DIFFICULT AIRWAY SOCIETY MEMBERS EZINE February 2024 Edition
February 2024
REMINDER TO DAS MEMBERS Please remember to update your details if your address or email address changes! Members can update their details by emailing das@anaesthetists.org
WE WANT TO HEAR FROM YOU DAS encourages member participation – we would love to read your comments, contributions and suggestions for future E-Zines. Have you been involved in an interesting airway case? Is there an article that has changed your practice? Do you have an idea for improving airway anaesthesia that you would like to collaborate on? All formats welcome: text, video, photo, infographic… We know you are a creative bunch! The E-Zine is something we are passionate about and we love to hear from you about it . We want it to be as useful to members as possible so please do get in contact with any suggestions and/or feedback - ezine@das.uk.com or tag us on X / Twitter @dasairway or @dastrainees
@dasairway @dastrainees
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Dif cult Airway Society E-Zine
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February 2024
CONTENTS Executive Updates
Trainees
Editorial
4
Trainee Competition
DAS Executive Update
5
Journal Club - Recommended Reads
DAS Scienti c Of cer Report
7
DAS Professorship Applications
9
2023 Macewen Medal - Prof Anil Patel
10
2023 DAS Professor - Prof Andy Higgs
12
31 32
Miscellaneous Airway Leads Update
33
Dif cult Airway Database
34
Education Conference Corner 2023 DAS ASM Highlights
13
Clinical Dilemma
15
What's new about CICO and eFONA?
20
WAMM 2025
36
Anaesthetic management for patients living with obesity 24 2024 DAS Webinars
28
#JanuAIRWAY - The Compilation
30
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EDITORIAL | Nisha Abraham-Thomas | Moon-Moon Majumdar |
A warm welcome to the February edition of
living with obesity. We thank all of the authors
the Dif cult Airway Society e-zine!
involved for their contributions.
We look back on another successful year for
Our clinical dilemma discusses anaesthesia
the society. We had a fantastic time at the
for laryngeal laser surgery. What do you do?
2023 DAS Annual Scienti c Meeting and
How does your approach differ in the event of
hope you did too! In this month's e-zine we
airway compromise?
share highlights from the conference.
We are incredibly excited to announce this
Congratulations goes to Professor Anil Patel who was awarded the DAS Macewen medal, and to Professor Andy Higgs who was
year's trainee competition - see more details on page 31. We can't wait to see your submissions!
conferred the 2023 DAS Professorship. A huge thank you to the local organising
Finally, we would like to say a special thank
committee for delivering such a high yield
you to our outgoing DAS trainee
educational meeting.
representative Natalie Silvey. We wish her all the best for the future!
2024 has already got off to a great start with the annual #JanuAIRWAY educational series.
As always, we love to hear from you so if you
We are eagerly looking forward to exciting
have any comments, feedback or
events ahead including the 2024 DAS ASM in
contributions, then please get in touch with
London, and the World Airway Management
our editorial team by emailing
Meeting (WAMM) to be held in Florence in
ezine@das.uk.com or tag us on X / Twitter
2025. Save the dates in your diary and
@dasairway or @dastrainees. Now, sit back
register your interest now!
with a coffee and enjoy the read!
The educational articles in this month's
Nisha Abraham-Thomas
edition focus on two hot topics in airway
Moon-Moon Majumdar
management - updates in emergency front of neck access, and anaesthesia for patients
DAS Trainee Representatives
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EXECUTIVE UPDATE | Ravi Bhagrath | Imran Ahmad | Fauzia Mir |
Welcome to the rst edition of the DAS ezine
There were also excellent abstract
in 2024. There are a number of updates on
submissions for the poster and oral
the Airway front and numerous new projects
presentations. The enthusiastic presenters
and ideas for all of us at DAS central to
and delegate attendance at these
pursue.
presentations re ected the high quality and interest these generated. Other highlights
We have had a steady increase in our
were the 2023 DAS Professorship being
membership numbers (both associate and
awarded to Professor Andy Higgs, the
full members) with a total number of 3727
Macewen medal awarded to Professor Anil
including 332 new members in the last year.
