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Fritz CG, Monos SD, Romeo D, Lowery A, Xu K, Atkins J, Rajasekaran K. Medico-legal liability of injuries arising from laryngoscopy. J Laryngol Otol 2024; 138:554-558. [PMID: 37982243 PMCID: PMC11063656 DOI: 10.1017/s0022215123001986] [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: 05/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Dental and mucosal injuries from laryngoscopy in the peri-operative period are common medico-legal complaints. This study investigated lawsuits arising from laryngoscopy. METHODS Westlaw, a legal database containing trial records from across the USA, was retrospectively reviewed. Plaintiff and/or defendant characteristics, claimed injuries, legal outcomes and awards were extracted. RESULTS Of all laryngoscopy-related dental or mucosal injuries brought before a state or federal court, none (0 per cent) resulted in a defence verdict against the provider or monetary gain for the patient. Rulings in the patient's favour were observed only when laryngoscopy was found to be the proximate cause of multiple compounding complications that culminated in severe medical outcomes such as exsanguination, septic shock or cardiopulmonary arrest. CONCLUSION Proper laryngoscopy technique and a robust informed-consent process that accurately sets patients' expectations reduces litigation risk. Future litigation pursuits should consider the low likelihood of malpractice allegation success at trial.
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Affiliation(s)
- Christian G Fritz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Stylianos D Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Anne Lowery
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
| | - Katherine Xu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Joshua Atkins
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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2
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Kotani T, Inoue S, Kawaguchi M. Perioperative Dental Injury Associated With Intubated General Anesthesia. Anesth Prog 2022; 69:3-9. [PMID: 35377930 DOI: 10.2344/anpr-68-03-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 04/28/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Factors related to perioperative dental injury have likely changed as a variety of airway devices and preventive measures have been introduced. This retrospective chart review used data from an institutional registry to evaluate the incidence, timing, and contributing factors of patient self-reported dental injury and to assess the impact of dental injury on patient satisfaction. METHODS Multivariate logistic analysis was performed on the records of 14,820 patients using the incidence of dental injury as the dependent variable and covariates in the anesthesia registry and a postoperative questionnaire as independent variables to investigate factors significantly associated perioperative dental injury. In addition, satisfaction with the anesthesia service was compared between patients with and without injury using a matched-pair population. RESULTS A total of 101 dental injuries were identified. Of those, 25% were associated with intubation and extubation in the operating room, while most other injuries occurred postoperatively. Duration of anesthesia (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.03) and emergency surgery (OR, 1.92; 95% CI, 1.11-3.30) were independently associated with perioperative dental injury. Dental injury did not significantly decrease a patient's satisfaction with the anesthesia service (P = .441). CONCLUSION Most perioperative dental injuries are unrelated to anesthesia procedures. However, the duration of anesthesia and emergency surgery were significantly associated with perioperative dental injury, while decreased patient satisfaction was not.
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Affiliation(s)
- Taichi Kotani
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Nara, Japan
| | - Satoki Inoue
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Nara, Japan
| | - Masahiko Kawaguchi
- Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Nara, Japan
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3
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Wilson CP, Romano E, Vasan NR. Comparison of Dental Injury Rates in Perioperative Intubation and Suspension Laryngoscopy for Otolaryngology Procedures. OTO Open 2021; 5:2473974X211065021. [PMID: 34926975 PMCID: PMC8671680 DOI: 10.1177/2473974x211065021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Direct laryngoscopy is an essential skill during perioperative intubation and otolaryngology procedures. Dental injury is a common complication of direct laryngoscopy. However, the technique and tools used by anesthesiologists, nurse anesthetists, and others during perioperative intubation and by ear, nose, and throat surgeons for their procedures are different. The purpose of this review is to explore the literature for all studies detailing rates of dental injury in each of these settings and to compare them to see if the approaches have a significant difference in rate of dental injury. Data Sources PubMed. Review Methods A comprehensive search of PubMed was performed through February 2021 with search terms “dental” and “intubation” or “laryngoscopy.” PRISMA guidelines were followed. Studies documenting rates of dental injuries during intubation or during laryngologic procedures were included, and the 2 groups were compared. Results Twenty-three studies met inclusion criteria: 17 in the perioperative intubation group and 6 in the suspension laryngoscopy group. There was an increased incidence of dental injury in the perioperative intubation group (4.86%) as compared with the suspension laryngoscopy group (1.70%). Conclusions The difference in dental injury rate between the groups could be due to the differences in direct laryngoscopy technique or tools used, the presence vs absence of a dental guard, or a combination of these factors. More studies need to be performed to develop definitive and specific conclusions to recommend changes that prevent dental injury.
