Vices Or Devices Y Ion Protocol.asa 2008

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ASA Annual Meeting Orlando, Florida on October 18-22, 2008. 2008 Scientific Abstracts -

Línea de Investigación en Vía Aérea: Protocolo y Encuesta de Extubación. CEDIVA DENIA | FORMACIÓN CONTINUADA EN VÍA AÉREA

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ASA Annual Meeting 2008. Orlando Anesthesiology 2008; 109 A1725 A1725 October 22, 2008 9:00 AM - 11:00 AM Room Hall E2-Area D, 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., Yvon F. Bryan, M.D. Department of Anesthesiology, Hospital G.U. Marina Alta, Denia, Alicante, Spain

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Managing the Difficult Airway at Extubation: Vices or Devices

• 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.[figure1]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.[figure2]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 individual's 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. CEDIVA DENIA | FORMACIÓN CONTINUADA EN VÍA AÉREA

Anesthesiology 2008; 109 A1725

Managing the Difficult Airway at Extubation: Vices or Devices

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•Managing the Difficult Airway at Extubation: Vices or Devices

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the 2008 ASA Annual Meeting in Orlando, FL on October 18-22, 2008.

2008 Scientific Abstracts October 22, 2008 9:00 AM - 11:00 AM Room Hall E2-Area D,

Extubating the Difficult Airway: A Protocol for Timing and Not Burning Bridges Francisca Llobell, M.D., Patricia Marzal, M.D., Luis Gonzalez, M.D., Lauren K. Hoke, B.S., Yvon F. Bryan, M.D. Department of Anesthesiology, Hospital G.U. Marina Alta, Denia, Alicante, Spain

Anesthesiology 2008; 109 A1729 CEDIVA DENIA | FORMACIÓN CONTINUADA EN VÍA AÉREA

Extubating the Difficult Airway: A Protocol for Timing and Not Burning Bridges

•Introduction Different airway devices may be used to facilitate extubating patients with difficult airways (1, 2). The timing and devices needed to bridge the extubation, however, depend on the patient's condition and risk. The possibility of aspiration, experiencing potential difficulty with oxygenation and ventilation and the need for re-intubation are problems frequently encountered. A protocol for extubation must take into account these problems and combine them with the timing of extubation and the availability of the necessary airway devices needed to bridge. We present our experience using a protocol for extubating patients with difficult airways. Methods The protocol for extubating patients with difficult airways combined the timing (immediate versus delayed) of extubation with the availability of the necessary airway devices required for bridging (see Figure 1). A table of airway devices set up according to their function was used for the patients (3).[figure1]Results No complications occurred in any patients in which the protocol was used (see Table 1).[figure2]Discussion The extubation protocol provided a strategy for timing the extubation with the necessary airway devices needed to bridge the extubation. The protocol was designed to take into account the risks associated with the patient's underlying condition and/or surgical intervention with the airway device best suited for the patient. By allowing for versatility, the protocol facilitated reassessing the patient's need to remain intubated, to bridge or to delay the extubation. Further studies are needed in the management of patients with difficult airways during extubation. References 1) Anesth Analg 2007; 105:1357-1362. 2) Anesth. Analg. 2007; 105: 1182–1185. 3) Llobell F, et al. Euroanaesthesia 2008 Annual Meeting. CEDIVA DENIA | FORMACIÓN CONTINUADA EN VÍA AÉREA

Extubating the Difficult Airway: A Protocol for Timing and Not Burning Bridges

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Extubating the Difficult Airway: A Protocol for Timing and Not Burning Bridges

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