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Difficult intubation and extubation in adult anaesthesia.
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 ® methodology. The SFAR Guideline panel ...
Difficult intubation and extubation in adult anaesthesia.
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 ® methodology. The SFAR Guideline panel ...
Difficult intubation and extubation in adult anaesthesia.
Langeron, O. (Autor:in) / Bourgain, J.L. (Autor:in) / Francon, D. (Autor:in) / Amour, J. (Autor:in) / Baillard, C. (Autor:in) / Bouroche, G. (Autor:in) / Chollet Rivier, M. (Autor:in) / Lenfant, F. (Autor:in) / Plaud, B. (Autor:in) / Schoettker, P. (Autor:in)
01.12.2018
Anaesthesia, critical care & pain medicine, vol. 37, no. 6, pp. 639-651
Aufsatz (Zeitschrift)
Elektronische Ressource
Englisch
Anesthesia/standards , Intubation , Strategy , Airway Management/standards , Adult , Humans , Intratracheal , Intubation/standards , Guidelines as Topic , Anesthesiology , Updated guidelines , Difficult airway management , Airway Extubation/standards , Difficult tracheal intubation , Difficult tracheal extubation , Algorithms
DDC:
690
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