anesthesia and Intensive Care, University Clermont Auvergne, Clermont Ferrand, France
| | - Jean Etienne Bazin
- Department of Anesthesia and Intensive Care, University Clermont Auvergne, Clermont Ferrand, France
| | - Linden Baxter
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | | | - Henry Jefferson
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | - Anika Sud
- Department of Anesthesia, Oxford University, Oxford, United Kingdom
| | - Tim Davies
- Department of Anesthesia, University of Warwick and Coventry, Coventry, United Kingdom
| | - Cyprian Mendonca
- Department of Anesthesia, University of Warwick and Coventry, Coventry, United Kingdom
| | - Matteo Parotto
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Matt Kurrek
- Department of Anesthesia and Intensive Care, University Toulouse 3 Paul Sabatier, Toulouse, France
- Department of Anesthesia, University of Toronto, Toronto, Canada
- * E-mail:
| |
Collapse
|
7
|
Gómez-Ríos MÁ, López T, Sastre JA, Gaszyński T, Van Zundert AAJ. Video laryngeal masks in airway management. Expert Rev Med Devices 2022; 19:847-858. [DOI: 10.1080/17434440.2022.2142558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Manuel Á. Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, Galicia, Spain
| | - Teresa López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - José Alfonso Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Tomasz Gaszyński
- Department of Anesthesiology and Intensive Therapy Medical University of Lodz, Poland
| | - André A. J. Van Zundert
- Professor & Chairman Discipline of Anesthesiology, The University of Queensland
- Faculty of Medicine & Biomedical Sciences, Brisbane, QLD, Australia
- Chair, University of Queensland Burns, Trauma & Critical Care Research Centre
- Chair, RBWH/University of Queensland Centre for Excellence & Innovation in Anaesthesia
| |
Collapse
|
8
|
The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial. PLoS One 2022; 17:e0273410. [PMID: 36084154 PMCID: PMC9462747 DOI: 10.1371/journal.pone.0273410] [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: 02/20/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of atelectasis is high in patients undergoing general anesthesia. This may cause oxygenation impairment and further contribute to postoperative pulmonary complications (PPCs). As important airway management devices for general anesthesia, few studies have compared the effects of laryngeal mask airway (LMA) and endotracheal tube (ETT) on atelectasis. Additionally, lung ultrasound has been increasingly used for bedside atelectasis diagnosis. For the above considerations, this trial is designed to compare the effects of LMA and ETT on atelectasis assessed by lung ultrasound scores, further providing more powerful clinical evidence for perioperative respiratory management of non-laparoscopic elective lower abdominal surgery under general anesthesia. Methods This is a prospective, single-center, single-blind, randomized controlled trial. From July 2021 to July 2022, 180 patients undergoing elective non-laparoscopic lower abdominal surgery under general anesthesia will be recruited and randomly divided into the ETT and LMA groups at a ratio of 1:1. The primary outcome is the total atelectasis LUS of 12 lung regions 15 min after the establishment of the artificial airway. The total atelectasis LUS at the end of surgery and 30 min after extubation, oxygenation index, postoperative airway complications, PPCs, and length of stay will be analyzed as secondary indicators. Trial registration ClinicalTrials.gov identifier: ChiCTR1900020818. Registered on January 20, 2019. Registered with the name of “Laryngeal mask airway versus endotracheal tube for atelectasis.” URL: https://www.chictr.org.cn/showproj.aspx?proj=35143.
