All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

Ramkumar, Venkateswaran (2016) All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults. Indian Journal of Anaesthesia, 60 (12). pp. 885-898. ISSN 0019-5049

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Abstract

The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations Were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre‑oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway de ice (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart.

Item Type: Article
Uncontrolled Keywords: Complete ventilation failure; emergency cricothyroidotomy; pre‑oxygenation; supraglottic airway devices; unanticipated difficult intubation.
Subjects: Medicine > KMC Manipal > Anaesthesiology
Depositing User: KMC Library
Date Deposited: 13 Mar 2017 04:49
Last Modified: 13 Mar 2017 04:49
URI: http://eprints.manipal.edu/id/eprint/148425

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