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06.04.2024 | Airway Management (LC Berkow, Section Editor)

Complications of Airway Management

verfasst von: Lauren Berkow

Erschienen in: Current Anesthesiology Reports

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Abstract

Purpose of Review

Despite notable advancements in technology and monitoring, coupled with the dissemination of guidelines, complications associated with airway management persist. This comprehensive review delves into the most prevalent complications, exploring their incidence rates, identifying associated risk factors, and proposing reduction strategies. Drawing insights from recent closed claims analyses, comprehensive reviews, and established guidelines, this review aims to provide a contemporary understanding of the challenges in airway management.

Recent Findings

Notwithstanding the progress in technology and adherence to guidelines, serious complications persist, particularly in emergent situations and non-operating room settings. The evolving landscape of medical practice has witnessed a substantial rise in anesthetic procedures conducted outside the traditional operating room environment. Concurrently, the patient demographic for these procedures has shifted towards individuals with heightened medical complexities, amplifying the susceptibility to complications.

Summary

The key to mitigating the risk of complications lies in conducting a thorough airway assessment, meticulously planning for potential difficulties and failures, and proactively anticipating complications. Notably, the surge in non-operating room procedures and emergency settings necessitates an equivalent level of preparation and patient assessment as observed in the traditional operating room. This includes the deployment of identical equipment and support. The integration of Airway Leads assumes significance in this scenario, contributing significantly to the standardization of equipment and procedures across the hospital. Their role also extends to education initiatives aimed at enhancing airway safety and reducing complications hospital-wide.

Metzner J, Posner KL, Lam MS, Domino KB. Closed claims’ analysis. Best Pract Res Clin Anaesthesiol. 2011;31:263–76. https://doi.org/10.1016/j.bpa.2011.02.007.CrossRef

Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology. 2019;131:818–29. https://doi.org/10.1097/ALN.0000000000002815.CrossRefPubMed

3.••

Cook TM, Woodall N, Frerk C. NAP4, 4th national audit project of the Royal College of Anaesthetists and Difficult Airway Society: major complications of airway management in the United Kingdom, report and findings. The Royal College of Anaesthetists and the Difficult Airway Society; 2011. https://www.nationalauditprojects.org.uk/downloads/NAP4%20Full%20Report.pdf. Accessed 15 Jan 2024. Landmark report of airway complications over a 1-year period in the UK highlighting the need for airway assessment and planning.

Woodall N, Frerk C, Cook TM. Can we make airway management (even) safer? – lessons from national audit. Anaesthesia. 2011;66(Suppl 2):27–33. https://doi.org/10.1111/j.1365-2044.2011.06931.x.CrossRefPubMed

Cumberworth A, Lewith H, Sud A, Jefferson H, Athanassoglou V, Pandit JJ. Major complications of airway management: a prospective multicentre observational study. Anaesthesia. 2022;77:640–8. https://doi.org/10.1111/anae.15668.CrossRefPubMed

Cook TM, Oglesby F, Kane AD, Armstrong RA, Kursumovic E, Soar J. Airway and respiratory complications during anaesthesia and associated with peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists. Anaesthesia. 2023. https://doi.org/10.1111/anae.16187

Cook TM, Woodall N, Harper J, Fourth National Audit Project. Benger J 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 II: intensive care and emergency departments. Br J Anaesth. 2011;106:632–42. https://doi.org/10.1093/bja/aer059.CrossRefPubMed

Mort TC. The incidence and risk factors for cardiac arrest during emergency tracheal intubation: a justification for incorporating the ASA guidelines in the remote location. J Clin Anesth. 2004;16:508–16. https://doi.org/10.1016/j.jclinane.2004.01.007.CrossRefPubMed

Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Crit Care Med. 2005;33:2672–5. https://doi.org/10.1097/01.ccm.0000187131.67594.9e.CrossRefPubMed

10.•

Mosier JM, Joshi R, Hypes C, Pacheco G, Valenzuela T, Sakles JC. The physiologically difficult airway. West J Emerg Med. 2015;16:1109–17. https://doi.org/10.5811/westjem.2015.8.27467. This paper introduced the concept of a physiological difficult airway as a risk factor for complications.CrossRefPubMedPubMedCentral

11.

