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Procedural Challenges During Intubation in Patients With Oropharyngeal Masses: A Prospective Observational Study
- Source :
- Anesthesia and analgesia. 128(6)
- Publication Year :
- 2019
-
Abstract
- In patients who undergo surgery for oropharyngeal masses, intubation is almost always successful. However, technical aspects of airway management, including bag mask ventilation and oxygenation, may still be difficult. Although rates of airway difficulty and intubation success in these patients have been studied, these data may not reflect difficulty with individual components of the intubation process. We hypothesized that rates of complications with individual elements of the intubation process would not be reflected in the rate of eventual intubation success. To test our hypothesis, we observed the process of airway management and resulting complications with oxygenation and bag mask ventilation in patients with oropharyngeal masses undergoing otorhinolaryngology procedures under general anesthesia.Forty-four patients with oropharyngeal masses scheduled for surgery were observed during the process of airway management. Observers recorded the number of airway devices used, the overall number of intubation attempts, the number and type of manual maneuvers required during bag mask ventilation, and the incidence of oxygen desaturation. The eventual intubation success rate was also recorded.All 44 patients (100%; 95% CI, 92%-100%) were successfully intubated. Thirty-six (81.8%) of 44 patients were intubated asleep and 8 (18.2%) of 44 were intubated awake using flexible fiberoptic bronchoscopy. Thirty-one (86.1%) of 36 patients who were intubated asleep received bag mask ventilation before intubation, while the other 5 patients underwent a rapid sequence induction. Twenty-seven (61.4%) of 44 patients (95% CI, 45%-75%) had ≥1 complication during airway management. Ten (23%) of 44 patients (95% CI, 11%-37%) required ≥3 attempts to intubate, 21 (68%) of 31 patients (95% CI, 49%-83%) had difficult mask ventilation, and 15 patients (34%; 95% CI, 20%-50%) experienced desaturation (oxygen saturation measured by pulse oximetry,95%).We found that, although all patients were successfully intubated, clinicians frequently encountered complications with both intubation and mask ventilation. These complications required frequent use of additional manual maneuvers during mask ventilation and a high incidence of oxygen desaturation. The difficulty of airway management in patients with oropharyngeal masses may not be effectively assessed by success rate alone.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Laryngoscopy
Anesthesia, General
Laryngeal Masks
03 medical and health sciences
0302 clinical medicine
Bronchoscopy
030202 anesthesiology
medicine
Intubation, Intratracheal
Intubation
Fiber Optic Technology
Humans
Oximetry
Prospective Studies
Airway Management
Intensive care medicine
Prospective cohort study
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
respiratory system
Middle Aged
Respiration, Artificial
Ventilation
Oxygen
Oropharyngeal Neoplasms
Anesthesiology and Pain Medicine
Breathing
Observational study
Airway management
Female
business
Airway
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15267598
- Volume :
- 128
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Anesthesia and analgesia
- Accession number :
- edsair.doi.dedup.....8d3108ee98b7e6fa7d2628a56404e4ec