A proposal for a new scoring system to predict difficult ventilation through a supraglottic airway

Saito, T.; Chew, Sophia Tsong Huey; Liu, W.L.; Thinn, Kyu Kyu; Ti, Lian Kah

doi:10.1093/bja/aew191

Cited by 26 publications

(23 citation statements)

References 24 publications

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“…14e16 In addition, any airway management method (including rescue method) can fail, but the reasons for failure have not been fully elucidated. 14,17 Furthermore, tracheal intubation might not benefit patients who are receiving cardiopulmonary resuscitation, 18,19 and it is not clear whether or not this may also be so in critically ill patients. Therefore, there are still many areas requiring study in order to improve strategies for airway management in critically ill patients.…”

Section: What Next?mentioning

confidence: 99%

Airway management inside and outside operating rooms—circumstances are quite different

Asai

2018

British Journal of Anaesthesia

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Problems associated with airway management are the main causes of anaesthesia-related death or permanent brain damage. 1,2 Since this fact became apparent in the early 1990s, major efforts have been made to reduce problems: guidelines for difficult airway management have been formulated, more reliable airway devices developed, and oximetry and capnography have become widely available. 3,4 In 2011, the 4th National Audit Project (NAP4) of The Royal College of Anaesthetists (RCoA) and the Difficult Airway Society (DAS) 5 found that life-threatening airway complications still occur in a limited number of patients during anaesthesia care. This has led to further attempts at reducing complications. 6,7 Airway management is required not only in patients undergoing anaesthesia in operating rooms, but also in critically ill patients outside operating rooms (such as intensive care units, on the ward, or in emergency departments). Nevertheless, it seems that less effort has been taken to minimize problems associated with airway management in critically ill patients, in particular for patients on the ward. Does this mean that there are no such problems in critically ill patients? The answer is no: those who perform airway management outside operating rooms know that airway management can often be difficult, and can end up with serious consequences. In fact, the NAP4 has pointed out deficiencies in airway management outside operating rooms, and much greater incidences of death or brain damage when serious airway complications occur there. 5,8 Therefore, it is clear that we need to improve strategies for airway management for critically ill patients. The existing guidelines for difficult airway management during anaesthesia might be insufficient for critically ill patients, as they pose unique challenges. Therefore, comprehensive guidelines providing a structured approach to management of the airway in the critically ill are required. 9,10 This issue of the British Journal of Anaesthesia contains such guidelines for airway management in the critically ill, formulated by Higgs and colleagues 11 on behalf of the DAS, Intensive Care Society, Faculty of Intensive Care Medicine, and the RCoA.

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Section: What Next?mentioning

confidence: 99%

Airway management inside and outside operating rooms—circumstances are quite different

Asai

2018

British Journal of Anaesthesia

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“…With such premises, the point of difficult insertion, unless not corrected for a precise sizing policy, remains affected by a serious bias, whereas different techniques like tongue dimension-based sizing (46) show interesting but not definitive results, and further research is aiming to find out specific criteria for prediction of difficult SGAs positioning and ventilation (47).…”

Section: Sorbello and Petrini Supraglottic Airway Devices Features Amentioning

confidence: 99%

Supraglottic Airway Devices: the Search for the Best Insertion Technique or the Time to Change Our Point of View?

Sorbello¹,

Petrini²

2017

Turk J Anaesth Reanim

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Editorial Comment / Editoryal YorumKalabalık supraglottik havayolu araçları (SHA) dünyasında birçok çalışmada, cerrahın memnun olduğu farklı sonlanım noktalarına dayanılarak bu araçların takılma kolaylığı karşılaştırılmaktadır: ilk geçiş başarısı, ventilasyon etkinliği, komplikasyonlar ve morbidite. Proseal LMATM (Laryngeal Mask Airway, Teleflex Medical, Dublin, İrlan-da) kapsamlı bir şekilde çalışılmıştır. Çünkü diğer SHA'lar ile karşılaş-tırıldığında bir yandan daha dik bir öğrenme eğrisi ve daha kompleks yerleştirilme şekli varken diğer yandan takılmasını kolaylaştırmak için birçok alternatif teknik bulunmaktadır. Bu çalışma bazı cihazların ebatları, yapıldıkları madde, havayolu kanalı ve kaf dizaynı, performans ve sonuncu ama en önemlisi de deneyimden dolayı yerleştiril-mesinin zorluğu konusunda yapılan çalışmalardan birisidir. Ancak, araştırılması gereken en önemli konu araçların yerleştirilme zorluklarının sistematik olarak sınıflandırılması ve en iyi cihaz seçimine ve en iyi yerleştirme tekniğine olanak sağlayacak kriterlerin belirlenmesi olmalıdır. Kullandığımız cihazın yapısal özelliklerinden dolayı cihazın yerleştirilmesi, ancak aracın yerleştirilmesinde zorluk çıkaran etkenler belirlendikten sonra ve cihazdan elde edeceğimiz sonuçlar, ulaşabi-leceğimiz performans ve havayolu koruma seviyesi konusunda beklentilerimiz dengelendikten sonra düşünülmesi gereken ikinci konu olabilir. Bu geleneksel derlemenin amacı SHA'nın yerleştirilmesini zorlaştıran faktörleri dikkate alarak klinik uygulamada SHA'ların kullanımıyla ilgili hekimlere yönelik bazı kriterler belirlemektir.Anahtar sözcükler: Supraglottik havayolu araçları, laringeal maske havayolu, boğaz ağrısı, havayolu yönetimiIn the crowded world of supraglottic airway devices (SADs), many papers compare the easiness of insertion based on the different endpoints of an operator's satisfaction: first pass success, ventilation effectiveness, complications and morbidity. Proseal LMA TM (Laryngeal Mask Airway, Teleflex Medical, Dublin, Ireland) has been extensively studied because on one hand it has a steeper learning curve and more complex insertion when compared with other SADs and on the other hand many alternative techniques are available to facilitate insertion. This research is part of a larger body of studies exploring the issue that some devices are more difficult to insert because of many features related to sizing, constructive material, airway conduit and cuff design, performance and last but not least experience. Nevertheless, the biggest question might be the search for a systematic categorization of insertion difficulty features and identification of criteria allowing the choice for the best device and consequently for the best insertion technique. Given that, as a result of many intrinsic characteristics of the device we are using, insertion might become the secondary issue to be considered only after we clearly identify what makes it difficult, and to be counterbalanced on the results we expect from the device, performance we can achieve and degr...

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“…A validation study of a new clinical score to predict difficult ventilation through a supraglottic airway (based on the risk factors of male, age >45 years, short thyromental distance, and limited neck movements) [31] indicated that a high score is associated with a six-to sevenfold increased risk of failure. When a supraglottic airway has been inserted, its cuff should not be overinflated as it would increase the risk of pulmonary aspiration [32].…”

Section: 'Rescue Device'mentioning

confidence: 99%

Progress in difficult airway management

Asai

2017

J Anesth

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A proposal for a new scoring system to predict difficult ventilation through a supraglottic airway

Abstract: The new score for prediction of difficult ventilation through a supraglottic airway device is easy to perform and reliable, and could help anaesthetists plan for difficult airway management.

Cited by 26 publications

References 24 publications

Airway management inside and outside operating rooms—circumstances are quite different

Airway management inside and outside operating rooms—circumstances are quite different

Supraglottic Airway Devices: the Search for the Best Insertion Technique or the Time to Change Our Point of View?

Progress in difficult airway management

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