Practice Patterns in Managing the Difficult Airway by Anesthesiologists in the United States

Rosenblatt, William H.; Wagner, Philip; Ovassapian, Andranik; Kain, Zeev N.

doi:10.1213/00000539-199807000-00032

Cited by 120 publications

(41 citation statements)

References 6 publications

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“…1,31 This behaviour, i.e., being excessively reliant on expertise, may well be extrapolated to other anesthesiologists. 1,22,31 As previously discussed, adults learn more when they willingly search for knowledge. 21 However, since consultant physicians tend to participate in meeting workshops where they are already knowledgeable about the topics being addressed 32 and since they often fail in their selfassessment of educational needs, 32,33 more effective approaches are needed to engage consultant anesthesiologists in maintaining excellence in the management of the emergency airway.…”

Section: Discussionmentioning

confidence: 76%

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Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

Borges

Boet

Siu

et al. 2010

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 76%

“…21 Fortunately, a CICV situation is quite rare, and few anesthesiologists will ever have performed a cricothyroidotomy during their careers. 18,22 Most participants in this study had not previously encountered such a situation in real-life (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

Borges

Boet

Siu

et al. 2010

Can J Anesth/J Can Anesth

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“…A 1998 American anesthesiologist survey involving management techniques in difficult airway scenarios demonstrated that 1/199 would consider using an C-LMA in a patient with an unstable c-spine. 52 This result contrasts to a similarly constructed 2002 Canadian anesthesiologist survey that showed 3/100 respondents managing a c-spine injury with the FT-LMA. 53 In a recent survey of 115 European anesthesiologists' and emergency medicine physicians' airway management practices for c-spine injuries, nearly half of the respondents were familiar with the use of the FT-LMA vs less than a quarter with the FOB.…”

Section: Unanticipated Difficult Intubation In the Operating Roommentioning

confidence: 73%

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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Purpose To provide an evidence-based overview and update on the use of the Fastrach TM Intubating Laryngeal Mask AirwayÒ (FT-LMA) when used within operative and non-operative settings. Principal findings The FT-LMA is available in three sizes to provide ventilation and the ability to pass an endotracheal tube (ETT) into the trachea blindly, semi-blindly, or with indirect visualization for patients over 30 kg. The Chandy maneuver is recommended routinely; the first maneuver optimizes ventilation, and the second maneuver increases success at endotracheal intubation (ETI). The manufacturer's reinforced tube or a pre-warmed or reversed standard ETT may be utilized. Insertion and ventilation are successful in almost all patients. Blind ETI is highly successful; adjuncts are generally not necessary. The FT-LMA has a proven role in the airway management of anticipated difficult operating room (OR) intubations, unanticipated OR intubations, cervical spine injuries, and limited airway access situations. Literature in the pre-hospital and emergency department settings is limited but favourable. The FT-LMA has compared favourably with fibreoptic intubation, the LMA-Classic TM , the laryngeal tube, and the CobraPLA TM . Initially, the more expensive LMA CTrach TM appeared to be more successful, but overall it is not. The FT-LMA airway seal pressures are excellent; serious complications are uncommon, and the FT-LMA figures prominently in most difficult airway guidelines. Conclusions The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. Constatations principales Le FT-LMA est disponible en trois tailles pour permettre la ventilation et le passage d'une sonde endotrache´ale (SET) dans la trache´e de façon aveugle, semi-aveugle ou avec visualisation directe chez les patients pesant plus de 30 kg. La manoeuvre de Chandy est recommande´e de façon routinie`re; la premie`re manoeuvre optimise la ventilation, et la seconde augmente le succe`s lors d'une intubation endotrache´ale (IET). La sonde arme´e du fabricant ou une SET standard pre´chauffe´e ou inverse´e peut eˆtre utilise´e. L'insertion et la ventilation re´ussissent chez presque tous les patients. L'IET en aveugle a un taux de re´ussite e´leve´; en re`gle ge´ne´rale, les accessoires ne sont pas ne´cessaires. Le FT-LMA joue un rôle e´prouve´dans la prise en charge des voies ae´riennes lors d'intubations anticipe´es comme difficiles dans la salle d'ope´ration (SOP), d'intubations impre´vues en SOP, de le´sions de la colonne cervicale et dans les situations oul 'acce`s aux voies ae´riennes est limite´. La litte´rature portant sur son utilisation dans des contextes pre´-hospitaliers et dans le de´partement des urgences est restreinte mais favorable. Le FT-LMA a e´te´favorablement compare´al 'intubation par fibroscopie, au LMA...

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“…All of these focus on the maintenance of spontaneous ventilation in responsive patients -the so-called 'awake intubation'. Most anaesthetists consider the flexible fibrescope and conscious sedation as standard tools in such cases [2,3,5]. An alternative approach to the flexible fibreoptic is a rigid fibreoptic.…”

Section: Discussionmentioning

confidence: 99%

Awake tracheal intubation using the Sensascope™ in 13 patients with an anticipated difficult airway

2010

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SummaryWe present the use of the SensaScope™, an S‐shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans‐cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. In all cases, tracheal intubation was achieved using the SensaScope. The median (IQR [range]) insertion time (measured from the time the facemask was taken away from the face until an end‐expiratory CO2 reading was visible on the monitor) was 58 s (38–111 [28–300]s). In nine of the 13 cases, advancement of the SensaScope into the trachea was easy. Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway.

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Practice Patterns in Managing the Difficult Airway by Anesthesiologists in the United States

Cited by 120 publications

References 6 publications

Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

Incomplete adherence to the ASA difficult airway algorithm is unchanged after a high-fidelity simulation session

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Awake tracheal intubation using the Sensascope™ in 13 patients with an anticipated difficult airway

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