Collapse
|
9
|
Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev 2022; 4:CD011136. [PMID: 35373840 PMCID: PMC8978307 DOI: 10.1002/14651858.cd011136.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tracheal intubation is a common procedure performed to secure the airway in adults undergoing surgery or those who are critically ill. Intubation is sometimes associated with difficulties and complications that may result in patient harm. While it is traditionally achieved by performing direct laryngoscopy, the past three decades have seen the advent of rigid indirect videolaryngoscopes (VLs). A mounting body of evidence comparing the two approaches to tracheal intubation has been acquired over this period of time. This is an update of a Cochrane Review first published in 2016. OBJECTIVES To assess whether use of different designs of VLs in adults requiring tracheal intubation reduces the failure rate compared with direct laryngoscopy, and assess the benefits and risks of these devices in selected population groups, users and settings. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and Web of Science on 27 February 2021. We also searched clinical trials databases, conference proceedings and conducted forward and backward citation searches. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs with adults undergoing laryngoscopy performed with either a VL or a Macintosh direct laryngoscope (DL) in any clinical setting. We included parallel and cross-over study designs. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data for the following outcomes: failed intubation, hypoxaemia, successful first attempt at tracheal intubation, oesophageal intubation, dental trauma, Cormack-Lehane grade, and time for tracheal intubation. MAIN RESULTS We included 222 studies (219 RCTs, three quasi-RCTs) with 26,149 participants undergoing tracheal intubation. Most studies recruited adults undergoing elective surgery requiring tracheal intubation. Twenty-one studies recruited participants with a known or predicted difficult airway, and an additional 25 studies simulated a difficult airway. Twenty-one studies were conducted outside the operating theatre environment; of these, six were in the prehospital setting, seven in the emergency department and eight in the intensive care unit. We report here the findings of the three main comparisons according to videolaryngoscopy device type. We downgraded the certainty of the outcomes for imprecision, study limitations (e.g. high or unclear risks of bias), inconsistency when we noted substantial levels of statistical heterogeneity and publication bias. Macintosh-style videolaryngoscopy versus direct laryngoscopy (61 studies, 9883 participants) We found moderate-certainty evidence that a Macintosh-style VL probably reduces rates of failed intubation (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.26 to 0.65; 41 studies, 4615 participants) and hypoxaemia (RR 0.72, 95% CI 0.52 to 0.99; 16 studies, 2127 participants). These devices may also increase rates of success on the first intubation attempt (RR 1.05, 95% CI 1.02 to 1.09; 42 studies, 7311 participants; low-certainty evidence) and probably improve glottic view when assessed as Cormack-Lehane grade 3 and 4 (RR 0.38, 95% CI 0.29 to 0.48; 38 studies, 4368 participants; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.51, 95% CI 0.22 to 1.21; 14 studies, 2404 participants) but this finding was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of this evidence was very low (RR 0.68, 95% CI 0.16 to 2.89; 18 studies, 2297 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 96%). Hyperangulated videolaryngoscopy versus direct laryngoscopy (96 studies, 11,438 participants) We found moderate-certainty evidence that hyperangulated VLs probably reduce rates of failed intubation (RR 0.51, 95% CI 0.34 to 0.76; 63 studies, 7146 participants) and oesophageal intubation (RR 0.39, 95% CI 0.18 to 0.81; 14 studies, 1968 participants). In subgroup analysis, we noted that hyperangulated VLs were more likely to reduce failed intubation when used on known or predicted difficult airways (RR 0.29, 95% CI 0.17 to 0.48; P = 0.03 for subgroup differences; 15 studies, 1520 participants). We also found that these devices may increase rates of success on the first intubation attempt (RR 1.03, 95% CI 1.00 to 1.05; 66 studies, 8086 participants; low-certainty evidence) and the glottic view is probably also improved (RR 0.15, 95% CI 0.10 to 0.24; 54 studies, 6058 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). However, we found low-certainty evidence of little or no clear difference in rates of hypoxaemia (RR 0.49, 95% CI 0.22 to 1.11; 15 studies, 1691 participants), and the findings for dental trauma were unclear because the certainty of this evidence was very low (RR 0.51, 95% CI 0.16 to 1.59; 30 studies, 3497 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 99%). Channelled videolaryngoscopy versus direct laryngoscopy (73 studies, 7165 participants) We found moderate-certainty evidence that channelled VLs probably reduce rates of failed intubation (RR 0.43, 95% CI 0.30 to 0.61; 53 studies, 5367 participants) and hypoxaemia (RR 0.25, 95% CI 0.12 to 0.50; 15 studies, 1966 participants). They may also increase rates of success on the first intubation attempt (RR 1.10, 95% CI 1.05 to 1.15; 47 studies, 5210 participants; very low-certainty evidence) and probably improve glottic view (RR 0.14, 95% CI 0.09 to 0.21; 40 studies, 3955 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.54, 95% CI 0.17 to 1.75; 16 studies, 1756 participants) but this was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of the evidence was very low (RR 0.52, 95% CI 0.13 to 2.12; 29 studies, 2375 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 98%). AUTHORS' CONCLUSIONS VLs of all designs likely reduce rates of failed intubation and result in higher rates of successful intubation on the first attempt with improved glottic views. Macintosh-style and channelled VLs likely reduce rates of hypoxaemic events, while hyperangulated VLs probably reduce rates of oesophageal intubation. We conclude that videolaryngoscopy likely provides a safer risk profile compared to direct laryngoscopy for all adults undergoing tracheal intubation.
