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Cumberworth A, Lewith H, Sud A, Jefferson H, Athanassoglou V, Pandit JJ. Major complications of airway management: a prospective multicentre observational study. Anaesthesia 2022; 77:640-648. [PMID: 35254669 DOI: 10.1111/anae.15668] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 12/12/2022]
Abstract
We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with 'predicted easy' airways were rare (approximately 1 in 14,200), but 45 times more common in those with 'predicted difficult' airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.
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Affiliation(s)
- A Cumberworth
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Lewith
- Department of Anaesthetics, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - A Sud
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Jefferson
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Athanassoglou
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
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Affiliation(s)
- Thomas Heidegger
- From the Department of Anesthesia, Spital Grabs, Grabs, and the Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern - both in Switzerland; and the Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
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Klucka J, Kosinova M, Kratochvil M, Marecek L, Kovalcikova P, Urik M, Stourac P. Difficult airway prediction in paediatric anaesthesia (Diffair): Prospective observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:298-304. [PMID: 32424374 DOI: 10.5507/bp.2020.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/29/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The incidence of difficult airway in paediatric patients is lower than that the adult population, and the majority should be predictable. AIMS The primary aim of this trial was to evaluate the incidence of difficult airway in pediatric patients. The secondary aim was to predict difficult airway in these patients. METHODS Paediatric patients undergoing elective surgery under general anaesthesia in a tertiary university hospital were examined, and a panel of difficult airway prediction tests was performed. We recorded the incidence, risk factors for difficult airway and events associated with difficult airway together with the sensitivity and specificity of tests for difficult airway and events associated with difficult airway prediction. RESULTS We prospectively included 389 paediatric patients. The incidence of difficult airway was 3.6%; the incidence of events associated with difficult airway was 10%. The sensitivity for prediction of events associated with difficult airway during the pre-anaesthesia evaluation was 5.3% with the specificity 93.3%. In the operating room, the sensitivity of prediction was 15% with 97.8% specificity. CONCLUSION We found minimal efficacy for preanaesthesia difficult airway prediction.
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Affiliation(s)
| | | | - Milan Kratochvil
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukas Marecek
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Kovalcikova
- Institute of Biostatistics and Bioanalyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Milan Urik
- Department of Paediatric Otorhinolaryngology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Lim WY, Wong P. Awake supraglottic airway guided flexible bronchoscopic intubation in patients with anticipated difficult airways: a case series and narrative review. Korean J Anesthesiol 2019; 72:548-557. [PMID: 31475506 PMCID: PMC6900415 DOI: 10.4097/kja.19318] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022] Open
Abstract
Awake intubation is indicated in difficult airways if attempts at securing the airway after induction of general anesthesia may lead to harm due to potential difficulties or failure in those attempts. Conventional awake flexible bronchoscopic intubation is performed via the nasal, or less commonly, oral route. Awake oral flexible bronchoscopic intubation (FBI) via a supraglottic airway device (SAD) is a less common technique; we refer to this as ‘supraglottic airway guided’ FBI (SAGFBI). We describe ten cases with anticipated difficult airways in which awake SAGFBI was performed. After sedation and adequate airway topicalization, an Ambu AuragainTM SAD was inserted. A flexible bronchoscope, preloaded with a tracheal tube, was then inserted through the SAD. Finally, the tracheal tube was railroaded over the bronchoscope, through the SAD and into the trachea. The bronchoscope and the SAD were carefully removed, whilst keeping the tracheal tube in-situ. The technique was successful and well tolerated by all patients, and associated complications were rare. It also offered the advantages of performing an ‘awake test insertion’ of the SAD, an ‘awake look’ at the periglottic region, and an ‘awake test ventilation.’ In certain patients, awake SAGFBI offers advantages over conventional awake FBI or awake videolaryngoscopy. More research is required to evaluate its success and failure rates, and identify associated complications. Its place in difficult airway algorithms may then be further established.
