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Other hazards associated with difficulty in airway management have been highlighted in recent publications. Encountering difficult tracheal intubation in the unconscious patient is a concern, as many studies involving several specialties have documented increasing patient morbidity with multiple tracheal intubation attempts. Conversely, unanticipated failure of tracheal intubation by direct laryngoscopy or other technique can occur when no such challenges were expected. Accordingly, when general anesthesia (GA) is induced despite predictors of difficult intubation, many cases prove unchallenging. The pediatric airway: special considerationsĭocumentation following an encounter with a difficult airwayĮducation in the management of a difficult airwayīedside predictors of difficult tracheal intubation are imperfect. The obstetric airway: special considerations L imits to attempts at tracheal intubationįailed oxygenation: the emergency strategy
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The alternative approach to tracheal intubation: “Plan B” in the adequately oxygenated patientįailed tracheal intubation in the adequately oxygenated patient U nsuccessful primary approach to tracheal intubation
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R esponse to difficulty encountered in the unconscious patient The primary approach to tracheal intubation: “Plan A” Management of the difficult and failed airway in the unconscious/induced patient These statements differ from existing recommendations in order to simplify decision-making when failed tracheal intubation or failed oxygenation is encountered in the unconscious/induced patient. Why do these statements differ from existing recommendations? The importance of engaging an exit strategy after a limited number of attempts at tracheal intubation is emphasized, as is a simplified response to a failed oxygenation, “cannot intubate, cannot oxygenate” situation.
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These statements reflect current evidence and thinking on an appropriate response to difficult airway management encountered in the unconscious/induced patient. How do these statements differ from existing recommendations? In addition, the Anesthesia Closed Claims Project and other observational studies have highlighted potential areas for improvement in management of the difficult and failed airway. Since the last review, many new devices useful in difficult airway management have been introduced. Why were these recommendations developed?Ĭanadian recommendations were overdue for an update. More recent national recommendations and guidelines on difficult airway management have been published in the USA, the United Kingdom, and other western European countries. In 1998, Canadian recommendations were published on management of the unanticipated difficult airway. What other statements of recommendation are available on this topic? Celle-ci peut alors être effectuée rapidement et parallèlement à la réalisation de la cricothyrotomie. Il est alors impératif de procéder sans délai à une cricothyrotomie, à moins que l’insertion d’un dispositif supraglottique n’ait été tentée. Une situation dans laquelle il est impossible de procéder à l’oxygénation du patient à l’aide d’un masque facial, d’un dispositif supraglottique ou de l’intubation endotrachéale est qualifiée de scénario cannot intubate, cannot ventilate. Nonobstant la ou les techniques choisies, un maximum de trois tentatives infructueuses mène à la conclusion qu’il s’agit d’un échec d’intubation et devrait inciter le clinicien à adopter une stratégie de retrait. Il est possible d’éviter de telles lésions en abandonnant rapidement une technique d’intubation infructueuse afin d’opter pour une méthode alternative (ou ‘plan B’) à condition que l’oxygénation par masque facial ou par l’utilisation d’un dispositif supraglottique s’avère possible. Le clinicien doit avoir conscience des lésions qu’il peut infliger lors de tentatives multiples d’intubation trachéale.