Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group.
Sachin Kheterpal,David W. Healy,Michael F. Aziz,Amy Shanks,Robert E. Freundlich,Fiona Linton,Lizabeth D. Martin,Jonathan Linton,Jerry L. Epps,Ana Fernandez-Bustamante,Leslie C. Jameson,Tyler Tremper,Kevin K. Tremper +12 more
Reads0
Chats0
TLDR
DMV combined with DL is an infrequent but not rare phenomenon, most patients can be managed with the use of direct or videolaryngoscopy, and an easy to use unweighted risk scale has robust discriminating capacity.Abstract:
Background Research regarding difficult mask ventilation (DMV) combined with difficult laryngoscopy (DL) is extremely limited even though each technique serves as a rescue for one another. Methods Four tertiary care centers participating in the Multicenter Perioperative Outcomes Group used a consistent structured patient history and airway examination and airway outcome definition. DMV was defined as grade 3 or 4 mask ventilation, and DL was defined as grade 3 or 4 laryngoscopic view or four or more intubation attempts. The primary outcome was DMV combined with DL. Patients with the primary outcome were compared to those without the primary outcome to identify predictors of DMV combined with DL using a non-parsimonious logistic regression. Results Of 492,239 cases performed at four institutions among adult patients, 176,679 included a documented face mask ventilation and laryngoscopy attempt. Six hundred ninety-eight patients experienced the primary outcome, an overall incidence of 0.40%. One patient required an emergent cricothyrotomy, 177 were intubated using direct laryngoscopy, 284 using direct laryngoscopy with bougie introducer, 163 using videolaryngoscopy, and 73 using other techniques. Independent predictors of the primary outcome included age 46 yr or more, body mass index 30 or more, male sex, Mallampati III or IV, neck mass or radiation, limited thyromental distance, sleep apnea, presence of teeth, beard, thick neck, limited cervical spine mobility, and limited jaw protrusion (c-statistic 0.84 [95% CI, 0.82-0.87]). Conclusion DMV combined with DL is an infrequent but not rare phenomenon. Most patients can be managed with the use of direct or videolaryngoscopy. An easy to use unweighted risk scale has robust discriminating capacity.read more
Citations
More filters
Journal ArticleDOI
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
C. Frerk,V.S. Mitchell,A.F. McNarry,C. Mendonca,R Bhagrath,Anil Kumar Patel,E.P. O’Sullivan,N. M. Woodall,Imran Ahmad +8 more
TL;DR: The Difficult Airway Management Guidelines as discussed by the authors provide a strategy to manage unanticipated difficulty with tracheal intubation and rapid sequence induction, which emphasizes assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions.
Journal ArticleDOI
Difficult tracheal intubation: A retrospective study
G. L. T. Samsoon,J. R. B. Young +1 more
TL;DR: There is a correlation between the degree of difficulty and the anatomy of the oropharynx in the same patient, and any screening test which adds to ability to predict difficulty in intubation must be welcomed, as failure to intubate can potentially lead to fatality.
Journal ArticleDOI
Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea.
Frances Chung,Stavros G. Memtsoudis,Satya Krishna Ramachandran,Mahesh Nagappa,Mathias Opperer,Crispiana Cozowicz,Sara Patrawala,Sara Patrawala,David Lam,Anjana Kumar,Girish P. Joshi,John A. Fleetham,Najib T. Ayas,Nancy A. Collop,Anthony G. Doufas,Matthias Eikermann,Marina Englesakis,Bhargavi Gali,Adrian V. Hernandez,Roop Kaw,Eric J. Kezirian,Atul Malhotra,Babak Mokhlesi,Sairam Parthasarathy,Tracey L. Stierer,Frank Wappler,Frank Wappler,David R. Hillman,Dennis Auckley +28 more
TL;DR: The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea is to present recommendations based on the available clinical evidence where possible, and these recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication.
Journal ArticleDOI
Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology.
Stefan De Hert,Sven Staender,Gerhard Fritsch,Jochen Hinkelbein,Arash Afshari,Gabriella Bettelli,Matthias Bock,Michelle S Chew,Mark Coburn,Edoardo De Robertis,Hendrik Drinhaus,Aarne Feldheiser,Götz Geldner,Daniel Lahner,Andrius Macas,Christopher Neuhaus,Simon Rauch,Maria Angeles Santos-Ampuero,Maurizio Solca,Nima Tanha,Vilma Traskaite,Gernot Wagner,Frank Wappler +22 more
TL;DR: The European Society of Anaesthesiology (ESA) guidelines on pre-operative evaluation of the adult undergoing noncardiac surgery are updated in this article, with recommendations based on the available relevant clinical evidence.
Journal ArticleDOI
Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database
A. K. Nørskov,C. V. Rosenstock,Jørn Wetterslev,G. Astrup,Arash Afshari,Lars Hyldborg Lundstrøm +5 more
TL;DR: A previously unpublished estimate of the accuracy of anaesthesiologists’ prediction of airway management difficulties in daily routine practice is presented and underline the importance of being constantly prepared for unexpected difficulties.
References
More filters
Journal ArticleDOI
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
Jeffrey L. Apfelbaum,Carin A. Hagberg,Robert A. Caplan,Casey D. Blitt,Richard T. Connis,David G. Nickinovich,Jonathan L. Benumof,Frederic A. Berry,Robert H. Bode,Frederick W. Cheney,Orin F. Guidry,Andranik Ovassapian +11 more
TL;DR: This document updates the “Practice Guidelines for Management of the Difficult Airway: An Updated Report by”, which provides basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open-forum commentary, and clinical feasibility data.
Journal ArticleDOI
Difficult tracheal intubation in obstetrics
R. S. Cormack,J. Lehane +1 more
TL;DR: Frequency analysis suggests that, in obstetrics, the main cause of trouble is grade 3, in which the epiglottis can be seen, but not the cords, which is fairly rare, and can be helpful as part of the training before starting in the maternity department.
Journal ArticleDOI
A clinical sign to predict difficult tracheal intubation: a prospective study
S. Rao Mallampati,Stephen P. Gatt,Laveme D. Gugino,Sukumar P. Desai,Barbara Waraksa,Dubravka Freiberger,Philip L. Liu +6 more
TL;DR: In this paper, a relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure.
Journal ArticleDOI
Difficult tracheal intubation: a retrospective study
G. L. T. Samsoon,J. R. B. Young +1 more
TL;DR: There is a correlation between the degree of difficulty and the anatomy of the oropharynx in the same patient, and any screening test which adds to the ability to predict difficulty in intubation must be welcomed, as failure to intubate can potentially lead to fatality.
Journal ArticleDOI
A Clinical Sign to Predict Difficult Tracheal Intubation: A Prospective Study
S. R. Mallampati,Stephen P. Gatt,Laverne D. Gugino,Sukumar P. Desai,B. Waraksa,Dubravka Freiberger,P. L. Liu +6 more
TL;DR: A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure.
Related Papers (5)
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
Tim Cook,N.M. Woodall,C. Frerk +2 more