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Affiliation(s)
- Caleb P Wilson
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Erica Romano
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Nilesh R Vasan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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4
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Doğan Ö, Altıntepe Doğan SS, Altıntepe N, Şahin ND, Çelik İH. An analysis of anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. Dent Traumatol 2021; 37:786-794. [PMID: 34216178 DOI: 10.1111/edt.12702] [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: 12/15/2020] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Peri-anesthetic dental trauma is a common anesthesia-related complication. It is the reason for a significant number of malpractice lawsuits against anesthetists through insurance companies. The frequency, outcomes, and risk factors related to peri-anesthetic dental trauma have been well documented. The aim of this study was to evaluate anesthetists' awareness, knowledge, and attitudes toward peri-anesthetic dental trauma. MATERIAL AND METHODS This nationwide, cross-sectional, descriptive study comprising 220 anesthetists was conducted in Turkey between June 2019 and May 2020. A specific questionnaire was created using Google Forms and delivered to 591 participants via WhatsApp. Pearson's Chi-squared test and the Fisher-Freeman-Halton tests were used to analyze the results. RESULTS The overall response rate was 37.2% (220 out of 591 participants). Of the 80.5% of the participants who encountered peri-anesthetic dental trauma during their practice, 32.8% had encountered avulsion and 32.8% reported that they had caused soft tissue injuries. More than one-third of the participants (38.9%) stated that the patient group that was the most at-risk for peri-anesthetic dental trauma was older people with missing teeth. Half of the participants (50.9%) stated that avulsed teeth could be replanted; among them, 21.8% and 11.8% specified that the ideal replantation time was <30 min and that the ideal storage medium for the avulsed tooth was fresh milk, respectively. Furthermore, 88.1% of the participants noted that peri-anesthetic dental trauma occurred more frequently during emergency intubations and only 20.9% were aware of custom-made mouthguards. CONCLUSIONS Anesthetists lack knowledge around peri-anesthetic dental trauma and its interventions.
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Affiliation(s)
- Özgür Doğan
- Department of Pediatric Dentistry Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Suat Serhan Altıntepe Doğan
- Department of Periodontology Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nihan Altıntepe
- Department of Anaesthesiology and Reanimation, Cemil Taşcıoğlu, City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Necibe Damla Şahin
- Department of Pediatric Dentistry Tokat, School of Dentistry, Tokat Gaziosmanpasa University, Afyonkarahisar, Turkey
| | - İsmail Haktan Çelik
- Department of Pediatric Dentistry Afyonkarahisar, School of Dentistry, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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5
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Galvão AK, Cabral GM, Miranda AF, Baeder FM, Santos MT. Tooth avulsion accidents due to urgent and emergency orotracheal intubation. Med Oral Patol Oral Cir Bucal 2020; 25:e353-e358. [PMID: 32040466 PMCID: PMC7211367 DOI: 10.4317/medoral.23375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background Intubation is necessary during critical situations to reduce the risk of death. In Brazil, a need exists to determine the prevalence of tooth avulsions in emergency and urgent care. The objective of this study was to identify the causes of orotracheal intubation (OTI), the number of tooth avulsions, and the avulsed teeth that result from urgent and emergency intubation.
Material and Methods The sample consisted of 116 patients (total group) in intensive care units (ICUs) distributed across Group 1 (G1), which was composed of 71 patients from an urgent-care hospital, and Group 2 (G2), which was composed of 45 patients from an emergency hospital. Clinical examinations showed dental alveolus with signs of recent exodontia in the upper and lower anterior regions. Sociodemographic data and the reason for intubation were evaluated. The Shapiro-Wilk normality test, chi-square test, Fisher’s exact test, Mann-Whitney U test, and univariate logistic regression were performed with a significance level of 5%.
