What is the most common reason for a difficult intubation?
The main factors implicated in difficult endotracheal intubation were poor dental condition in young patients, low Mallampati score and interincisor gap in middle-age patients, and high Mallampati score and cervical joint rigidity in elderly patients.
How do you know if intubation is difficult?
A reduction in space (<5 mm) between the C1 spinous process and the occiput, seen on a lateral neck radiograph taken in a neutral position, is recognized as an indicator of difficult intubation.
What does difficult intubation mean?
Difficult intubation has been defined as one that requires external laryngeal manipulation, laryngoscopy requiring more than 3 attempts at intubation, intubation requiring nonstandard equipment or approaches, or the inability to intubate at all.
How common is difficult intubation?
The prevalence of difficult intubation varies widely from 0.1% to 10.1% depending on the definition used [2,3]. There have been many definitions and methods to describe or predict difficult intubation, but predicting difficult intubation is difficult with low sensitivity and specificity [4,5].
What happens if you can’t intubate?
If it fails to provide an airway leave it in situ, to provide route for egress of air if needle cricothyrotomy needed. It is possible that, if suxamethonium is used, its rapid offset will allow the patient to ‘wake-up’ and regain their own airway before serious hypoxia ensues.
How do you prepare for difficult intubation?
Preparation of the patient Preoxygenate for a minimum of 3 minutes. During this time, either position the patient for intubation, or (if they cannot tolerate that position) prepare equipment and assistants to put them into that position as soon as the induction is commenced.
What is the best predictor of difficult intubation?
The greater the number of positive findings, the more likely intubation by direct laryngoscopy will be difficult. The highest positive predictive value comes from a history of difficulty with intubation, or findings of a short thyromental distance or decreased range of motion of the neck.
What happens if intubation fails?
When intubation has failed, face mask ventilation or LMA insertion may be difficult due to decreasing depth of anaesthesia and incomplete muscle relaxation. In this situation, the patient may not be sufficiently awake to spontaneously ventilate or deep/paralysed enough for ventilation to be effectively provided.
Who is difficult to intubate?
Given the prevalence of a difficult intubation of 10%, the inability to bite the upper lip with the lower incisors raises the probability of experiencing a difficult intubation to more than 60%. Other individual tests that are helpful include hyomental distance, retrognathia, and impaired mandibular protrusion.
How do you handle a difficult airway?
Noninvasive interventions intended to manage a difficult airway include, but are not limited to: (1) awake intubation, (2) video-assisted laryngoscopy, (3) intubating stylets or tube-changers, (4) SGA for ventilation (e.g., LMA, laryngeal tube), (5) SGA for intubation (e.g., ILMA), (6) rigid laryngoscopic blades of …
How do we manage difficult intubation?
Gas exchange can be maintained using mask ventilation after re-establishing the patency of the upper airway – or by use of a tube that entirely bypasses the upper airway, passing through the glottis directly into the trachea.