Difficult intubation and extubation in adult anaesthesia.

Details

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_003572B44ECD
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Difficult intubation and extubation in adult anaesthesia.
Journal
Anaesthesia, critical care & pain medicine
Author(s)
Langeron O., Bourgain J.L., Francon D., Amour J., Baillard C., Bouroche G., Chollet Rivier M., Lenfant F., Plaud B., Schoettker P., Fletcher D., Velly L., Nouette-Gaulain K.
ISSN
2352-5568 (Electronic)
ISSN-L
2352-5568
Publication state
Published
Issued date
12/2018
Peer-reviewed
Oui
Volume
37
Number
6
Pages
639-651
Language
english
Notes
Publication types: Guideline ; Journal Article
Publication Status: ppublish
Abstract
To provide an update to French guidelines about "Difficult intubation and extubation in adult anaesthesia 2006".
A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Few recommendations were ungraded.
The panel focused on 6 questions: 1) Why must oxygen desaturation be avoided during intubation and what preoxygenation and oxygenation techniques should be used to prevent it? 2) Should videolaryngoscopes be used instead of standard laryngoscopy with or without a long stylet to achieve a better success rate of intubation after the first attempt during anticipated difficult intubation off fiberoptic intubation? 3) Should TCI or target controlled inhalation anaesthesia (TCIA) be used instead of bolus sedation for airway control in the event of suspected or proven difficulty in a patient spontaneously breathing? 4) What mode of anaesthesia should be performed in patients with difficult intubation criteria and potentially difficult mask ventilation? 5) In surgical patients, what criteria predict difficulties encountered during postoperative tracheal extubation? 6) Should decision trees and algorithms be employed to direct decision-making for the management of difficult intubation, whether foreseen or not? (based on the information from the preceding five issues). Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE <sup>®</sup> methodology.
The SFAR Guideline panel provided 13 statements on difficult intubation and extubation in adult anaesthesia. After two rounds of discussion and various amendments, a strong agreement was reached for 99% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), 8 have a low level of evidence (Grade 2±). No recommendation was provided for one question.
Substantial agreement exists among experts regarding many strong recommendations for the best care of patients with difficult intubation and extubation in adult anaesthesia.
Keywords
Adult, Airway Extubation/standards, Airway Management/standards, Algorithms, Anesthesia/standards, Anesthesiology, Guidelines as Topic, Humans, Intubation/standards, Intubation, Intratracheal, Difficult airway management, Difficult tracheal extubation, Difficult tracheal intubation, Strategy, Updated guidelines
Pubmed
Web of science
Open Access
Yes
Create date
31/05/2018 17:35
Last modification date
13/12/2019 6:20
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