Elective IntubationDiscussion

Abstract

Endotracheal intubation is a commonly performed operating room (OR) procedure that provides safe delivery of anesthetic gases and airway protection during surgery. The most common intubation technique in the perioperative environment is direct laryngoscopy with orotracheal tube insertion. Infrequently, difficulties that require an alternative intubation technique are encountered due to patient anatomy, equipment limitations, or patient pathophysiology. Careful patient evaluation, advanced planning, equipment preparation, system redundancy, use of checklists, familiarity with airway algorithms, and availability of additional help when needed during OR intubations have resulted in exceptional success and safety. Airway difficulties during intubation outside the controlled environment of the OR are more frequent and more serious. Translating the intubation processes practiced in the OR to intubations outside the perioperative setting should improve patient safety. This paper considers each step in the OR intubation process in detail and proposes ways of incorporating perioperative procedures into intubations outside the OR. Management of the physiologic impact of intubation, lack of readily available specialized equipment and experienced help, and planning for transfer of care following intubation are all challenges during these intubations.

Upside Down Hospital: Co-Producing Safety With Patients

“…At a structural level redundancy might be important for the set-up of viable rural health services (Kornelsen, McCartney, & Williams, n.d.), and to plan the evacuation of patients from healthcare facilities in case of an emergency (McGrady, Blanke, & Swanson, 2014). Descriptive manuscripts referenced redundancy in operating rooms (OR) as a necessary feature for essential equipment for tracheal intubation (Durbin, Bell, & Shilling, 2014), for broader intra-operative resourcing (Kolodzey, Trbovich, Kashfi, & Grantcharov, 2019), and in the performance of surgical checklists (Treadwell, Lucas, & Tsou, 2014). The World Health Organisations Safer Surgery checklist (Haynes et al, 2009) uses features of a redundant system by mandating the presence of whole teams (including patients) for a forcing function, briefing prior to surgery.…”

Outcomes and follow-up for children intubated in an adult-based community hospital system: A retrospective chart review

“…Intubation is the placement of an endotracheal tube (ETT) into an airway, with the majority occurring during non-emergency elective surgery (>90%), with a small percentage in emergency departments (EDs), intensive care units (ICUs), and by Emergency Medical Services (EMS) [ 1 , 2 ]. Emergency intubation is a high-risk procedure and may cause adverse outcomes such as cardiac arrest [ 3 – 6 ].…”

“…Training and educating providers to be competent in advanced airway management can be a challenge in pediatric EDs [ 19 – 21 ], where emergency intubations are rare [ 1 , 2 , 22 ]. This is especially true in adult-based community EDs where intubations (pediatric and adults) are even more scarce, and the opportunities for training with pediatric patients is low [ 18 , 23 ].…”

Basic Airway Management Training for Physicians in Intensive Care and Other Services: A Mini Survey

“…ETE kardiyopulmoner resüsitasyon, invaziv mekanik ventilasyon, hava yolunun korunması, hasta transportunun kolaylaştırılması gibi klinik amaçlarla ameliyathane dışında da sıklıkla uygulanan bir girişimdir. Amerikan Hastalık Kontrol Merkezi verilerine göre 2010'da Birleşik Devletler'de 15 milyon kişi ameliyat esnasında entübe edilmiş ve ameliyathane dışında uygulanan 650.000 işlemin 300.000'i acil servislerde yapılmıştır (2). Ameliyathane dışında uygulandığında genellikle aciliyet nedeniyle hava yolu değerlendirmesinde yetersizlik, mekan koşullarının uygunsuzluğu ve anestezistler kadar deneyimli olmayan personellerle çalışmak gibi dezavantajlar ortaya çıkmaktadır.…”