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Affiliation(s)
- Wan Yen Lim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Patrick Wong
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
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El-Boghdadly K, Onwochei DN, Cuddihy J, Ahmad I. A prospective cohort study of awake fibreoptic intubation practice at a tertiary centre. Anaesthesia 2018; 72:694-703. [PMID: 28654138 DOI: 10.1111/anae.13844] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 12/22/2022]
Abstract
Contemporary data are lacking for procedural practice, training provision and outcomes for awake fibreoptic intubation in the UK. We performed a prospective cohort study of awake fibreoptic intubations at a tertiary centre to assess current practice. Data from 600 elective or emergency awake fibreoptic intubations were collected to include information on patient and operator demographics, technical performance and complications. This comprised 1.71% of patients presenting for surgery requiring a general anaesthetic, with the majority occurring in patients presenting for head and neck surgery. The most common indication was reduced mouth opening (26.8%), followed by previous airway surgery or head and neck radiotherapy (22.5% each). Only five awake fibreoptic intubations were performed with no sedation, but the most common sedative technique was combined target-controlled infusions of remifentanil and propofol. Oxygenation was achieved with high-flow, heated and humidified oxygen via nasal cannula in 49.0% of patients. Most operators had performed awake fibreoptic intubation more than 20 times previously, but trainees were the primary operator in 78.6% of awake fibreoptic intubations, of which 86.8% were directly supervised by a consultant. The failure rate was 1.0%, and 11.0% of awake fibreoptic intubations were complicated, most commonly by multiple attempts (4.2%), over-sedation (2.2%) or desaturation (1.5%). The only significant association with complications was the number of previous awake fibreoptic intubations performed, with fewer complications occurring in the hands of operators with more awake fibreoptic intubation experience. Our data demonstrate that awake fibreoptic intubation is a safe procedure with a high success rate. Institutional awake fibreoptic intubation training can both develop and maintain trainee competence in performing awake fibreoptic intubation, with a similar incidence of complications and success compared with consultants.
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Affiliation(s)
| | - D N Onwochei
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Cuddihy
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Schäuble JC, Heidegger T. [Management of the difficult airway : Overview of the current guidelines]. Anaesthesist 2018; 67:725-737. [PMID: 30291405 DOI: 10.1007/s00101-018-0492-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several national airway task forces have recently updated their recommendations for the management of the difficult airway in adults. Routinely responding to airway difficulties with an algorithm-based strategy is consistently supported. The focus is increasingly not on tools and devices but more on good planning, preparation and communication. In the case of anticipated airway difficulties the airway should be secured when the patient is awake with maintenance of spontaneous ventilation. Unaltered a flexible bronchoscopic intubation technique is advised as a standard of care in such patients. The importance of maintenance of oxygenation is emphasized. Face mask ventilation and the use of supraglottic devices are recommended if unexpected airway difficulties occur. Face mask ventilation may be facilitated and optimised by early administration of neuromuscular blocking agents. If required, in not fastened patients threatened by acute hypoxia, carefully applied and pressure-controlled ventilation may ensure sufficient oxygenation until the airway is secured. Apnoeic oxygen techniques are recommended in high-risk patients and to relieve the time pressure of falling oxygen saturation during decision-making processes. The early use of video laryngoscopy is advised for endotracheal intubation in the case of failed direct laryngoscopy or if intubation is expected to be difficult. For the coverage of cannot intubate-cannot oxygenate scenarios, second generation supraglottic devices and invasive airway access are advocated. The discussion regarding the optimal technique for emergency invasive airway access is still in progress. In the case of uncontrollable respiratory deterioration and progressive hypoxia, the algorithm must be consistently executed and without delay due to ineffective activities (straightforward strategy). Although there is no evidence to support the selection of a particular approach, the importance and the need for a defined airway concept/algorithm in any anesthesia department is fostered. Simplicity and clarity are essential for recall under stressful and time-sensitive conditions. The algorithm should be adapted to local conditions and preferences and devices should be limited to a definite number. The acquisition and maintenance of expertise by education and training is demanded.
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Affiliation(s)
- J C Schäuble
- Institut für Anästhesiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Schweiz.
