2021 Update on airway management from the Anaesthesia Continuing Education Airway Management Special Interest Group

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Abstract

Airway Management is the key for anaesthetists dealing with patients undergoing diagnostic procedures and surgical interventions. The present coronavirus pandemic underpins even more how important safe airway management is. It also highlights the need to apply stringent precautions to avoid infection and ongoing transmission to patients, anaesthetists and other healthcare workers (HCWs). In light of this extraordinary global situation the aim of this article is to update the reader on the varied aspects of the ever-changing tasks anaesthetists are involved in and highlight the equipment, devices and techniques that have evolved in response to changing technology and unique patient and surgical requirements.

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Most cited references 54

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Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia.

T.M. Cook, N Woodall, C. Frerk (2011)

This project was devised to estimate the incidence of major complications of airway management during anaesthesia in the UK and to study these events. Reports of major airway management complications during anaesthesia (death, brain damage, emergency surgical airway, unanticipated intensive care unit admission) were collected from all National Health Service hospitals for 1 yr. An expert panel assessed inclusion criteria, outcome, and airway management. A matched concurrent census estimated a denominator of 2.9 million general anaesthetics annually. Of 184 reports meeting inclusion criteria, 133 related to general anaesthesia: 46 events per million general anaesthetics [95% confidence interval (CI) 38-54] or one per 22,000 (95% CI 1 per 26-18,000). Anaesthesia events led to 16 deaths and three episodes of persistent brain damage: a mortality rate of 5.6 per million general anaesthetics (95% CI 2.8-8.3): one per 180,000 (95% CI 1 per 352-120,000). These estimates assume that all such cases were captured. Rates of death and brain damage for different airway devices (facemask, supraglottic airway, tracheal tube) varied little. Airway management was considered good in 19% of assessable anaesthesia cases. Elements of care were judged poor in three-quarters: in only three deaths was airway management considered exclusively good. Although these data suggest the incidence of death and brain damage from airway management during general anaesthesia is low, statistical analysis of the distribution of reports suggests as few as 25% of relevant incidents may have been reported. It therefore provides an indication of the lower limit for incidence of such complications. The review of airway management indicates that in a majority of cases, there is 'room for improvement'.

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Consensus guidelines for managing the airway in patients with COVID ‐19

T M Cook, K El-Boghdadly, B McGuire … (2020)

Summary Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.

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Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

C. Frerk, V. Mitchell, A McNarry … (2015)

These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

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Author and article information

Contributors

André AJ Van Zundert: (View ORCID Profile)

Yasmin Endlich: (View ORCID Profile)

William PL Bradley: (View ORCID Profile)

Journal

Title: Anaesthesia and Intensive Care

Abbreviated Title: Anaesth Intensive Care

Publisher: SAGE Publications

ISSN (Print): 0310-057X

ISSN (Electronic): 1448-0271

Publication date Created: July 2021

Publication date (Electronic): June 22 2021

Publication date (Print): July 2021

Volume: 49

Issue: 4

Pages: 257-267

Affiliations

[1 ]Department of Anaesthesia, Royal Brisbane and Women’s Hospital, Brisbane, Australia

[2 ]University of Queensland, Brisbane, Australia

[3 ]Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, Australia

[4 ]Department of Anaesthesia, The Alfred, Melbourne, Australia

[5 ]Department of Anaesthesia, Royal Perth Hospital, Perth, Australia

[6 ]Department of Anaesthesia, St Vincent’s Hospital, Darlinghurst, Australia

[7 ]Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand

[8 ]Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia

[9 ]Department of Anaesthesia, Northern Beaches Hospital, Sydney, Australia

[10 ]Department of Anaesthesia, St James’s Hospital, Dublin, Ireland

Article

DOI: 10.1177/0310057X20984784

SO-VID: 8edb6ad0-d8a7-4296-af5b-5efb7d65ef8b

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http://journals.sagepub.com/page/policies/text-and-data-mining-license

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