Term
| Predicting difficult placement of supraglottic devices |
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Definition
RODS
Restrictive mouth opening
Obstruction of the upper airway -->trauma infection, stiffness
Disrupted airway-->trauma infection, masses
Stiff lungs or stiff cervical spine. |
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Term
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Definition
A fundamental & critical skill for CRNAs
Management ranges from chin lift to surgical techniques
Frequently called upon to manage failed airways by other providers |
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Term
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Definition
Death occurs from Failure to Ventilate
not failure to intubate |
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Term
| What is a Difficult Airway |
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Definition
| A clinical situation when a conventionally trained (Anesthesia Provider) experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both |
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Term
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Definition
Difficult tracheal intubation (DTI) = > 3 intubation attempts or > 10 minutes
DTI occurs in 1.5 - 8.5% of patients
Impossible to intubate in 0.5% of patients |
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Term
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Definition
Failure to intubate occurs in up to 1:2,500 non-obstetric population
Up to 1:300 in the obstetric population
DTI may result from difficulty in visualization of the larynx (difficult direct laryngoscopy)
May result from anatomic abnormality (distortion or narrowing of the larynx or trachea) |
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Term
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Definition
| Inability to maintain O2 saturation greater than 90% and/or 3 failed intubation attempts by a experienced provider |
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Term
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Definition
“The difficult airway is something one anticipates; the failed airway is something one experiences.”
(Ron M. Walls, MD 2002) |
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Term
| ASA Closed Claims Project |
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Definition
Examined >9000 closed anesthesia malpractice claims
Goal was to identify injury types and patterns and devise prevention strategy
Respiratory events are closely linked with death and permanent brain damage
DI is 2nd most frequent event leading to malpractice claims of anesthesia related claims |
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Term
| ASA Closed Claims Project |
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Definition
Airway problems can occur throughout the perioperative period
67% upon induction
15% during surgery
12% at extubation
5% during recovery |
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Term
| ASA Closed Claims Project |
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Definition
DI is the leading cause of poor outcomes
Death or brain damage outcome in 57% of claims
41% of difficult airways were ASA Class 3 or 4
Obesity was a factor in 32% of DA claims |
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Term
| Factors Related to Assessment |
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Definition
Large portion of DA claims had no preoperative airway assessment
DA management was anticipated in only 525 of the claims, these people were assessed.
Therefore there was no anticipated DA in 48% , was not recognized until laryngoscopy |
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Term
| Frequency of Difficult Airway |
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Definition
Grade 3 or 4 laryngoscopy <20%
True Grade 4 view <5%
Failed intubation <1% |
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Term
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Definition
Best defense is to identify difficult airways before surgery
Unexpected difficult airways can occur despite careful pre-op evaluation
Always have back-up plans
Always know where emergency/difficult airway equipment is located and be familiar with it use |
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Term
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Definition
Poor patient position
Airway adjuncts not readily available
Failure to have appropriate assistance
Use of too small of a blade
Poor pre-oxygenation
Poor drug choices
Wrong type/size of ETT |
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Term
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Definition
Use a systematic approach to predict difficulty of airway management
Most airway grading tools have poor predictive value
Review past surgical records
Review past intubation records
Patient history suggesting a difficult airway
Discuss plan and possible complications with patient and anesthesia care team
Document findings |
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Term
| Difficult Mask Ventilation |
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Definition
Independent predictors of DMV;
Age >55 years
BMI >26 kg/m2
Beard and facial hair
Edentulous
Snoring history |
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Term
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Definition
Anticipated difficult airway (all resources and assistance are available)
Unanticipated difficult airway (OK with proper preparation, potential disaster if unprepared)
Unanticipated difficult airway resulting in a cannot intubate/cannot ventilate situation (always a potential disaster) |
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Term
| Difficult Intubation Identification |
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Definition
When a DI/DA is encountered, the patient must be counseled and further information given.
APSF Example of a Standardized Written patient notification of a difficult airway. |
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