Incidence Of Difficult Airway Research Articles

Comparison between clinical and ultrasonographic parameters in predicting difficult airway: An observational prospective study

Introduction : Various clinical tests are applied at the bedside to predict difficult airway during the pre-anaesthetic examination. Ultrasonography can be used to evaluate the airway and predict difficulty in laryngoscopy and endotracheal intubation.
 Objective : To compare the various clinical and ultrasonographic parameters in predicting difficult airway.
 Methodology: This prospective observational study was carried out at Birat Medical College and Teaching Hospital. The clinical parameters obtained were Modified Mallampati Grade (MMP), Upper Lip Bite Test (ULBT) and Thyromental Distance (TMD) and the ultrasonographic (USG) parameters used were Tongue Volume (TV), Hyomental Distance Ratio (HMDR) and distance of soft tissue from skin to hyoid bone (DSHB).These results were correlated with Cormack-Lehane (CL) grade during laryngoscopy of 200 patients. The sensitivity, specificity, Receiver Operating Characteristic (ROC) curve along with Area under the curve (AUC) was calculated for each parameter.
 Result: Incidence of difficult airway was 15.5%. The sensitivity and specificity of ultrasonographic tongue volume (TV) was higher among all parameters in predicting difficult airway. The specificity of HMDR and DSHB were better compared to clinical parameters.
 Conclusion: The use of ultrasound in pre-anaesthetic examination can be a viable tool along with clinical parameters for prediction of difficult airway.

Incidence of difficult airway among adult patients of undiagnosed obstructive sleep apnea who are undergoing elective surgery: a prospective cohort study

Introduction: Obstructive sleep apnea (OSA) is a dangerous medical disorder marked by obstruction of the upper airway during sleep that is frequently undiagnosed before surgery. Preoperative identification of suspected OSA patients necessitates appropriate preparation and prevents unfavorable outcomes. The incidence of difficult airway in adult patients with OSA who are undergoing elective surgery is significantly increased. Materials and method: The study population was separated into high and low-risk groups based on STOP-BANG scores of ≥3 and <3, respectively. The rate of occurrence was compared between the study groups. SPSS version 23 was used for statistical analysis. P-values <0.05 are considered significant. To find characteristics that predict problematic airway, researchers used logistic regression. Result: A total of 113 participants was enrolled. Based on STOP-BANG 77 patients and 36 patients were grouped in to low risk OSA and high risk OSA, respectively, the incidence of difficult intubation (DI) was significantly higher (22.2%) in high risk OSA group versus 5.2% in low risk OSA group, relative risk of 4.278 (95% confidence interval: 1.378–13.2). Mask ventilation was significantly more problematic for the high-risk group (P=0.011) (25% against 6.5%). Male sex, neck circumference >40 cm, Mallampati class 3, and 12.5 cm stern mental distance were all linked to DI. Age above 50 years, snoring history, and a neck circumference of >40 cm were all found to be predictors. Conclusion: Patients who scored ≥3 on the STOP-BANG had a significantly higher rate of DI and difficult mask ventilation. As a result, the STOP-BANG questionnaire should be used to screen every adult patient undergoing elective surgery for OSA.

THE EFFICACY OF DIFFERENT PREDICTORS OF DIFFICULT AIRWAY IN SIKKIMESE PEOPLE

Aim: To find out the incidence of difficult airway and which parameter will be suitable to predict it in sikkimese population. Material and methods: This is observational single blinded study was done on 500 patients between 18 to 65 years of age coming for surgery under general anaesthesia . The airway parameters assessed were Modified Mallampati test (MMP), Inter incisor gap (IG), Thyromental distance (TMD), Sternomental distance (SMD) and Mandibular protrusion (MP) along with demographic characteristics. Then difficult intubation was graded according to the Cormack–Lehane classification and was compared with above mentioned parameters. Result: 86 patients had difficult intubation with incidence of 17.20%. Gender and different ethnicity showed significant association. MMP, TMD and among combination test MMP+TMD, MMP+SMD was found to be statistically significant. Maximum AUC of ROC curve was seen in TMD (0.65) followed by MMP+TMD (0.615). The Mandibular protrusion has highest sensitivity (100%). The MMP showed least sensitivity (27.91%) but highest specificity (93%), PPV (45.3%) and diagnostic accuracy (81.8%). The sensitivity for MMP was found to be increased in combined parameters MMP+ SMD (73.26%), MMP + TMD (55.81%). Conclusion: It’s better to use combination of test to predict difficult airway. TMD, MMP+TMD and MMP+SMD can be used.

