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

A rude awakening after our fourth ‘NAP’: lessons for airway management

Point: Should an Anesthesiologist Be the Specialist of Choice in Managing the Difficult Airway in the ICU? Yes

Critical airways, critical language

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 2: intensive care and emergency departments

National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists

The airway.

Intensive care units should routinely use a capnograph to monitor breathing to significantly reduce numbers of deaths and brain damage, a new report concludes. The report by the Royal College...

Sugammadex to rescue a ‘can't ventilate’ scenario in an anticipated difficult intubation: is it the answer?

We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with 'predicted easy' airways were rare (approximately 1 in 14,200), but 45 times more common in those with 'predicted difficult' airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.

“Airway management complications during anaesthesia, in intensive care units and in emergency departments in the UK”

Airway management research: what problem are we trying to solve?

Reply from the authors

Reply from the authors

Editorial| October 2022 Walk a Tightrope or Burn a Bridge?: Sedation versus General Anesthesia for Intubation of a Pediatric Difficult Airway This article has an Audio Podcast Allan F. Simpao, M.D., M.B.I.; Allan F. Simpao, M.D., M.B.I. 3 Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania https://orcid.org/0000-0001-8871-2579 Search for other works by this author on: This Site PubMed Google Scholar Clyde T. Matava, M.B.Ch.B., D.A., M.Med.; Clyde T. Matava, M.B.Ch.B., D.A., M.Med. 2 Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Search for other works by this author on: This Site PubMed Google Scholar Andrew Davidson, M.B.B.S., M.D., F.A.N.Z.C.A. Andrew Davidson, M.B.B.S., M.D., F.A.N.Z.C.A. 1 Department of Anesthesia, Royal Children’s Hospital, Parkville, Victoria, Australia; Melbourne Children’s Trials Center, Murdoch Children’s Research Institute, Parkville, Victoria, Australia; and Departments of Pediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information This editorial accompanies the article on p. 418. Accepted for publication August 2, 2022. Address correspondence to Dr. Simpao: Anesthesiology October 2022, Vol. 137, 384–386. https://doi.org/10.1097/ALN.0000000000004343 Connected Content Article: Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Allan F. Simpao, Clyde T. Matava, Andrew Davidson; Walk a Tightrope or Burn a Bridge?: Sedation versus General Anesthesia for Intubation of a Pediatric Difficult Airway. Anesthesiology 2022; 137:384–386 doi: https://doi.org/10.1097/ALN.0000000000004343 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: anesthesia, general, burns, intubation, pediatric difficult airway, sedation procedure Children—and their airways—come in all shapes and sizes, and the most seasoned pediatric anesthesiologists can share harrowing stories of patients who were difficult to ventilate or intubate. In 2012, a special interest group in the Society for Pediatric Anesthesia created the Pediatric Difficult Intubation Registry, an international, multicenter, web-based registry of observational data on pediatric difficult airway management, with the goal of improving the care of these challenging patients. The Pediatric Difficult Intubation Collaborative has produced a panoply of clinically relevant findings, and their most recent research sought to answer how these patients fare when managed with sedation versus general anesthesia.1–4 When confronted with a potentially or known difficult airway, most pediatric anesthesiologists induce general anesthesia, albeit with the goal of maintaining both adequate depth and spontaneous respiration.1 In contrast, there are some who decry general anesthesia may “burn the bridge” of spontaneous ventilation and instead choose to... You do not currently have access to this content.

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations