Difficult Laryngoscopy in Routine Anesthesia
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.
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