Anesthesia Experts

Procedural Challenges During Intubation in Patients With Oropharyngeal Masses

by Leave a Comment

AUTHORS: Bryan, Yvon F. MD et al

Anesthesia & Analgesia: June 2019 – Volume 128 – Issue 6 – p 1256-1263
BACKGROUND: In patients who undergo surgery for oropharyngeal masses, intubation is almost always successful. However, technical aspects of airway management, including bag mask ventilation and oxygenation, may still be difficult. Although rates of airway difficulty and intubation success in these patients have been studied, these data may not reflect difficulty with individual components of the intubation process. We hypothesized that rates of complications with individual elements of the intubation process would not be reflected in the rate of eventual intubation success. To test our hypothesis, we observed the process of airway management and resulting complications with oxygenation and bag mask ventilation in patients with oropharyngeal masses undergoing otorhinolaryngology procedures under general anesthesia.

METHODS: Forty-four patients with oropharyngeal masses scheduled for surgery were observed during the process of airway management. Observers recorded the number of airway devices used, the overall number of intubation attempts, the number and type of manual maneuvers required during bag mask ventilation, and the incidence of oxygen desaturation. The eventual intubation success rate was also recorded.

RESULTS: All 44 patients (100%; 95% CI, 92%–100%) were successfully intubated. Thirty-six (81.8%) of 44 patients were intubated asleep and 8 (18.2%) of 44 were intubated awake using flexible fiberoptic bronchoscopy. Thirty-one (86.1%) of 36 patients who were intubated asleep received bag mask ventilation before intubation, while the other 5 patients underwent a rapid sequence induction. Twenty-seven (61.4%) of 44 patients (95% CI, 45%–75%) had ≥1 complication during airway management. Ten (23%) of 44 patients (95% CI, 11%–37%) required ≥3 attempts to intubate, 21 (68%) of 31 patients (95% CI, 49%–83%) had difficult mask ventilation, and 15 patients (34%; 95% CI, 20%–50%) experienced desaturation (oxygen saturation measured by pulse oximetry, <95%).

CONCLUSIONS: We found that, although all patients were successfully intubated, clinicians frequently encountered complications with both intubation and mask ventilation. These complications required frequent use of additional manual maneuvers during mask ventilation and a high incidence of oxygen desaturation. The difficulty of airway management in patients with oropharyngeal masses may not be effectively assessed by success rate alone.

Leave a Reply

Call (660) 596-2224
What people thought about us

Testimonials

“As Director of Surgical Services Departments there has been considerable changes have occurred in my department and Anesthesia Experts has always risen to meet our demands of our facility. They have been very pro-active in meeting the increase volumes allowing us to keep our surgeons and patients very satisfied with our services.”

AR BSN 346 beds AL   

“Before AE took over the anesthesia department was described by the surgeons as the worst in the history of our hospital. The prior management company was having a cancelled surgery per day. I am happy to report there has not been one since they have taken over the department. Additionally we have seen a 905 reduction if requested preop
lab tests. The anesthesia department is now the very best hospital department in our entire facility.”

DS CEO 272 beds MS   

“Anesthesia Experts has provided consistent anesthesia providers who display a high degree of integrity, responsibility and professionalism. They have become a more valuable part of our facility and community.”

LR CEO 150 beds TX   

“Even though they are physically located 1000 miles away Anesthesia Experts just does not provide great anesthesia coverage they personally engage surgeons to increase their business. Last year my surgical volume rose by 24% and we are currently 50% ahead of last year and all of that growth is organic.”

JE FACHE CEO AL 92 bed hospital   

“Anesthesia Experts is more responsive than anyone I have dealt with. They are available by phone whenever needed and will be on site for any need or request and has been on site to address issues before we can make the request.”

SW CEO 25 beds NM   

“While problems are extremely rare when they do occur Anesthesia Experts quickly and professionally implements a solution. Our surgical volume has grown over 100 cases per month and now our GI docs want to perform all of their endoscopies in our hospital instead of their GI lab that they own!”

SP CEO 346 beds AL   

“Our anesthesia department was a thorn in my side that kept me awake at night. Anesthesia Experts swept in and brought order to our mess and our department was quickly redirected.”

JAM CNO AL 89 bed hospital   

Add a Testimonial

Verification Captcha