Predicting the difficult airway

Crawley, Simon; Dalton, Andrew

doi:10.1093/bjaed/mku047

Cited by 57 publications

(54 citation statements)

References 12 publications

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“…The clinical rationale for this is threefold. First, patients who have undergone airway reconstruction procedures such as laryngotracheal reconstruction (LTR) or cricotracheal resection (CTR) are high risk and challenging to intubate (Crawley and Dalton 2015). Second, prolonged ventilation of patients with an altered airway is likely to lead to worse long‐term outcomes (e.g., further airway damage).…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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Background The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working.

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Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

View full text Add to dashboard Cite

show abstract

“…Still, 26 patients with CL grade 2 had DI in our study. The factors that contributed to DI in these patients included visibility of only posterior part of glottis or arytenoid during direct laryngoscopy, deep-seated larynx or reduced space within the oropharynx [13].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway

Agarwal

Jain

Agarwal

et al. 2021

Korean J Anesthesiol

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Background: We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting difficult intubation (DI). The validity of models based on combined ultrasonography-based parameters was also investigated. Methods: In a prospective, observational, double-blinded cohort trial, 1043 ASA-PS I-III patients without anticipated difficult airway, undergoing tracheal intubation under general anesthesia were enrolled. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from skin to thyrohyoid membrane (ST) and hyoid bone (SH) respectively, were measured under sublingual and submandibular ultrasonographic scans. Based on tracheal intubation, they were categorized as easy intubation (EI) or DI. The logistic regression, youden index, and receiver operator characteristic analysis were used.

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“…There are many independent predictors of difficult intubation such as previous history of difficult intubation, Mallampati scoring, restricted neck movements, and short thyromental and sternomental distance. [ 21 22 ]…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it has to be a combination of multiple tests. [ 22 ] Several multivariate scores for assessing difficult airway have been described such as Wilson score, M-TAC, Simplified Airway Risk Index, and LEMON score. [ 22 23 ]…”

Section: Discussionmentioning

confidence: 99%

Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

et al. 2018

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Context:Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI.Aim:This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI.Methodology:This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis.Results:Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB.Conclusion:Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

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Predicting the difficult airway

Cited by 57 publications

References 12 publications

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway

Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

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