Prediction of difficult mask ventilation

Gautam, Parshotam Lal; Gaul, T. K.; Luthra, Neeru

doi:10.1017/s026502150523106x

Cited by 17 publications

(12 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Even if the need for awake intubation had been diminished by more frequent use of VL, it is also conceivable that such a decrease could have been masked by a concomitant rise in awake intubation for an increasing population of obese patients 10 in whom a higher incidence of anticipated difficult airway management might be expected. [11][12][13][14][15][16][17][18][19][20] While the overall incidence of awake tracheal intubation was 1.06% of GETA cases, there was substantial variability in the rate (0-3.4 per 100 GETA cases) at which individual attending staff performed the procedure. These results were not controlled for subspecialty practice (e.g., anesthesiologists performing mainly regional vs neuroanesthesia), although anecdotally, the four individuals with the two lowest and the two highest rates of awake intubation had similar practice profiles (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study Incidence, taux de réussite et complications de l'intubation trachéale chez 1554 patients éveillés sur une période de 12 ans: une étude de cohorte historique AbstractPurpose Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) at our institution. Methods The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling. Results Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4 -4 incidenceÁyear -1 ; 95% confidence interval [CI]: -3.0 -4 to 3.0 -5 ; P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidenceÁyear -1 ; 95% CI: 0.076 to 0.083; P \ 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011)(2012)(2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. Conclusions At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway. RésuméObjectif L'intubation trachéale du patient éveillé, qu'on appelle aussi intubation vigile, est une alternative recommandée dans certaines situations précises pour

show abstract

Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Even below this level, a BMI > 26 or 30 kg·m −2 is an independent predictor of difficult face mask ventilation. 40 , 42 - 44 Other conditions frequently accompanying morbid obesity, such as a thick neck, history of snoring or obstructive sleep apnea, are similarly associated with difficult face mask ventilation. 40 - 44 Studies are contradictory on whether morbid obesity or its coexisting anatomic or pathophysiologic features are predictive of difficult direct laryngoscopy; although again, a thick neck does appear to portend difficulty.…”

Section: The Morbidly Obese Patientmentioning

confidence: 99%

The difficult airway with recommendations for management – Part 2 – The anticipated difficult airway

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

256

214

View full text Add to dashboard Cite

BackgroundAppropriate planning is crucial to avoid morbidity and mortality when difficulty is anticipated with airway management. Many guidelines developed by national societies have focused on management of difficulty encountered in the unconscious patient; however, little guidance appears in the literature on how best to approach the patient with an anticipated difficult airway.MethodsTo review this and other subjects, the Canadian Airway Focus Group (CAFG) was re-formed. With representation from anesthesiology, emergency medicine, and critical care, CAFG members were assigned topics for review. As literature reviews were completed, results were presented and discussed during teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made, and levels of evidence were assigned.Principal findingsPreviously published predictors of difficult direct laryngoscopy are widely known. More recent studies report predictors of difficult face mask ventilation, video laryngoscopy, use of a supraglottic device, and cricothyrotomy. All are important facets of a complete airway evaluation and must be considered when difficulty is anticipated with airway management. Many studies now document the increasing patient morbidity that occurs with multiple attempts at tracheal intubation. Therefore, when difficulty is anticipated, tracheal intubation after induction of general anesthesia should be considered only when success with the chosen device(s) can be predicted in a maximum of three attempts. Concomitant predicted difficulty using oxygenation by face mask or supraglottic device ventilation as a fallback makes an awake approach advisable. Contextual issues, such as patient cooperation, availability of additional skilled help, and the clinician’s experience, must also be considered in deciding the appropriate strategy.ConclusionsWith an appropriate airway evaluation and consideration of relevant contextual issues, a rational decision can be made on whether an awake approach to tracheal intubation will maximize patient safety or if airway management can safely proceed after induction of general anesthesia. With predicted difficulty, close attention should be paid to details of implementing the chosen approach. This should include having a plan in case of the failure of tracheal intubation or patient oxygenation.

show abstract

“…Class C has been reported to be associated with DMV. 49 The Mallampati classification system involves an examination of the patient's oral cavity. The different classifications are illustrated in Figure 12 and are described as follows: class 1, the soft palate and entire uvula are visible; class 2, the soft palate and a portion of the uvula are visible; class 3, the soft palate is visible (the base of the uvula may or may not be visible); and class 4, the soft palate is not visible.…”

Section: Moansmentioning

confidence: 99%

Approaches to Manual VentilationDiscussion

2014

View full text Add to dashboard Cite

Manual ventilation is a basic skill that involves airway assessment, maneuvers to open the airway, and application of simple and complex airway support devices and effective positive-pressure ventilation using a bag and mask. An important part of manual ventilation is recognizing its success and when it is difficult or impossible and a higher level of support is necessary to sustain life. Careful airway assessment will help clinicians identify what and when the next step needs to be taken. Often simple airway maneuvers such as the head tilt/chin lift and jaw thrust can achieve a patent airway. Appropriate use of airway adjuncts can further aid the clinician in situations in which airway maneuvers may not be sufficient. Bag-mask ventilation (BMV) plays a vital role in effective manual ventilation, improving both oxygenation and ventilation as well as buying time while preparations are made for endotracheal intubation. There are, however, situations in which BMV may be difficult or impossible. Anticipation and early recognition of these situations allows clinicians to quickly make adjustments to the method of BMV or to employ a more advanced intervention to avoid delays in establishing adequate oxygenation and ventilation.

show abstract

Prediction of difficult mask ventilation

Cited by 17 publications

References 5 publications

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

The difficult airway with recommendations for management – Part 2 – The anticipated difficult airway

Approaches to Manual VentilationDiscussion

Contact Info

Product

Resources

About