Patel and the trade partner award going to
The attendance at the Birmingham ASM led
Simon Murray. We also welcomed Nisha
by Dr Achuthan Sajayan re ected this,
Abraham-Thomas, our new trainee
marking the end of a successful year.
representative, and look forward to working
Over 700 delegates attended the two days of Scienti c programme and with all the
The venue will be at one of the most iconic
hugely successful meeting. Delegates from
places in Central London, the Guildhall, lled
all over the world attended the 3 days lled
with history and character along with a
with fun, learning and networking. Amongst
museum to visit and explore the history of the
the excellent speakers from all over the
city. The Gala dinner will be held at the
airway world, we had Dr Richard Harris, the
House of Commons, one to be remembered
Thai cave rescue lead, who shared his experiences with the delegates. His talk was a memorable highlight and he deservedly received a standing ovation from the awe inspired audience.
with her over the next few years. This year’s DAS ASM will be held in London.
workshops completely full, it was another
for sure. The places are restricted for this unique experience so early registration and booking is recommended, so please look out for the registration details once they are released.
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On the projects front, DAS Intubation
huge amount of interest, the Airway Leads day
guidelines are progressing well with a
led by Dr Sandeep Sudan has been planned
completion date of November 2025 at the
for March and the Regional Airway Meeting
WAMM meeting in Florence, Italy. The Ethics
(https://regionalairwaymeeting.com )in
guidelines are shaping up and nearly
Malaysia are some of the events to note in the
complete. We hope to see a full version of
diaries.
these at the London ASM in November 2024. The FONA database led by Dr Alistair
The DAS constitution has been in need of updating and this project has now been taken
McNarry is progressing steadily and we will
over and led by Dr Alistair McNarry, so watch
be hearing updates at the next ASM.
this space. We look forward to working on all
We have been updating the DAS website over
of these exciting projects and events over the
the past year and we are delighted to
forthcoming year with you, and hope to see
announce that a new fully functional website
you all in November at the London DAS ASM.
will be launched at the end of this year. It has taken considerable effort, time and organisation by the committee to reach this
Fauzia Mir, DAS Treasurer
stage and we are almost there now!
Imran Ahmad, DAS President
DAS has an exciting year ahead with regards
Ravi Bhagrath, DAS Secretary
to the educational activities planned. A number of DAS webinars (free to DAS members) have been scheduled, the excellent Januairway series has already generated a
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February 2024
SCIENTIFIC OFFICER REPORT | Kariem El-Boghdadly | Airway management remains high-
rolling process of grant funding via
stakes, but we continue to strive to
direct application to DAS.
improve patient safety and quality.
Applications for funding of up to
In recent months, we have seen
£5,000 for studies broadly related
practice-changing publications,
to airway management will be
several projects with wide-
peer-reviewed. Further details are
reaching implications, and
available on the DAS website or by
continued interest in research.
contacting me directly. We have
DAS remains at the global forefront
already funded one application,
of this, providing several academic
and we are always open to receive more.
opportunities to members. It is down to you,
Reach out for more information on this today!
the DAS Membership, to take advantage of these opportunities, develop yourselves
2.
professionally, get engaged in academia,
DAS Grants via the NIAA. DAS funds
up to £20,000, split between large Project
and, importantly, harness the chance to
Grants (up to £15,000) and Small Grants (up
improve patient care.
to £5,000). Last year saw a single application
A CALL TO APPLY FOR OPPORTUNITIES...
round, with one application of £15,000 being
1.
received. The rst round of 2024 closes in
Direct DAS Grants. To ensure
continuity and sustainability of grass-roots
February. We look forward to receiving
airway management research, we have a
applications through this stream.
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3.
February 2024
appropriate forms of scholarship, and through
DAS PhD Programme. This
Programme gives support to researchers who
teaching and administration. Following an
have a list of publications that may be
extremely competitive series of previous
suitable to put together as a PhD. DAS will
rounds, the application will open early in 2024.
support applicants throughout the process of a PhD by publication, including funding
Our vision remains to take continue to
support.
cultivate academia through DAS and airway management, and begin to support, design
4.
and develop our own projects with our
DAS Faculty of Professors. This is
an untapped resource that is open to any
enthusiastic, creative and brilliant
DAS Member to reach out to for guidance,
membership. Don’t hesitate to reach out and
support or advice on any academic matters,
get involved!
including grant applications and study design. Kariem El-Boghdadly 5.
