Airway problems during surgery can be catastrophic:
A 58 year old male entered a major urban hospital for shoulder surgery. In the course of the lengthy surgery, an extravasation of fluid went unnoticed to the point where the patient’s airway was compromised. The patient remained unconscious in SICU and required lengthy intubation. Attempts to remove the tube were initially unsuccessful and the risk of a permanent ventilator was presented to the family of the individual as a possible outcome. The excuse? A thick neck.
A 57 year old active female was not so fortunate. She was admitted to a major urban hospital for neck surgery. In the course of the surgery something happened that resulted in a bilateral injury to her vocal cords and a permanent trach. In this case, the intubation was said to be a difficult one with multiple attempts.
In its December 2010 issue, the Commonwealth of Pennsylvania’s Patient Safety Authority in “Management of Unanticipated Difficult Intubation” argues that problems with intubation can be strategically anticipated so that they are properly managed. The article describes an analysis of the American Society of Anesthesiologists’ closed claims of medical malpractice for the period 1975 through 2000. Of the 2,632 patients within this group who died or were permanently brain-damaged, over 50 percent were due to “[r]espiratory-related damaging events.” In the latter category, these were most often difficult intubations and inadequate ventilation/oxygenation.
In the Commonwealth, 448 complications related to anesthesia were reported to the Authority in 2009. Of the number related to intubation problems, most were the result of unanticipated difficulties with intubation.
According to the Authority disastrous outcomes associated with difficulty in intubation can be reduced with proper steps such as a comprehensive preliminary patient assessment to anticipate possible problems, “multidisciplinary cooperation” entailing strategic planning of airway management and other steps such as awareness of difficult airways in patients with thick necks or sleep apnea.