scholarly journals (P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study

2011 ◽  
Vol 26 (S1) ◽  
pp. s118-s118
Author(s):  
C. Hsu
Keyword(s):  
Risk Factors ◽  
Airway Management ◽  
Difficult Airway ◽  
Healthcare Providers ◽  
Positive Association ◽  
Daily Practice ◽  
Trauma Patients ◽  
Airway Trauma ◽  
Failed Airway ◽  
Airway Devices

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper managementof difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.

An Update on Airway Management

2020 ◽  
Keyword(s):  
Airway Management ◽  
Surgical Techniques ◽  
Daily Practice ◽  
Postoperative Management ◽  
Diagnostic Methods ◽  
Emergency Rooms ◽  
Specific Patient ◽  
Medical Practitioners ◽  
Preoperative Diagnostic ◽  
Airway Devices

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases

scholarly journals Airway Management with Cervical Spine Immobilisation: A Comparison between the Macintosh Laryngoscope, Truview Evo2, and Totaltrack VLM Used by Novices—A Manikin Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Dawid Aleksandrowicz ◽  
Tomasz Gaszyński
Keyword(s):  
Cervical Spine ◽  
Airway Management ◽  
Macintosh Laryngoscope ◽  
Spine Injury ◽  
Trauma Patients ◽  
Laryngoscopic View ◽  
Ventilation Time ◽  
Spine Mobility ◽  
Airway Devices ◽  
Time Required

Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F=26,M=14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed. All three airway devices were used by each student (a novice) and they were randomly chosen. The mean time required to obtain the entry-to-the-larynx view was the shortest for the Macintosh laryngoscope 13.4 s (±2.14). Truview Evo2 had the shortest successful ventilation time 35.7 s (±9.27). The best view of the entry to the larynx was obtained by the Totaltrack VLM device. The Truview Evo2 and Totaltrack VLM may be an alternative to the classic Macintosh laryngoscope for intubation of trauma patients with suspected injury to the cervical spine. The use of new devices enables achieving better laryngoscopic view as well as minimising incisor damage during intubation.

scholarly journals Airway management in critically sick in intensive care

2020 ◽  
Author(s):  
S. K. Malhotra ◽  
Komal Gandhi
Keyword(s):  
Intensive Care ◽  
Airway Management ◽  
Difficult Airway ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operation Theatre ◽  
Physiological Reserve ◽  
Airway Equipment ◽  
One Airway ◽  
Airway Devices

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

scholarly journals A Cohort and Database Study of Airway Management in Patients Undergoing Thyroidectomy for Retrosternal Goitre

2014 ◽  
Vol 42 (6) ◽  
pp. 700-708 ◽  
Author(s):  
N. Gilfillan ◽  
C. M. Ball ◽  
P. S. Myles ◽  
J. Serpell ◽  
W. R. Johnson ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Thyroid Surgery ◽  
Good Evidence ◽  
Anaesthetic Induction ◽  
Tracheal Compression ◽  
Induction Technique ◽  
Failed Airway ◽  
Symptoms And Signs

Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning.

scholarly journals The Difficult Airway Trolley: A Narrative Review and Practical Guide

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Martin F. Bjurström ◽  
Mikael Bodelsson ◽  
Louise W. Sturesson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Future Research ◽  
Clinical Settings ◽  
Airway Equipment ◽  
National Expert ◽  
Airway Devices ◽  
Facemask Ventilation

Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

scholarly journals Tracheal Intubation with Aura-i and aScope-2: How to Minimize Apnea Time in an Unpredicted Difficult Airway

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Vittorio Pavoni ◽  
Valentina Froio ◽  
Alessandra Nella ◽  
Martina Simonelli ◽  
Lara Gianesello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Laryngeal Mask ◽  
Difficult Airway Management ◽  
Ventilation Technique ◽  
The Subject ◽  
Airway Devices ◽  
Entire Procedure

The supraglottic airway’s usefulness as a dedicated airway is the subject of continuing development. We report the case of an obese patient with unpredicted difficult airway management in which a new “continuous ventilation technique” was used with the Aura-i laryngeal mask and the aScope-2 devices. The aScope-2/Aura-i system implemented airway devices for the management of predictable/unpredictable difficult airway. The original technique required the disconnection of the mount catheter from Aura-i, the introduction of the aScope-2 into the laryngeal mask used as a conduit for video assisted intubation and then towards the trachea, followed by a railroading of the tracheal tube over the aScope-2. This variation in the technique guarantees mechanical ventilation during the entire procedure and could prevent the risk of hypoventilation and/or hypoxia.

scholarly journals ¿ Caminamos hacia el manejo del videolaringoscopio como primera opción en una vía aérea difícil?

