This memorable case ended with the patient receiving a difficult air-
way letter that would warn future anesthesia providers about the
potential of facing a challenging intubation.
Jonathan E. Charnin, MD, foresaw that the patient's congenital
issues would lead to problems in adulthood that would likely
require several surgeries. Establishing the patient's airway proved
challenging, but Dr. Charnin was ready to manage it. "So, after the
successful surgery, I sent the patient home with a difficult airway
letter," says Dr. Charnin, an anesthesiologist at the Mayo Clinic in
Rochester, Minn.
That letter came in handy for both the patient, who, as expected,
wound up having several additional surgeries, and the patient's anes-
thesia providers.
"The patient could show up with the difficult airway letter and let
future providers know that this was an obstacle that they had to
address and manage," says Dr. Charnin.
Planning for failure
Dr. Hagberg says the mistakes providers commonly make generally
fall into 3 categories:
• failure, delay or difficulty in securing the
airway;
• aspiration of gastric contents; and
• extubation-related complications.
But it's human factors that ultimately lead to these mistakes. "It
comes down to poor assessment of the airway, poor planning, and a
lack of personal and institutional preparedness for managing difficult
airways," says Dr. Hagberg.
Her close call occurred back in 1992 and, as she now notes, "We
were not as equipped with intubation aids and devices as we are today.
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