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Herculean’ Study of Airway Complications Finds Room For Improvement

by David Wild
 
Airway management experts are hailing a large-scale review of airway-related complications in the United Kingdom as “herculean,” saying it yields important insights into the nature of airway management complications. Based on the results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4), up to 75% of the 184 serious airway complications reported could have been averted if better airway management practices were used (Br J Anaesth 2011;106:617-631).

“The amount of information here is a treasure trove,” said Richard Cooper, MD, professor in the Department of Anesthesia at the University of Toronto, in Canada, and president-elect of the Society for Airway Management.

Lead investigator Tim Cook, MBBS, and his team analyzed data from a United Kingdom national registry that included 2.9 million general anesthesia procedures conducted between September 2008 and September 2009. The data included 184 serious airway complications that led to death, brain damage, emergency airway surgery, unanticipated admission to the intensive care unit (ICU) or prolonged ICU stay.

Two panels, each including at least five physicians from a range of clinical specialties, reviewed each complication and determined the precipitating factors, severity of the event and quality of airway management.

Of the complications, 133 occurred during anesthesia; 36 occurred in the ICU; and 15 events took place in an emergency department. Sixteen cases of anesthesia-related airway complications resulted in death; three led to brain damage; six were associated with a partial recovery; and 106 ended with complete recovery. Two patients with anesthesia-related airway complications died from complications not related to the airway.

Dr. Cook, consultant in the Department of Anaesthesia at Royal United Hospital, in Bath, England, said that approximately 40% of anesthesia-related airway complications developed in patients with acute or chronic head, neck or tracheal disease, and 70% of those occurred in patients with obstructive lesions...
 
The complete NAP4 report, as well as presentations and podcasts, can be found online at www.rcoa.ac.uk/index.asp?PageID=1089.
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