Complications and failure of airway management – update to NAP4

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You should read British Journal of Anaesthesia, even if its only for the abstracts.
This is a good one here and an update on airway management by the authors of the NAP4 project

Complications and failure of airway management

The article begins with a powerful quote :
“There is one skill above all else that an anaesthetist is expected to exhibit and that is to maintain the airway impeccably”. M. Rosen and I. P. Latto 1984

For those who cant access the full article here are some highlights to share!

1. In regard to video laryngoscopy,

“Evidence as to which of the novel intubation aids performs best remains lacking: it is highly unlikely that all offer equal benefit and some may offer none.”

2. Concept of composite failure of airway management – when one technique fails, others are more likely to fail. In other words, you must be confident at multiple approaches to securing the airway and train to flow through a logical sequence

3. In regard to surgical airways

“the evidence is clear:when ESA (emergency surgical airway) is required it is not the procedure that kills patients, but delaying or not doing it that causes harm.”

4. all airway management techniques fail and this is often unanticipated

5. Believe the history of previous difficult airway management

6. Assess every airway for difficulty

7. Never fail to be prepared for failure

8. Communicate your airway strategy and plans

9. Do what you can but do not do what you cannot . If possible ask for help. Airway management should suit the patient, not the doctor, nurse nor paramedic.

10. Obesity is a major risk for lethal hypoxia during airway management. Refer to 1 – 9.

11. Hypoxia is the killer. Avoid it.

Thankyou Dr Cook & Dr MacDougall-Davis and British Journal of Anaesthesia.

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