Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

Background During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based ''enhanced'' perioperative protocol. Methods The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Results Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. Conclusions A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.

show abstract

“…Bag and mask ventilation has been demonstrated to be difficult in up to 15 % of patients with higher BMI [109,110].…”

Section: Anaesthesiamentioning

confidence: 99%

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Problems with tracheal intubation are the main cause of hypoxemic anesthetic death and brain injury [2]. For the past three decades, the anesthesia literature has described poor airway management as a serious patient safety concern, requiring vigilant airway evaluation prior to induction of anesthesia [3]. The ASA task force on the management of the difficult airway describes it as a clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both [4].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of unexpected difficult airway in clinical practice has not decreased despite advances in anesthesia protocols, devices, and patient monitoring [3]. Currently available screening tests for difficult intubation have only poor to moderate discriminative power when used alone [5].…”

Section: Discussionmentioning

confidence: 99%

“…Combinations of tests add some incremental diagnostic value in comparison to the value of each test alone, however, the clinical value of bedside screening tests for predicting difficult intubation remains limited [5]. A recent study by Cattano et al in March 2013 showed that the use of a comprehensive airway assessment in 3460 preoperative patient encounters did not improve anesthesia resident ability to predict a difficult airway [3]. A complete airway assessment form using 11 of the ASA's proposed airway risk predictors improved documentation of airway assessment, but not the accuracy of such predictions [3].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthesia Alert—A Preoperative Safety Concept for the Surgeon

Protyniak¹,

Pearce²,

Giambarberi³

et al. 2015

View full text Add to dashboard Cite

Background: Advances in modern medicine and surgical technique have allowed patients with multiple comorbidities to undergo invasive surgery electively. This places additional stress on hospital resources to anticipate and deal with potential complications. We have introduced a preoperative safety concept called "Anesthesia Alert". The surgeon or preoperative interviewing anesthesiologist assigns an Anesthesia Alert when booking to denote possible difficulty with anesthesia induction or intubation. As a result, two anesthesiologists and fiber optic equipment are made available on the day of surgery. Methods: A retrospective study of patients from all surgical specialties who were assigned Anesthesia Alerts between January 2012 and November 2012. Records were analyzed for reasons requiring Anesthesia Alerts. Patient demographics, comorbidities, and perioperative complications were reviewed. Results: A total of 112 patients formed this study group. Difficult airway comprised the majority of Anesthesia Alerts (n = 75, 67.0%). Hypertension was the most prevalent comorbidity among patients. There were only 7 patients (6.3%) admitted to the ICU postoperatively and no mortalities. Conclusion: Perioperative patient safety is an evolving concept that requires a team approach amongst the surgeon, anesthesiologist, and operating room staff. An Anesthesia Alert raises awareness for possible complications during anesthesia induction as well as allocates resources to increase patient safety and avoid preoperative delays. Most importantly, this concept places the onus on the surgeon to alert the anesthesiologist for possible complications during induction and extubation.

show abstract

“…More recently, Cattano et al proposed a new assessment form on airway prediction but showed that it did not improve resident ability to predict a difficult airway [47].…”

Section: A Related Workmentioning

confidence: 99%

Facial Image Analysis for Fully Automatic Prediction of Difficult Endotracheal Intubation

Cuendet

Schoettker²,

Yüce

et al. 2016

IEEE Trans. Biomed. Eng.

View full text Add to dashboard Cite

Abstract-Goal: Difficult tracheal intubation is a major cause of anesthesia related injuries with potential life threatening complications. Detection and anticipation of difficult airway in the preoperative period is thus crucial for the patients' safety. We propose an automatic face analysis approach to detect morphological traits related to difficult intubation and improve its prediction. Methods: For this purpose, we have collected a database of 970 patients including photos, videos and ground truth data. Specific statistical face models have been learned using the faces in our database providing an automated parametrization of the facial morphology. The most discriminative morphological features are selected through the importance ranking provided by the random forest algorithm. The random forest approach has also been used to train a classifier on these selected features. We compare a threshold tuning method based on class prior with two methods which learn an optimal threshold on a training set for tackling the inherent imbalanced nature of the database. Results: Our fully-automated method achieves an AUC of 81.0% in a simplified experimental setup where only easy and difficult patients are considered. A further validation on the entire database has proven that our method is applicable for real-world difficult intubation prediction, with AUC = 77.9%. Conclusion:The system performance is in line with the state-ofthe-art medical diagnosis, based on ratings provided by trained anesthesiologists, whose assessment is guided by an extensive set of criteria. Significance: We present the first completely automatic and non-invasive difficult intubation detection system that is suitable for use in clinical settings.

show abstract

Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

Cited by 56 publications

References 32 publications

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Anesthesia Alert—A Preoperative Safety Concept for the Surgeon

Facial Image Analysis for Fully Automatic Prediction of Difficult Endotracheal Intubation

Contact Info

Product

Resources

About