Evolving challenges and opportunities for difficult airway management guidelines (original) (raw)

Canadian Journal of Anaesthesia-journal Canadien D Anesthesie

Airway management is a key competency for every anesthesiologist. In 1990, Caplan et al. reported that 34% of anesthesia-related claims were related to airway management.1 Since that time, several national airway management guidelines have been published with the aim to establish and promote safer airway management practice.2,3 Since the publication of those guidelines, studies have shown a decrease in anesthesia complications related to airway management.4,5 Of course, it is not possible to determine causality, and there have been other significant changes in practice over this time, e.g., supraglottic airways are now used in more than half the patients in the United Kingdom (UK).5 Unfortunately, despite these advances in both protocols and technology, airway complications in anesthesia still occur, and they are often associated with severe complications, i.e., brain damage or death.5 Herein, we consider the contents of future airway management guidelines that might create a further i

Sign up for access to the world's latest research.

checkGet notified about relevant papers

checkSave papers to use in your research

checkJoin the discussion with peers

checkTrack your impact

Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia

British Journal of Anaesthesia, 2011

This project was devised to estimate the incidence of major complications of airway management during anaesthesia in the UK and to study these events. Reports of major airway management complications during anaesthesia (death, brain damage, emergency surgical airway, unanticipated intensive care unit admission) were collected from all National Health Service hospitals for 1 yr. An expert panel assessed inclusion criteria, outcome, and airway management. A matched concurrent census estimated a denominator of 2.9 million general anaesthetics annually. Of 184 reports meeting inclusion criteria, 133 related to general anaesthesia: 46 events per million general anaesthetics [95% confidence interval (CI) 38-54] or one per 22,000 (95% CI 1 per 26-18,000). Anaesthesia events led to 16 deaths and three episodes of persistent brain damage: a mortality rate of 5.6 per million general anaesthetics (95% CI 2.8-8.3): one per 180,000 (95% CI 1 per 352-120,000). These estimates assume that all such cases were captured. Rates of death and brain damage for different airway devices (facemask, supraglottic airway, tracheal tube) varied little. Airway management was considered good in 19% of assessable anaesthesia cases. Elements of care were judged poor in three-quarters: in only three deaths was airway management considered exclusively good. Although these data suggest the incidence of death and brain damage from airway management during general anaesthesia is low, statistical analysis of the distribution of reports suggests as few as 25% of relevant incidents may have been reported. It therefore provides an indication of the lower limit for incidence of such complications. The review of airway management indicates that in a majority of cases, there is 'room for improvement'.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Anesthesiology, 2021

The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

End of year summary 2019: anaesthesia and airway management

Journal of Clinical Monitoring and Computing

This end of the year summary reviews anesthesia related manuscripts that have been published in the Journal of Clinical Monitoring and Computing in 2019. Anesthesia is currently defined as being composed of unconsciousness, immobility, and autonomic nervous system (ANS) control (Br J Anaesth;122:e127-e135135, Egan 2019). Pain is a postoperative issue, because by definition unconsciousness implies pain cannot be experienced. We first review work related to these aspect of the profession: unconsciousness (EEG, target control), immobility (muscle relaxants), and ANS control. Regaining consciousness has to be accompanied by pain control, and it is important to ensure that the patient regains baseline cognitive function. Anesthesia machine equipment, drug administration, and airway related topics make up the rest of published manuscripts.

Determining airway complications during anaesthesia induction: a prospective, observational, cross-sectional clinical study

Anaesthesiology Intensive Therapy, 2020

Complications related to airway management rarely occur in operating theatres; however, these complications may cause life-threatening situations [1]. Qualitative and quantitative analysis from the Fourth National Audit Project (NAP4) of the Royal College of Anaesthetists and Difficult Airway Society shows major airway complication prevalence in the United Kingdom [2, 3]. The NAP4 adds valuable information to anaesthesia practice. However, one of the limitations of NAP4 is being only a reflection of practices in one country. Therefore it cannot be extended to other countries. Additionally, Cook and MacDougall-Davis [4] noted that it was hard to measure practical differences for the application of the NAP4 in other countries. This prospective ob

Airway management and anesthesia for airway surgery: a narrative review

Translational Lung Cancer Research

Objective: To discuss and summarize the literature for airway and anesthetic management tools the anesthesiologist can use for airway surgery to both successfully manage the patient's physiological needs and provide the surgeon the optimal surgical conditions with which to perform the surgery safely. Background: The airway and anesthetic management of patients presenting for thoracic surgery poses the anesthesiologist with a unique set of challenges, but also a unique set of opportunities to artfully utilize and adapt a variety of management options that has developed over several decades of innovation. Sixty years ago, airway surgery was initially performed with the patient spontaneously breathing and providing anesthesia with halogenated agents and airway topicalization. As medicine entered the latter half of the twentieth century with its development of new airway devices and modern anesthetic agents, most airway surgeries could be safely performed under general anesthesia with secured airways. Today, with continued technological advancements in surgical techniques and an expanding population of challenging patients, the application of nonintubated anesthetic techniques and extracorporeal support is on the rise. Methods: We conduct a narrative review of the literature on the history of airway and anesthetic management for thoracic surgery, the current management methods and evidence for each modality, and discuss future directions for the field. Conclusions: While the airway and anesthetic management for airway surgery is challenging, the anesthesiologist has a variety of options including cross-field ventilation, jet ventilation, nonintubated techniques, and extracorporeal support to safely care for the patient. Whichever methods are chosen for the patient and surgery, thoracic surgery remains uniquely positioned in its need for close sharing and collaboration of all airway and anesthetic management decisions between the anesthesiologist and the surgeon.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.