DAS Professor of Anaesthesia and
DAS Scienti c Of cer
Airway Management for 2024. This is an award conferred in recognition of a member’s
scienti c-of cer@das.uk.com
national/international standing in the eld of airway management as established by outstanding contributions through publications, creative work or other
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DAS PROFESSOR OF ANAESTHESIA AND AIRWAY MANAGEMENT: APPLICATIONS | Kariem El-Boghdadly | We are delighted to announce that applications for the DAS Professor of Anaesthesia and Airway Management 2024 will open in March! DAS Professor of Anaesthesia and Airway Management is an award conferred in recognition of a member’s national/international standing in the eld of airway management as established by outstanding contributions through publications, creative work or other appropriate forms of scholarship, and through teaching and administration.
DAS Professors of Anaesthesia and Airway Management have been awarded since 2012. Please follow the links for the criteria and application form. Applications open on 11/03/2024 and close at midnight on 26/05/2024. Awards will be presented at the next DAS ASM.
https://das.uk.com/das_professor_2024
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DAS MACEWEN MEDAL 2023 PROFESSOR ANIL PATEL | Ellen O’Sullivan | Professor Anil Patel graduated from University College London in 1991 and was appointed a consultant at The Royal National Throat Nose & Ear Hospital in 1999. He is now a Consultant Anaesthetist at University College London Hospitals NHS Foundation Trust and DAS Professor of anaesthesia & airway management. He is an exceptional leader, innovator and, most importantly, clinician in his chosen area of airway management. Locally he continues to
revolutionised oxygenation for critical airway
develop and re ne the largest individual experience of anaesthetising complex adult airway patients (>6,000) in the UK and
patients, signi cantly impacting on their safety during intubation, and for this reason has been adopted worldwide. He is a
probably worldwide.
renowned innovator and has also developed
In the last decade, industry has invested
an award winning videolaryngoscope. He has
large sums of money in his ideas. Nationally
been involved in numerous seminal
& internationally he is best known for
publications including NAP4, the 2015 DAS
introducing a new anaesthetic technique for
guidelines and the 2019 DAS Awake Tracheal
airway procedures, Transnasal Humidi ed
Intubation Guidelines, all of which changed
Rapid Insuf ation Ventilatory Exchange
practice. He received the Humphry Davy
(THRIVE). The resulting publication was
award from the Royal College of
voted best paper in Anaesthesia in 2015. His
Anaesthetists, and the Distinguished
introduction of the THRIVE technique has
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Research Award from the International Airway
Dif cult Airway Society, his commitment to
Management Society.
clinical anaesthetic work, teaching & research. He is passionate in his quest to
He is a superb communicator and is a sought
improve patient safety from airway
after lecturer worldwide. He has 130 + peer
management complications. He richly
reviewed publications, 25 book chapters and
deserves the DAS Macewen Medal for his
an h-index of 23. He completed three years as
extraordinary contribution to the eld of airway
DAS President and in this role he coordinated
management.
expert groups to develop national guidance on important clinical areas of practice. Anil is
Prof Ellen O’Sullivan
Executive Director of WAAM (World Alliance for Airway Management) & co-chaired WAMM
Past President College of Anaesthetist of
1 in Dublin in 2015, and WAMM 2 in
Ireland
Amsterdam in 2019.
Past Vice President AAGBI
He has contributed to this subspecialty through his exemplary leadership of the
Past President Dif cult Airway Society
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DAS PROFESSOR 2023 PROFESSOR ANDY HIGGS | Kariem El-Boghdadly| It is with absolute pleasure we report that DAS conferred the 2023 DAS Professor of Anaesthesia and Airway Management upon Andy Higgs. Professor Higgs is well known for his sustained, highimpact contributions in the eld of anaesthesia and airway management. In particular, Professor Higgs’s contributions to DAS as the Treasurer for 7 years, leading the DAS Guidelines on tracheal intubation in critically ill adults, and contributing to a further ve guidelines. He has been a global leader in airway management, being a core member of the ongoing PUMA Guidelines project, and authoring 32 peer-reviewed papers in airway management, of a total of 69 publications. An expert in teaching and training, Professor Higgs has also delivered education in a wide range of forums, including courses, conferences, book chapters, educational manuals, and online. It is safe to say that Professor Higgs has had an instrumental role in improving quality and safety in airway management globally, and this award could not be more deserved.
