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Naik NB, Mathew PJ, Kundra P. Scope of artificial intelligence in airway management. Indian J Anaesth 2024; 68:105-110. [PMID: 38406331 PMCID: PMC10893795 DOI: 10.4103/ija.ija_1228_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 02/27/2024] Open
Abstract
The evolution of artificial intelligence (AI) systems in the field of anaesthesiology owes to notable advancements in data processing, databases, algorithmic programs, and computation power. Over the past decades, its accelerated progression has enhanced safety in anaesthesia by improving the efficiency of equipment, perioperative risk assessments, monitoring, and drug administration systems. AI in the field of anaesthesia aims to improve patient safety, optimise resources, and improve the quality of anaesthesia management in all phases of perioperative care. The use of AI is likely to impact difficult airway management and patient safety considerably. AI has been explored to predict difficult intubation to outperform conventional airway examinations by integrating subjective factors, such as facial appearance, speech features, habitus, and other poorly known features. This narrative review delves into the status of AI in airway management, the most recent developments in this field, and its future clinical applications.
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Affiliation(s)
- Naveen B. Naik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J. Mathew
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Kundra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Medical Education and Research, Puducherry, India
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Xia M, Ma W, Zuo M, Deng X, Xue F, Battaglini D, Aggarwal V, Varrassi G, Cerny V, Di Giacinto I, Cataldo R, Ma D, Yamamoto T, Rekatsina M, De Cassai A, Carsetti A, Chang MG, Seet E, Davis DP, Irwin MG, Huang Y, Jiang H. Expert consensus on difficult airway assessment. Hepatobiliary Surg Nutr 2023; 12:545-566. [PMID: 37600997 PMCID: PMC10432292 DOI: 10.21037/hbsn-23-46] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/23/2023] [Indexed: 08/22/2023]
Abstract
Background Identifying a potentially difficult airway is crucial both in anaesthesia in the operating room (OR) and non-operation room sites. There are no guidelines or expert consensus focused on the assessment of the difficult airway before, so this expert consensus is developed to provide guidance for airway assessment, making this process more standardized and accurate to reduce airway-related complications and improve safety. Methods Seven members from the Airway Management Group of the Chinese Society of Anaesthesiology (CSA) met to discuss the first draft and then this was sent to 15 international experts for review, comment, and approval. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) is used to determine the level of evidence and grade the strength of recommendations. The recommendations were revised through a three-round Delphi survey from experts. Results This expert consensus provides a comprehensive approach to airway assessment based on the medical history, physical examination, comprehensive scores, imaging, and new developments including transnasal endoscopy, virtual laryngoscopy, and 3D printing. In addition, this consensus also reviews some new technologies currently under development such as prediction from facial images and voice information with the aim of proposing new research directions for the assessment of difficult airway. Conclusions This consensus applies to anesthesiologists, critical care, and emergency physicians refining the preoperative airway assessment and preparing an appropriate intubation strategy for patients with a potentially difficult airway.
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Affiliation(s)
- Ming Xia
- Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingzhang Zuo
- Department of Anaesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, CAMS and PUMC, Beijing, China
| | - Fushan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Jamia Millia Islamia, New Delhi, India
| | | | - Vladimir Cerny
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Ida Di Giacinto
- Unit of Anesthesia and Intensive Care, Mazzoni Hospital, Ascoli Piceno, Italy
| | - Rita Cataldo
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico of Rome, Roma, Italy
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, and Chelsea and Westminster Hospital, London, UK
| | - Toru Yamamoto
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Martina Rekatsina
- Department of Anaesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alessandro De Cassai
- Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Andrea Carsetti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Marvin G. Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin Seet
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel P. Davis
- Division of Emergency Medical Services, Logan Health, Kalispell, MT, USA
- Air Methods Corporation, Greenwood Park, CO, USA
| | - Michael G. Irwin
- Department of Anesthesiology, The University of Hong Kong, Hong Kong, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhou JW, Wang CG, Chen G, Zhou YF, Ding JF, Zhang JW. Unexpected difficult airway due to severe upper tracheal distortion: A case report. World J Clin Cases 2022; 10:9348-9353. [PMID: 36159427 PMCID: PMC9477678 DOI: 10.12998/wjcc.v10.i26.9348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/20/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Difficult airway is a significant cause of anesthesia-associated death and disability. Currently, physical examinations of thyromental distance, mouth opening, Mafampaii classification, etc. combined with X-ray, computed tomography (CT), and other imaging technologies are mainly used to evaluate difficult airways. However, in many special cases, i.e., emergency surgery, imaging examinations cannot be completed preoperatively. Such patients' airway can only be evaluated through general physical examination, which inevitably increases the likelihood of an unexpected difficult airway during anesthesia.
CASE SUMMARY We report a rare case of difficult intubation because of severe upper trachea distortion after induction. Emergency holmium laser lithotripsy was performed under transurethral ureteroscopy because the patient had anuria for 4 d and a creatinine level of 890 μmol/L. Due to the urgency of the condition, chest radiography or chest CT was not examined before surgery and the anesthesiologist did not evaluate the airway adequately, resulting in an unexpected difficult airway.
CONCLUSION The incidence of tracheal malformation and tracheal stenosis is extremely low, but the risk of hypoxia and even death due to difficult airways is extremely high for such patients. It is recommended to complete preoperative imaging examinations of the airway. For life-threatening emergency patients, a pre-anesthesia reassessment should be performed and surgeons should be prepared to prevent and manage the difficult airway.
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Affiliation(s)
- Jian-Wei Zhou
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Chuan-Guang Wang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Gang Chen
- Department of Anesthesia, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
| | - You-Fa Zhou
- Department of Anesthesia, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Feng Ding
- Department of Urology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Jia-Wei Zhang
- Department of Anesthesia, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
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