2020 ◽  
Vol 12 (7) ◽  
pp. 1
Author(s):  
Juan José Correa Barrera ◽  
Mónica San Juan Álvarez ◽  
Blanca Gómez Del Pulgar Vázquez ◽  
Gholamian Ovejero Soraya
Keyword(s):  
Decision Making ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
The Other ◽  
Optimal Decision ◽  
Difficult Airway Management ◽  
Toma De Decisiones ◽  
Failed Airway ◽  
Optimal Decision Making

Determinar los factores predictivos de una vía aérea difícil constituye un reto para el médico anestesiólogo. La mayoría de guías actuales, sitúan los videolaringoscopios como elementos de rescate de una vía aérea fallida, tras una laringoscopia tradicional óptima. Establecer un algoritmo que en base a unas características físicas, permita determinar qué pacientes se beneficiarán del uso del videolaringoscopio como primera opción, puede suponer una ventaja y una disminución en los problemas relacionados con la vía aérea. Por otra parte, establecer cuáles de estos factores predicen con más fuerza una dificultad con el videolaringoscopio, nos ayudará a realizar mejores planes de abordaje y una óptima toma de decisiones sobre una vía aérea difícil. Este algoritmo ha sido capaz de conseguir la intubación traqueal de todos los pacientes en los que se ha previsto una laringoscopia difícil. ABSTRACT Moving towards videolaryngoscopy handling as first option in difficult airway management? Determining the predictors of a difficult airway is a challenge for the anesthesiologist. Most current guides place videolaryngoscopes as recue elements of a failed airway, after an optimal traditional laryngoscopy. Establishing an algorithm which, based on physical charcteristics, allows to determine which patients will benefit from the use of videolaryngoscopy as a first option, may lead to a potential advantage and a net decrease in airway related problems. On the other hand, establishing which of those factors predict in a more reliable way a difficulty with the videolaryngoscopy, will contribute to make better plans of approach as well as an optimal decision making on a difficult airway. This algorithm has been able to achieve tracheal intubation of all patients for which a difficult laryngoscopy is expected.

scholarly journals Crossover Comparison of the Laryngeal Mask Supreme™ and the i-gel™ in Simulated Difficult Airway Scenario in Anesthetized Patients

2009 ◽  
Vol 111 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Lorenz G. Theiler ◽  
Maren Kleine-Brueggeney ◽  
Dagmar Kaiser ◽  
Natalie Urwyler ◽  
Cedric Luyet ◽  
...  
Keyword(s):  
United Kingdom ◽  
Airway Management ◽  
Difficult Airway ◽  
Success Rate ◽  
Mouth Opening ◽  
Laryngeal Mask ◽  
Insertion Time ◽  
Leak Pressure ◽  
Neck Movement ◽  
Airway Devices

Background The single-use supraglottic airway devices LMA-Supreme (LMA-S; Laryngeal Mask Company, Henley-on-Thames, United Kingdom) and i-gel (Intersurgical Ltd, Wokingham, Berkshire, United Kingdom) have a second tube for gastric tube insertion. Only the LMA-S has an inflatable cuff. They have the same clinical indications and might be useful for difficult airway management. This prospective, crossover, randomized controlled trial was performed in a simulated difficult airway scenario using an extrication collar limiting mouth opening and neck movement. Methods Sixty patients were included. Both devices were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, and adverse events. Results Success rate for the LMA-S was 95% versus 93% for the i-gel (P = 1.000). LMA-S needed shorter insertion time (34 +/- 12 s vs. 42 +/- 23 s, P = 0.024). Tidal volumes and airway leak pressure were similar (LMA-S 26 +/- 8 cm H20; i-gel 27 +/- 9 cm H20; P = 0.441). Fiberoptic view through the i-gel showed less epiglottic downfolding. Overall agreement in insertion outcome was 54 (successes) and 1 (failure) or 55 (92%) of 60 patients. The difference in success rate was 1.7% (95% CI -11.3% to 7.6%). Conclusions Both airway devices had similar insertion success and clinical performance in the simulated difficult airway situation. The authors found less epiglottic downfolding and better fiberoptic view but longer insertion time with the i-gel. Our study shows that both devices are feasible for emergency airway management in patients with reduced neck movement and limited mouth opening.

scholarly journals Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Jérôme Sudrial ◽  
Caroline Birlouez ◽  
Anne-Laurette Guillerm ◽  
Jean-Luc Sebbah ◽  
Roland Amathieu ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Macintosh Laryngoscope ◽  
Difficult Airway Management ◽  
Arterial Oxygenation ◽  
Management Algorithm ◽  
Early Activation ◽  
Airway Devices

We report a case of prehospital “cannot intubate” and “cannot ventilate” scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.

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