Results The avulsion prevalence was 4.3%, with more cases receiving emergency intubation (n=4). All avulsions occurred in adults, and a significant difference (p=0.011) was observed with regard to the elderly. A 1-year reduction in age increased the chance of tooth avulsion during intubation by 1.09 times; being female increased the chance by 2.88 times.
Conclusions Pulmonary problems were the major causes of intubation, with the highest tooth avulsion prevalence observed during emergency intubation. The avulsed teeth were 11, 12, 13, 22, 32, and 33 across all cases. Key words:Tooth avulsion, tooth injuries, intubation, intensive care units, emergencies.
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Affiliation(s)
- A-K Galvão
- Universidade Cruzeiro do Sul Rua Constantino de Sousa, 454, apto 141 zip code: 04605-001, São Paulo - SP, Brazil
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Christensen RE, Baekgaard JS, Rasmussen LS. Dental injuries in relation to general anaesthesia-A retrospective study. Acta Anaesthesiol Scand 2019; 63:993-1000. [PMID: 31016717 DOI: 10.1111/aas.13378] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dental injuries may occur during general anaesthesia, especially during airway management. The aim of this study was to describe cases of dental injury related to general anaesthesia, focusing on the type and extent of the injuries as well as the timing of recognition. METHOD We reviewed the nationwide electronic database available at the Danish Patient Compensation Association and scrutinized all claims classified as possible dental injuries in relation to general anaesthesia between 2007 and 2017. RESULTS During the 10-year study period, there were 2523 claims for compensation related to anaesthesia. Of these, 552 (21.9%) were cases of possible dental injuries following general anaesthesia. The most commonly injured teeth were the central maxillary incisors with 174 (25.3%) cases related to the left and 118 (17.2%) cases related to the right incisor. The most common injuries were fractures (41.2%) and subluxations (25.9%). Airway management included the use of Macintosh laryngoscope in 296 (64.4%) cases and a supraglottic airway device in 69 (15%) cases. Claims were more frequently approved if more than two intubation attempts were used (100% vs 82.8%, RR = 0.83, 95% CI [0.78-0.88], P = 0.0037). Injuries recognized in-hospital were more frequently approved than injuries recognized after discharge (91.6% vs 70.7%, RR = 0.83, 95% CI [0.70-0.86], P < 0.0001). CONCLUSION The most commonly reported dental injury related to general anaesthesia in the Danish Patient Compensation Association database was a fracture. Claims were more frequently approved if more than two intubation attempts were used and if the injury was recognized in-hospital.
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Affiliation(s)
| | - Josefine S. Baekgaard
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Lars S. Rasmussen
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen Copenhagen Denmark
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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.
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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
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Engoren M, Rochlen LR, Diehl MV, Sherman SS, Jewell E, Golinski M, Begeman P, Cavanaugh JM. Mechanical strain to maxillary incisors during direct laryngoscopy. BMC Anesthesiol 2017; 17:151. [PMID: 29115945 PMCID: PMC5688811 DOI: 10.1186/s12871-017-0442-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 10/31/2017] [Indexed: 01/19/2023] Open
Abstract
Background While most Direct laryngoscopy leads to dental injury in 25–39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP). Methods A mannequin head designed to teach and test intubation was instrumented with eight single axis strain gauges placed on the four maxillary incisors: four on the facial or front surface of the incisors and four on the lingual or back, near the insertion of the incisor in the gums to measure bending strain as well as compression. Anesthesiology faculty, residents, and certified registered nurse anesthetists intubated with Macintosh and Miller blades with and without APP. Using strain-time curves, the maximum strain, strain rate, and strain time integral were calculated. Results Across the 92 subjects, strain varied 8–12 fold between the 25th and 75th percentiles for all four techniques, but little by experience, while strain rate and strain integral varied 6–13 fold and 15–26 fold, respectively, for the same percentiles. Intubators who had high strain values with one blade tended to have high strains with the other blade with and without the APP (all pairwise correlation rho = 0.42–0.63). Conclusions Strain varies widely by intubator and that the use of the APP reduces strain rate which may decrease the risk of or the severity of dental injury.