Collapse
Affiliation(s)
| | - Andrew M Rogers
- Department of Anaesthesia, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Tim M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - Andrew F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
- Lancaster University, Lancaster, UK
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Schumacher J, Carvalho C, Greig P, Ragbourne S, Ahmad I. Influence of respiratory protective equipment on simulated advanced airway skills by specialist tracheal intubation teams during the COVID-19 pandemic. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 39:21-27. [PMID: 38620908 PMCID: PMC8123411 DOI: 10.1016/j.tacc.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Background The COVID-19 pandemic has highlighted the importance of respiratory protective equipment for clinicians performing airway management. Aim To evaluate the impact of powered air-purifying respirators, full-face air-purifying respirators and filtering facepieces on specially trained anaesthesiologists performing difficult airway procedures. Methods All our COVID-19 intubation team members carried out various difficult intubation drills: unprotected, wearing a full-face respirator, a filtering facepiece or a powered respirator. Airway management times and wearer comfort were evaluated and analysed. Results Total mean (SD) intubation times did not show significant differences between the control, the powered, the full-face respirator and the filtering facepiece groups: Airtraq 6.1 (4.4) vs. 5.4 (3.1) vs. 6.1 (5.6) vs. 7.7 (7.6) s; videolaryngoscopy 11.4 (9.0) vs. 7.7 (4.3) vs. 9.8 (8.4) vs. 12.7 (9.8) s; fibreoptic intubation 16.6 (7.8) vs.13.8 (6.7) vs. 13.6 (8.1) vs. 16.9 (9.2) s; and standard endotracheal intubation by direct laryngoscopy 8.1 (3.5) vs. 6.5 (5.6) vs. 6.2 (4.2) vs. 8.0 (4.4) s, respectively. Use of the Airtraq achieved the shortest intubation times. Anaesthesiologists rated temperature and vision significantly better in the powered respirator group. Conclusions Advanced airway management remains unaffected by the respiratory protective equipment used if performed by a specially trained, designated team. We conclude that when advanced airway skills are performed by a designated, specially trained team, airway management times remain unaffected by the respiratory protective equipment used.
Collapse
Affiliation(s)
- Jan Schumacher
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clarissa Carvalho
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Greig
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Ragbourne
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Ahmad
- Dept of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Duggan LV, El-Boghdadly K. The importance of prospective observational studies in airway management: yet only the first step. Anaesthesia 2021; 76:1555-1558. [PMID: 34189730 DOI: 10.1111/anae.15538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Affiliation(s)
- L V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
13
|
Assessment of the Thyromental Height Test as an Effective Airway Evaluation Tool. Ann Emerg Med 2021; 77:305-314. [PMID: 33618808 DOI: 10.1016/j.annemergmed.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 11/22/2022]
|
14
|
Bessmann EL, Rasmussen LS, Konge L, Kristensen MS, Rewers M, Kotinis A, Rosenstock CV, Graeser K, Pfeiffer P, Lauritsen T, Østergaard D. Anesthesiologists' airway management expertise: Identifying subjective and objective knowledge gaps. Acta Anaesthesiol Scand 2021; 65:58-67. [PMID: 32888194 DOI: 10.1111/aas.13696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Failure in airway management continues to cause preventable patient harm, and the recommended continuing education is challenged by anesthesiologists' unknown knowledge gaps. This study aimed to identify anesthesiologists' subjective and objective knowledge gaps as well as areas where anesthesiologists are incorrect and unaware. METHODS An adaptive E-learning program with 103 questions on adult airway management was used for subjective and objective assessment of anesthesiologists' knowledge. All anesthesiologists in the Capital Region of Denmark were invited to participate. RESULTS The response rate was 67% (191/285). For preoperative planning, participants stated low confidence (subjective assessment) regarding predictors of difficult airway management in particular (69.1%-79.1%). Test scores (objective assessment) were lowest for obstructive sleep apnea as a predictor of difficult airway management (28.8% correct), with participants being incorrect and unaware in 33.5% of the answers. For optimization of basic techniques, the lowest confidence ratings related to patient positioning and prediction of difficulties (57.4%-83.2%), which agreed with the lowest test scores. Concerning advanced techniques, videolaryngoscopy prompted the lowest confidence (72.4%-85.9%), while emergency cricothyrotomy resulted in the lowest test scores (47.4%-67.8%). Subjective and objective assessments correlated and lower confidence was associated with lower test scores: preoperative planning [r = -.58, P < .001], optimization of basic techniques [r = -.58, P = .002], and advanced techniques [r = -.71, P < .001]. CONCLUSION We identified knowledge gaps in important areas of adult airway management with differing findings from the subjective and objective assessments. This underlines the importance of objective assessment to guide continuing education.
