Difficult Intubation

• Introduction
• Relevant Material
• Proposal
• Postings
• Action Taken
• Adhoc Committee on Difficult Intubation

Introduction

Relevant Material

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Anne has added yet another article for your perusal. Most unfortunately, the quality of the next article is much, much worse than the previous one. So don't bother to tell me if you can't read it. I can't either. If any of you have a better copy, please pass it to me. The article is entitled,

Proposal

1. The first matter is for all of us to make our suggestions on what steps need to be taken so that we don't need to panic so much when such a situation recurs. In particular, you should all give your opinion on what equipment needs to be acquired and be made available.
2. The second matter concerns our current practice of offering general anaesthesia as a first choice to patients undergoing Caesarean sections. Should we reconsider and push much harder for a change to regional anaesthesia as a first choice for all patients going for Caesarean sections?

Postings

We already have the fibreoptic intubating laryngoscope and recently, the Flex Tip laryngoscope blade and the Portex introducer have been added to our armamentarium. Radha has suggested the straight blade (small, medium and large).

A intubating cart with the necessary equipment is being readied for each OT complex.

As aspiration pneumonia and inability to intubate are often quoted as the most common cause of death in patients undergoing Caesarean sections, I think we need to seriously think of changing our style of anaesthesia. If a regional takes longer to perform, the surgeons will just have to learn to wait a little longer for the case to be ready.

Patient safety has to be paramount in our minds and we would be failing in our responsibility if we did not stand our ground on this matter.

The only exception is dire cases where the slightest delay may be detrimental to the well-being of the foetus.

2 of 2
difficult intubation
From: gasbach
Date: May 22 1999

I agree that a so called difficult intubation tray or cart be available/handy.

Besides the usual suggestions,one other item that I have come across in some units is as follows;

• A 14 G canula,a suitable Portex connector (I think a size 5 will be suitable). If all else fails, punture the cricothyroid ligament with 14 G canula, remove the needle attech Portex connector and then the patient can be ventilated through this using an anaesthetic circuit.
• Another suggestion is a Minitracheostomy set.We use to do this quite often in UK for patients with retention of secretions who needed suction and not ventilation and it is actually a piece of cake as far as doing is concerned.

Action Taken

1. The suggestions for the equipment will be forwarded to the hospital management
2. Regional anaesthesia should be encouraged in patients for Caesarean section especially if difficult intubation is suspected.

Adhoc Committee on Difficult Intubation

The hospital organised an adhoc committee on this issue on 28 July 1999. The committee met and made its recommendations which have been submitted to Dr. Jacob Thomas, SJMC Director.