Gleason JM, Christian BR, Barton ED. Nasal cannula apneic oxygenation prevents desaturation during endotracheal intubation: an integrative literature review. West J Emerg Med. 2018;19:403–11. https://doi.org/10.5811/westjem.2017.12.34699.CrossRefPubMedPubMedCentral

12.••

Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136:31–81. https://doi.org/10.1097/ALN.0000000000004002. This updated set of guidelines introduced new infographics to guide decision-making and management.CrossRefPubMed

13.•

Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, et al. DAS guidelines on the airway management of critically ill patients. Anaesthesia. 2018;73:1035–6. https://doi.org/10.1111/anae.14352. Airway guidelines focused on the critically ill patient.CrossRefPubMed

14.•

Kornas RL, Owyang CG, Sakles JC, Foley LJ, Mosier JM, Society for Airway Management’s Special Projects Committee. Evaluation and management of the physiologically difficult airway: consensus recommendations from Society for Airway Management. Anesth Analg. 2021;132:395–405. https://doi.org/10.1213/ANE.0000000000005233. Recommendations for safe management of the physiologically difficult airway.CrossRefPubMed

15.

Mitsuyama Y, Nakao S, Shimazaki J, Ogura H, Shimazu T. Effectiveness of high-flow nasal cannula for tracheal intubation in the emergency department. BMC Emerg Med. 2022;22:115. https://doi.org/10.1186/s12873-022-00674-w.CrossRefPubMedPubMedCentral

16.

Guy L, Christensen R, Dodd B, Pelecanos A, Wyssusek K, Van Zundert A, et al. The effect of transnasal humidified rapid-insufflation ventilator exchange (THRIVE) versus nasal prongs on safe apnoea time in paralysed obese patients: a randomised controlled trial. Br J Anaesth. 2022;128:375–81. https://doi.org/10.1016/j.bja.2021.10.048.CrossRefPubMed

17.

Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth. 2022;129:612–23. https://doi.org/10.1016/j.bja.2022.05.027.CrossRefPubMedPubMedCentral

18.

Cook TM, Aziz MF. Has the time really come for universal videolaryngoscopy? Br J Anaesth. 2022;129:474–7. https://doi.org/10.1016/j.bja.2022.07.038.CrossRefPubMed

19.

Russotto V, Lascarrou JB, Tassistro E, Parotto M, Antolini L, Bauer P, et al. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. Br J Anaesth. 2023;131:607–16. https://doi.org/10.1016/j.bja.2023.04.022.CrossRefPubMed

20.

Mort TC. Complications of emergency tracheal intubation: hemodynamic alterations—part I. J Intensive Care Med. 2007;22:157–65. https://doi.org/10.1177/0885066607299525.CrossRefPubMed

21.

Russotto V, Tassistro E, Myatra SN, Parotto M, Antolini L, Bauer P, et al. Peri-intubation cardiovascular collapse in patients who are critically ill: insights from the INTUBE study. Am J Respir Crit Care Med. 2022;206:449–58. https://doi.org/10.1164/rccm.202111-2575OC.CrossRefPubMed

22.

Janz DR, Casey JD, Semler MW, Russell DW, Dargin J, Vonderhaar DJ, et al. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial. Lancet Respir Med. 2019;7:1039–47. https://doi.org/10.1016/S2213-2600(19)30246-2.CrossRefPubMedPubMedCentral

23.•

Russotto V, Myatra SN, Laffey JG, Tassistro E, Antolini L, Bauer P, et al. Intubation practices and adverse peri-intubation events in critically ill patients from 29 countries. JAMA. 2021;325:1164–72. https://doi.org/10.1001/jama.2021.1727. Results of multicenter study of intubations in the ICU setting, identifying risks and providing recommendations for management.CrossRefPubMedPubMedCentral

24.

Sbeghen V, Verdonck O, McDevitt J, Zaphiratos V, Brulotte V, Loubert C, et al. A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anaesth. 2021;68:855–67. https://doi.org/10.1007/s12630-021-01936-0.CrossRefPubMed

25.

Jones P, Dauger S, Peters MJ. Bradycardia during critical care intubation: mechanisms, significance and atropine. Arch Dis Child. 2012;97:139–44. https://doi.org/10.1136/adc.2010.210518.CrossRefPubMed

26.

