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Abraham-Thomas N, Ahmad I, El-Boghdadly K. The how and the what of mandatory training. Anaesthesia 2024. [PMID: 39129210 DOI: 10.1111/anae.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2024] [Indexed: 08/13/2024]
Affiliation(s)
| | - Imran Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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Uzun DD, Tryjanowski T, Arians N, Mohr S, Schmitt FCF, Michalski CW, Weigand MA, Debus J, Lang K. Impact of Radiotherapy on Endotracheal Intubation Quality Metrics in Patients with Esophageal Cancer: A Challenge for Advanced Airway Management? Cancers (Basel) 2024; 16:2540. [PMID: 39061180 PMCID: PMC11274552 DOI: 10.3390/cancers16142540] [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: 06/18/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Currently, no data are available in the literature investigating the influence of radiotherapy (RT) on endotracheal intubation success in patients with esophageal cancer. This study aims to evaluate the impact of RT on endotracheal intubation quality metrics in patients with esophageal cancer. (2) Methods: Patients with esophageal cancer who underwent RT followed by surgery between 2012 and 2023 at the University Hospital Heidelberg, Germany, were retrospectively analyzed. (3) Results: Fifty-five patients, predominantly males 65.5% with a mean age of 64 years, were enrolled. Overall, 81.8% of the patients had an ASA class of III, followed by 27.2% ASA II. The mean prescribed cumulative total dose to the primary tumor and lymph node metastasis was 48.2 Gy with a mean single dose of 1.8 Gy. The mean laryngeal total dose was 40.0 Gy. Direct laryngoscopy was performed in 80.0% of cases, followed by 12.1% videolaryngoscopy, and 7.2% required fiberoptic intubation. Overall, 96.4% of patients were successfully intubated on the first attempt. (4) Conclusions: It has been demonstrated that post-RT effects can increase the risk of airway management difficulties and complications. The results of our study did not indicate any evidence of impaired advanced airway management in patients with esophageal cancer who had undergone RT.
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Affiliation(s)
- Davut D. Uzun
- Department of Anesthesiology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (D.D.U.); (S.M.); (F.C.F.S.); (M.A.W.)
| | - Timo Tryjanowski
- Department of Radiation Oncology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (T.T.); (N.A.); (J.D.)
| | - Nathalie Arians
- Department of Radiation Oncology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (T.T.); (N.A.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Stefan Mohr
- Department of Anesthesiology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (D.D.U.); (S.M.); (F.C.F.S.); (M.A.W.)
| | - Felix C. F. Schmitt
- Department of Anesthesiology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (D.D.U.); (S.M.); (F.C.F.S.); (M.A.W.)
| | - Christoph W. Michalski
- Department of General, Visceral and Transplantation Surgery, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany;
| | - Markus A. Weigand
- Department of Anesthesiology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (D.D.U.); (S.M.); (F.C.F.S.); (M.A.W.)
| | - Juergen Debus
- Department of Radiation Oncology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (T.T.); (N.A.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Medical Faculty Heidelberg, University Heidelberg, 69120 Heidelberg, Germany; (T.T.); (N.A.); (J.D.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
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Müller-Wirtz LM, Turan A, Ruetzler K. Videolaryngoscopy is superior to direct laryngoscopy: It's time to change our clinical practice! J Clin Anesth 2024:111536. [PMID: 38908956 DOI: 10.1016/j.jclinane.2024.111536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/16/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Lukas M Müller-Wirtz
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States; Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Alparslan Turan
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States; Division of Multi-Specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt Ruetzler
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States; Division of Multi-Specialty Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, United States.
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Oglesby FC, Scholefield BR, Cook TM, Smith JH, Pappachan VJ, Kane AD, Armstrong RA, Kursumovic E, Soar J. Peri-operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia 2024; 79:583-592. [PMID: 38369586 DOI: 10.1111/anae.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/20/2024]
Abstract
The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri-operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2-3.3 per 10,000). The incidence of peri-operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non-cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri-operative cardiac arrest.
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Affiliation(s)
- F C Oglesby
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B R Scholefield
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - 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
| | - J H Smith
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - V J Pappachan
- Department of Paediatric Anaesthesia and Intensive Care Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- National Institute for Health and Care Research Biomedical Research Centre, University of Southampton, Southampton, UK
| | - A D Kane
- Department of Anaesthesia, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
- Hull York Medical School, Hull, UK
| | - R A Armstrong
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - E Kursumovic
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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Haag AK, Tredese A, Bordini M, Fuchs A, Greif R, Matava C, Riva T, Scquizzato T, Disma N. Emergency front-of-neck access in pediatric anesthesia: A narrative review. Paediatr Anaesth 2024; 34:495-506. [PMID: 38462998 DOI: 10.1111/pan.14875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Children undergoing airway management during general anesthesia may experience airway complications resulting in a rare but life-threatening situation known as "Can't Intubate, Can't Oxygenate". This situation requires immediate recognition, advanced airway management, and ultimately emergency front-of-neck access. The absence of standardized procedures, lack of readily available equipment, inadequate knowledge, and training often lead to failed emergency front-of-neck access, resulting in catastrophic outcomes. In this narrative review, we examined the latest evidence on emergency front-of-neck access in children. METHODS A comprehensive literature was performed the use of emergency front-of-neck access (eFONA) in infants and children. RESULTS Eighty-six papers were deemed relevant by abstract. Finally, eight studies regarding the eFONA technique and simulations in animal models were included. For all articles, their primary and secondary outcomes, their specific animal model, the experimental design, the target participants, and the equipment were reported. CONCLUSION Based on the available evidence, we propose a general approach to the eFONA technique and a guide for implementing local protocols and training. Additionally, we introduce the application of innovative tools such as 3D models, ultrasound, and artificial intelligence, which can improve the precision, safety, and training of this rare but critical procedure.
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Affiliation(s)
- Anna-Katharina Haag
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alberto Tredese
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Martina Bordini
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Robert Greif
- University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Clyde Matava
- Department of Anaesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tommaso Scquizzato
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Disma
- Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Cook T, Oglesby F, Soar J. NAP7 and airway management: as important as life and death. Anaesthesia 2024; 79:548-549. [PMID: 38319863 DOI: 10.1111/anae.16246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/08/2024]
Affiliation(s)
- T Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - J Soar
- Southmead Hospital, Bristol, UK
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Hansel J, Jones SJ. Anaesthetic rooms are no longer needed. Anaesthesia 2024; 79:465-468. [PMID: 38214405 DOI: 10.1111/anae.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Affiliation(s)
- J Hansel
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - S J Jones
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, UK
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Ahmad I, El-Boghdadly K. Time for confidential enquiries into airway complications? Anaesthesia 2024; 79:349-352. [PMID: 38114266 DOI: 10.1111/anae.16210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
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, London, 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
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Hansel J, Cook TM. Harm during airway management by anaesthetists: its absence in randomised controlled trials does not mean it does not exist. Anaesthesia 2024; 79:444-445. [PMID: 38306494 DOI: 10.1111/anae.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/04/2024]
Affiliation(s)
- J Hansel
- University of Manchester, Manchester, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Shrimpton AJ, Quayle AC, Sleep DL, Brown JM, Cook TM. Quantification of aerosol generation during positive pressure ventilation via a supraglottic airway with an intentional leak. Anaesthesia 2024; 79:318-320. [PMID: 38217363 DOI: 10.1111/anae.16197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 01/15/2024]
Affiliation(s)
| | - A C Quayle
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D L Sleep
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J M Brown
- North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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