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Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital

  • Christopher M. BurkleEmail author
  • Michael T. Walsh
  • Barry A. Harrison
  • Timothy B. Curry
  • Steven H. Rose
Article

Abstract

Purpose

The purpose of this single-centre database review was to establish the incidence of failure to intubate by direct laryngoscopy, to measure morbidity and mortality associated with this event, and to examine the use and efficacy of alternative airway devices.

Methods

Difficult intubation via direct laryngoscopy at Mayo Clinic Rochester is recorded in an electronic database using a functional classification: 0 = no difficulty; 1 = mild to moderate difficulty; and 2 = severe difficulty often requiring a change in intubation technique. Using this database, the total number of intubations was determined for a selected review period and the incidence of failure to intubate by direct laryngoscopy was established. Abstraction of chart data allowed for determination of associated morbidity and mortality, success of alternative airway devices, and case cancellation rate.

Results

During the period from August 1, 2001 through December 31, 2002, 37,482 patients underwent general anesthesia with attempted direct laryngoscopy. One hundred sixty-one patients (0.43%) could not be intubated by direct laryngoscopy alone. Morbidity associated with difficult intubation included soft tissue/ dental damage (n = 8), intraoperative cardiac arrest (n = 1), and possible aspiration (n = 1). Three patients required intensive care unit admission. There was no associated mortality. The most commonly used alternative airway device was the flexible fibreoptic scope. Five case cancellations resulted from failure to intubate with alternative devices.

Conclusion

The rate of unexpected failure to intubate by direct laryngoscopy is essentially unchanged from earlier studies. While morbidity was low, continued education and early use of alternative difficult airway devices may further limit complications associated with this event.

Keywords

Airway Management Laryngeal Mask Airway Difficult Airway Direct Laryngoscopy Difficult Intubation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le contrôle des voies aériennes après l’échec de l’intubation par laryngoscopie directe: résultats obtenus dans un grand hôpital universitaire

Résumé

Objectif

Établir, par une revue de la base de données d’un seul centre, la fréquence des échecs à intuber par laryngoscopie directe, mesurer la morbidité et la mortalité associées et vérifier l’usage et l’efficacité d’autres instruments d’intubation.

Méthode

Les cas d’intubation difficile par laryngoscopie directe à la clinique Mayo de Rochester ont été notés dans une base de données électronique selon une classification fonctionnelle : 0 = aucune difficulté 1 = difficulté légère à modérée et 2 = difficulté sévère exigeant souvent le recours à d’autres techniques d’intubation. Le nombre total d’intubations a été déterminé pour une période de révision choisie et la fréquence des échecs à intuber par laryngoscopie directe a été établie. Un résumé analytique des données a permis de déterminer la morbidité et la mortalité associées, le succès des autres techniques et le taux d’annulation.

Résultats

Du premier août 2001 au 31 décembre 2002, 37 482 patients ont eu une anesthésie générale et subi une laryngoscopie directe. Cent soixante et un patients (0,43 %) n’ont pu être intubés par laryngoscopie directe seulement. La morbidité associée à l’intubation difficile comprenait une lésion des tissus mous/des dents (n = 8), un arrêt cardiaque peropératoire (n = 1) et une aspiration possible (n = 1). Trois patients ont dû être admis à l’unité des soins intensifs. Il n’y a pas eu de mortalité associée. L’instrument de remplacement le plus souvent utilisé a été le fibroscope flexible. Cinq annulations ont résulté de l’échec à intuber avec d’autres instruments.

Conclusion

Le taux imprévu d’échec à intuber par laryngoscopie directe est essentiellement le même depuis les études antérieures. La morbidité est faible, mais une formation continue et un usage précoce d’autres instruments réduiraient davantage les complications qui y sont associées.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Christopher M. Burkle
    • 1
    Email author
  • Michael T. Walsh
    • 1
  • Barry A. Harrison
    • 1
  • Timothy B. Curry
    • 1
  • Steven H. Rose
    • 1
  1. 1.Department of AnesthesiologyMayo Clinic College of MedicineRochesterUSA

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