Collapse
Affiliation(s)
- Ebbe L. Bessmann
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael S. Kristensen
- Department of Anaesthesia Centre of Head and Orthopaedics Rigshospitalet Copenhagen Denmark
| | - Mikael Rewers
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
| | - Alexandros Kotinis
- Department of Anesthesia and Intensive Care, Brain and Nervous Diseases Rigshospitalet Glostrup Denmark
| | | | - Karin Graeser
- Department of Anaesthesia and Intensive Care Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | - Peter Pfeiffer
- Department of Anaesthesia Herlev and Gentofte Hospital Gentofte Denmark
| | - Torsten Lauritsen
- Department of Anaesthesia The Juliane Marie Center Rigshospitalet Copenhagen Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | | |
Collapse
|
15
|
Ahmad I, Smith AF. Principles for guidelines and guidelines for principles of universal airway management. Anaesthesia 2020; 75:1570-1573. [PMID: 33165957 DOI: 10.1111/anae.15298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/14/2022]
Affiliation(s)
- I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - A F Smith
- Department of Anaesthesia, Lancaster Royal Infirmary, Lancaster, UK.,Lancaster University, Lancaster, UK
| |
Collapse
|
16
|
Gómez-Ríos MÁ, Abad-Gurumeta A, Casans-Francés R, Esquinas AM. Safe extubation procedure of the difficult airway: "think twice, act wise". Minerva Anestesiol 2020; 86. [DOI: 10.23736/s0375-9393.20.14712-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
17
|
Ahmad I, Arora A, El‐Boghdadly K. Embracing the robotic revolution into anaesthetic practice. Anaesthesia 2020; 75:848-851. [DOI: 10.1111/anae.14986] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 01/22/2023]
Affiliation(s)
- I. Ahmad
- Department of Anaesthesia Guy's and St Thomas NHS Foundation Trust London UK
- King's College London UK
| | - A. Arora
- Department of Surgery Guy's and St. Thomas NHS Foundation Trust London UK
| | - K. El‐Boghdadly
- Department of Anaesthesia Guy's and St Thomas NHS Foundation Trust London UK
- King's College London UK
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Zdravkovic M, Berger‐Estilita J, Sorbello M, Hagberg CA. An international survey about rapid sequence intubation of 10,003 anaesthetists and 16 airway experts. Anaesthesia 2019; 75:313-322. [DOI: 10.1111/anae.14867] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/14/2022]
Affiliation(s)
- M. Zdravkovic
- Department of Anaesthesiology, Intensive Care and Pain Management University Medical Centre Maribor Maribor Slovenia
- Faculty of Medicine University of Maribor Maribor Slovenia
| | - J. Berger‐Estilita
- Department of Anaesthesiology and Pain Medicine, Inselspital Bern University Hospital Bern Switzerland
| | - M. Sorbello
- Department of Anesthesia and Intensive Care AOU Policlinico Vittorio Emanuele Catania Italy
| | - C. A. Hagberg
- Department of Anesthesiology, Critical Care and Pain Medicine University of Texas MD Anderson Cancer Center Houston TX USA
| |
Collapse
|
20
|
O'Carroll JE, Wong DJN, Ahmad I. A difficulty with the
DIFFMASK
score is the difficult statistics. Anaesthesia 2019; 74:1337. [DOI: 10.1111/anae.14775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - D. J. N. Wong
- Guy's and St. Thomas’ NHS Foundation Trust London UK
| | - I. Ahmad
- Guy's and St. Thomas’ NHS Foundation Trust London UK
| |
Collapse
|
21
|
Schieren M, Kleinschmidt J, Schmutz A, Loop T, Staat M, Gatzweiler KH, Wappler F, Defosse J. Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study. Anaesthesia 2019; 74:1563-1571. [PMID: 31448404 DOI: 10.1111/anae.14815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
Abstract
Dental trauma is a common complication of tracheal intubation. As existing evidence is insufficient to validly assess the impact of different laryngoscopy techniques on the incidence of dental trauma, the force exerted onto dental structures during tracheal intubation was investigated. An intubation manikin was equipped with hidden force sensors in all maxillary incisors. Dental force was measured while 104 anaesthetists performed a series of tracheal intubations using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC® , or the hyperangulated GlideScope® or KingVision® laryngoscopes in both normal and difficult airway conditions. A total of 624 tracheal intubations were analysed. The median (IQR [range]) peak force of direct laryngoscopy in normal airways was 21.1 (14.0-32.8 [2.3-127.6]) N and 29.3 (17.7-44.8 [3.3-97.2]) N in difficult airways. In normal airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 4.6 N (p = 0.006) and 10.9 N (p < 0.001) compared with direct laryngoscopy, respectively. In difficult airways, these were lower with the GlideScope and KingVision hyperangulated laryngoscopes, with a reduction of 9.8 N (p < 0.001) and 17.6 N (p < 0.001) compared with direct laryngoscopy, respectively. The use of the C-MAC did not have an impact on the median peak force. Although sex of anaesthetists did not affect peak force, more experienced anaesthetists generated a higher peak force than less experienced providers. We conclude that hyperangulated videolaryngoscopy was associated with a significantly decreased force exerted on maxillary incisors and might reduce the risk for dental injury in clinical settings.
