English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Quentin A. Fisher, MD As a sage observer once noted, the more treatments there are available for a condition, the less likely any of them are ideal. The same principle might hold for assessing and managing airway difficulties. Readers well know how our literature is replete with tests, scoring systems, and devices aimed at anticipating and dealing with these vexing problems. However, a small but persistent number of unanticipated airway catastrophes and near-catastrophes seem to occur. No method of examination can identify the variety of pathologies connoted by the term “difficult airway,” and certainly no single piece of equipment can resolve all of these difficulties. Other components include lack of equipment or facility in its use and even failure to identify previously discovered difficulties. Thus, it requires a combination of best practices in preoperative evaluation, communication about prior experiences, availability of airway equipment, and training to deal with the small but important population occupying the very end layers of the American Society of Anesthesiologists’ algorithm for management of the difficult airway. In this issue of Anesthesia & Analgesia, Dr. Berkow et al. document how a multifaceted program instituted in 1996 contributed to a sharp reduction in, but not complete elimination of, emergency surgical airways in a large teaching hospital. There were 5 components: 1) Information: Patients were reported to a centralized database; they were given special hospital identification bands and written information for future reference by medical personnel; and they were encouraged to enroll in the MedicAlert difficult intubation registry. 2) Evaluation: The anesthesia preoperative evaluation form was redesigned to target more specific issues in airway assessment; patients with possibly difficult airways were noted on the operating room (OR) schedule. 3) Equipment: Standardized difficult airway carts were placed to be readily accessible in the ORs, obstetric unit, and intensive care units. 4) Training: Regularly scheduled training sessions were developed for staff and residents, including a “difficult airway” rotation for residents and twice yearly interdisciplinary grand rounds. 5) Oversight: An interdisciplinary team was formed to serve as expert resources, trainers, and supervisors of the program. The effort paid dividends. In the 4 yr before 1996, there were 6–7 emergency surgical airways required per year because an anesthesiologist was unable to intubate the trachea or ventilate the patient’s lungs. For the 11 yr after instituting the program, the range of emergency surgical airways was 0–3 per year, even though the patient population had increased by more than 50%. No single component of the program can be identified as responsible for the improvement. Surely, many things were happening during the years the program was underway. There was rapid growth in recognizing the problem of difficult airways. Hundreds of articles have appeared in the anesthesia literature, documenting new observations, assessment tools, intubation devices, and in many cases, revisiting the old (e.g., the reintroduction of lighted stylets in the 1990s subsequent to their first introduction in the 1950s). Fiberoptic devices proliferated in the 1990s, and, in the 2000s, we have witnessed the introduction of camera-based videolaryngoscopes. Computers have become accessible in or near most ORs, and software to From the Georgetown University School of Medicine, MedStar–Washington Hospital Center, Washington, DC. Accepted for publication July 2, 2009. Supported by MedStar–Washington Hospital Center. Address correspondence and reprint requests to Quentin A. Fisher, MD, MedStar– Washington Hospital Center, 110 Irving St., NW, Washington, DC 20010. Address e-mail to quentin.fisher@medstar.net. Copyright © 2009 International Anesthesia Research Society

The Ultimate Difficult Airway: Minimizing Emergency Surgical Access