Failed Tracheal Intubation

King, T.A.; Adams, A. P.

doi:10.1093/bja/65.3.400

Cited by 159 publications

(68 citation statements)

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“…It is higher in obstetric patients than in surgical patients [7] and the incidence in parturients may approach 1 in 500 [8]. Screening tests as Mallampatti oropharyngeal classification, thyromental distance, mouth opening and Wilson risk score yield possible sensitivity (20% -62%) and moderate specificity (82% -97%) [9,10].…”

Section: Discussionmentioning

confidence: 99%

Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Govindarajan¹,

Chang²,

Khalil³

et al. 2014

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Introduction: Knowledge, skill and training in addition to quick thinking, come to the rescue of Anesthesiologists when encountering an unanticipated difficult airway during emergency Caesarean section. Ability to react with time to spare will ensure maternal and fetal well being while handling this life threatening emergency. Case History: While anesthetizing a 22-year parturient for emergency Caesarean section, the endotracheal tube was inadvertently placed in the esophagus. As the "call for help" was activated, the esophageal tube was delivered thru the endoscopic port of a Patil-Syracuse face mask. After confirming our ability to ventilate the patient without distending the stomach while maintaining the oxygen saturation and end tidal carbon dioxide levels within normal limits, surgery was allowed to proceed under mask anesthesia employing oxygen, nitrous oxide and sevoflurane with rocuronium for muscle relaxation. After a healthy infant was delivered, definitive airway access was obtained with Glidescope ® assisted fiberoptic intubation. The esophageal tube was then removed. Further surgery proceeded uneventfully. Discussion: By choosing to deliver the proximal end of the inadvertently placed esophageal tube thru the endoscopic port of a Patil-Syracuse mask and mask ventilating the patient, we have been able to provide that few precious minutes of oxygenation to the distressed fetus before delivery. By isolating and venting the stomach thru the esophageal tube we provided maternal air way protection during the initial phase of the delivery. Definitive airway access was obtained as soon as additional help and equipment were available. Conclusion: Difficult airway algorithm while comprehensive, does not address the question of time management. While dealing with a difficult airway in obstetric anesthesia, time is the single most important factor, which will determine the maternal and fetal well being. We in our case report have attempted to answer that question of "time".

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Section: Discussionmentioning

confidence: 99%

Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Govindarajan¹,

Chang²,

Khalil³

et al. 2014

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“…Worldwide, upto 600 patients are thought to die annually as a result of complications occurring at the time of tracheal intubation 16 . Approximately 30% of the deaths in patients who experienced difficulties at laryngoscopy or intubation are caused by hypoxic brain damage secondary to inability to maintain a patent airway 17 .…”

Section: Discussionmentioning

confidence: 99%

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Naithani¹,

Gupta²,

Gupta³

et al. 2013

jemds

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BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anaesthetic practice which can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it and the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year) undergoing general anaesthesia with intubation were examined preoperatively for demographic details (age, sex, weight), dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG), Modified Mallampatti Grading (MMPG), Upper lip bite test (ULBT), Thyromental distance (TMD), Sternomental distance (SMD) and subluxation of mandible (SLM). All patients were anaesthetized using standard protocol with thiopentone (5mg/kg) and succinylcholine (1.5 mg/kg). On direct laryngoscopy, Cormack Lehane (CL) grading was noted. CL grade I, II was defined as easy visualization of larynx (EVL) and CL grade III, IV as difficult visualization of larynx (DVL). Difficult intubation score (DIS) was calculated as sum of CL grade and number of intubation attempts. DIS of less than or equal to 4 was defined as easy intubation (EI) and DIS > 4 was defined as difficult intubation (DI).Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios(LR) and odd's ratio value for six airway predictor tests was calculated by standard formulae. RESULTS: Incidence of DVL was 12.65% (n=55) and DI was 9.65% (n=42), with no failed intubation. All airway tests had very high negative predictive value (>90%) which implicates they identify easy intubations more precisely. MMPG and ULBT were found as nearly perfect airway predictors for difficult intubation having odds ratio of .7%) respectively, along with very high sensitivity of 92.80% and 85.7% respectively. Presence of ULBT III is the best predictor of difficult intubation (+LR 21.97) and absence of MMPG III, IV is the best predictor of difficult intubation (-LR 0.091). Abnormal dentition and airway pathology also increase the risk of difficult intubation, P<0.001. CONCLUSION: We conclude that ULBT and MMPG are "nearly perfect" airway predictors and should be used routinely during pre-anesthetic visit for screening of difficult intubation.

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“…1,5,6,8 Difficult or impossible intubation kills an estimated 600 people a year worldwide. 4,9 In fact, up to 28% of all anaesthesia related deaths are secondary to the inability to mask ventilate or intubate. 3,10 Predictive Indicators of Difficult Intubation Assessment of difficult airway in patients begins with comprehensive history and physical examination.…”

Section: Incidencementioning

confidence: 99%

Predictors of Difficult Airway: Preoperative Assessment

Sonavdekar¹,

Nayak²

2016

jemds

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BACKGROUNDThe primary goal of anaesthesiologist is to maintain a patent airway. Successful airway management requires a range of knowledge and skill sets. The ability to predict difficulty with airway management beforehand is very important. The management of difficult airway is different and requires skill besides the use of various equipment. It is therefore essential to assess the airway preoperatively to prevent further complications.

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Failed Tracheal Intubation

Cited by 159 publications

References 0 publications

Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Management of an Unanticipated Difficult Airway during Emergency “C” Section—A Novel Approach

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Predictors of Difficult Airway: Preoperative Assessment

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