Difficult Laryngoscopy in Routine Anesthesia

A.I. Mohylnyk

Abstract


Introduction. Airway management — one of the key tasks in the routine anesthesia. Almost a third of all cases of anesthetic mortality is associated with difficulty in ventilating patients after induction of anesthesia. Most of them are caused by intubation and difficulties of further ventilation directly. The cause of 80 % of the private claims of the American Society of Anesthesiologists about the damage of the larynx was repeated attempts of tracheal intubation during routine anesthesia.
Objective: to increase the efficiency and to reduce the incidence of complications in airway management during difficult laryngoscopy in routine anesthesia.
Materials and methods. We have analyzed the results of 66 cases of difficult laryngoscopy in elective surgical interventions at the premises of the Poltava Regional Clinical Hospital for 2013–2015. In all patients, glottis was not visualized during direct laryngoscopy on the background of myoplegia. In patients in group I, we used clinical protocol of care for patients with difficult intubation, in group II patients, after intubation failure we immediately used laryngeal mask of appropriate size. We investigated the frequency of successful attempts of airway ma­nagement by means of endotracheal intubation and laryngeal mask, the incidence and causes of complications.
Results of the study. In patients in group I, second attempt of intubation was successful in 43.8 % of cases. With the following intubation attempts, efficiency of manipulation progressively decreased to 6.2 % in the fourth attempt. The effectiveness of the subsequent use of the laryngeal mask was 45.4 %; causes of failure: mucosal trauma, hypersalivation, bronchorrhea, laryngo- and bronchospasm. In group II patients, in 91.2 % of cases, positioning of laryngeal mask provided the tightness of the breathing circuit and adequate ventilation during surgery. A few complications were observed. Conclusions. Using a clinical protocol of care for patients with difficult intubation in routine anesthesia is less effective and has a high rate of complications associated with direct laryngoscopy, compared to the only intubation attempt and the subsequent use of the laryngeal mask.


Keywords


difficult laryngoscopy; tracheal intubation; laryngeal mask; complications

References


Anesteziolohiya i reanimatolohiya, toksykolohiya: Normatyvne vyrobnycho-praktychne vydannya. – K.: MNIATs medychnoyi statystyky; MVTs «Medinform», 2013. – S. 116-119.

Tarabrin O.O. Prohnozuvannya skladnoyi intubatsiyi trakheyi v tyreoyidniy khirurhiyi / O.O. Tarabrin, O.O. Budnyuk, I.L. Basenko // Bil', znebolyuvannya i intensyvna terapiya.– 2010.– №2 (d).– C. 214-215.

Brain A.I.J. The development of the laryngeal mask — a brief history of the invention, early clinical studies and experimental work from which the laryngeal mask evolved // European Journal of Anaesthesiology. — 1991. — Suppl. 4. — P. 5­17.

Benumof J., Scheller M.S. The importance of transtracheal jet ventilation in the management of the difficult airway // Anesthesio­logy. — 1989. — Vol. 71. — P. 769­778.

Benumof J. The Laryngeal Mask Airway and ASA difficult airway algorithm // Anesthesiology. — 1996. — Vol. 84. — P. 686­699.

Brimacombe J.R. Laryngeal Mask Anaesthesia. Principles and Practice. — London: WB Saunders, 2004. — 606 p.

Caplan R.A. Medico-legal considerations: The ASA Closed Claim Project / R.A. Caplan, K.L. Posner, J.L. Benumof (ed.) Airway management, principles and practice. — St. Louis-Baltimore: Mosby, 1996. — Vol. 242. — P. 1-7.

Complications associated with anaesthesia — a prospective survey in France / L. Tiret, J.M. Desmonts, F. Hatton, G. Vourc’h // Can. Anaesth. Soc. J. — 1986. — Vol. 33, № 3 (1). — P. 336-344.

Cook T.M. Ligitation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995-2007 / T.M. Cook, S. Scott, R. Mihai // Anaesthesia. — 2010. — Vol. 65. — P. 556-563.

Desmonts J.M. A retrospective of studies of anaesthesia morbidity and mortality / J.M. Desmonts, P.G. Duncan // Eur. J. Ana­esth. — 1993. — Vol. 10, № 7. — P. 33-41.

Domino K.В., Posner K.L., Caplan R.A. et al. Airway injury during anesthesia: a closed claims analysis // Anesthesiology. — 1999. — Vol. 91 (6). — P. 1703­1711.

Gataure P.S., Hughes J.A. The laryngeal mask airway in obstetrical anaesthesia // Can. J. Anaesth. — 1995. — Vol. 42. — P. 130­133.

Latto I.P. Management of difficult intubation // Difficulties in Tracheal Intubation / Ed. by I.P. Latto, M. Rosen. — London: BailliereTindall, 1987. — P. 99­141.

Leach A.B., Alexander C.A. The laringeal mask: An overview // European Journal of Anaesthesiology. — 1991. — Suppl. 4. — P. 19­31.

Lockey D., Davies G., Coats T. Survival of trauma patients who have prehospital tracheal intubation without anesthesia or muscle rela­xants: An observational study // BMJ. — 2001. — Vol. 323. — P. 141.

McCoy E.P. The levering laryngoscope / E.P. McCoy, R.K. Mirakhur // Anaesthesia. — 1993. — Vol. 48, № 6. — P. 516-519.

Practice Guidelines for Management of the Difficult Airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway // Anesthesiology. — 2003. — Vol. 98. — P. 1269-­1277.

Paix A.D. Crisis management during anaesthesia: difficult intubation / A.D. Paix, J.A. Williamson, W.B. Runciman // Qual. Saf. Health Care. — 2005. — Vol. 14, № 3. — P. 5.

Patil V.U. Fiberoptic endoscopy in anesthesia / V.U. Patil, L.C. Stehling, H.L. Zaunder. — Chicago: Year Book Medical Publishers, 1983. — P. 9-15.

Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics / S. Kheterpal, L. Martin, A.M. Shanks, K.K. Tremper // Anesthesiology. — 2009. — Vol. 110, № 4. — P. 891-897.

Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study / T.S. Yildiz, F. Korkmaz, M. Solak [et al.] // Eur. J. Anaesthesiol. — 2007. — Vol. 24, № 3. — Р. 1034-1040.

Predictive performance of three multivariate difficult tracheal intubation models: a double-blind and case-controlled study / M. Naguib, F.L. Scamman, C. O’Sullivan [et al.] // Anesth. Analg. — 2006. — Vol. 102, № 3. — P. 818-824.

Rose D.K., Cohen M.M. The airway: problems and predictions in 18,500 patients // Can. J. Anaesth. — 1994. — Vol. 41. — 372­-383.

Rose D.K., Cohen M.M. The incidence of airway problems depends on the definition used // Can. J. Anaesth. — 1996. — Vol. 43. — 30­-34.

Janssens M. Management of Difficult Intubation / M. Janssens, G. Hartstein // Eur. J.Anesthesiol. — 2001. — Vol. 18. — P. 3-12.

Schaeuble J.C., Heidegger T. Strategies and algorithms for the management of the difficult airway: An update // Trends in Anaesthesia and Critical Care. — 2012. — Vol. 2, Issue 5. — P. 208-217.




DOI: https://doi.org/10.22141/2224-0586.1.72.2016.74456

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