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Affiliation(s)
- Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. .,Department of Anesthesiology, Mercy St. Vincent Medical Center, Toledo, OH, USA.
| | - Lauryn R Rochlen
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew V Diehl
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Sarah S Sherman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Elizabeth Jewell
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Mary Golinski
- Beaumont Graduate Program of Nurse Anesthesia, Oakland University, Rochester, MI, USA
| | - Paul Begeman
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - John M Cavanaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
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9
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Basavaraju A, Slade K. Dental damage in anaesthesia. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2017. [DOI: 10.1016/j.mpaic.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Fornebo I, Simonsen KA, Bukholm IRK, Kongsgaard UE. Claims for compensation after injuries related to airway management: a nationwide study covering 15 years. Acta Anaesthesiol Scand 2017; 61:781-789. [PMID: 28556897 DOI: 10.1111/aas.12914] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/25/2017] [Accepted: 05/08/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement. METHODS All claims to The Norwegian System of Compensation to Patients from 1 January 2001 to 31 December 2015 within the medical specialty of anaesthesiology were studied. Data were extracted from this database for patients and coded by airway management procedures. RESULTS Of 400 claims for injuries related to airway management, 359 were classified as 'non-severe' and 41 as 'severe'. Of the severe cases, 37% of injuries occurred during emergency procedures. Eighty-one claims resulted in compensation, and 319 were rejected. A total of €1,505,344 was paid to the claimants during the period. Claims of dental damage contributed to a numerically important, but financially modest, proportion of claims. More than half of the severe cases were caused by failed intubation or a misplaced endotracheal tube. CONCLUSION Anaesthesia procedures are not without risk, and injuries can occur when securing the airway. The most common injury was dental trauma. Clear patterns of airway management that resulted in injuries are not apparent from our data, but 37% of severe cases were related to emergency procedures which suggest the need for additional vigilance. Guidelines for difficult intubation situations are well established, but adherence to such guidelines varies. Good planning of every general anaesthesia should involve consideration of possible airway problems and assessment of pre-existing poor dentition.
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Affiliation(s)
- I. Fornebo
- Medical Faculty; Oslo University; Oslo Norway
| | - K. A. Simonsen
- Department of Medical Experts; The Norwegian system of Compensation to Patients (NPE); Oslo Norway
| | - I. R. K. Bukholm
- Medical Faculty; Oslo University; Oslo Norway
- The Norwegian system of Compensation to Patients (NPE); Oslo Norway
| | - U. E. Kongsgaard
- Medical Faculty; Oslo University; Oslo Norway
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
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11
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. [Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]. Rev Bras Anestesiol 2016; 67:6-14. [PMID: 27692805 DOI: 10.1016/j.bjan.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Espanha
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madri, Espanha; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madri, Espanha; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madri, Espanha
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Espanha; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madri, Espanha
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Espanha
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madri, Espanha.
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12
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Ruíz-López Del Prado G, Blaya-Nováková V, Saz-Parkinson Z, Álvarez-Montero ÓL, Ayala A, Muñoz-Moreno MF, Forjaz MJ. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation. Braz J Anesthesiol 2016; 67:6-14. [PMID: 28017172 DOI: 10.1016/j.bjane.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/17/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. METHODS Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. RESULTS The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. CONCLUSIONS The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.