A Prospective Audit of Airway Code Activations and Adverse Events in Two Tertiary Hospitals

Airway management outside the operating room can be challenging, with an increased risk of difficult intubation, failed intubation and complications. We aim to examine airway practices, incidence of difficult airway and complications associated with airway code (AC) activation. We conducted a prospective audit of AC activations and adverse events in two tertiary hospitals in Singapore. We included all adult patients outside the operating room who underwent emergency intubation by the AC team after AC activation. Adult patients who underwent emergency intubation without AC activation or before the arrival of the AC team were excluded. Data were collected and documented by the attending anaesthetists in a standardised survey form shortly after their responsibilities were completed. The audit was conducted over a 20-month period from July 2016 to March 2018, during which a total of 224 airway activations occurred. Intubation was successful in 218 of 224 AC activations, giving a success rate of 97.3%. Overall, 48 patients (21.4%) suffered an adverse event. Thirteen patients (5.8%) had complications when intubation was carried out by the AC team compared with 35 (21.5%) by the non-AC team. Dedicated AC team offers better success rate for emergency tracheal intubation. Non-AC team attempted intubation in the majority of the cases before the arrival of the AC team. Increased intubation attempts are associated with increased incidence of adverse events. Equipment and patient factors also contributed to the adverse events. A multidisciplinary programme including the use of supraglottic devices may be helpful to improve the rate of success and minimise complications.

Difficult airway prediction in paediatric anaesthesia (Diffair): Prospective observational study.

The incidence of difficult airway in paediatric patients is lower than that the adult population, and the majority should be predictable. The primary aim of this trial was to evaluate the incidence of difficult airway in pediatric patients. The secondary aim was to predict difficult airway in these patients. Paediatric patients undergoing elective surgery under general anaesthesia in a tertiary university hospital were examined, and a panel of difficult airway prediction tests was performed. We recorded the incidence, risk factors for difficult airway and events associated with difficult airway together with the sensitivity and specificity of tests for difficult airway and events associated with difficult airway prediction. We prospectively included 389 paediatric patients. The incidence of difficult airway was 3.6%; the incidence of events associated with difficult airway was 10%. The sensitivity for prediction of events associated with difficult airway during the pre-anaesthesia evaluation was 5.3% with the specificity 93.3%. In the operating room, the sensitivity of prediction was 15% with 97.8% specificity. We found minimal efficacy for preanaesthesia difficult airway prediction.

Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review

Study objectiveThe association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway. DesignThe OVID Medline in process, Medline (vis Pub Med), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched up to April 2016 using specific keywords. Inclusion criteria were: [1] airway management in patients with a diagnosis of OSA, [2] comparison of airway management between OSA and non-OSA patients, [3] publications or abstracts in the English language. The incidence of difficult airway between OSA and non-OSA patients was compared using Chi-square analysis or Fisher's exact test. Main resultsTen studies were included in the final review. Overall, the incidence of difficult tracheal intubation was higher in OSA patients versus non-OSA patients [56/386 (14.5%) vs. 69/897 (7.7%); P=0.0002]. OSA patients also have a higher incidence of difficult mask ventilation [115/4626 (2.5%) vs. 471/64,684 (0.7%); P<0.0001]. Compared to non-OSA patients, OSA was not associated with difficulty in the use of a supraglottic airway (SGA) device [10/663 (1.5%) vs. 162/15,171 (1.1%); P=0.38]. No studies compared difficult surgical airway in OSA and non-OSA patients. ConclusionsOSA was found to be a risk factor associated with difficult tracheal intubation and difficult mask ventilation. There was no association between OSA and difficult SGA use.

Iatrogenic surgical emphysema and pneumomediastinum in a case of emergency lower segment caesarean section.

Incidence of difficult airway in the obstetric population is high (0.3%), but multiple reattempts should be avoided to prevent trauma and likely desaturation.[1] Proseal laryngeal mask airway (PLMA®)/LMA Supreme® (SLMA) can be the first choice after failed intubation attempts as these two devices have been shown to be effective. These devices have their own problems, however, and one such potential complication is presented in this case report.

Evaluation Of Knowledge Of The Anesthesiologists About The Available Resources For The Approach Of Difficult Airway Within The Macro-Region Of Cariri

Introduction: Secure the airway is essential for a safe anesthetic practice and it occurs without difficulties in most cases. However, complications resulting from a failure in the approach used for a difficult airway are the main causes of morbidity and mortality attributable to anesthesia. In an attempt to prevent its severity, it becomes imperative to try to anticipate the difficulty whenever possible. Reports show incidence of difficult airway in approximately 2% of the general population and the ASA recommends the prior identification and the use of algorithms to address this complication. Objective: The objective is to evaluate the knowledge of anesthesiologists from Cariri in relation to the available resources to handle difficult airway in hospitals where they work. Method: Cross-sectional and qualitative study with the use of a questionnaire applied to all anesthesiologists. For this evaluation, we used a questionnaire to all anesthesiologists working in 9 hospitals in the macro-region of Cariri. Results: 27 professionals answered the questionnaire. The prevalence of males was observed and 74% of anesthesiologists do not know the resources available or the protocols of the institutions in which they work. Conclusion : It is essential that the anesthesiologists also know the equipment available for an approach in the case of difficult airway in the services which they provide assistance so they can provide oxygenation to the patient in a fast and effective way, avoiding complications.

