Difficult Airway Management in Patients Submitted to General Anesthesia. Is it a Matter of Devices or Predictive Scores?

Lavinia Bergesio

doi:10.23937/2377-4630/3/1/1039

Abstract

Background: Incidence of difficult tracheal intubation in elective surgery population varies in a wide range, with estimated pooled frequency of 6.8%. Unanticipated difficult intubation has been reported in 1.5 8.5% of all general anesthesia. Among devices providing indirect laryngoscopy, Truview EVO2 ® offers advantages in terms of glottic exposure, short training, and low cost. Methods: Retrospective review of unexpected difficult intubation among 24.500 patients scheduled for elective surgery under general anesthesia over a 44 months period. Direct laryngoscopy was first performed in all patients, thus, in case of any difficulty encountered, an alternative device was utilized. Incidence and characteristics of difficult intubation are reported. Preoperative airway evaluation parameters have been correlated with intubation difficulty. Results: Difficult tracheal intubation (DTI) was observed in 0.4% (90 patients). Truview laryngoscope has been used in 59 of 90 patients and succeeded in achieving intubation in 75% of cases. Among risk factors for difficult intubation, neither Mallampati class nor Body Mass Index (BMI) were shown to have high predictive value. An El-Ganzouri Risk Index (EGRI) score of 3 has been estimated to represent the cut-off value between easy and difficult intubation. Conclusion: Truview laryngoscope represents a useful tool in case of unexpected difficult intubation, and could be eventually introduced in a difficult airway management algorithm without burden on Unit costs and staff training. DTI predictive scores have been applied in clinical practice but still lack in cut-off values validation. As in our experience the risk score failed in predicting difficult airway, we speculate that the Anesthesiologist’s confidence with one or more alternative intubation devices could obviate the need for predictive scores. patient airway occurs, exposes the patient to the risk of complications basically related to hypoxia. Its incidence has been reported around 1-4% of patients with normal airway and, more recently, in a range of 1.5 8.5% of all general anesthesia [2,3]. Management of unanticipated difficult airways has been standardized in various algorithms, with an increasing need in updating related to development of novel devices [4].

Highlights

IntroductionAirway management is mostly performed in the operating room, and unexpected difficult tracheal intubation may be a life-threatening event which incidence varies in a wide range (Table 1) with estimated pooled frequency of 6.8% [1]
Airway management is mostly performed in the operating room, and unexpected difficult tracheal intubation may be a life-threatening event which incidence varies in a wide range (Table 1) with estimated pooled frequency of 6.8% [1].Difficulty at laryngoscopy or intubation, if inability to maintain a patient airway occurs, exposes the patient to the risk of complications basically related to hypoxia
Truview laryngoscope represents a useful tool in case of unexpected difficult intubation, and could be eventually introduced in a difficult airway management algorithm without burden on Unit costs and staff training

Summary

Introduction

Airway management is mostly performed in the operating room, and unexpected difficult tracheal intubation may be a life-threatening event which incidence varies in a wide range (Table 1) with estimated pooled frequency of 6.8% [1]. Difficulty at laryngoscopy or intubation, if inability to maintain a patient airway occurs, exposes the patient to the risk of complications basically related to hypoxia. Its incidence has been reported around 1-4% of patients with normal airway and, more recently, in a range of 1.58.5% of all general anesthesia [2,3]. Incidence of difficult tracheal intubation in elective surgery population varies in a wide range, with estimated pooled frequency of 6.8%. Unanticipated difficult intubation has been reported in 1.58.5% of all general anesthesia. Among devices providing indirect laryngoscopy, Truview EVO2® offers advantages in terms of glottic exposure, short training, and low cost

Methods

Results

Discussion

Conclusion