Temporal Trends in Difficult and Failed Tracheal Intubation in a Regional Community Anesthetic Practice

Background When tracheal intubation is difficult or unachievable before surgery or during an emergent resuscitation, this is a critical safety event. Consensus algorithms and airway devices have been introduced in hopes of reducing such occurrences. However, evidence of improved safety in clinical practice related to their introduction is lacking. Therefore, we selected a large perioperative database spanning 2002 to 2015 to look for changes in annual rates of difficult and failed tracheal intubation.Methods Difficult (more than three attempts) and failed (unsuccessful, requiring awakening or surgical tracheostomy) intubation rates in patients 18 yr and older were compared between the early and late periods (pre-vs. post-January 2009) and by annual rate join-point analysis. Primary findings from a large, urban hospital were compared with combined observations from 15 smaller facilities.Results Analysis of 421,581 procedures identified fourfold reductions in both event rates between the early and late periods (difficult: 6.6 of 1,000vs. 1.6 of 1,000,P
Source: Anesthesiology - Category: Anesthesiology Source Type: research

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CONCLUSION The prospective observational study confirms the relationship between ultrasound assessment of the anterior soft tissues of the neck and difficult laryngoscopy and DMV. DSHB and the other distances extend the available evidence, not only for difficult laryngoscopy but also for DMV. TRIAL REGISTRATION Clinicaltrials.gov. identified NCT03592758.
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Airway management Source Type: research
AbstractPurposeThe purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections.MethodsPerioperative risk factors were retrospectively analyzed in 499 cases. Fisher ’s exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysi...
Source: Oral and Maxillofacial Surgery - Category: ENT & OMF Source Type: research
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Semin Respir Crit Care Med 2019; 40: 040-056 DOI: 10.1055/s-0039-1685179A rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Diff...
Source: Seminars in Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Review Article Source Type: research
Publication date: Available online 7 February 2019Source: The Annals of Thoracic SurgeryAuthor(s): Francesco Puma, Mattia Meattelli, Miroslawa Kolodziejek, Marina Giuliana Properzi, Rosanna Capozzi, Alberto Matricardi, Lucio Cagini, Jacopo VannucciAbstractAn innovative technique for airway management, utilizing a small diameter, short-cuffed, orotracheal tube for assisting rigid bronchoscopy in critical airway obstruction is reported. The device, part of Translaryngeal Tracheostomy KIT, was placed beyond the stenosis and used in combination with the rigid bronchoscope.This procedure improves safety during the management of...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Abstract An innovative technique for airway management, utilizing a small diameter, short-cuffed, orotracheal tube for assisting rigid bronchoscopy in critical airway obstruction is reported. The device, part of Translaryngeal Tracheostomy KIT, was placed beyond the stenosis and used in combination with the rigid bronchoscope. This procedure improves safety during the management of critical tracheal stenoses, because the airway is constantly under the anesthesiologist's control. Consequently, inhalation anesthesia is feasible, use of neuromuscular blockage is possible, end-tidal CO2 monitoring is reliable and the ...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
ConclusionThe results of our study lead us to recommend continuing to perform temporary tracheotomies in oral cancer surgery with microvascular flap reconstruction. The overall complication rate is low and postoperative airway management can be performed in a safe and controlled manner. Nevertheless, the time period for the inserted cannula should be kept as short as possible.
Source: Journal of Cranio Maxillofacial Surgery - Category: ENT & OMF Source Type: research
Publication date: Available online 21 October 2018Source: American Journal of OtolaryngologyAuthor(s): Akina Tamaki, Claudia Cabrera, Clare Richardson, Nicole MaronianAbstractPurposeDeficiencies in airway management knowledge can result in harm, especially in tracheostomy patients. Our objective is to assess the degree of knowledge in different medical specialties, before and after targeted airway education.Materials and methodsA lecture on tracheostomy management was prepared for Otolaryngology, Anesthesia, Emergency Medicine, General Surgery, Oral and Maxillofacial Surgery (OMFS), Internal Medicine (IM), and Family Medic...
Source: American Journal of Otolaryngology - Category: Endocrinology Source Type: research
Abstract External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requirin...
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
In a letter to the editor regarding our recent publication on the management of lung isolation in patients with an existing tracheostomy undergoing one-lung ventilation (OLV),1 Essandoh et al. described the common techniques used to manage patients with an existing tracheostomy stoma. Essandoh et al. summarized our report and concurred with our recommendations for airway management for OLV in both fresh and stable tracheostomy stomas.2
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
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