Anesthesiology Airway-related Medicolegal Cases From the Canadian Medical Protection Association

Abstract

F ET. O 2 ) of ≥ 90% is recommended. Preoxygenation is typically carried out using a tight-fitting facemask with 100% inspired oxygen fraction (FiO 2 ) at a flow rate of 10 L/ min, with 3 to 5 minutes of tidal breathing. As obstetrical intubation often requires prompt induction, alternative preoxygenation methods are being explored.A recent study used high-flow nasal oxygen for preoxygenation for term pregnant women. The study had an up-down sequential allocation design, so the predetermined number of VC breaths used for oxygenation differed for each participant, depending on the previous participant. The number of VC breaths needed to achieve F ET O 2 ≥ 90% was the primary outcome. The study was ended early after collecting data for 20 participants because authors believed the primary outcome could not be achieved in most patients. Successful preoxygenation was achieved in 4 participants receiving HFNO with mouth closed, 3 participants using HFNO with mouth open, and 14 using oxygen facemask.The study only considered the efficacy of achieving F ET O 2 ≥ 90%, but not the efficiency of preoxygenation, meant to prolong the "safe apnea" period, of HFNO. In patients undergoing rapid sequence induction, continued HFNO between the time of neuromuscular blockade to intubation, or "peroxygenation," can improve safety. The efficiency of HFNO has not been studied in pregnant patients due to ethical limitations, but a study by Wong et al, in morbidly obese patients undergoing bariatic surgery found a significant increase in the safe apnea time period in patients who used HFNO compared with standard preoxygenation with a facemask.Multiple studies have found achieving F ET O 2 ≥ 90% in pregnant patients to be challenging. While HFNO may not have a high efficacy, there is evidence from other patient populations that it can provide ongoing apneic oxygenation. Clinicians may need to move forward with the use of HFNO during RSI without reassuring trial data, perhaps by using a tight-fitting facemask combined with HFNO.

Medicolegal aspects and anesthesiologists- aware and beware

“…Airway related issues are most common and one should never get compromised while managing airway especially working in a periphery set up. 5 4. Recordkeeping in Anesthesia and Critical Care 6,7 Various invasive and risky procedures are carried out by the anesthesiologists in day to day life.…”

The importance of prospective observational studies in airway management: yet only the first step

“…As minor airway events are relatively common, and if not managed appropriately may be a harbinger for more serious airway events, then major airway events may occur in any elective surgical patient. Elective patients, most of whom were not anticipated to have airway management difficulty, comprised 57% and 63% in recent studies of airway-related medicolegal closed-claims in Canada and the USA respectively [4,5]. Medicolegal claims represent the 'sharp end' of patient outcomes, with most patients involved having suffered brain damage or death directly related to their airway event(s).…”

“…Understanding current clinical practice, and associated patient outcomes, informs quality improvement initiatives. From national audit projects [4, 6, 13], review of system‐specific databases [5, 14], to case report collections [15], observational studies can provide both overall patient care themes as well as powerful narratives of patient experiences [5, 6]. Recently, we have also seen international COVID‐19‐related prospective observational studies regarding both healthcare professional and patient risks [16, 17].…”

“…From national audit projects [4,6,13], review of systemspecific databases [5,14], to case report collections [15],…”

Diagnostic Efficacy and Clinical Value of Ultrasonography in Difficult Airway Assessment: Based on a Prospective Cohort Study

“…caused by difficult airway [2]. Crosby et al reviewed the 406 anesthesia-related civil litigation cases recorded by the Canadian Medical Protection Association from 2007 to 2016, and concluded that 11% of the disputes were caused by failure of airway management [3]. e incidence of difficult airway is different in different literature.…”