Validez de los predictores de vía aérea difícil en medicina extrahospitalaria

Isolation of the airway sometimes determines the survival or death of the patient. To anticipate the presence of a difficult airway (DA) there are a number of indicators that are validated for hospitals: Mallampati, sternum and thyromental distance, interdental distance and Cormack grade. The aim of this study is to evaluate the use of these indicators in the ambulatory setting and to know the incidence of DA. This data was collected from 324 intubations. Most patients were males (65.2%). The average age of the population was 63 years and no significant difference in age between DA and DA was found. A DA presence of 20.7% was objectified and an alternative device utilization of 21.4%. The thyromental distance was abnormal in 59% of patients and sternomentonal distance in 56.4% but neither showed an association with the presence of DA (p = 0.681 and p = 0.415 respectively). Interdental distance was less than 3 cm if presence is associated with DA (p = 0.005). The sensitivity and specificity of all measures are low. According to our series the sternum and thyromental distance are not useful in the ambulatory setting, but interdental distance is useful for predicting a DA.

Incidence of difficult airway in a pediatric tertiary hospital

Vilardell, M. E.; Schmucker, E.; Andreu, E.; Villaverde, I.; Munar, F.; Montferrer, N. Author Information

Lightwand-guided nasotracheal intubation in oromaxillofacial surgery patients with anticipated difficult airways: a comparison with blind nasal intubation

In oromaxillofacial surgery patients, the incidence of difficult airways is up to 15.4–16.9%. Blind nasal intubation remains a safe technique for difficult airway management in some remote areas where a fibreoptic bronchoscope is not always available. The lightwand is an easy-to-use, highly economical device, and can facilitate endotracheal intubation through illumination in the neck. The study aims to evaluate the efficacy of nasotracheal intubation using lightwand in oromaxillofacial surgery patients with difficult airways. One hundred and sixteen patients with difficult airways requiring nasotracheal intubation were randomly divided into a lightwand group and a blind group, with 58 cases in each group. The first attempt and overall success rates of lightwand intubation were 84.5% and 93.1%, respectively, which were higher than those of blind intubation (65.5% and 75.9%, respectively; P<0.05). The total intubation time was 91.4±27.7s in the lightwand group and 130.7±33.4s in the blind group (P<0.001). Patients in the lightwand group also experienced more stable haemodynamic responses and less pharyngalgia. In conclusion, lightwand-guided nasotracheal intubation is superior to blind intubation in patients with difficult airways, with a higher success rate, more stable haemodynamic responses, and fewer postoperative complications.

Rapid-sequence induction of anesthesia in obstetric women: how safe is it?

A cautionary tale…A 35-year-old woman, 154 cm, 86 kg, with placentaprevia and preeclampsia, had massive bleeding afterconsuming a lunch. She was immediately transferredto the operating room, where an anesthesiologist wascalled in. She was morbidly obese, having largebreasts and a low-pitched voice (indicative of lar-yngeal edema), and the view of the oropharynx wasobscured (Mallampati score 4). Awake trachealintubation was attempted, but the patient refused toopen her mouth. General anesthesia was induced as arapid sequence, and tracheal intubation was attemp-ted, but failed twice. A senior anesthesiologist wascalled in and accomplished intubation. Cesareansection was started. Soon after this, it was found thatthe tube was wrongly inserted into the esophagus.The tube was taken out and mask ventilation wasattempted, but this was difficult. Arterial hemoglobinoxygen saturation rapidly decreased to 70 % withcardiac arrhythmia. Nevertheless, the baby was suc-cessfully taken out and the mother started to breathe.As the operation would continue, the laryngeal maskairway was inserted. The mother vomited andaspirated.This is a fiction, but we all might have heard about a realstory like this. And, what was wrong with this case? Whycannot we clearly answer what should have been done tothis case?In this issue of the Journal, Tao et al. [1] report a ret-rospective analysis of pregnant women who underwentgeneral anesthesia during 2001–2006 in a teaching hospi-tal, to obtain the incidence of ‘difficult airway,’ which wasdefined as follows: necessity of three or more attempts atdirect laryngoscopy, the use of any maneuvers or tech-niques outside the rapid sequence induction routine(including mask ventilation resulting from oxygen desatu-ration from unsuccessful intubation attempts), the use ofadditional airway equipment, or inability to intubate thetrachea. The incidence was 0.56 % (12 of 2,158 patients).They state that tracheal intubation was possible in morethan 99.9 % of pregnant patients, and the incidence ofdifficult airway in pregnant patients is no higher than theincidence in nonpregnant patients. They attempted to seekfactors contributing to the difficult airway, and have foundthat the lack of experience of anesthesia providersincreased the incidence, whereas emergency cesareansection did not add another level of difficulty over plannedcesarean section [1].So, can we conclude that tracheal intubation in pregnantwomen is as easy as in nonpregnant patients? The reportedincidence in the general population of difficult trachealintubation is about 1 %, and that for difficult facemaskventilation is as much as 5 % [2–4]. Therefore, it seemsreasonable to conclude that the incidence in pregnantpatients may be similar to, or not much higher than, theincidence in the general population.Can we then state that the pregnant patients are not atincreased risk of serious airway complications duringanesthesia? To answer this question, we need to know therisk in the general population. Until recently, the incidence,consequences, and causes of the problems had not been that

Resuscitation guidelines 2010: a scientific consensus

Resuscitation guidelines 2010: a scientific consensus