Prediction of Difficult Mask Ventilation

Langeron, Olivier; Massó, E.; Huraux, Catherine; Guggiari, Michel; Bianchi, André Luis; Coriat, Pierre; Riou, Bruno

doi:10.1097/00000542-200005000-00009

Cited by 817 publications

(471 citation statements)

References 26 publications

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“…Even if the need for awake intubation had been diminished by more frequent use of VL, it is also conceivable that such a decrease could have been masked by a concomitant rise in awake intubation for an increasing population of obese patients 10 in whom a higher incidence of anticipated difficult airway management might be expected. [11][12][13][14][15][16][17][18][19][20] While the overall incidence of awake tracheal intubation was 1.06% of GETA cases, there was substantial variability in the rate (0-3.4 per 100 GETA cases) at which individual attending staff performed the procedure. These results were not controlled for subspecialty practice (e.g., anesthesiologists performing mainly regional vs neuroanesthesia), although anecdotally, the four individuals with the two lowest and the two highest rates of awake intubation had similar practice profiles (data not shown).…”

Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study Incidence, taux de réussite et complications de l'intubation trachéale chez 1554 patients éveillés sur une période de 12 ans: une étude de cohorte historique AbstractPurpose Awake tracheal intubation is one recommended option to address select situations in the management of a patient with an anticipated difficult airway. A scarcity of data exists on how often awake intubation is performed or whether its use is changing over time, particularly with the increasingly widespread availability of video laryngoscopy. This retrospective database review was undertaken to determine the incidence, success, and complications of awake intubation and the incidence of other tracheal intubation techniques in the operating room over a 12-yr period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) at our institution. Methods The Anesthesia Information Management System in use at a Canadian tertiary care centre was searched for all awake intubations that occurred during the years 2002-2013. Records were also searched to identify airway methods other than direct laryngoscopy that may have been used after the induction of general anesthesia. Changes in both the incidence of awake intubation and in the use of video laryngoscopy over the 12 years were analyzed using linear regression modelling. Results Of 146,252 cases performed under general anesthesia with endotracheal intubation, 1,554 intubations (1.06%) were performed awake. There was no significant change in the rate of awake intubation over the studied years (slope -1.4 -4 incidenceÁyear -1 ; 95% confidence interval [CI]: -3.0 -4 to 3.0 -5 ; P = 0.102). The relatively steady rate of awake intubation occurred despite a significant increase in the use of video laryngoscopy over the same time (slope 0.080 incidenceÁyear -1 ; 95% CI: 0.076 to 0.083; P \ 0.001), particularly from 2009 onwards. Attempted awake intubation failed in 31 (2%) of the cases. Self-reported complications occurred in 15.7% of successful procedures. In addition, in a convenience sample of three years (2011)(2012)(2013), the rate at which each of 49 attending staff performed awake intubation varied widely from 0-3.4 awake intubations per 100 cases of general anesthesia with endotracheal intubation. Conclusions At our tertiary care centre, we did not find a significant change in the use of awake tracheal intubation over the studied years 2002-2013 despite increasing availability and use of video laryngoscopy. It appears that awake tracheal intubation retains an important and consistent role in the management of the difficult airway. RésuméObjectif L'intubation trachéale du patient éveillé, qu'on appelle aussi intubation vigile, est une alternative recommandée dans certaines situations précises pour

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Section: Discussionmentioning

confidence: 99%

The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study

Law

Morris

Brousseau

et al. 2015

Can J Anesth/J Can Anesth

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“…The reported incidence in the general population of difficult tracheal intubation is about 1 %, and that for difficult facemask ventilation is as much as 5 % [2][3][4]. Therefore, it seems reasonable to conclude that the incidence in pregnant patients may be similar to, or not much higher than, the incidence in the general population.…”

Section: A Cautionary Tale…mentioning

confidence: 93%

Rapid-sequence induction of anesthesia in obstetric women: how safe is it?

Asai

2012

J Anesth

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A cautionary tale…A 35-year-old woman, 154 cm, 86 kg, with placenta previa and preeclampsia, had massive bleeding after consuming a lunch. She was immediately transferred to the operating room, where an anesthesiologist was called in. She was morbidly obese, having large breasts and a low-pitched voice (indicative of laryngeal edema), and the view of the oropharynx was obscured (Mallampati score 4). Awake tracheal intubation was attempted, but the patient refused to open her mouth. General anesthesia was induced as a rapid sequence, and tracheal intubation was attempted, but failed twice. A senior anesthesiologist was called in and accomplished intubation. Cesarean section was started. Soon after this, it was found that the tube was wrongly inserted into the esophagus. The tube was taken out and mask ventilation was attempted, but this was difficult. Arterial hemoglobin oxygen saturation rapidly decreased to 70 % with cardiac arrhythmia. Nevertheless, the baby was successfully taken out and the mother started to breathe. As the operation would continue, the laryngeal mask airway was inserted. The mother vomited and aspirated. This is a fiction, but we all might have heard about a real story like this. And, what was wrong with this case? Why cannot we clearly answer what should have been done to this case?In this issue of the Journal, Tao et al.[1] report a retrospective analysis of pregnant women who underwent general anesthesia during 2001-2006 in a teaching hospital, to obtain the incidence of 'difficult airway,' which was defined as follows: necessity of three or more attempts at direct laryngoscopy, the use of any maneuvers or techniques outside the rapid sequence induction routine (including mask ventilation resulting from oxygen desaturation from unsuccessful intubation attempts), the use of additional airway equipment, or inability to intubate the trachea. The incidence was 0.56 % (12 of 2,158 patients). They state that tracheal intubation was possible in more than 99.9 % of pregnant patients, and the incidence of difficult airway in pregnant patients is no higher than the incidence in nonpregnant patients. They attempted to seek factors contributing to the difficult airway, and have found that the lack of experience of anesthesia providers increased the incidence, whereas emergency cesarean section did not add another level of difficulty over planned cesarean section [1].So, can we conclude that tracheal intubation in pregnant women is as easy as in nonpregnant patients? The reported incidence in the general population of difficult tracheal intubation is about 1 %, and that for difficult facemask ventilation is as much as 5 % [2-4]. Therefore, it seems reasonable to conclude that the incidence in pregnant patients may be similar to, or not much higher than, the incidence in the general population.Can we then state that the pregnant patients are not at increased risk of serious airway complications during anesthesia? To answer this question, we need to know the risk in the general population. Until recent...

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“…If the results of several authors with large groups of patients are summarized irrespective of the various divergent definitions, the incidence of difficult mask ventilation in an unselected group of elective patients is 2 % [6][7][8]. The incidence of impossible mask ventilation is 0.15 % (1:670) [6].…”

Section: Incidence Of Difficult Mask Ventilationmentioning

confidence: 99%

“…Table 1 shows typical predictors for a difficult or impossible mask ventilation [6][7][8]. The combination of several factors increases the risk of difficult mask ventilation.…”

Section: Predictors Of Difficult or Impossible Mask Ventilationmentioning

confidence: 99%