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Evaluating the utility of pre-operative airway assessment for intubation management in difficult airway patients

Published online by Cambridge University Press:  23 October 2020

S Narula ,
D S Mann ,
N Sadana  and
N R Vasan
S Narula
Affiliation:
University of Oklahoma College of Medicine, Oklahoma City, USA
D S Mann
Affiliation:
Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
N Sadana
Affiliation:
Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts, USA
N R Vasan*
Affiliation:
Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
*
Author for correspondence: Nilesh R Vasan, Department of Otolaryngology, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 1400, Oklahoma City, OK73104, USA E-mail: Nilesh-Vasan@ouhsc.edu
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Abstract

Objective

To assess intubation management in difficult airway patients by performing a multidisciplinary pre-operative examination of the airway using a flexible fibre-optic laryngoscope.

Methods

Patients with a known but stable difficult airway were evaluated prior to surgery in the pre-operative holding suite by both an ENT surgeon and an anaesthesiologist via a fibre-optic laryngeal examination.

Results

Performing a pre-operative fibre-optic examination of the difficult airway led to a change in intubation strategy in 6 out of 12 cases. Intubation ‘first-pass’ success occurred in 9 out of 12 (75 per cent) of our patients.

Conclusion

By performing a multidisciplinary airway examination immediately prior to surgery, a safe plan to intubate on the initial attempt was developed. This resulted in improved first-pass success at intubation compared to historical data.

Keywords

Airway ManagementIntubationGeneral AnesthesiaMultidisciplinary TeamLaryngoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 10 , October 2020 , pp. 909 - 916
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Dr N R Vasan takes responsibility for the integrity of the content of the paper

References

Apfelbaum, JL, Hagberg, CA, Caplan, RA, Connis, RT, Nickinovich, DG, Benumof, JL et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013;118:251–70CrossRefGoogle ScholarPubMed
Frerk, CM. Predicting difficult intubation. Anaesthesia 1991;46:1005–8CrossRefGoogle ScholarPubMed
Rose, DK, Cohen, MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994;41(5 Pt 1):372–83CrossRefGoogle ScholarPubMed
Cook, TM, Macdougall-Davis SR. Complications and failure of airway management. Br J Anaesth 2012;109(suppl 1):i68–85CrossRefGoogle ScholarPubMed
Metzner, J, Posner, KL, Lam, MS, Domino, KB. Closed claims’ analysis. Best Pract Res Clin Anaesthesiol 2011;25:263–76CrossRefGoogle ScholarPubMed
Katz, JA. 4th National Audit Project of the Royal College of Anaesthetists and The Difficult Airway Society: major complications of airway management in the United Kingdom. Anesthesiology 2012;116:496CrossRefGoogle Scholar
Rosenstock, CV, Nørskov, AK, Wetterslev, J, Lundstrøm, LH; Danish Anaesthesia Database. Emergency surgical airway management in Denmark: a cohort study of 452 461 patients registered in the Danish Anaesthesia Database. Br J Anaesth 2016;117(suppl 1):i75–82CrossRefGoogle ScholarPubMed
Iseli, TA, Iseli, CE, Golden, JB, Jones, VL, Boudreaux, AM, Boyce, JR et al. Outcomes of intubation in difficult airways due to head and neck pathology. Ear Nose Throat J 2012;91:E1–5CrossRefGoogle ScholarPubMed
Sakles, JC, Chiu, S, Mosier, J, Walker, C, Stolz, U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20:71–8CrossRefGoogle ScholarPubMed
Driver, BE, Prekker, ME, Klein, LR, Reardon, RF, Miner, JR, Fagerstrom, ET et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA 2018;319:2179–89CrossRefGoogle ScholarPubMed
Driver, B, Dodd, K, Klein, LR, Buckley, R, Robinson, A, McGill, JW et al. The bougie and first-pass success in the emergency department. Ann Emerg Med 2017;70:473–8CrossRefGoogle ScholarPubMed