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Popat, M.; Mitchell, V.; Dravid, R. M.; Patel, Angira; Swampillai, C.; Higgs, A.

doi:10.1111/j.1365-2044.2012.07253.x

Cited by 42 publications

(8 citation statements)

References 8 publications

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“…In addition, full recovery from NMB should be confirmed both objectively using a nerve stimulator and clinically. During this period, continuous communication with the patient and verbal reassurance may mitigate any adverse recall of events [40].…”

Section: Emergence From Anaesthesiamentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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SummaryWe present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700–23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030–9700), and without it was ~1:135 900 (1:78 600–299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380–1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out‐of‐hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project – the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

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Section: Emergence From Anaesthesiamentioning

confidence: 99%

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

et al. 2014

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“…Its management remains a challenge. Because of the high vital impact for the patient, many societies [3][4][5][6][7][8][9][10][11][12] have published guidelines or recommendations to manage these difficult airway situations. These guidelines have proved to be very helpful in the management of the difficult airway as they allow anticipating the next step in the difficult airway management for all staff members.…”

Section: Difficult Airway Algorithmmentioning

confidence: 99%

“…The optimal timing for extubating the patient with a difficult airway continues to be a matter of debate, despite the fact that guidelines 4,7,47 have been published. Two considerations must be taken into account: first, the neurologic status of the patient and its anticipated course; second, an evaluation of the airway by inspection and endoscopy.…”

Section: Extubationmentioning

confidence: 99%

Airway Management in Facial Trauma Patients

Jacomet

Tasman

2015

Facial plast Surg

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Airway management in craniofacial trauma patients is a challenge for an anesthetist. Treating these patients requires a close interdisciplinary communication and cooperation. Maintaining the airway and oxygenation of the patient is the initial challenge in craniofacial trauma patients. The management of the difficult airway is facilitated and patient's safety improved by following one of several published difficult airway algorithms. We describe the St. Gallen difficult airway algorithm for the management of difficult airway in general and the airway in facial trauma patients in particular. Whenever possible, the airway should be secured in a conscious and spontaneously breathing patient. It is important to be familiar with different techniques and to change the approach after two unsuccessful attempts with one technique. Once the airway is established, all available preventive measures should be used to avoid losing the airway. A tracheotomy has its place in a significant number of patients in whom an immediate postoperative or a delayed extubation appears unfeasible.

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“…In cases where re-intubation is likely to be difficult, an airway-exchange catheter (AEC) can be placed through the endotracheal tube (ETT) prior to extubation 1. Should re-intubation prove necessary, an ETT can be advanced over the AEC.…”

Section: Introductionmentioning

confidence: 99%

“…Because of the inability to estimate inspiratory volumes and the risk of incomplete exhalation, injection of oxygen through an AEC or IC bears a significant risk of hyperinflation, barotrauma, hemodynamic deterioration, and even death 1,4,5. To decrease the risks associated with intrapulmonary/intrathoracic pressure buildup, the inspiration time must be minimized, leading to low minute volumes 1…”

Section: Introductionmentioning

confidence: 99%

Emergency ventilation with the Ventrain® through an airway exchange catheter in a porcine model of complete upper airway obstruction

Wolf

Gottschall

Preussler

et al. 2016

Can J Anesth/J Can Anesth

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PurposeDuring difficult airway management, oxygen insufflation through airway-exchange and intubating catheters (AEC/IC) can lead to life-threatening hyperinflation. Ventrain® was originally designed to facilitate emergency ventilation using active expiration through short, small-bore cannulas. Herein, we studied its efficacy (oxygenation and ventilation) and safety (avoidance of hyperinflation) in a long, small-bore AEC.MethodsIn six anesthetized pigs, the upper airway was obstructed, except for a 100 cm long, 3 mm internal diameter AEC. After apneic desaturation to a peripheral oxygen saturation (SpO2) of < 70%, ventilation through the AEC was started with Ventrain at an oxygen flow of 15 L·min−1, a frequency of 30 breaths·min−1, and an inspiration/expiration ratio of approximately 1:1. It was continued for ten minutes.ResultsWithin one minute, severe hypoxia was reversed from a median [interquartile range] arterial saturation (SaO2) of 48 [34-56] % before initiation of Ventrain ventilation to 100 [99-100] % afterward (median difference 54%; 95% confidence interval [CI] 44 to 67; P = 0.028). In addition, hypercarbia was reversed from PaCO2 of 59 [53-61] mmHg to 40 [38-42] mmHg (median difference of −18 mmHg; 95% CI −21 to −15; P = 0.028). After ten minutes of Ventrain use, peak inspiratory and end-expiratory pressures were lower than during baseline pressure-controlled ventilation (8 [7-9] mmHg vs 12 [10-14] mmHg and −2 [−3 to +1] mmHg vs 4 [2 to 4] mmHg, respectively; P = 0.027 for both). No hemodynamic deterioration occurred.ConclusionVentrain provides rapid reoxygenation and effective ventilation through a small-bore AEC in pigs with an obstructed airway. In clinical emergency situations of obstructed airways, this device may be able to overcome problems of unintentional hyperinflation and high intrapulmonary pressures when ventilating through long, small-bore catheters and could therefore minimize the risks of barotrauma and hemodynamic instability.

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A reply

Cited by 42 publications

References 8 publications

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

Airway Management in Facial Trauma Patients

Emergency ventilation with the Ventrain® through an airway exchange catheter in a porcine model of complete upper airway obstruction

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