| | - T Heidegger
- Departement für Anästhesie, Intensivmedizin und Reanimation, Spitalregion Rheintal, Werdenberg, Sarganserland, Schweiz.,Universität Bern, Bern, Schweiz
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Reviriego-Agudo L, de Togores-Lopez AR, Charco-Mora P. The significance and weight of manikin studies in airway management. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bryan YF, Johnson KN. Procedural difficulties during successful intubation in octogenarians: A prospective observational study. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:499-505. [PMID: 28366293 DOI: 10.1016/j.redar.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Octogenarians undergo anatomic and physiopathologic degradation, making airway management problematic, specific to intubation, bag mask ventilation, leading to desaturation and aspiration. Our study's aim was to examine the process of airway management regarding the steps involved in intubation and any deviations or delays in the tasks. MATERIALS AND METHODS An institutional review board-approved difficult airway prospective observational study in older adults was conducted. Inclusion criteria included airway features indicative of difficult airway, history of failed intubation, the planned use of specialized airway devices, and/or expected airway complications due to comorbidities. Patients 80 years and older were analyzed. Demographic data collected were age, weight, BMI, gender, ASA classification, airway indices, diagnosis, and procedures. Problems with intubation (INT) (≥3 intubation attempts), laborious assisted ventilation (VEN) (2-person and/or application of CPAP>20cmH2O), and complications with oxygenation (OXY) (SpO2<95%) were analyzed. RESULTS Of the 41 patients enrolled in the study, 3 (7.3%) had all 3: problematic (INT), laborious (VEN), and desaturated (OXY); 8 (19.5%) patients experienced problematic (INT), 20 (48.8%) were described as laborious (VEN), and 14 (34.1%) experienced complications with (OXY). CONCLUSION In octogenarians, we found a low incidence of difficulty with INT-VEN-OXY together. However, bag mask ventilation was found to be laborious with a high incidence of desaturation. Success rate of INT as a sole metric may not accurately describe the process of the intubation. We recommend alternative airway devices and techniques and the establishment of protocols for airway management in the elderly.
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Affiliation(s)
- Y F Bryan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos.
| | - K N Johnson
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Estados Unidos
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Pandit JJ, Heidegger T. Airway assessment/management paradigm - does a spectral or a binary approach fit better? A reply. Anaesthesia 2017; 72:1037-1038. [DOI: 10.1111/anae.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - T. Heidegger
- Spitalregion Rheintal Werdenberg; Grabs Switzerland
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Comparison of airway management techniques for different access in a simulated motor vehicle entrapment scenario. Eur J Emerg Med 2017; 23:279-285. [PMID: 25715022 DOI: 10.1097/mej.0000000000000254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency airway management can be particularly challenging in patients entrapped in crashed cars because of limited access. The aim of this study was to analyse the feasibility of four different airway devices in various standardized settings utilized by paramedics and emergency physicians. METHODS Twenty-five paramedics and 25 emergency physicians were asked to perform advanced airway management in a manikin entrapped in a car's left front seat, with access to the patient through the opened driver's door or access from the back seat. Available airway devices included Macintosh and Airtraq laryngoscopes, as well as laryngeal mask airway (LMA) Supreme and the Laryngeal Tube. The primary endpoints were successful placement, along with attempts needed to do so, and time for successful placement. The secondary endpoints included Cormack-Lehane grades and rating of the difficulty of the technique with the different devices. RESULTS The overall intubation and placement success rates were equal for the Macintosh and Airtraq laryngoscopes as well as the LMA Supreme and Laryngeal Tube, with access from the back seat being superior in terms of placement time and ease of use. Supraglottic airway devices required half of the placement time and were easier to use compared with endotracheal tubes (with placement times almost >30 s). Paramedics and emergency physicians achieved equal overall successful placement rates for all devices. CONCLUSION Both scenarios of securing the airway seem suitable in this manikin study, with access from the back seat being superior. Although all airway devices were applicable by both groups, paramedics and emergency physicians, supraglottic device placement was faster and always possible at the first attempt. Therefore, the LMA Supreme and the Laryngeal Tube are attractive alternatives for airway management in this context if endotracheal tube placement fails. Furthermore, supraglottic device placement, while the patient is still in the vehicle, followed by a definitive airway once the patient is extricated would be a worthwhile alternative course of action.
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Moser B, Audigé L, Keller C, Brimacombe J, Gasteiger L, Bruppacher HR. Flexible bronchoscopic intubation through the AuraGain™ laryngeal mask versus a slit Guedel tube: a non-inferiority randomized-controlled trial. Can J Anaesth 2017; 64:1119-1128. [DOI: 10.1007/s12630-017-0936-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/22/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022] Open
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Airway management guidelines: Why do we look backward when we have to look forward? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Schaeuble JC, Heidegger T. Strategies and algorithms for the management of the difficult airway: Traditions and Paradigm Shifts 2017. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.01.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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EAMS corner. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pandit JJ, Heidegger T. Putting the ‘point’ back into the ritual: a binary approach to difficult airway prediction. Anaesthesia 2016; 72:283-288. [DOI: 10.1111/anae.13720] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. J. Pandit
- Department of Anaesthesia; Oxford University Hospitals; Oxford UK
- St John's College; Oxford UK
| | - T. Heidegger
- Spitalregion Rheintal Werdenberg Sarganserland; Grabs Switzerland
- University of Bern; Bern Switzerland
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Lee JSE, Wong J, Iqbal R, Wong TGL, Wong P. Practical aspects and training in fibreoptic intubation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kleine-Brueggeney M. Airway management in a changing environment: The impact of advances in technology on standard procedures and training. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- I Ahmad
- Department of Anaesthesia, Guys and St. Thomas' Hospitals, London, UK.