Mazzotta E, Soghomonyan S, Hu LQ. Postoperative sore throat: prophylaxis and treatment. Front Pharmacol. 2023;14:1284071. https://doi.org/10.3389/fphar.2023.1284071.CrossRefPubMedPubMedCentral

27.

Mitobe Y, Yamaguchi Y, Baba Y, Yoshioka T, Nakagawa K, Itou T, Kurahashi K. A literature review of factors related to postoperative sore throat J. Clin Med Res. 2022;14:88–94. https://doi.org/10.14740/jocmr4665.CrossRef

28.

El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016;71:706–17. https://doi.org/10.1111/anae.13438.CrossRefPubMed

29.

Levin PD, Chrysostomos C, Ibarra CA, Ledot S, Naito D, Weissman C, et al. Causes of sore throat after intubation: a prospective observational study of multiple anesthesia variables. Minerva Anestesiol. 2017;83:582–9. https://doi.org/10.23736/S0375-9393.17.11419-7.CrossRefPubMed

30.

Fritz AV, Mickus GJ, Vega MA, Renew JR, Brull SJ. Detrimental effects of filling laryngotracheal airways to excessive pressure (DEFLATE-P): a quality improvement initiative. BMC Anesthesiol. 2020;20:46. https://doi.org/10.1186/s12871-020-00963-6.CrossRefPubMedPubMedCentral

31.

Puthenveettil N, Kishore K, Paul J, Kumar L. Effect of cuff pressures on postoperative sore throat in gynecologic laparoscopic surgery: an observational study. Anesth Essays Res. 2018;12:484–8. https://doi.org/10.4103/aer.AER_72_18.CrossRefPubMedPubMedCentral

32.

Singh NP, Makkar JK, Cappellani RB, Sinha A, Lakshminarasimhachar A, Singh PM. Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis. Can J Anaesth. 2020;67:1624–42. https://doi.org/10.1007/s12630-020-01792-4.CrossRefPubMed

33.

Wang G, Qi Y, Wu L, Jiang G. Comparative efficacy of 6 topical pharmacological agents for preventive interventions of postoperative sore throat after tracheal intubation: a systematic review and network meta-analysis. Anesth Analg. 2021;133:58–67. https://doi.org/10.1213/ANE.0000000000005521.CrossRefPubMedPubMedCentral

34.

Nair A, Seelam S. Postoperative sore throat prevention: is there an evidence or is it much ado about nothing? Saudi J Anaesth. 2022;16:125–7. https://doi.org/10.4103/sja.sja_344_21.CrossRefPubMedPubMedCentral

35.

Neto JM, Teles AR, Barbosa J, Santos O. Teeth damage during general anesthesia. J Clin Med. 2023;12:5343. https://doi.org/10.3390/jcm12165343.CrossRefPubMedPubMedCentral

36.

Diakonoff H, De Rocquigny G, Tourtier J, Guigon A. Medicolegal issues of peri-anaesthetic dental injuries: a 21-years review of liability lawsuits in France. Dent Traumatol. 2022;38:391–6. https://doi.org/10.1111/edt.12770.CrossRefPubMedPubMedCentral

37.

Lee K, Kim SY, Park KM, Yang S, Kim KD, Park W. Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries. J Dent Anesth Pain Med. 2023;23:9–17. https://doi.org/10.17245/jdapm.2023.23.1.9.CrossRefPubMedPubMedCentral

38.

Greer D, Marshall KE, Bevans S, Standlee A, McAdams P, Harsha W. Review of videolaryngoscopy pharyngeal wall injuries. Laryngoscope. 2017;127:349–53. https://doi.org/10.1002/lary.26134.CrossRefPubMed

39.

Pacheco-Lopez PC, Berkow LC, Hillel AT, Akst LM. Complications of airway management. Respir Care. 2014;59:1006–19. https://doi.org/10.4187/respcare.02884.CrossRefPubMed

40.

41.

Han I, Kim TK, Yoo JH, Park JH, Chung EY. Dislocation of the temporomandibular joint following general anesthesia. Korean J Anesthesiol. 2014;67(Suppl):S113–4. https://doi.org/10.4097/kjae.2014.67.S.S113.CrossRefPubMedPubMedCentral

42.

