Awake fibreoptic intubation with high risk of aspiration

Sutcliffe, M.; Lawton, Tom; Hollins, T.

doi:10.1111/j.1365-2044.2011.06850.x

Cited by 1 publication

(4 citation statements)

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“…Our results compare reasonably with other published studies from the UK [2][3][4]. However, the overall cancellation rate is still too high.…”

Section: Referencessupporting

confidence: 89%

“…Awake fibreoptic intubation has been described as a suitable technique for patients at high risk of aspiration [3] and appears in some algorithms designed for use in situations where aspiration is a possibility [4]. We would be grateful for the expert opinions of anaesthetists with experience in using this technique to manage patients at high risk of aspiration as to when the cuff should be inflated and, if inflated before general anaesthesia, whether the adequacy of the seal can safely be tested.…”

Section: Awake Fibreoptic Intubation With High Risk Of Aspirationmentioning

confidence: 99%

“…

We started auditing the transfer of our patients from the Emergency Department after intubation, looking at both the indications for transfer and the monitoring used.

…”

mentioning

confidence: 99%

“…Care Society [4] for critical care transfers. Indeed, in a recent editorial, Whitaker [5] reaffirmed the need for capnography everywhere, specifically mentioning the transfer of critically ill patients.…”

mentioning

confidence: 99%

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Causes of cancellation of elective surgical procedures

Dolenska

2011

Anaesthesia

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Care Society [4] for critical care transfers. Indeed, in a recent editorial, Whitaker [5] reaffirmed the need for capnography everywhere, specifically mentioning the transfer of critically ill patients.We started auditing the transfer of our patients from the Emergency Department after intubation, looking at both the indications for transfer and the monitoring used. At the end of each shift, the on-call anaesthetic registrar was contacted and asked to provide details of any transfers that had occurred. During the first 3 months, two of 18 (11%) transfers were performed with continuous capnography. We then made several interventions aimed at improving the use of capnography, including ensuring the availability of capnography leads and monitors, educating anaesthetic trainees on how to conduct transfers, placing reminder posters in the resuscitation bays and feeding back the results of audit.Our audit ran continuously and after 18 months, 20 out of 23 (87%) transfers were conducted with continuous capnography. This demonstrates that by identifying the challenges faced by trainees, collecting high quality data and feeding back effectively to the consultant and trainee bodies, both groups were made aware of the problems and the situation improved. Some of the differences in our results can be explained by a different patient casemix; González-Arévalo et al. studied all operations, including paediatric patients. These represented a substantial proportion of their total and included a high rate of upper respiratory tract infections. Our patients were adults, often with multiple co-morbidities requiring anaesthetic input.The authors described a relatively high proportion of patients' non-attendance (20% of cancellations, or 1% of operations). Their pre-assessment was scheduled 2-3 months before surgery, and they argued the case for earlier preassessment on the grounds of better optimisation. Our pre-assessments occurred about 4 weeks before surgery in both years. My audit showed that preassessment closer to the operation date did not affect the cancellation rate adversely.Our results compare reasonably with other published studies from the UK [2-4]. However, the overall cancellation rate is still too high. To improve theatre efficiency, operating list booking systems should take into consideration individual surgeons' operating times.

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“…Our results compare reasonably with other published studies from the UK [2][3][4]. However, the overall cancellation rate is still too high.…”

Section: Referencessupporting

confidence: 89%

Section: Awake Fibreoptic Intubation With High Risk Of Aspirationmentioning

confidence: 99%

“…

We started auditing the transfer of our patients from the Emergency Department after intubation, looking at both the indications for transfer and the monitoring used.

…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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