Publication: Anticipated and unanticipated difficult intubation in the perioperative and anesthetic adverse events in Thailand (PAAD Thai) study
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Issued Date
2019
Resource Type
File Type
application/pdf
ISSN
1252208
Other identifier(s)
2-s2.0-85062920021
Rights Holder(s)
Scopus
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol 102, No.2 (2019), p.156-163
Suggested Citation
Plansangkate P., Wasinwong W., Charuluxananan S., Lapisatepun W., Sriraj W., Pitimana-Aree S., Ratanasuwan P., Thanasriphakdeekul S., Luetrakool P., Luanpholcharoenchai J., Pongruekdee S. Anticipated and unanticipated difficult intubation in the perioperative and anesthetic adverse events in Thailand (PAAD Thai) study. Journal of the Medical Association of Thailand. Vol 102, No.2 (2019), p.156-163. Retrieved from: https://hdl.handle.net/20.500.14740/5475
Abstract
Background: Difficult intubation is a common problem. The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study was performed in 22 hospitals across Thailand in 2015 to investigate incidence of anesthesia related adverse events including the difficult intubation events. Objective: To evaluate the difficult intubation events in terms of prediction, management, complications, contributing factors, and corrective strategies, and compare the management of the unanticipated (UDI) and anticipated difficult intubation (ADI). Materials and Methods: The multicenter-observational study was prospectively performed. The research on difficult intubation was obtained using data from the first 2,000 events of the study. There were 115 difficult intubation events. The described details of each report on management of difficult intubation and outcomes were reviewed by two anesthesiologists. The opinions on causative factors, contributing preventive factors, and strategies for correction were agreed by three reviewers. Results: Sixty-nine and forty-six cases were indicated as UDI and ADI, respectively. Almost all of the patients in UDI group were successfully intubated under general anesthesia (95.7%) by switching of intubators (67.7%), using stylet (20%), and/or using different laryngoscopic blades (50.7%). The most successful blade in UDI was the direct laryngoscopic blade. The main rescue blade after failed direct laryngoscopy was the videolaryngoscopic blade. Most of the ADI were successfully intubated by using the videolaryngoscopic blade. Immediate complications were not significantly different. Cardiac arrest was found only in the immediate postoperative period. The contributing factors included inadequate experience, inappropriate decision, and inadequate airway evaluation. Conclusion: Most of the UDI and ADI were successfully intubated by using conventional technique and videolaryngoscope, respectively. The immediate adverse effects were not significantly different. Proper preparation, additional training, and presence of experienced anesthesia personnel would decrease the incidences and improve anesthetic outcomes. © Journal of the medical association of Thailand.
Subject(s)
Adolescent
Adult
Anesthesia
Anticipation
Article
Body mass
Bradycardia
Child
Clinical outcome
End tidal carbon dioxide tension
Endotracheal intubation
Esophagus intubation
Female
General anesthesia
Heart arrest
Human
Hypoxia
Intubation
Laryngoscopy
Larynx spasm
Major clinical study
Male
Middle aged
Multicenter study
Numeric rating scale
Observational study
Percutaneous nephrolithotomy
Perioperative period
Postoperative period
Prospective study
Respiration control
Respiratory tract injury
Retrospective study
Thyroidectomy
Tonsillectomy
Aging
Bleeding
Decision making
Disease classification
Endotracheal tube cuff leakage
Gum elastic bougie
Health care management
Heart arrest
Incidence
Infection
Interincisal angle
Mallampati grading
Neck movement
Neck tumor
Risk factor
Surgical technique
Thailand
Thyromental distance
Training
Frovatriptan
Midazolam
Narcotic agent
Propofol
Suxamethonium
Adult
Anesthesia
Anticipation
Article
Body mass
Bradycardia
Child
Clinical outcome
End tidal carbon dioxide tension
Endotracheal intubation
Esophagus intubation
Female
General anesthesia
Heart arrest
Human
Hypoxia
Intubation
Laryngoscopy
Larynx spasm
Major clinical study
Male
Middle aged
Multicenter study
Numeric rating scale
Observational study
Percutaneous nephrolithotomy
Perioperative period
Postoperative period
Prospective study
Respiration control
Respiratory tract injury
Retrospective study
Thyroidectomy
Tonsillectomy
Aging
Bleeding
Decision making
Disease classification
Endotracheal tube cuff leakage
Gum elastic bougie
Health care management
Heart arrest
Incidence
Infection
Interincisal angle
Mallampati grading
Neck movement
Neck tumor
Risk factor
Surgical technique
Thailand
Thyromental distance
Training
Frovatriptan
Midazolam
Narcotic agent
Propofol
Suxamethonium