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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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