| | - C R Bailey
- Department of Anaesthesia, Guys and St. Thomas' Hospitals, London, UK
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Gómez-Ríos MÁ. Can fiberoptic bronchoscopy be replaced by video laryngoscopy in the management of difficult airway? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:189-191. [PMID: 26778672 DOI: 10.1016/j.redar.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- M Á Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain; Head of the Anaesthesiology and Pain Management Research Group, Institute for Biomedical Research of A Coruña (INIBIC), A Coruña, Spain.
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Heidegger T. Difficult Airway Society guidelines 2015: what about the anticipated difficult airway? Anaesthesia 2016; 71:467-8. [DOI: 10.1111/anae.13420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Black AE, Flynn PER, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth 2015; 25:346-62. [PMID: 25684039 DOI: 10.1111/pan.12615] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching. OBJECTIVE Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children. We aimed to develop guidelines for the management of the unanticipated difficult pediatric airway for use by anesthetists working in the nonspecialist pediatric setting. METHOD We reviewed available guidelines used in individual hospitals. We also reviewed research into airway management in children and graded papers for the level of evidence according to agreed criteria. A Delphi panel comprising 27 independent consultant anesthetists considered the steps of the acute airway management guidelines to reach consensus on the best interventions to use and the order in which to use them. If following the literature review and Delphi feedback, there was insufficient evidence or lack of consensus, regarding inclusion of a particular point; this was reviewed by a Second Specialist Group comprising 10 pediatric anesthetists. RESULTS Using the Delphi group's deliberations and feedback from the Second Specialist Group, we developed three guidelines for the acute airway management of children aged 1-8 years. CONCLUSIONS This paper provides the background, available evidence base, and justification for each step in the resultant guidelines and gives a rationale for their use.
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Affiliation(s)
- Ann E Black
- Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK
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Zoric L, Savoldelli GL. Evidence base in airway management training. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2015. [DOI: 10.1016/j.tacc.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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McCahon RA, Whynes DK. Cost comparison of re-usable and single-use fibrescopes in a large English teaching hospital. Anaesthesia 2015; 70:699-706. [DOI: 10.1111/anae.13011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 01/01/2023]
Affiliation(s)
- R. A. McCahon
- Department of Anaesthesia; Queen's Medical Centre; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - D. K. Whynes
- School of Economics; University of Nottingham; Nottingham UK
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Goto T, Gibo K, Hagiwara Y, Morita H, Brown DFM, Brown CA, Hasegawa K. Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data. Scand J Trauma Resusc Emerg Med 2015; 23:5. [PMID: 25700237 PMCID: PMC4307194 DOI: 10.1186/s13049-014-0085-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/30/2014] [Indexed: 01/01/2023] Open
Abstract
Background Although the international guidelines emphasize early and systematic use of rescue intubation techniques, there is little evidence to support this notion. We aimed to test the hypothesis that preceding multiple failed intubation attempts are associated with a decreased success rate on the first rescue intubation in emergency departments (EDs). Methods We analysed data from two multicentre prospective registries designed to characterize current ED airway management in Japan between April 2010 and June 2013. All patients who underwent a rescue intubation after a failed attempt or a series of failed attempts were included for the analysis. Multiple failed intubation attempts were defined as ≥2 consecutive failed intubation attempts before a rescue intubation. Primary outcome measure was success rate on the first rescue intubation attempt. Results Of 6,273 consecutive patients, 1,151 underwent a rescue intubation. The success rate on the first rescue intubation attempt declined as the number of preceding failed intubation attempts increased (81% [95% CI, 79%-84%] after one failed attempt; 71% [95% CI, 66%-76%] after two failed attempts; 67% [95% CI, 55%-78%] after three or more failed attempts; Ptrend <0.001). In the multivariable analysis adjusting for age, sex, principal indication, change in methods, devices, and intubator specialty, and clustering of patients within EDs, success rate on the first rescue intubation after two failed attempts was significantly lower (OR, 0.56; 95% CI, 0.41-0.77) compared to that after one failed attempt. Similarly, success rate on the first rescue intubation attempt after three or more failed attempts was significantly lower (OR, 0.49; 95% CI, 0.25-0.94) compared to that after one failed attempt. Conclusion Preceding multiple failed intubation attempts was independently associated with a decreased success rate on the first rescue intubation in the ED.
