Management of difficult and failed intubation in the general surgical population: a historical cohort study in a tertiary care centre

Jayaraj, Ashok Kumar; Siddiqui, Naveed; Abdelghany, Sameh Mohammed Osman; Balki, Mrinalini

doi:10.1007/s12630-021-02161-5

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…The incidence of difficult intubation in these NPC patients was markedly higher than that in the general surgical population—28% in our cohort compared to 0.36–2.0% in the general surgical literature 15–17 . Though we did not study the incidence of inability to oxygenate or ventilate, neck fibrosis and radiation changes represent two of the most significant predictors of impossible mask ventilation 18,19 .…”

Section: Discussionmentioning

confidence: 52%

“…The incidence of difficult intubation in these NPC patients was markedly higher than that in the general surgical population-28% in our cohort compared to 0.36-2.0% in the general surgical literature. [15][16][17] Though we did not study the incidence of inability to oxygenate or ventilate, neck fibrosis and radiation changes represent two of the most significant predictors of impossible mask ventilation. 18,19 In combination with difficult tracheal intubation, the inability to oxygenate/ventilate may lead to higher rates of emergent surgical airways than in the general surgical population.…”

Section: Discussionmentioning

confidence: 96%

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Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma

et al. 2023

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ObjectiveThe aim of the study was to characterize the incidence and management of difficult tracheal intubations (DTIs) in nasopharyngeal carcinoma (NPC) after primary radiation therapy (RT).MethodsThe study was a retrospective review of airway assessment and outcomes in post‐RT NPC patients. Primary analysis was performed on patients who underwent post‐RT procedures, who were split into non‐DTI and DTI groups. Patients were classified as DTI if they (i) required >1 attempt to intubate, (ii) failed to be intubated, or (iii) experienced complications attributed to airway management. Secondary analysis was performed between patients who underwent post‐RT procedures (procedure group) and those who did not (control group).ResultsOne‐hundred and fifty patients were included, and 71.3% underwent post‐RT procedures, with no differences in characteristics between the procedure and control groups. One‐hundred and fifty procedures were identified, and 28.0% were categorized as DTI. There was no difference in patient characteristics or airway assessment measures between DTI and non‐DTI groups. Regression analysis revealed concurrent cervical mobility restriction, and trismus increased DTI incidence by 7.1‐fold (p = 0.011). Being non‐White was an independent predictor of DTI. The incidence of high‐grade intraoperative laryngoscopic view was lower in the non‐DTI compared to the DTI group (20.4% vs. 64.3%, p < 0.0001). Failure to intubate occurred in 2.0% of cases, and 6.0% cases had perioperative complications. Based on preoperative assessment, sensitivity of predicting DTI was 54.8% and specificity was 63.9%.ConclusionNPC patients frequently undergo post‐RT procedures requiring complex airway management. Rates of DTI and failed intubation are significantly higher than those in the general surgical population, and the ability to predict DTI with standard preoperative airway measures is poor.Level of EvidenceLevel 4 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 96%

Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma

et al. 2023

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“…To some extent, it has been shown that the video laryngoscope possesses some advantages to reveal glottis. [6] While, selecting an appropriate catheter facilitates successful intubation and avoids damage to soft tissue surrounding the airway. In addition, the supraglottic airway device was found inappropriate for this patient due to the almost complete laryngeal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Emergency treatment of airway obstruction caused by a laryngeal neuroendocrine tumor: A case report

Zhang

Yin

2023

Medicine

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Rationale: Laryngeal obstruction is a life-threatening adverse event that requires urgent and appropriate management, particularly in patients with coexisting cardiopulmonary and brain comorbidities. However, laryngeal obstruction caused by laryngeal neuroendocrine tumors has rarely been reported.Patient concerns: Neuroendocrine tumors can cause pathological changes in the neuro-humoral system, and asphyxia caused by airway obstruction has a more adverse effect on patients with neuroendocrine tumors.Diagnoses: We report the case of a 64-year-old man with clinical manifestations of dyspnea. Preoperative and intraoperative pathological examination indicated that the patient was diagnosed with life-threatening airway obstruction caused by a laryngeal neuroendocrine tumor, pneumonia, and scoliosis. Interventions:The patient underwent laryngeal tumor resection under general anesthesia. He was recovered well and was generally good without the necessity of undergoing radiotherapy and chemotherapy at the 6-months follow-up.Outcomes: This case report has provided an emergency treatment strategy associated with awake intubation. We concluded that flexible establishment of an artificial airway, skilled anesthesia and surgical manipulation, and necessary postoperative intensive care are extremely important for improving the prognosis of patients with severely difficult airway. It is noteworthy that the timely adjust for endotracheal intubation strategy according to the patient's response is needed. It is important for the longterm prognosis of patients to avoid the establishment of a traumatic artificial airway and the occurrence of adverse complications.

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“…In the previously mentioned study by Khan et al, the prevalence of difficult intubation was as low as 3% ( 23 ). One Canadian center has reported high performance as having only 111 (0.26%) cases of difficult intubation and 14 (0.03%) cases of failed intubation in 42,805 general surgical cases requiring endotracheal intubation over the seven-year period ( 33 ). Interestingly, in OSA patients, the rate of difficult intubation was 6.7% (58 of 869), as reported by Seet et al ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Preoperative Single Anthropometric Screening Tests of Difficult Face Mask Ventilation and Difficult Direct Laryngoscopy Intubation in Patients Undergoing Otorhinolaryngological Surgery: A Prospective, Observational, Single Center Study

Goranović

2023

ACC

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SUMMARY The aim of this study was to assess preoperative airway history data and single anthropometric screening tests of difficult face mask ventilation (FMV) and difficult direct laryngoscopy intubation (DLI) in otorhinolaryngological surgery. Final analysis included 62 patients aged ≥14 years undergoing elective surgery with endotracheal intubation at a single center during a one-month period. Data on difficult intubation history, airway symptoms and pathology related to difficult airway were prospectively collected. Han scoring classification of FMV and Intubation Difficulty Score (IDS) were used. There were 14 (22.6%) patients with a history of current airway tumors or abscesses. Only two (3.2%) patients were preoperatively evaluated as anticipated difficult airway. Both were slightly difficult to ventilate and scored IDS 5 and IDS 8. FMV was graded as easy in 50 (80.5%), slightly difficult in 10 (16.1%) and difficult in 2 (3.2%) cases. There were 29 (46.78%) slightly difficult DLIs and one (1.6%) case of difficult DLI. The study confirmed clinically relevant incidence of difficulties with FMV and DLI in otorhinolaryngologic surgery patients. However, there should be stronger evidence to identify a single preoperative variable predicting difficult airway.

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Management of difficult and failed intubation in the general surgical population: a historical cohort study in a tertiary care centre

Cited by 14 publications

References 26 publications

Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma

Difficult Tracheal Intubation and Airway Outcomes after Radiation for Nasopharyngeal Carcinoma

Emergency treatment of airway obstruction caused by a laryngeal neuroendocrine tumor: A case report

Preoperative Single Anthropometric Screening Tests of Difficult Face Mask Ventilation and Difficult Direct Laryngoscopy Intubation in Patients Undergoing Otorhinolaryngological Surgery: A Prospective, Observational, Single Center Study

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