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Management of unanticipated difficult intubation: a survey of current practice in the Oxford region

Published online by Cambridge University Press:  23 December 2004

A. Bokhari ,
S. W. Benham  and
M. T. Popat
A. Bokhari
Affiliation:
The John Radcliffe, Nuffield Department of Anaesthetics, Headley Way, Oxford, UK
S. W. Benham
Affiliation:
The John Radcliffe, Nuffield Department of Anaesthetics, Headley Way, Oxford, UK
M. T. Popat
Affiliation:
The John Radcliffe, Nuffield Department of Anaesthetics, Headley Way, Oxford, UK
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Abstract

Summary

Background and objective: Unanticipated difficulty in tracheal intubation in an anaesthetized patient has always been a cause of concern to anaesthesiologists. This difficulty may lead to morbidity and mortality. This survey was carried out to determine the technique commonly favoured in centres in the Oxford region in the UK for the management of unanticipated difficult intubation.

Methods: We conducted a clinical scenario-based questionnaire survey of 181 anaesthesiologists in the Oxford region. In this scenario, difficulty in endotracheal intubation is recognized only after induction of anaesthesia. A number of options were available to deal with this situation. We used this scenario as a tool to gain insight into the training and the training needs of anaesthesiologists at various levels of training.

Results: Of the 181 questionnaires sent, we received 143 (79%) completed replies. The vast majority (141/143 (99%)) of anaesthesiologists would use a gum-elastic bougie together with head and neck positioning and optimal external laryngeal manipulation to gain the best attempt at intubation. If intubation still failed, overall 129/143 (90%) had a back-up plan, while 14/143 (10%) had no plan. Flexible fibreoptic techniques were more commonly planned by 92/143 (64%) anaesthesiologists compared to blind techniques which were less commonly planned by 37/143 (26%) anaesthesiologists. Differences in choice of technique among anaesthesiologists in teaching and district general hospitals were not significant (P = 0.87). Overall, trainees were less likely to choose fibreoptic techniques compared to consultants (P = 0.0009) and would use blind techniques or ask a more experienced colleague to take over. The main reason for the choice was previous experience with the technique.

Conclusions: Although fibreoptic techniques were most commonly planned, these were less often chosen by trainees than consultants due to lack of experience/training, while unavailability of intubating laryngeal mask airway (Intavent®) was an additional issue precluding its use as an adjunct to intubation.

Keywords

INTUBATION, INTRATRACHEAL, laryngeal masksRESPIRATORY INSUFFICIENCY, airway obstruction
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 2 , February 2004 , pp. 123 - 127
Copyright
2004 European Society of Anaesthesiology

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References

Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anesth 1998; 45: 757–776.Google Scholar
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487–490.Google Scholar
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.Google Scholar
Benumof JL. Management of the difficult adult airway. Anesthesiology 1991; 75: 1087–1110.Google Scholar
Tunstall M. Failed intubation drill. Anaesthesia 1976; 31: 850.Google Scholar
Caplan RA, Benumof JL, Berry FA, et al. Practice guidelines for the management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on the Management of the Difficult Airway. Anesthesiology 1993; 78: 597–602.Google Scholar
Buck N, Devlin HB. The Report of a Confidential Enquiry into Perioperative Deaths.London, UK: NCEPOD, 1987.
Cheyney FW, Posner KL, Caplan RA. Adverse respiratory events infrequently leading to a malpractice suits. A closed claim analysis. Anesthesiology 1991; 75: 932–939.Google Scholar
Finucane B. The difficult airway – a Canadian perspective. Can J Anaesth 1998; 45: 713–718.Google Scholar
Murphy PA. A fibreoptic endoscope used for nasal intubation. Anaesthesia 1967; 22: 489–491.Google Scholar
Brain AIJ. The laryngeal mask – a new concept in airway management. Br J Anaesth 1983; 55: 805–808.Google Scholar
Ovassapian A. Fibreoptic tracheal intubation in adults. In: Ovassapian A, ed. Fibreoptic Endoscopy and the Difficult Airway, 2nd edn. Philadelphia, USA: Lippincott-Raven, 1996: 72–103.
Heidegger T, Gerig HJ, Kreienbühl G. Validation of a simple algorithm for tracheal intubation: daily practice is the key to success in emergencies – an analysis of 13,248 intubations. Anesth Analg 2001; 92: 517–522.Google Scholar
Rosenblatt WH, Wagner PJ, Ovassapian A, Kain ZN. Practice pattern in managing the difficult airway by anaesthesiologists in the United States. Anesth Analg 1998; 87: 153–157.Google Scholar
Brain AI, Verghese C, Addey EV, Kapila A, Brimacombe J. The intubating laryngeal mask. II. A preliminary clinical report of a new means of intubating the trachea. Br J Anaesth 1997; 79: 704–709.Google Scholar
Baskett PJF, Parr MJ, Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia 1998; 53: 1174–1179.Google Scholar