Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Mar 27, 2018; 7(1): 1-9
Published online Mar 27, 2018. doi: 10.5313/wja.v7.i1.1
Change in management of predicted difficult airways following introduction of video laryngoscopes
Mary Jarzebowski, Arvind Rajagopal, Bryce Austell, Mario Moric, Asokumar Buvanendran
Mary Jarzebowski, Arvind Rajagopal, Bryce Austell, Mario Moric, Asokumar Buvanendran, Department of Anesthesiology, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: Jarzebowski M and Rajagopal A designed the study; Jarzebowski M and Austell B performed the data collection; Moric M provided the statistical analysis; Jarzebowski M and Austell B wrote the manuscript with oversight and input from Rajagopal A and Buvanendran A; Jarzebowski M and Austell B performed edits on the manuscript; Austell B submitted the manuscript and all accompanying documents.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Rush University Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bryce Austell, MD, Doctor, Department of Anesthesiology, Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL 60612, United States. bryce_t_austell@rush.edu
Telephone: +312-9425000 Fax: +312-9428858
Received: December 4, 2017
Peer-review started: December 5, 2017
First decision: December 18, 2017
Revised: December 24, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: March 27, 2018
Processing time: 157 Days and 10.9 Hours
Abstract
AIM

To determine if video laryngoscopy (VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation (FOI).

METHODS

Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009 (“pre-VL” group) and over the same 2-mo period after the introduction of VLs in 2012 (“post-VL” group). Patient records with predicted difficult airways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.

RESULTS

To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually (P = 0.1768), it showed a trend toward significance when covariates were accounted for (P = 0.0910). Several factors predicting a higher likelihood of awake FOI were found to be statistically significant: Morbid obesity (larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender (P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score (P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.

CONCLUSION

Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.

Keywords: Difficult airway; Video laryngoscope; Awake fiberoptic intubation

Core tip: This study shows that the introduction of video laryngoscopes has not significantly impacted the management of predicted difficult airways in the operating room; specifically, that the rate of awake fiberoptic intubation (FOI), the previous gold standard for intubating a predicted difficult airway, has not decreased. Although video laryngoscopy (VL) has clear advantages compared to direct laryngocscopy and has been proven to have increased in popularity in the operating room for non-difficult airways, we postulate that the anesthesiologist’s assessment of the ability to mask ventilate is likely a key factor in the choice of awake FOI vs VL.