Collapse
Affiliation(s)
- M Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Kleinschmidt
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - A Schmutz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - T Loop
- Department of Anaesthesiology and Intensive Care Medicine, Medical Centre, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - M Staat
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - K-H Gatzweiler
- Institute of Bioengineering, FH Aachen University of Applied Sciences, Biomechanics Laboratory, Julich, Germany
| | - F Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - J Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Carvalho CC, Silva DM, de Carvalho Junior AD, Santos Neto JM, Rio BR, Neto CN, Orange FA. Pre‐operative voice evaluation as a hypothetical predictor of difficult laryngoscopy. Anaesthesia 2019; 74:1147-1152. [DOI: 10.1111/anae.14732] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2019] [Indexed: 12/12/2022]
Affiliation(s)
- C. C. Carvalho
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) Recife Pernambuco Brazil
| | - D. M. Silva
- Hospital das Clínicas de Pernambuco Recife Pernambuco Brazil
| | | | | | - B. R. Rio
- Hospital das Clínicas de Pernambuco Recife Pernambuco Brazil
| | - C. N. Neto
- Instituto Dante Pazzanese de Cardiologia São Paulo Brazil
| | - F. A. Orange
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) Recife Pernambuco Brazil
| |
Collapse
|
24
|
Affiliation(s)
- P. A. Ward
- Chelsea and Westminster Hospital London UK
| | | |
Collapse
|
25
|
El‐Boghdadly K, Aziz MF. Face‐mask ventilation: the neglected essentials? Anaesthesia 2019; 74:1227-1230. [DOI: 10.1111/anae.14703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
- K. El‐Boghdadly
- Guy's and St. Thomas’ NHS Foundation Trust LondonUK
- King's College London LondonUK
| | - M. F. Aziz
- Oregon Health and Science University Portland Oregon
| |
Collapse
|
26
|
Law JA, Duggan LV. The airway assessment has come of age—or has it? Anaesthesia 2019; 74:834-838. [DOI: 10.1111/anae.14658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Affiliation(s)
- J. A. Law
- Department of Anesthesia, Pain Management and Peri‐operative Medicine Dalhousie University Halifax NSCanada
| | - L. V. Duggan
- Department of Anesthesiology University of British Columbia Vancouver BC Canada
| |
Collapse
|
27
|
Shah A, Bailey CR. Outcomes following surgery: are we measuring what really matters? Anaesthesia 2019; 74:696-699. [DOI: 10.1111/anae.14562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Shah
- Nuffield Department of Anaesthesia John Radcliffe Hospital OxfordUK
- Radcliffe Department of Medicine University of OxfordUK
| | - C. R. Bailey
- Department of Anaesthesia Guys and St. Thomas’ NHS Foundation Trust London UK
| |
Collapse
|
28
|
El‐Boghdadly K, Wiles MD. Regional anaesthesia for rib fractures: too many choices, too little evidence. Anaesthesia 2019; 74:564-568. [DOI: 10.1111/anae.14634] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 12/11/2022]
Affiliation(s)
- K. El‐Boghdadly
- Department of Anaesthesia Guy's and St Thomas' NHS Foundation Trust LondonUK
- King's College London UK
| | - M. D. Wiles
- Department of Anaesthesia Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| |
Collapse
|
29
|
McGrenaghan E, Smith AF. Airway management research: what problem are we trying to solve? Anaesthesia 2018; 74:704-707. [DOI: 10.1111/anae.14563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/23/2022]
|