Recommendations of Adhoc Committee
on Difficult Intubation
(28th July 1999)
Based on their discussion of the problems likely to be faced during difficult intubation the Committee recommended the following,
1) An intubation trolley should be made available in each OT. Each such trolley should be equipped with the following as a minimum,
a) Endotracheal tubes (ETT) of all sizes,
b) A range of microlaryngeal tubes (MLT’s),
c) Two adult and one paediatric laryngoscope handles with regularly checked batteries.
d) Laryngoscope blades
i) Adult,
(1) Medium and large curved blades (Macintosh, sizes 3 & 4),
(2) Long straight blade,
ii) Paediatric,
(1) Curved blades (Macintosh, sizes 1 & 2), and
(2) Straight blades (Miller, sizes 0 & 1).
e) Intubating stylets, one for adult and one for paediatric patients,
f) Tracheal tube introducers or gum elastic bougies, one for adult and one for paediatric patients,
g) A range of laryngeal mask airways (LMA’s), sizes 1 to 5,
h) A Failed Intubation Drill Chart.
2) Easy availability of other intubation aids (minimum of one set in each OT complex).
a) Fibre-optic laryngoscope (one adult and one paediatric size),
b) Flexi-tip laryngoscope.
3) To install a Code Blue “Panic Button” in each OT and in each recovery area, including the one in the day-care centre.
a) Pressing the button should activate an audio and visual alarm in the corresponding reception area alerting the nurse co-ordinator of a Code Blue situation.
b) The precise OT or recovery area activating the Code Blue must be displayed.
c) The alarm should only be resettable at the reception counter and only the co-ordinator should be empowered to reset the alarm.
d) The co-ordinator is then responsible to activate the Code Blue and to arrange for all necessary equipment and staff to be sent to the appropriate area. She should also alert all anaesthetists who may be free to assist their colleague.
e) A program to regularly check the working condition of the system must be implemented.
4) To facilitate communication especially during crisis situations, the intercom system in the OT’s should be repaired to working order. The staff must be educated on how to use it.
5)
To allow the anaesthetist to be
able to pay full attention to the monitoring of the patient and not be
distracted by the need to chart the patient data, an anaesthetic charting
system including a printer should be available in each OT
6)
Section 1.2 of the Recommendations
for Standards of Monitoring during Anaesthesia and Recovery, by the
Malaysian Society of Anaesthesiologists states,
1.2 Skilled assistance must be available for an anaesthetist throughout
an anaesthetic. Such assistance must be provided by an assistant who shall not
have duties other than providing assistance to the anaesthetist. The assistant
shall not attend to more than one patient at any one time when providing
assistance to the anaesthetist.
The Committee strongly recommends that this requirement be adhered to.
7) Where difficulty is anticipated, the anaesthetist should inform the nurse manager to ensure that he is given a suitably experienced assistant capable of coping with the case.
The above recommendations are to be submitted to Dr. Jacob Thomas, the Director of Subang Jaya Medical Centre for his consideration and action.
At the 15 December 1999 MAB meeting, Dr. Ngun asked Dr. Jacob Thomas concerning the introduction of an automated anaesthetic charting system as set out in item 5) above.
At the 19 January 2000 meeting, Dr. Thomas asked Dr. Ngun to communicate with Ms. Irene Quah on the matter.
However, at the 8 March 2000 MAB meeting, Dr. Thomas revealed that the hospital had decided to upgrade the 5 non-Narkomed anaesthetic machines. Dr. Ngun suggested that these be acquired with the automated printout system. Dr. Thomas agreed to this and also said that the other 4 Narkomed machines would be upgraded with the printout system at a later date.