444 Correspondence
Fig. 1
References 1
2 3
Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59:675–694. Rai MR. The humble bougie. . .forty years and still counting? Anaesthesia 2014; 69:199–203. Greenland KB, Edwards MJ, Hutton NJ, et al. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth 2010; 105:683–690. DOI:10.1097/EJA.0000000000000134
Rotate tube while withdrawing stylet.
Airway obstruction in the postanaesthetic care unit of a tertiary care centre A prospective audit
Fig. 2
William Curtis, Rajesh Sethi and Thavarajah Visvanathan From the Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South (WC, RS, TV), and University of Adelaide, Adelaide, South Australia, Australia (RS, TV) Correspondence to Dr Rajesh Sethi, MD, FRCA, FANZCA, Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia Tel: +61 08 8222 6640; fax: +61 08 8222 7065; e-mail: [email protected] Published online 13 February 2015
Editor,
A three dimensional tube dance is obtained.
(Figs 1 and 2). A two-panel picture of the main manoeuvres necessary to obtain tube dance is shown (Figs 1 and 2). A videolink of the dynamic tube movement (Mallinckrodt Hi-Contour Oral/Nasal Tracheal Tube Cuffed ID 7.5; Covidien, Hazelwood, Missouri, USA) obtained by properly coupling tube rotation, stylet stiffness and removal is provided (Supplemental Digital Content 1, http:// links.lww.com/EJA/A55). The stylet must be lubricated and shaped ‘straight-to-cuff’ with a bend angle at the extremity not exceeding 358. Its withdrawal will move the tip of the tube anteriorly while tube rotation will lead to extremity ‘dancing’. These conjoint manoeuvres of dynamic stylet intubation under videolaryngoscopic view can be extremely helpful in tracheal intubation owing to difficulty in tube advancing beyond the glottis opening, modified anatomy or oropharyngeal tumours.
Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: none. Conflicts of interest: none.
Airway obstruction in the immediate postoperative period can pose a threat to patient safety.1 The fourth National Audit Project of the Royal College of Anaesthetists showed that airway obstruction was a major contributor to airway-related complications.2 The purpose of this prospective audit was to assess the incidence and to quantify the severity and outcomes after airway obstruction in the recovery room of a tertiary care hospital. We also aimed to make recommendations for improvement in practice. Prior to the completion of this study, there were no data available for comparison at our institution. The Royal College of Anaesthetists proposes that less than 5% of postoperative patients should require airway support in postanaesthetic care unit (PACU), with less than 1% needing re-intubation of their trachea.3 Over a 2-month period, all patients admitted to PACU from the operating rooms were included in the audit. The study group comprised adult patients undergoing orthopaedic, urologic, thoracic, gynaecologic, vascular, upper gastrointestinal, colorectal, plastic or otorhinolaryngologic (ENT) surgical procedures. Patients undergoing day surgical procedures were excluded from the study. Being a quality assurance project, formal approval from the ethics committee was not required (Human Research and Ethics Committee, The Queen Elizabeth, Lyell McEwin & Modbury Hospitals, Chair: Dr Timothy Matthew, 15 September 2014).
Eur J Anaesthesiol 2015; 32:439–450 Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.
Correspondence
In the operating room, demographic data, anaesthetic technique and airway adjuncts (if utilised) were noted. Conscious state on arrival, episodes of airway obstruction or apnoea, need for airway support and outcomes were recorded in PACU. Airway obstruction was identified by the presence of heavy snoring, choking4 or presence of a tracheal tug with paradoxical breathing, that was responsive to simple airway interventions. Apnoea was defined as absence of airflow at the mouth for more than 10 s.4 Airway obstruction was classified as mild (normal oxygen saturation) (SpO2), moderate (SpO2
Fig. 1
References 1
2 3
Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59:675–694. Rai MR. The humble bougie. . .forty years and still counting? Anaesthesia 2014; 69:199–203. Greenland KB, Edwards MJ, Hutton NJ, et al. Changes in airway configuration with different head and neck positions using magnetic resonance imaging of normal airways: a new concept with possible clinical applications. Br J Anaesth 2010; 105:683–690. DOI:10.1097/EJA.0000000000000134
Rotate tube while withdrawing stylet.
Airway obstruction in the postanaesthetic care unit of a tertiary care centre A prospective audit
Fig. 2
William Curtis, Rajesh Sethi and Thavarajah Visvanathan From the Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South (WC, RS, TV), and University of Adelaide, Adelaide, South Australia, Australia (RS, TV) Correspondence to Dr Rajesh Sethi, MD, FRCA, FANZCA, Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia Tel: +61 08 8222 6640; fax: +61 08 8222 7065; e-mail: [email protected] Published online 13 February 2015
Editor,
A three dimensional tube dance is obtained.
(Figs 1 and 2). A two-panel picture of the main manoeuvres necessary to obtain tube dance is shown (Figs 1 and 2). A videolink of the dynamic tube movement (Mallinckrodt Hi-Contour Oral/Nasal Tracheal Tube Cuffed ID 7.5; Covidien, Hazelwood, Missouri, USA) obtained by properly coupling tube rotation, stylet stiffness and removal is provided (Supplemental Digital Content 1, http:// links.lww.com/EJA/A55). The stylet must be lubricated and shaped ‘straight-to-cuff’ with a bend angle at the extremity not exceeding 358. Its withdrawal will move the tip of the tube anteriorly while tube rotation will lead to extremity ‘dancing’. These conjoint manoeuvres of dynamic stylet intubation under videolaryngoscopic view can be extremely helpful in tracheal intubation owing to difficulty in tube advancing beyond the glottis opening, modified anatomy or oropharyngeal tumours.
Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: none. Conflicts of interest: none.
Airway obstruction in the immediate postoperative period can pose a threat to patient safety.1 The fourth National Audit Project of the Royal College of Anaesthetists showed that airway obstruction was a major contributor to airway-related complications.2 The purpose of this prospective audit was to assess the incidence and to quantify the severity and outcomes after airway obstruction in the recovery room of a tertiary care hospital. We also aimed to make recommendations for improvement in practice. Prior to the completion of this study, there were no data available for comparison at our institution. The Royal College of Anaesthetists proposes that less than 5% of postoperative patients should require airway support in postanaesthetic care unit (PACU), with less than 1% needing re-intubation of their trachea.3 Over a 2-month period, all patients admitted to PACU from the operating rooms were included in the audit. The study group comprised adult patients undergoing orthopaedic, urologic, thoracic, gynaecologic, vascular, upper gastrointestinal, colorectal, plastic or otorhinolaryngologic (ENT) surgical procedures. Patients undergoing day surgical procedures were excluded from the study. Being a quality assurance project, formal approval from the ethics committee was not required (Human Research and Ethics Committee, The Queen Elizabeth, Lyell McEwin & Modbury Hospitals, Chair: Dr Timothy Matthew, 15 September 2014).
Eur J Anaesthesiol 2015; 32:439–450 Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited.
Correspondence
In the operating room, demographic data, anaesthetic technique and airway adjuncts (if utilised) were noted. Conscious state on arrival, episodes of airway obstruction or apnoea, need for airway support and outcomes were recorded in PACU. Airway obstruction was identified by the presence of heavy snoring, choking4 or presence of a tracheal tug with paradoxical breathing, that was responsive to simple airway interventions. Apnoea was defined as absence of airflow at the mouth for more than 10 s.4 Airway obstruction was classified as mild (normal oxygen saturation) (SpO2), moderate (SpO2