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Cricothyrotomy training increases adherence to the ASA difficult airway algorithm in a simulated crisis: a randomized controlled trial. Can J Anaesth 2014; 62:485-94. [DOI: 10.1007/s12630-014-0308-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
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An Audit of Fibreoptic Intubation Training Opportunities in a UK Teaching Hospital. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/703820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Airway management is the foundation upon which anaesthesia is built, and fibreoptic intubation (FOI) is a key facet of this skill. Despite this, many trainee anaesthetists in the UK have been unable to perform sufficient FOIs to gain competence. We aimed to establish the incidence of FOI in adult patients, in a UK teaching hospital, in order to determine what FOI training opportunities actually exist. During the study period (from October 1st, 2008, to September 30th, 2009) an estimated 11 712 general anaesthetics were undertaken that necessitated tracheal intubation. In 141 of these cases FOIs were performed giving an incidence of FOI of 1.2% (95% confidence interval 1%–1.4%). Of these, 86 (61%) were in awake and 55 (39%) in anaesthetised patients. Only 16 (11%) of the FOIs were done solely for the purposes of training. We suggest that a greater number of FOIs should be undertaken to allow trainees to gain and consultants to maintain the FOI expertise necessary for the provision of safe anaesthesia.
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The difficult airway with recommendations for management--part 1--difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth 2013; 60:1089-118. [PMID: 24132407 PMCID: PMC3825644 DOI: 10.1007/s12630-013-0019-3] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/13/2013] [Indexed: 12/14/2022] Open
Abstract
Background Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group’s mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered.
Methods Nineteen clinicians with backgrounds in anesthesia, emergency medicine, and intensive care joined this iteration of the CAFG. Each member was assigned topics and conducted reviews of Medline, EMBASE, and Cochrane databases. Results were presented and discussed during multiple teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made together with assigned levels of evidence modelled after previously published criteria. Conclusions The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative “Plan B” technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, “cannot intubate, cannot oxygenate” situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.
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Legrand MAL, Steinmann D, Priebe HJ, Mols G. Comparison of Bullard and Airtraq laryngoscopes with conventional laryngoscopy in a manikin study of simulated difficult intubation. Eur J Anaesthesiol 2012; 29:343-50. [PMID: 22569030 DOI: 10.1097/eja.0b013e328354b22c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND When airway management is difficult, various measures can be taken to facilitate tracheal intubation. The Bullard and Airtraq laryngoscopes were developed for this purpose. We hypothesised that the Bullard and Airtraq laryngoscopes would perform better than a conventional laryngoscope in the management of a simulated difficult airway. We also hypothesised that the indirect laryngoscopes would perform comparably. METHODS In a randomised controlled study, 60 anaesthetists (30 with no or little experience and 30 with broader experience in the use of the Bullard laryngoscope, referred to as beginners and experts, respectively) performed three successive intubation attempts using conventional, Bullard and Airtraq laryngoscopes in two simulated difficult airway scenarios: neck immobilisation (scenario A) and neck immobilisation with additional tongue oedema (scenario B). The primary endpoint was overall intubation success rate. Secondary endpoints were time required for successful intubation, the amount of dental stress exerted during laryngoscopy and satisfaction with each airway device. RESULTS In scenario A, intubation success rates were 97-100% with all devices. In scenario B, all participants failed to intubate the trachea using the conventional laryngoscope. When using the Bullard laryngoscope, intubation success rates of 87-97% did not differ significantly (P > 0.05) from those during scenario A and between groups (beginners vs. experts). In contrast, when using the Airtraq laryngoscope, the overall intubation success rate was significantly lower (P < 0.05) compared with scenario A and compared with use of the Bullard laryngoscope, and differed between beginners and experts (20 and 50%, respectively). In cases of successful intubation, intubation times were comparable between devices and groups. Intubation times were longer during scenario B. Dental stress was always lower (P < 0.05) during use of the Bullard and Airtraq laryngoscopes compared with the conventional laryngoscope, lowest (P < 0.05) during use of the Bullard laryngoscope and (with the exception of use of the conventional laryngoscope by the experts) higher during scenario B than during scenario A. In scenario A, participants preferred both video laryngoscopes to the conventional laryngoscope. CONCLUSION In a moderately difficult airway scenario, all laryngoscopes performed equally well. However, in a more difficult airway scenario, the Bullard and Airtraq laryngoscopes performed better than the conventional laryngoscope, with the Bullard device performing better than the Airtraq. This may be in part related to differing prior experiences of operators with the respective airway devices.
