Anaesthetic management of acute airway obstruction (original) (raw)
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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'.
Crisis management during anaesthesia: obstruction of the natural airway
Quality and Safety in Health Care, 2005
Background: Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient. Objectives: To examine the role of a previously described core algorithm ''COVER ABCD-A SWIFT CHECK'', supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia. Methods: The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases. Conclusion: Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist's clinical practice requirements.
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.
Clinical review: management of difficult airways
Critical care (London, England), 2006
Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on bas...
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2020
Difficult airway management has till date been the most fearsome and challenging part of any anaesthetic management. Meticulous planning is always done prior to anaesthetic induction of such patients with multiple back up plans and rescue strategy. Significant advancements in terms of clinical protocols, techniques, and devices / gadgets in this field have led to decreased incidence of airway related complications. We hereby present a case series of 3 clinical cases with different airway scenarios; 1) Patient with huge goiter, who was intubated with the help of an indigenously developed fish mouth valve device, 2) a temporomandibular joint ankylosis case, managed with awake fibreoptic guided intubation 3) Patient with post burn contracture of face and neck, in which fibreoptic intubation was performed after partial release of scar under tumescent anaesthesia. Extensive preoperative airway evaluation and preparation to handle any emergency by multiple backup plans always helps in smo...
Anatolian Current Medical Journal
Aim: Central airway obstructions (CAO) are one of the main reasons for morbidity and mortality, often originate in the lungs, and are generally unresectable. Interventional airway procedure is a preferred method in these cases. This study aimed to analyze anesthesia management in patients undergoing interventional procedures for CAO. We aimed to highlight the problem and solutions that may be encountered in such cases. Material and Method: The data of 49 patients who had interventional airway procedure were analyzed retrospectively. Patients’ demographic data, type of interventional procedures, localization of the lesion, and duration of the procedure were analyzed. Vital parameters and arterial blood gases (ABG) levels had been recorded before anesthesia induction (T1), after rigid bronchoscope insertion (T2), 20th-minute of the procedure (T3), after extubation (T4), and in the postoperative care unit (T5). Results: The mean age was 57.90±11.99 years. The mean duration of the proce...
Brazilian Journal of Anesthesiology, 2023
Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The Brazilian Society of Anesthesiology presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.
Review of Difficult Airway Management
2018
DOI: 10.21276/sjams.2018.6.5.64 Abstract: The incidence of difficult airway and it's management frequently occur in the operating room. The anesthesiologists possess important responsibility to manage the difficult airway. Airway difficulties may be anticipated by the patient's airway assessment and asking previous anesthetic experience. Mallampati classification, Cormack and Lahane glottic appearance and Wilson Risk Sum are the most common methods to assess airway. An unpredictable difficult airway may occur, difficulty by mask ventilation, difficulty with intubation or can nor intubate cannot ventilate situation. American Anesthesia Association (ASA), DAS (Difficult Airway Society) create guidelines for difficult airway management .These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. In this review general evaluation of the difficult airway management was made.
Anesthetic considerations of central airway obstruction
Saudi Journal of Anaesthesia, 2011
Central airway obstruction (CAO) is a serious presentation of lung cancer and associated chest diseases. It presents a real challenge to the anesthesiologist because usually the patient admitted to the hospital as an emergency case with high grade dyspnea scheduled to undergo rigid bronchoscopy for diagnostic and possible therapeutic interventions. In this case report, we described the anesthetic management of a patient who was admitted to our hospital with CAO.