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Lnea de Investigacin en Va Area:

Protocolo y Encuesta de Extubacin.

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ASA Annual Meeting

Orlando, Florida on October 18-22, 2008.

2008 Scientific Abstracts -

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Welcome to the ASA Annual Meeting Abstract Website.

We look forward to seeing you all for the 2008 ASA Annual Meeting in

Orlando, FL on October 18-22, 2008. 2008 Scientific Abstracts -

ASA Copyright Disclaimer 2008 Meeting - The 2008 ASA AnnualMeeting will be held October 18-22 in Orlando, FL.

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A1725

October 22, 2008

9:00 AM - 11:00 AM

Room Hall E2-Area D,

Managing the Difficult Airway at Extubation: Vices or Devices

Francisca Llobell, M.D., Patricia Marzal, M.D., Maria Serna, M.D., Lauren K.

Hoke, B.S., Yvon F. Bryan, M.D.

Department of Anesthesiology, Hospital G.U. Marina Alta, Denia, Alicante, Spain

ASA Annual Meeting 2008. Orlando

Anesthesiology 2008; 109 A1725

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Problems encountered during extubation of patients with difficult airways are prevalent though formal guidelines seem to

be lacking (1). This dichotomy of problems occurring at extubation and a lack of specific strategies may be due to

anesthesiologist experience and/or training with specialized airway devices required during the management of thedifficult airway (2). Certain airway devices may be best suited for rescue (oxygenation and ventilation) while others arebetter used to bridge (reintubation) and to delay the extubation. We surveyed Spanish anesthesiologists about their

clinical practice management for the extubation of patients with difficult airways.

Methods

A survey was sent to the anesthesiology departments of 38 hospitals in the provinces of the Comunidad Valenciana(Castellon, Valencia, Alicante) and cities in the Comunidad Murciana (Murcia, Orihuela) of Spain. The survey consistedof 10 questions pertaining to the clinical management at extubation of patients with difficult airways (see Table 1). The

surveys were completed anonymously and returned via self-return envelope to Hospital G.U. Marina Alta in Denia

(Alicante), Spain.[figure1]Results

A total of 10 out of 38 anesthesiology departments completed and returned the survey (as of March 1, 2008) totaling 120anesthesiologists. Problems at extubation were reported by 95% of respondents with only 12% having a formal

extubation protocol. 34% reported experiencing difficulty with reintubation and 23% reported patients requiring surgicalaccess for airway support. 7% reported a patient death or a severe brain injury as a consequence of problems occurringat extubation. Of the airway devices used to rescue, 76% were supralaryngeal devices (LMA, ILMA, Proseal LMA). To

bridge the extubation, supralaryngeal devices and airway exchange catheters were used 53% and 16% of the time,respectively. See Table 2.[figure2]Discussion

Our survey found a very high incidence of problems occurring at extubation in patients with difficult airways. A lack of

established extubation protocols and training with specialized airway devices may be the reason for the problems. Thedevices used to rescue and bridge the extubation by the majority of respondents were supralaryngeal in nature. This mayhave reflected the individual's training with these devices, the unavailability of certain devices or not being familiar withother types of devices (ie, airway exchange catheters). Further research is required in the management of the difficult

airway to discern which devices are best suited for rescuing and/or bridging during extubation.

References

1) Anesthesiology 2005:103(1);33-9.

2) Anesthesiology 2007:100;A934.

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October 22, 2008

9:00 AM - 11:00 AM

Room Hall E2-Area D,

the 2008 ASA Annual Meeting in Orlando, FL on October 18-22, 2008.

2008 Scientific Abstracts -

Extubating the Difficult Airway: A Protocol

for Timing and Not Burning BridgesFrancisca Llobell, M.D., Patricia Marzal, M.D., Luis Gonzalez,M.D., Lauren K. Hoke, B.S., Yvon F. Bryan, M.D.

Department of Anesthesiology, Hospital G.U. Marina Alta,

Denia, Alicante, Spain

Anesthesiology 2008; 109 A1729

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Extubating the Difficult Airway: A Protocol for Timing and Not Burning Bridges

Introduction

Different airway devices may be used to facilitate extubating patients with difficult airways (1, 2). The timing

and devices needed to bridge the extubation, however, depend on the patient's condition and risk. Thepossibility of aspiration, experiencing potential difficulty with oxygenation and ventilation and the need forre-intubation are problems frequently encountered. A protocol for extubation must take into account these

problems and combine them with the timing of extubation and the availability of the necessary airwaydevices needed to bridge. We present our experience using a protocol for extubating patients with difficult

airways.

Methods

The protocol for extubating patients with difficult airways combined the timing (immediate versus delayed)

of extubation with the availability of the necessary airway devices required for bridging (see Figure 1). Atable of airway devices set up according to their function was used for the patients (3).[figure1]Results

No complications occurred in any patients in which the protocol was used (see Table 1).[figure2]Discussion

The extubation protocol provided a strategy for timing the extubation with the necessary airway devicesneeded to bridge the extubation. The protocol was designed to take into account the risks associated with

the patient's underlying condition and/or surgical intervention with the airway device best suited for thepatient. By allowing for versatility, the protocol facilitated reassessing the patient's need to remain

intubated, to bridge or to delay the extubation. Further studies are needed in the management of patientswith difficult airways during extubation.

References

1) Anesth Analg 2007; 105:1357-1362.

2) Anesth. Analg. 2007; 105: 11821185.

3) Llobell F, et al. Euroanaesthesia 2008 Annual Meeting.

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