Outpatient Surgery Magazine

The New Quality Standards - January 2013

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/153372

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Page 8 of 48

STANDARDIZING PRACTICE Defining the Difficult Airway W hat's a "difficult airway" anyway? Although there's no formal, standard definition, the American Society for CONSENSUS DESCRIPTION The ASA task force has provided a way to define and describe difficult airways in patient documentation. Anesthesiologists Task Force on the Difficult Airway sought to create one based on the literature and a consensus involving consultants, experts and members practicing nationwide. This process devised a streamlined definition: "The clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both." The task force suggests further describing a difficult airway in case documentation these ways: 1. Difficult facemask or supraglottic airway (SGA) ventilation. This includes situations in which, despite use of a laryngeal mask airway, intubating LMA and laryngeal tube, the anesthesia provider can't provide adequate ventilation. Issues may include one or more of the following: inadequate mask or SGA seal, excessive gas leak, or excessive resistance to the ingress or egress of gas. Physical signs include the following: absent or inadequate chest movement, absent or inadequate breath sounds, auscultatory signs of severe obstruction, cyanosis, gastric air entry or dilatation, decreasing or inadequate oxygen saturation (SpO2), absent or inadequate exhaled carbon dioxide, absent or inadequate spirometric measures of exhaled gas flow, and hemodynamic changes associated with hypoxemia or hypercarbia (hypertension, tachycardia, and arrhythmia, for example). 2. Difficult SGA placement. SGA placement requires multiple attempts, in the presence or absence of tracheal pathology. 3. Difficult laryngoscopy. It's not possible to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy. 4. Difficult tracheal intubation. Multiple attempts are required, whether or not tracheal pathology is present. 5. Failed intubation. Endotracheal tube placement fails after multiple attempts. — Robert Caplan, MD J A N U A R Y 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 9

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