Predictors and Clinical Outcomes From Failed Laryngeal Mask Airway Unique

Ramachandran, Satya Krishna; Mathis, Michael R.; Tremper, Kevin K.; Shanks, Amy; Kheterpal, Sachin

doi:10.1097/01.sa.0000425599.73198.81

Cited by 29 publications

(49 citation statements)

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“…However, the optimal use of SADs remains poorly defined in the adult population. Ramachandran et al, in an observational study of over 15 000 patients, reported a 1.1% incidence of failure of the LMA â Unique, defined as tracheal intubation after device removal, with 62% of patients having significant airway complications [5]. Our incidence of adverse airway complications was much lower at 23%, and therefore it is timely to assess difficult ventilation via a SAD.…”

Section: Discussionmentioning

confidence: 90%

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Incidence of and risk factors for difficult ventilation via a supraglottic airway device in a population of 14 480 patients from South‐East Asia

et al. 2015

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SummaryDifficult airway practice guidelines include the use of a supraglottic airway device as part of the armamentarium to provide and maintain ventilation and oxygenation. We retrospectively reviewed 14 480 patients aged ≥ 18 years who underwent general anaesthesia. We identified 74 (0.5%) patients whose lungs were identified as having been difficult to ventilate via a supraglottic airway device, and 29 (0.2%) patients in whom device placement failed. Multivariate analysis identified four risk factors for difficult ventilation via a supraglottic airway device: male sex (OR 1.75, 95% CI 1.07-2.86, p = 0.02); age > 45 years (OR 1.70, 95% CI 1.01-2.86, p = 0.04); short thyromental distance (OR 4.35, 95% CI 2.31-8.17, p < 0.001); and limited neck movement (OR 2.75, 95% CI 1.02-7.44, p = 0.04). Adverse respiratory events including oxygen desaturation, hypercapnoea, laryngospasm, and bronchospasm occurred in 17 patients (22%). The incidence of difficult ventilation via a supraglottic airway device was 0.5% in a large cohort of South-East Asian patients.

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Section: Discussionmentioning

confidence: 90%

“…Successful ventilation via a SAD may provide anaesthetists with a rescue technique if laryngoscopy is unsuccessful and/or a difficult airway is encountered unexpectedly. Risk factors for difficult laryngoscopy are well recognised [3,4], but difficult ventilation has not been well studied [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Incidence of and risk factors for difficult ventilation via a supraglottic airway device in a population of 14 480 patients from South‐East Asia

et al. 2015

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“…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

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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

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“…Laryngeal masks (LM) are a safe airway-device for GA in outpatient surgery with a failure rate of 1.1% defined as an airway event requiring LM removal and tracheal intubation [27]. The failure-rate in our study (n=1, 3.7%) may partly be explained by the small case number.…”

Section: Discussionmentioning

confidence: 46%