Airway management events more likely to occur in the intensive care unit, emergency department
THURSDAY, April 14 (HealthDay News) -- Airway management is a basic anesthetic responsibility and skill, and strategies need to be implemented to appropriately manage difficult airways, according to the Fourth National Audit Project (NAP4) of the Royal College of Anaesthetists and the Difficult Airway Society, published online March 29 in the British Journal of Anaesthesia.
Tim Cook, M.D., from the Royal United Hospital in Bath, U.K., and colleagues from the NAP4 identified anesthetics used, and evaluated all major complications of airway management, on all patients, including those in intensive care units (ICUs) and emergency departments, in the United Kingdom from 2008 to 2009.
The researchers found that approximately 2.9 million general anesthetics are administered each year, the majority by supraglottic airway devices. Obesity was identified as a risk factor for airway difficulty, with obese patients twice as likely to develop major complications, such as increased frequency of aspiration, difficulty during intubation, airway obstruction, and increased failure of rescue techniques. Anesthetic techniques for obese patients need to be modified accordingly. At least one-quarter of reported adverse events occurred in ICUs or emergency departments, with death or permanent damage the likely outcomes. Failure to use a capnograph in ventilated patients contributed to more than 70 percent of ICU-related deaths. Obese patients were particularly at risk from displaced tracheostomy or tracheal tubes.
"The incidence of serious complications associated with anesthesia is low. This is also true for airway management in ICU and the emergency department, though it is likely that a disproportionate number of airway events occur in these locations," the authors write.