General Anaesthesia and Failed Intubation

2021 ◽  
pp. 231-238
Author(s):  
Matthew Evans ◽  
Sarah Hammond ◽  
Christina Wood
Keyword(s):  
General Anaesthesia ◽  
Failed Intubation

PREOPERATIVE ASSESSMENT OF VARIABLES TO PREDICT DIFFICULT INTUBATION IN PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

2021 ◽  
pp. 68-71
Author(s):  
Veena Chatrath ◽  
Leena Mahajan ◽  
Gagandeep Kaur ◽  
Ankita Taneja ◽  
Ranjana Khetarpal ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Risk Index ◽  
Preoperative Assessment ◽  
High Sensitivity ◽  
Screening Tests ◽  
Failed Intubation ◽  
Upper Lip ◽  
Number Of Patients

Background- Advance prediction of difcult airway provides us ample time for optimal preparation of equipment and participation of experienced anaesthesiologist to handle difcult airway. The present study was designed to evaluate the efcacy of Upper Lip Bite Test (ULBT), Ratio of neck circumference (NC) and thyromental distance (TMD) and Arne Risk Index in predicting difcult airway. Material and methods-This prospective observational study was conducted on 250 patients, aged 18-60 years of ASAgrade I and II scheduled for surgeries under general anaesthesia. Three screening tests i.e. ULBT, NC/TMD and Arne Risk Index were used to predict difcult airway. Number of patients successfully intubated, number of attempts taken for intubation and time taken for intubation was noted. Difcult intubation was calculated using Intubation Difculty Score (IDS). All the three screening tests were compared for their sensitivity, specicity, negative predictive value (NPV) and Positive predictive value (PPV) to predict difcult airway. Result- The incidence of difcult intubation was found to be 6.8%. 233 (95.2%) patients were intubated in rst attempt and 12 (4.8%) patients were intubated in second attempt and there was no failed intubation. Arne Risk Index had high sensitivity (88.23%), high specicity (88.84%), highest NPV (99.04%) and PPV of 36.58%. ULBThas sensitivity of 76.47%, specicity of 88.41%, NPV of 98.09% and PPV of 32.50% and NC/TMD has sensitivity of 47.05%, specicity of 87.98%, PPVof 22.22% and NPVof 95.79% in predicting difcult airway. Conclusion- Arne Risk index, a multivariate clinical risk index had highest sensitivity, specicity, NPVand PPVto predict difcult airway.

scholarly journals Difficult and Failed Tracheal Intubation in Obstetrics: A Seven-year Review in a Saudi Maternity Hospital

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Bassey E. Edem ◽  
Khaled M.F. Elbeltagy
Keyword(s):  
Caesarean Section ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Medical Records ◽  
Maternity Hospital ◽  
Failed Intubation ◽  
Mortality And Morbidity ◽  
Factors Associated ◽  
The Mean ◽  
Surgery Outcomes

Background: Airway difficulty is a major contributor to mortality and morbidity during caesarean section (CS) under general anaesthesia. Though general anaesthesia is safe, the changes associated with pregnancy make securing airway more difficult. The purpose of this study was to investigate the pattern and factors associated with airway difficulty in the parturient in the region. Methods: This was a retrospective, descriptive study of parturients who suffered airway difficulty during caesarean section under general anaesthesia over seven-year period. Their medical records were reviewed and data collected included total CS done under general anaesthesia, age, weight, nature of airway difficulty, coexisting diseases, and timing of surgery, outcomes and Apgar scores. Data was analysed using SPSS version 23 for Windows®. Results: General anaesthesia was used in 51.3% of 10,275 CS with 42 documented as “difficult airway” giving 0.8% incidence and incidence ratio of 1:125. Failed intubation was recorded in 58% while difficult intubation was 42% of those with difficult airway. Among these, the CS was in 55% of cases “emergent”. The mean age was 33.32±5.96 years. The weight ranged from 60 to 163kg. Over 58% weighed more than 90kg. In 50% of cases, the airway was rescued with LMA and in 50%, reintubation succeeded. Outcome was good for mother and fetus in all cases. Conclusion: Obstetric airway difficulty remains a valid concern. Effort should be made to use regional anaesthesia to reduce the risk. High awareness and preparation during obstetric general anaesthesia are recommended.

Anaesthesia for Caesarean section: General anaesthesia

2020 ◽  
pp. 325-354
Author(s):  
Stephen Morris ◽  
Rhidian Jones
Keyword(s):  
Caesarean Section ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Current Evidence ◽  
Failed Intubation ◽  
Airway Assessment ◽  
Obstetric Anaesthetist ◽  
Obstetric Surgery

There will always be the need to give GA to pregnant womrn, and it is paramount that the obstetric anaesthetist is well prepared to perform a GA quickly and safely. This chapter reviews the current evidence, drugs, and conduct of GA for CS, with emphasis on exemplary communication within the delivery suite team and meticulous airway assessment to identify features suggestive of additional anticipated difficulty. A helpful ‘pre-induction’ checklist illustrates the need for team-based communication in preparation and planning to mitigate against complications following induction. The latest guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society on the management of failed intubation and ventilation have been included. The chapter also includes up-to-date information on accidental awareness in obstetric surgery from NAP4, and the steps to avoid and manage aspiration if it occurs.

scholarly journals Magnitude and Predisposing Factors of Difficult Airway during Induction of General Anaesthesia

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Sileshi Abiy Workeneh ◽  
Amare Hailekiros Gebregzi ◽  
Zewditu Abdissa Denu
Keyword(s):  
Difficult Airway ◽  
General Anaesthesia ◽  
Difficult Intubation ◽  
Mouth Opening ◽  
Predisposing Factors ◽  
Difficult Laryngoscopy ◽  
Failed Intubation ◽  
Predisposing Factor ◽  
Specific Test ◽  
Cross Sectional

Objective. To assess magnitude and predisposing factors of difficult airway during induction of general anaesthesia. Methods. Hospital based cross sectional study carried out to determine the incidence of difficult mask ventilation, difficult laryngoscopy (Cormack and Lehane III and IV), difficult intubation (IDS ≥ 5), and failed intubation. The association between each predisposing factor and airway parameters with components of difficult airway is investigated with binary logistic regression. Sensitivity, specificity, positive and negative predictive value of the test, and odds ratio with 95% confidence interval were calculated to determine the association between independent and dependent variable. Result. The incidence of difficult laryngoscopy, difficult intubation, and failed intubation are 12.3%, 9%, and 0.005%, respectively. Mouth opening < 30 mm and Mallampati classes III and IV are the most sensitive tests and second high specific test next to combination of tests to predict difficult intubation and laryngoscopy (P value < 0.001). Unrestricted multiple attempt without alternative airway techniques resulted in exponential increase in desaturation episodes and further difficulty of airway management (P value < 0.001). Discussion and Conclusion. Mallampati classes III and IV, mouth opening ≤ 30 mm, jaw slide grade C, attempt > 3, and ineffective alternative technique have increased predictability value of difficult airway.

General anaesthesia for caesarean section & difficult/failed intubation. Do we have a problem?

2013 ◽  
Vol 30 ◽  
pp. 180-180
Author(s):  
C. V. Rosenstock ◽  
A. K. Nørskov ◽  
L. H. Lundstrøm ◽  
J. Wetterslev
Keyword(s):  
Caesarean Section ◽  
General Anaesthesia ◽  
Failed Intubation
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