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Affiliation(s)
- Maria A-L Legrand
- Department of Anaesthesia and Critical Care Medicine, University Medical Centre Freiburg, Freiburg, Germany
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Strategies and algorithms for the management of the difficult airway: An update. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
In airway management, poor judgment, education and training are leading causes of patient morbidity and mortality. The traditional model of medical education, which relies on experiential learning in the clinical environment, is inconsistent and often inadequate. Curriculum change is underway in many medical organisations in an effort to correct these problems, and airway management is likely to be explicitly addressed as a clinical fundamental within any new anaesthetic curriculum. Competency-based medical education with regular assessment of clinical ability is likely to be introduced for all anaesthetists engaged in airway management. Essential clinical competencies need to be defined and improvements in training techniques can be expected based on medical education research. Practitioners need to understand their equipment and diversify their airway skills to cope with a variety of clinical presentations. Expertise stems from deliberate practice and a desire constantly to improve performance with a career-long commitment to education.
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Affiliation(s)
- P A Baker
- Department of Anaesthesiology, The University of Auckland, New Zealand.
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Crosby ET. An evidence-based approach to airway management: is there a role for clinical practice guidelines? Anaesthesia 2011; 66 Suppl 2:112-8. [PMID: 22074085 DOI: 10.1111/j.1365-2044.2011.06940.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Complications arising out of airway management represent an important cause of anaesthesia-associated morbidity and mortality. Anaesthetic practice itself can lead to preventable harm, a particular example being persistent attempts at direct laryngoscopy, that results in delay in employing alternative strategies (or devices) when intubation is difficult. When patients are injured, expert review is called upon and often concludes that airway management provided by the anaesthetists was substandard. Many training programmes do not offer their trainees structured or organised teaching in airway management and many trainees probably enter practice with limited skills to deal with difficult airways. The literature on the management of the difficult airway in anaesthesia practice (especially as it relates to new technology and salvage strategies) is expanding rapidly. New technologies and practised response algorithms may be helpful in the management of the difficult airway, reducing the potential for adverse patient outcomes. Specialist societies and national interest groups can play an important role by critically reviewing and then applying the evidence base to generate clinical practice guidelines. The recommendations contained in such guidelines should be based on the most current evidence and they should be reviewed regularly for their content and continued relevance.
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Affiliation(s)
- E T Crosby
- Department of Anesthesiology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
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Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anaesthesia 2011; 66 Suppl 2:57-64. [PMID: 22074080 DOI: 10.1111/j.1365-2044.2011.06935.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A myriad of new intubation equipment has been introduced commercially since the appearance of Macintosh/Miller blades in the 1940s. We review the role of devices that are relevant to current clinical practice based on their presence in the scientific literature. The comparative performance of new vs traditional direct laryngoscopes, their complications, their use in awake intubation techniques and the prediction of unsuccessful intubation with new devices are reviewed. Manikin studies are of limited value in this area. We conclude that in both predicted and unpredicted difficult or failed intubation, carefully selected new intubation equipment has a high success rate for tracheal intubation. Ideally, such devices should be available in all settings where tracheal intubation is performed. Most importantly, experience and competence with any of the new devices are critical for their successful use in any clinical setting.
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Affiliation(s)
- E C Behringer
- Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California, USA.
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Affiliation(s)
- F Gerheuser
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Deutschland.
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Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia 2011; 66 Suppl 2:65-80. [DOI: 10.1111/j.1365-2044.2011.06936.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Affiliation(s)
- Thomas Heidegger
- Department of Anesthesiology, Spitalregion Rheintal Werdenberg Sarganserland, Walenstadt, Switzerland.