Serck N, Piagnerelli M, Augy JL, Annoni F, Ottavy G, Courcelle R, et al. Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database. BMC Anesthesiol. 2023;23:138. https://doi.org/10.1186/s12871-023-02093-1.CrossRefPubMedPubMedCentral

43.

Epaud A, Levesque E, Clariot S. Dramatic cervical spine injury secondary to videolaryngoscopy in a patient suffering from ankylosing spondylitis. Anesthesiology. 2021;135:495–6. https://doi.org/10.1097/ALN.0000000000003866.CrossRefPubMed

44.

Pang S, Badenhorst C, West N, Malherbe S. Self-reported clinical practice and attitudes about cricoid pressure: an online survey of Canadian Pediatric Anesthesia Society members. Can J Anaesth. 2023;70:1857–9. https://doi.org/10.1007/s12630-023-02575-3.CrossRefPubMed

45.

Bhatia N, Bhagat H, Sen I. Cricoid pressure: where do we stand? J Anaesthesiol Clin Pharmacol. 2014;30:3–6. https://doi.org/10.4103/0970-9185.125683.CrossRefPubMedPubMedCentral

46.

Joshi GP, Abdelmalak BB, Weigel WA, Soriano SG, Harbell MW, Kuo CI, et al. American Society of Anesthesiologists consensus-based guidance on preoperative management of patients (adults and children) on glucagon-like peptide-1 (GLP-1) receptor agonists. 2023. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative. Accessed 22 Jan 2024

47.

Asokan R, Bhardwaj BB, Agrawal N, Chauhan U, Pillai A, Shankar T, et al. Point of care gastric ultrasound to predict aspiration in patients undergoing urgent endotracheal intubation in the emergency medicine department. BMC Emerg Med. 2023;23:111. https://doi.org/10.1186/s12873-023-00881-z.CrossRefPubMedPubMedCentral

48.

Khara B, Tobias JD. Perioperative care of the pediatric patient and an algorithm for the treatment of intraoperative bronchospasm. J Asthma Allergy. 2023;16:649–60. https://doi.org/10.2147/JAA.S414026.CrossRefPubMedPubMedCentral

49.

Bayable SD, Melesse DY, Lema GF, Ahmed SA. Perioperative management of patients with asthma during elective surgery: a systematic review. Ann Med Surg (Lond). 2021;70:102874. https://doi.org/10.1016/j.amsu.2021.102874.CrossRefPubMed

50.

Trivedi K, O’Brien VJ, Rochetto RP. Sugammadex-associated bronchospasm. Am J Ther. 2021;29(1):e139–41. https://doi.org/10.1097/MJT.0000000000001390.CrossRefPubMed

51.

Zhang J, Yin J, Li Y, Zhang Y, Bai Y, Yang H. Effect of dexmedetomidine on preventing perioperative respiratory adverse events in children: a systematic review and meta-analysis of randomized controlled trials. Exp Ther Med. 2023;25:286. https://doi.org/10.3892/etm.2023.11985.CrossRefPubMedPubMedCentral

52.

•• Chrimes N, Higgs A, Hagberg CA, Baker PA, Cooper RM, Greif R, et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies. Anaesthesia. 2022;77:1395–415. https://doi.org/10.1111/anae.15817. First article from the PUMA group addressing unrecognized esophageal intubation.CrossRefPubMedPubMedCentral

53.

Cook TM, Harrop-Griffiths AW, Whitaker DK, McNarry AF, Patel A, McGuire B. The ‘no trace=wrong place’ campaign. Br J Anaesth. 2019;122:e68–9. https://doi.org/10.1016/j.bja.2019.01.008.CrossRefPubMedPubMedCentral

54.

Berkow L, Kanowitz A. Unplanned extubation: a common and costly complication of airway management. Patient Safety. 2020;2:22–30. https://doi.org/10.33940/med/2020.3.2CrossRef

55.

Berkow L, Kanowitz A. Unplanned extubation in the perioperative environment. APSF Newsletter. 2022;37(14–6):18.

56.

McNett M, Kerber K. Unplanned extubations in the ICU: risk factors and strategies for reducing adverse events. J Clin Outcomes Manag. 2015;22(7):303–11.

57.

Gibbins M, Kelly FE, Cook TM. Airway management equipment and practice: time to optimise institutional, team, and personal preparedness. Br J Anaesth. 2020;125:221–4. https://doi.org/10.1016/j.bja.2020.06.012.CrossRefPubMed

58.