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Affiliation(s)
- Gema Ruíz-López Del Prado
- Hospital Clínico Universitario, Departamento de Medicina Preventiva y Salud Pública, Valladolid, Spain
| | - Vendula Blaya-Nováková
- Hospital General Universitario Gregorio Marañón, Servicio de Medicina Preventiva y Gestión de Calidad, Madrid, Spain; Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain
| | - Zuleika Saz-Parkinson
- Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Óscar Luis Álvarez-Montero
- Hospital Universitario Infanta Leonor, Departamento de Otorrinolaringología, Madrid, Spain; Hospital Universitario Puerta de Hierro, Departamento de Otorrinolaringología, Madrid, Spain
| | - Alba Ayala
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain
| | - Maria Fe Muñoz-Moreno
- Hospital Clínico Universitario, Unidad de Investigación Biomédica, Valladolid, Spain
| | - Maria João Forjaz
- Instituto de Salud Carlos III, Escuela Nacional de Sanidad, Madrid, Spain.
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Barletta M, Kleine SA, Quandt JE. Assessment of v-gel supraglottic airway device placement in cats performed by inexperienced veterinary students. Vet Rec 2015; 177:523. [DOI: 10.1136/vr.103407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 12/26/2022]
Affiliation(s)
- M. Barletta
- Department of Large Animal Medicine; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
| | - S. A. Kleine
- Department of Small Animal Medicine & Surgery; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
| | - J. E. Quandt
- Department of Small Animal Medicine & Surgery; College of Veterinary Medicine, University of Georgia; Athens GA 30602 USA
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14
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Brandão Ribeiro de Sousa JM, de Barros Mourão JI. Tooth injury in anaesthesiology. Braz J Anesthesiol 2015; 65:511-8. [DOI: 10.1016/j.bjane.2013.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/15/2013] [Indexed: 11/28/2022] Open
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15
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Asahi Y, Fujii R, Usui N, Kagamiuchi H, Omichi S, Kotani J. Anesthetic management by laryngeal mask airway in a patient with a history of difficult intubation resulting in dental injuries. Anesth Prog 2015; 62:20-1. [PMID: 25849470 DOI: 10.2344/0003-3006-62.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Disabled patients may face respiratory problems during general anesthesia because of head and neck anomalies. We describe a case of dental treatment under general anesthesia using a laryngeal mask airway in a disabled patient who faced difficulty in endotracheal intubation on several occasions, 5 of which resulted in dental injuries.
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Affiliation(s)
- Yoshinao Asahi
- Department of Dentistry, Morinomiya Hospital, Osaka, Japan
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Abstract
BACKGROUND AND OBJECTIVES Dental injury is the most common complication of general anaesthesia and has significant physical, economic and forensic consequences. The aim of this study is to review on the characteristics of dental injury associated with anaesthesiology and existing methods of prevention. CONTENTS In this review, the time of anaesthesia in which the dental injury occurs, the affected teeth, the most frequent type of injury, established risk factors, prevention strategies, protection devices and medico-legal implications inherent to its occurrence are approached. CONCLUSIONS Before initiating any medical procedure that requires the use of classic laryngoscopy, a thorough and detailed pre-aesthetic evaluation of the dental status of the patient is imperative, in order to identify teeth at risk, analyze the presence of factors associated with difficult intubation and outline a prevention strategy that is tailored to the risk of dental injury of each patient.
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17
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Mourão J, Neto J, Luís C, Moreno C, Barbosa J, Carvalho J, Tavares J. Dental injury after conventional direct laryngoscopy: a prospective observational study. Anaesthesia 2013; 68:1059-65. [DOI: 10.1111/anae.12342] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - J. Neto
- Institute of Biomedical Sciences Abel Salazar; University of Oporto; Oporto; Portugal
| | - C. Luís
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - C. Moreno
- Department of Anaesthesia; Centro Hospitalar São João; EPE; Oporto; Portugal
| | - J. Barbosa
- Center for Medical Education; University of Oporto; Oporto; Portugal
| | - J. Carvalho
- Faculty of Dental Medicine; University of Oporto; Oporto; Portugal
| | - J. Tavares
- Department of Surgery; Faculty of Medicine; University of Oporto; Oporto; Portugal
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18
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López AM, Valero R. Use of supraglottic airway devices in patients positioned other than supine. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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A prospective non-randomised study to compare oral trauma from laryngoscope versus laryngeal mask insertion. Br Dent J 2011. [DOI: 10.1038/sj.bdj.2011.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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