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Zugai BM, Eley V, Mallitt KA, Greenland KB. Practice Patterns for Predicted Difficult Airway Management and access to Airway Equipment by Anaesthetists in Queensland, Australia. Anaesth Intensive Care 2010; 38:27-32. [DOI: 10.1177/0310057x1003800106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A postal survey was conducted to investigate difficult airway management, training and equipment availability among Fellows of the Australian and New Zealand College of Anaesthetists in Queensland. The survey aimed to determine practise patterns for predicted difficult airways and investigate equipment availability. Participants were asked to nominate an induction method, intubation method and airway adjunct for each of the five difficult airway scenarios. The cases consisted of one elective and four emergency scenarios. Availability of difficult airway devices in their institution was also assessed, as well as demographics of practice and airway-related maintenance of professional standards participation. There were 454 surveys distributed and 250 returned (response rate 55%). Direct laryngoscopy and flexible fibreoptic intubation were the most commonly selected techniques for all five cases. Difficult intubation trolleys were available to 98% of responders. Certain types of equipment (such as fibreoptic bronchoscopes and cricothyroidotomy kits) were available less frequently in private institutions. We recommend a standardisation of difficult airway management equipment and an on-going training program to provide support for anaesthetists in all locations.
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Affiliation(s)
- B. M. Zugai
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - V. Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - K. A. Mallitt
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Biostatistician, Queensland Institute of Medical Research
| | - K. B. Greenland
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management. Can J Anaesth 2009; 56:939-59. [DOI: 10.1007/s12630-009-9197-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 09/14/2009] [Indexed: 01/22/2023] Open
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Affiliation(s)
- P. A. Baker
- Department of Anaesthesia, Starship Children's Health and Green Lane Department of Anaesthesia, Auckland City Hospital Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - A. F. Merry
- Department of Anaesthesia, Starship Children's Health and Green Lane Department of Anaesthesia, Auckland City Hospital Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Réactualisation de la conférence d’experts sur l’intubation difficile : et après ? ACTA ACUST UNITED AC 2008; 27:1-2. [DOI: 10.1016/j.annfar.2007.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Elizondo E, Navarro F, Pérez-Romo A, Ortega C, Muñoz H, Cicero R. Endotracheal Intubation with Flexible Fiberoptic Bronchoscopy in Patients with Abnormal Anatomic Conditions of the Head and Neck. EAR, NOSE & THROAT JOURNAL 2007. [DOI: 10.1177/014556130708601122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We performed a retrospective chart review to evaluate the indications for endotracheal intubation via flexible fiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our 1,100-bed, tertiary care university hospital. We reviewed 9,201 clinical records of anesthetic procedures during which endotracheal intubation had been performed from January to December 2002. We identified 66 patients who had been intubated with flexible fiberoptic bronchoscopy. On preanesthetic examination, 61 of these patients had been found to be poor candidates for conventional laryngoscopic intubation—51 because of abnormal head and neck anatomy and 10 because of reduced visual access to the airway (Mallampati class IV). The remaining 5 patients were intubated via flexible fiberoptic bronchoscopy after conventional intubation had failed during emergency surgery. Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units.
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Affiliation(s)
- Eduardo Elizondo
- Pneumology Unit and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Francisco Navarro
- Pneumology Unit and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Alfredo Pérez-Romo
- Pneumology Unit and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Conceptión Ortega
- Pneumology Unit and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Heberto Muñoz
- Department of Anesthesia and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
| | - Raúl Cicero
- Hospital General de México S.S.; and the Faculty of Medicine, Universidad Nacional Autonóma de México, Mexico City, Mexico
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Heidegger T, Gerig H. Algorithmen für das Management des schwierigen Atemwegs innerhalb des Krankenhauses. Notf Rett Med 2007. [DOI: 10.1007/s10049-007-0969-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McNarry AF, Dovell T, Dancey FML, Pead ME. Perception of training needs and opportunities in advanced airway skills. Eur J Anaesthesiol 2007; 24:498-504. [PMID: 17207298 DOI: 10.1017/s0265021506002031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE We surveyed delegates at the Group of Anaesthetists in Training (UK) meeting to investigate evidence of a training-gap (number of fibreoptic intubations believed to bestow competence vs. number actually performed). METHODS Questionnaires were distributed to and collected from delegates in person. Questions covered six areas, including experience of fibreoptic intubation and cricothyrotomy, fibreoptic intubation as a specialist skill and ethical issues. RESULTS We received 221 replies (76%). All trainees believed competence to be achievable with 10 intubations (interquartile range (IQR) 10-20); the median number performed was 2 (IQR 0-4). This was statistically significant for the groups' senior house officers, 1st and 2nd year registrars and 3rd and 4th year registrars; P < 0.0001. Many final year trainees (12/20, 60%) also failed to achieve their competency target. Few trainees had seen or performed any cricothyrotomies (medians 0, IQRs 0-1 and 0-0). Most (195/208, 94%) believed that fibreoptic intubation was a core skill and 199/212 (94%) believed that all should be competent by completion of training. Ten percent (n = 208) felt it unethical to perform an awake training intubation with full consent and 10% believed it acceptable without explanation. Most (82.7%) would fibreoptically intubate an asleep patient (requiring intubation) without consent. CONCLUSION Trainees reported a gap between their perception of competence and achievement in awake fibreoptic intubation. Simple and complex simulations and structured training programmes may help. Anaesthetists must address the ethics of clinical training in advanced airway management.
