Vices, Devices Poster

Managing the difficult airway at extubation: Vices or devices Francisca Llobell, M.D.1, Patricia Marzal, M.D.1, Maria Serna, M.D.1, Lauren K Hoke B.S.2, Yvon F. Bryan, M.D.2 1. Hospital G. U. Marina Alta, Denia (Alicante), Spain 2. Wake Forest University Baptist Medical Center, Winston-Salem, NC

Introduction •Problems occur during extubation in patients with difficult airways (DA’s)

Methods Table 1: Extubation survey questions

•Different airway devices may be used at extubation or for re-intubation

Discussion •High incidence of problems occured at extubation •Anesthesiologist experience and familiarity with different airway devices may have influenced choice of device

•[Timing of extubation depends on operator decision]

•Further research required in developing protocols for use during extubation in patients with DA’s

•We present experience of anesthesiologists in a region of Spain during extubation of patients with DA’s

Abstract Methods

Results

Title: Managing the difficult airway at extubation: Vices or devices   Francisca Llobell, M.D., Patricia Marzal, M.D., Maria Serna, M.D., Lauren K Hoke, B.S. and Yvon F Bryan, M.D.. Department of Anesthesiology, Hospital G.U. Marina Alta, Denia, Alicante, Spain.

•Survey consisted of 10 questions regarding management of DA during extubation •Surveyed 38 anesthesiology departments in Communities of Valenciana and Murciana in Spain

  Introduction Problems encountered during extubation of patients with difficult airways are prevalent though formal guidelines seem to be lacking (1). This dichotomy of problems occurring at extubation and a lack of specific strategies may be due to anesthesiologist experience and/or training with specialized airway devices required during the management of the difficult airway (2). Certain airway devices may be best suited for rescue (oxygenation and ventilation) while others are better used to bridge (reintubation) and to delay the extubation. We surveyed Spanish anesthesiologists about their clinical practice management for the extubation of patients with difficult airways. Methods A survey was sent to the anesthesiology departments of 38 hospitals in the provinces of the Comunidad Valenciana (Castellon, Valencia, Alicante) and cities in the Comunidad Murciana (Murcia, Orihuela) of Spain. The survey consisted of 10 questions pertaining to the clinical management at extubation of patients with difficult airways (see Table 1). The surveys were completed anonymously and returned via self-return envelope to Hospital G.U. Marina Alta in Denia (Alicante), Spain. Results A total of 10 out of 38 anesthesiology departments completed and returned the survey (as of March 1, 2008) totaling 120 anesthesiologists. Problems at extubation were reported by 95% of respondents with only 12% having a formal extubation protocol. 34% reported experiencing difficulty with reintubation and 23% reported patients requiring surgical access for airway support. 7% reported a patient death or a severe brain injury as a consequence of problems occurring at extubation. Of the airway devices used to rescue, 76% were supralaryngeal devices (LMA, ILMA, Proseal LMA). To bridge the extubation, supralaryngeal devices and airway exchange catheters were used 53% and 16% of the time, respectively. See Table 2.   Discussion Our survey found a very high incidence of problems occurring at extubation in patients with difficult airways. A lack of established extubation protocols and training with specialized airway devices may be the reason for the problems. The devices used to rescue and bridge the extubation by the majority of respondents were supralaryngeal in nature. This may have reflected the individuals training with these devices, the unavailability of certain devices or not being familiar with other types of devices (ie, airway exchange catheters). Further research is required in the management of the difficult airway to discern which devices are best suited for rescuing and/or bridging during extubation.   References 1) Anesthesiology 2005:103(1);33-9. 2) Anesthesiology 2007:100;A934