Management of unexpected difficult airway at a teaching institution over a 7-year period

Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management

“…7 More recently, a number of authors have reported that the occurrence of failed intubations was from 0.26 to 0.9% of all anesthetics when direct laryngoscopy was the primary technology employed to facilitate intubation. [8][9][10] If direct laryngoscopy fails at the outset, often persistent further attempts are also unsuccessful. A decade apart, Rose and Mort reported that persistent attempts at direct laryngoscopy to secure tracheal intubation were associated with incrementally lower rates of success, higher rates of patient morbidity, and a significant increase in the complications when more than two attempts were made.…”

“…7,11 In similar eras, Hung and Connelly respectively reported that early use of alternative devices improved the success of airway interventions and reduced the likelihood of patient injury compared with persistent efforts with the direct laryngoscope. 8,12 Our ability to predict difficult intubation using bedside screening is poor. 13 Unanticipated difficult and failed intubation will occur with the direct laryngoscope, and the evidence suggests that it is best managed by alternative strategies in order to enhance the likelihood of success and reduce patient injury.…”

“…Connelly et al retrospectively reviewed the experience of managing unanticipated difficult airways in 447 patients. 8 Four airway management techniques were utilized by care-providers to manage the airway: persistence with direct laryngoscopy; a laryngeal mask airway (LMA); Bullard TM (Olympus Canada Inc, Markham, Canada) laryngoscopy; or fibreoptic bronchoscopy (FOB). The success rates were: repeat direct laryngoscopy, 22%; LMA, 87%; Bullard TM 84%; and FOB, 90%.…”

Massive subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum after multiple direct laryngoscopies: an autopsy case report

“…Even when ETI proves difficult, the tendency is for many laryngoscopists as well as second laryngoscopists to attempt ETI repeatedly [10]. Connelly et al [11] reported that when direct laryngoscopy is unsuccessful, additional attempts using the same technique have close to an 80% failure rate, while the use of an alternative technique (i.e., SGA and video laryngoscopy) is more successful. There is much evidence to support the usefulness of an SGA [12][13][14] and video laryngoscopy [15][16][17][18] in difficult airway management.…”

Direct and Indirect Laryngoscopy: Equipment and TechniquesDiscussion

“…line stabilization, 46,47 in patients with suspected cervical spine injuries, 48 in routine airway management, 49 in anticipated difficult laryngoscopy, 50 and in unexpected difficult intubations. 51 It has been demonstrated in immobilized cervical spine simulators using naïve operators to be an easily mastered airway management device based on success, time, and ease of intubation. 52 Competence has also been shown with the Bullard laryngoscope after a selflearning course and mannequin practice only.…”