2017-18 HSC Section 3 Green Book

II.

Critical Care and Perioperative Care A. OSA considerations and airway management 1. Best practices for airway management

Aziz MF, Brambrink AM, Healy DW, et al. Success of intubation rescue techniques after failed direct laryngoscopy in adults: a retrospective comparative analysis from the Multicenter Perioperative Outcomes Group. Anesthesiology . 2016; 125(4):656- 666. EBM level 4..............................................................................................103-113 Summary : This is a recent large, multi-centered observational study describing success of rescue techniques after direct laryngoscopy has failed. It found that video laryngoscopy was superior to other rescue techniques. Darby JM, Halenda G, Chou C, et al. Emergency surgical airways following activation of a difficult airway management team in hospitalized critically ill patients: a case series. J Intensive Care Med . 2016 Nov 28. pii: 0885066616680594. [Epub ahead of print]. EBM level 4.............................................................................114-123 Summary : This article from University of Pittsburgh focuses on the surgical outcomes in difficult airway patients in a critical care setting. Specifically, it reviews the incidence of surgical airway management in difficult airway scenarios in addition to the morbidity and mortality associated with these interventions. Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope ® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Can J Anaesth . 2016; 63(8): 928-937. EBM level 1..................................................124-133 Accompanying Letter : Robert J, Gu Y, Law JA. In reply: deliberately restricted laryngeal view with GlideScope ® video laryngoscope: ramifications for airway research and teaching. Can J Anaesth . 2016; 63(9):1103. EBM level 1................134 Summary : This nice study demonstrated that the best view with the GlideScope may make intubation more difficult; the recommendation is to withdraw the blade and sacrifice the view for better alignment of tube insertion. 2. Best practices for perioperative management of OSA patients undergoing general anesthesia Asha’ari ZA, Rahman JA, Mohamed AH, et al. Association between severity of obstructive sleep apnea and number and sites of upper airway operations with surgery complications. JAMA Otolaryngol Head Neck Surg . 2017; 143(3):239-246. EBM level 4.................................................................................................................135-142 Summary : This study is a retrospective cohort study of 95 patients who underwent upper airway surgery for obstructive sleep apnea. The overall 30-day complication rate was increased with age and higher body mass index. Complication rates were not associated with apnea-hypopnea index severity, type of procedure, or whether the surgery was a single or combination surgery.