Anticipated and unanticipated difficult airway management

Xu, Zeping; Ma, Wuhua; Hester, Douglas L.; Jiang, Yandong

doi:10.1097/aco.0000000000000540

Cited by 34 publications

(33 citation statements)

References 46 publications

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“…There are a number of possible factors predisposing air leakage, for example: inappropriate mask size, patient's obesity (BMI >30), toothlessness, patient's snoring, lolly beard, inserted nasogastric tube, etc. (2,5,12). We excluded patients with two or more risk factors mentioned above.…”

Section: Discussionmentioning

confidence: 99%

“…Baillard and colleagues claim that incomplete preoxygenation is also associated with patient sex (males have an increased risk), age (patients over 55 years old), and the ASA score of IV. (2). These patients were not excluded so that the study subjects would represent a common population undergoing general anaesthesia for elective surgery.…”

Section: Discussionmentioning

confidence: 99%

“…There is no uniform recommendation concerning the fresh gas flow to be used for preoxygenation. Recently, some authors recommended using 100% oxygen with a high fresh gas flow set to 12-15 l/min (2,6,12). However, there are studies evaluating preoxygenation efficiency using oxygen flow as low as 5 l/min (15).…”

Section: Discussionmentioning

confidence: 99%

“…However, there are studies evaluating preoxygenation efficiency using oxygen flow as low as 5 l/min (15). A lower oxygen concentration, which may result from the lack of tight fit of the mask, rebreathing expired gas, or an anaesthesia machine contour not primed with 100% oxygen, is associated with incomplete preoxygenation (2,6,12). In our study, we used 8 l/min flow and hypothetically sufficient preoxygenation rate could be higher with a higher flow.…”

Section: Discussionmentioning

confidence: 99%

“…Room air is replaced with oxygen and its reservoir in the lungs is created (1). Proper preoxygenation prolongs safe apnea time during airway instrumentation and also helps to avoid arterial desaturation if an unanticipated difficult airway is encountered (2). It is well established that arterial desaturation is the risk factor of arrhythmia, hemodynamic decompensation, hypoxic brain injury, and also death (3).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of preoxygenation efficiency with Intersurgical Economy and Intersurgical QuadraLite anaesthetic face masks

Sakalauskaitė

Kauzonas

Bukelytė

et al. 2019

AML

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Background. Sufficient preoxygenation prevents arterial oxygen desaturation prior to intubation. An optimally sealed facemask is necessary for fast preoxygenation. The study was aimed at comparing the efficiency of preoxygenation using two different face masks. Materials and methods. In 2018, a prospective study was conducted. Patients were classified into two groups: group A – Intersurgical Economy face masks, group B – Intersurgical QuadraLite masks. The circuit was flushed with 100% O2 for 30s, preoxygenation started with flow of 8l/min, FiO2100. The patients were asked to breathe deeply. Fentanyl (1–2 mcg/kg) was administered to increase mask toleration. End-tidal oxygen concentration (EtO2) ≥90% was the goal. EtO2 was monitored after 30, 60, 90, 120, 180, 210, 240, 270 and 300 seconds. Data was analyzed using the Independent-Samples T-test and the Mann-Whitney-U test. Results. Twelve patients were enrolled in group A and 19 in group B. Differences in sex, age, BMI and Mallampati class in the groups were statistically insignificant (p = 0.13, 0.39, 0.65, 0.43 respectively). Patients assigned to ASA I – 25.8% (n = 8–>2/6), ASA II – 71.0% (n = 22–>10/12), ASA III – 3.2% (n = 1–>0/1), p = 0.64. The success rate of preoxygenation to EtO290 within 5 min was statistically significantly different in the groups, with 33.3% in group A and 94.7% in group B (p < 0.01). Mean time to EtO290 was 228.3 ± 104.0/164.4 ± 84.3. Mean EtO2 after: 30s – 56.0 ± 13.5/69.3 ± 11.2 (p < 0.01); 60s – 63.8 ± 15.3/76.1 ± 11.7 (p = 0.02), 90s – 67.8 ± 17.7/80.7 ± 10.1 (p = 0.03); 120s– 69.6 ± 18.2/83.4 ± 10.0 (p = 0.03), 150s–71.1 ± 19.0/87.1 ± 6.5 (p = 0.01); 180s – 72.9 ± 16.8/88.5 ± 5.3 (p = 0.01), 210s – 72.6 ± 18.0/89.2 ± 5.1 (p < 0.01); 240s – 74.17 ± 15.4/90.0 ± 4.3 (p < 0.01), 270s-76.3 ± 16.3/90.2 ± 3.6; 300s – 77.8 ± 14.6/90.2 ± 1.5 (p < 0.01). Conclusions. Preoxygenation was significantly more efficient and faster with Intersurgical QuadraLite face masks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of preoxygenation efficiency with Intersurgical Economy and Intersurgical QuadraLite anaesthetic face masks

Sakalauskaitė

Kauzonas

Bukelytė

et al. 2019

AML

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Implementing an Interprofessional Difficult Airway Response Team to Identify and Manage High‐Risk Airways

Shukairy

Chadwick

LaPorte

et al. 2023

Otolaryngol.--head neck surg.

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Objective. To describe a multidisciplinary approach to and results from the creation of a difficult airway response team (DART) to address the management of inpatient loss of airway events.Methods. Description of an interprofessional process to establish and sustain a DART program at a tertiary care hospital. An Institutional Review Board-approved retrospective review of the quantitative results was conducted from November 2019 through March 2021.Results. After establishing the existing processes for difficult airway management, a focus on "work as imagined" identified 4 pillars to address the goal for the project of bringing the right providers with the right equipment to the right patients at the right time through DART equipment carts, an expanded DART code team, a screening tool to identify patients with at-risk airways and unique messaging for DART code alerts. "Work as done" was assessed through simulations. Educational efforts included further simulations and group teaching. Sustainability was achieved through ongoing e-learning and bidirectional feedback. During the period of study, there were 40,752 patients admitted and 28,013 (69%) screens completed. At-risk airways were identified in 4282 admissions (11%), most commonly due to a history of a difficult airway (19%) and elevated body mass index (16%). The DART responded to 126 codes. There were no airway-related deaths or serious adverse events.Discussion. A successful DART program was created, optimized, and sustained using components of interprofessional meetings, simulation, bidirectional feedback, and quantitative analysis.Implications for Practice. The techniques described can serve to guide groups who identify a quality improvement project that involves interactions between multiple stakeholders.

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