• Berkow LC, Greenberg RS, Kan KH, Colantuoni E, Mark LJ, Flint PW, et al. Need for emergency surgical airway reduced by a comprehensive difficult airway program. Anesth Analg. 2009;109:1860–9. https://doi.org/10.1213/ane.0b013e3181b2531a. First article published demonstrating that the standardization of airway management can reduce surgical airway rates.CrossRefPubMed

59.

• Mark L, Lester L, Cover R, Herzer K. A decade of difficult airway response team: lessons learned from a hospital-wide difficult airway response team program. Crit Care Clin. 2018;34:239–51. https://doi.org/10.1016/j.ccc.2017.12.008. Article describing 10 years of experiences and results of the first multidisciplinary airway team.CrossRefPubMed

60.

Hubert V, Duwat A, Deransy R, Mahjoub Y, Dupont H. Effect of simulation training on compliance with difficult airway management algorithms, technical ability, and skills retention for emergency cricothyrotomy. Anesthesiology. 2014;120:999–1008. https://doi.org/10.1097/ALN.0000000000000138.CrossRefPubMed

61.

Duffy CC, Bass GA, Yi W, Rouhi A, Kaplan LJ, O’Sullivan E. Teaching airway management using virtual reality: a scoping review. Anesth Analg. 2023. https://doi.org/10.1213/ANE.0000000000006611.CrossRefPubMed

62.

Wong DT, Mehta A, Singh KP, Leong SM, Ooi A, Niazi A, et al. The effect of virtual reality bronchoscopy simulator training on performance of bronchoscopic-guided intubation in patients: a randomised controlled trial. Eur J Anaesthesiol. 2019;36:227–33. https://doi.org/10.1097/EJA.0000000000000890.CrossRefPubMed

63.

Schmidt E, Goldhaber-Fiebert SN, Ho LA, McDonald KM. Simulation exercises as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:426–32. https://doi.org/10.7326/0003-4819-158-5-201303051-00010.CrossRefPubMed

64.

Treki AA, Straker T. Limitations of the videolaryngoscope: an anesthetic management reality. Int Anesthesiol Clin. 2017;55:97–104. https://doi.org/10.1097/AIA.0000000000000130.CrossRefPubMed

65.

Damrose JF, Eropkin W, Ng S, Cale S, Banerjee S. The critical response team in airway emergencies. Perm J. 2019;23:18–219. https://doi.org/10.7812/TPP/18-219.CrossRefPubMedPubMedCentral

66.

Atkins JH, Rassekh CH, Chalian AA, Zhao J. An airway rapid response system: implementation and utilization in a large academic trauma center. Jt Comm J Qual Patient Saf. 2017;43:653–60. https://doi.org/10.1016/j.jcjq.2017.07.002.CrossRefPubMed

67.

Smith C, McNarry AF. Airway leads and airway response teams: improving delivery of safer airway management? Curr Anesthesiol Rep. 2020;10:370–7. https://doi.org/10.1007/s40140-020-00404-7.CrossRefPubMedPubMedCentral

68.

Baker PA, Behringer EC, Feinleib J, Foley LJ, Mosier J, Roth P, et al. Formation of an airway lead network: an essential patient safety initiative. Br J Anaesth. 2022;128:225–9. https://doi.org/10.1016/j.bja.2021.11.013.CrossRefPubMed

69.

McNarry AF, M Cook T, Baker PA, O'Sullivan EP. The Airway Lead: opportunities to improve institutional and personal preparedness for airway management. Br J Anaesth. 2020;125(1):e22–4. https://doi.org/10.1016/j.bja.2020.04.053.

Titel: Complications of Airway Management
verfasst von: Lauren Berkow
Publikationsdatum: 06.04.2024
Verlag: Springer US
Erschienen in: Current Anesthesiology Reports
Elektronische ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-024-00628-x

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Springer Medizin

Complications of Airway Management

Abstract

Purpose of Review

Recent Findings

Summary

Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

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Neu im Fachgebiet AINS

Sind Frauen die fähigeren Ärzte?

Akuter Schwindel: Wann lohnt sich eine MRT?

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Hinter dieser Appendizitis steckte ein Erreger

Update AINS