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Affiliation(s)
- A F McNarry
- Boyle Department of Anaesthesia, Barts and the London NHS Trust, St Bartholomew's Hospital, West Smithfield, London, UK.
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Kaplan MB, Hagberg CA, Ward DS, Brambrink A, Chhibber AK, Heidegger T, Lozada L, Ovassapian A, Parsons D, Ramsay J, Wilhelm W, Zwissler B, Gerig HJ, Hofstetter C, Karan S, Kreisler N, Pousman RM, Thierbach A, Wrobel M, Berci G. Comparison of direct and video-assisted views of the larynx during routine intubation. J Clin Anesth 2006; 18:357-62. [PMID: 16905081 DOI: 10.1016/j.jclinane.2006.01.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 01/11/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the direct and indirect (video monitor) views of the glottic opening using a new Macintosh blade that is modified to provide a video image of airway structures during laryngoscopy. DESIGN Prospective multicenter trial. SETTING 11 university-affiliated hospitals. PATIENTS 867 adults undergoing elective surgery requiring general anesthesia and tracheal intubation. INTERVENTIONS Patients received general anesthesia and were paralyzed. Direct laryngoscopy was supervised by one of the investigators at each institution. The best possible view was obtained with a Macintosh video laryngoscope during direct vision using standard techniques such as external laryngeal manipulation and backward, upward, and rightward pressure, if necessary. The laryngoscopist then looked at the video monitor and performed any necessary maneuvers to obtain the best view on the video monitor. Thus, 2 assessments were made during the same laryngoscopy (direct naked-eye view vs video monitor view). Tracheal intubation was then performed using the monitor view. Glottic views were rated according to the Cormack-Lehane scoring system, as modified by Yentis and Lee. A questionnaire was completed for each patient. MEASUREMENTS AND MAIN RESULTS Data from 865 patients were suitable for analysis. Visualization was considered easy (Cormack-Lehane score<3) in 737 patients and difficult (Cormack-Lehane score=3 or 4) in 21 for both direct and video-assisted views. In 7 patients, the view was considered easy during direct visualization yet difficult on the video monitor view. On the other hand, the view was considered difficult in 100 patients during direct visualization yet easy on the video monitor view (P<0.001). CONCLUSIONS Video-assisted laryngoscopy provides an improved view of the larynx, as compared with direct visualization. This technique may be useful for cases of difficult intubation and reintubation as well as for teaching laryngoscopy and intubation.
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Affiliation(s)
- Marshal B Kaplan
- Department of Anesthesiology, UCLA and Cedars-Sinai Medical Center, Los Angeles, CA 90095, USA, and Department of Anesthesiology, Cantonal Hospital, St Gallen, Switzerland
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Heidegger T, Gerig HJ, Henderson JJ. Strategies and algorithms for management of the difficult airway. Best Pract Res Clin Anaesthesiol 2005; 19:661-74. [PMID: 16408540 DOI: 10.1016/j.bpa.2005.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.
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Affiliation(s)
- Thomas Heidegger
- Department of Anaesthesiology, Cantonal Hospital St Gallen, Switzerland.
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Abstract
Despite the use of alternative training methods and efforts to structure training, it remains a challenge to ensure that every anaesthesia trainee gains sufficient experience in the use of core techniques of airway management. As less time is spent in the operating room during training, it becomes less likely that trainees will be exposed to an adequate number of challenging airway cases that enable them to practise advanced techniques of airway management under supervision. Nowadays the only way to overcome this deficit in anaesthesia training is to prepare trainees as well as possible outside the operating room so that clinical training opportunities can be used most effectively when they arise. Sufficient training can only be ensured when the required equipment and time are provided. Therefore, particularly in the light of increasing economic pressures, it is necessary to address the responsibilities of everyone involved in the training process. Here, we critically review traditional and recent modalities of anaesthesia training, assess their value, and describe a multi-modal approach to airway management education.
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Affiliation(s)
- Kai Goldmann
- Department of Anaesthesia and Intensive Care Therapy, Airway Management Research and Training Centre, Philipps University Marburg, Germany.
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