Kariem El-Boghdadly DAS Scienti c Of cer
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DAS ASM 2023 HIGHLIGHTS FROM THE LOC TRAINEE REPS | Carl Groves | Niladri Das | After many months of
Next up was an
organisation, the DAS
engaging session
scienti c meeting was
on speciality
nally here and what a
airways covering
jam packed
paediatrics,
programme it was! Let
obstetrics and
us re ect on a
bariatric surgery.
successful 28th Annual
Swiftly followed by
Scienti c Meeting of the
Professor Cyprian
Dif cult Airway Society (DAS) UK, held at
Mendonca sharing his years of experience
the International Convention Centre (ICC) in
in interprofessional education at Coventry
Birmingham.
and beyond. Just before we descended on the lunch queue and viewed everyone’s
The meeting commenced with traditional
latest projects and posters, we were treated
and cadaveric workshops run
to a fascinating presentation of ‘How I do it’
simultaneously. The human cadaveric
scenarios.
airway workshop was held at University Hospitals Coventry and Warwickshire (UHCW). This enabled delegates to hone their practical skills with specialist airway equipment and novel airway techniques, including videolaryngoscopy, breoptic intubation and airway ultrasonography. Delegates were also provided a rare handson experience with emergency cricothyroidotomy in the human cadaver. The 2-day scienti c programme featured presentations from airway experts across the world to include keynote speakers Dr Richard Harris, Professor Tim Cook and Dr Malin Jonsson Fagerlund.
After a delicious lunch, we were treated to an international themed look at airway
The rst day of the scienti c programme
emergencies and the physiologically
kicked off with Professor Tim Cook giving
dif cult airway as we were visited by our
his keynote address revealing some of the
colleagues of the American, Australasian
key ndings from NAP7 into perioperative
and Turkish airway societies.
cardiac arrest.
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We were then honoured to be joined by Dr
The highlight of the afternoon session was a
Malin Jonsson Fagerlund who delivered a
battle for the ages: Professor William
keynote address on apnoeic oxygenation -
Harrop-Grif ths vs Dr Imran Ahmad in a
when, why and how? Dr Fagerlund gave an
controversial debate on airway
engaging talk enjoyed by all present. After a
management guidelines.
quick coffee break and a chance to browse
The day concluded with the DAS Presidents
the posters and projects, we were then
session taking us through the history of the
engaged in an international case based
Dif cult Airway Society and its many
discussion.
achievements.
It was a packed schedule and we were only half way through, the gala dinner awaited us!
Once again we would like to thank the organising committee for a grand conference and look forward to seeing you at DAS 2024, London, UK.
The nal day of the scienti c programme opened with an Education & Research and ODP session run in parallel. Here, alongside oral presentations, we discussed the latest in research, training opportunities and importance of human factors and ergonomics in airway anaesthesia. This was followed by a session on patient information and consent. The morning came to a close with a captivating and awe-inspiring talk from Dr Richard Harris who shared a moving account of his involvement in the Thai Cave Rescue and received an extremely well-deserved standing ovation.
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CLINICAL DILEMMA | What Would You Do? |
This month, we have a non-emergency clinical question for you...
Talk us through the key points of how you perform anaesthesia for laryngeal laser surgery
- How would your strategies differ if the lesion is subglottic/tracheal?
- How would your strategies differ in case of a patient with severe airway compromise?
What Would You Do? Contact us on X / Twitter with your thoughts! @dasairway @dastrainees
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WHATWOULDYOUDO? DAS Expert Corner Airway Expert 1: Fundamental concerns with laser laryngeal surgery are airway re (requires the re triangle: oxygen, heat, fuel) and shared airway.
Principles are: Communicate with team re: risks of airway re Be prepared for airway re Use lowest safe oxygen concentration during laser Use safest equipment that will not form a source of fuel for a re Airway aims: tracheal intubation with a laser-resistant tracheal tube. If awake tracheal intubation is required, then perform ATI with a nasal tube, induce anaesthesia, and then change the tube under general anaesthesia to an oral laser tube. Use the smallest acceptable laser tube to facilitate access. Ensure the cuff is in ated with saline. Ensure neuromuscular blockade throughout. Use TIVA. Reduce FiO2 during lasering.
How would your strategies differ if the lesion is subglottic/tracheal? For a subglottic lesions, a laser tube would not be suitable. In this setting, I would induce anaesthesia in the operating theatre with the surgeon ready to perform the procedure. When the patient is paralysed, the surgeon would place the rigid laryngoscope, and I would then perform subglottic jet ventilation with 100% oxygen. I would stop jetting before laser begins, and restart when done. I would not use continuous oxygen during laser, such as HFNO.
How would your strategies differ in case of a patient with severe airway compromise? I would ensure a tracheostomy kit is available and ready. I would scan the neck and mark the cricothyroid membrane. I would have HFNO cannulae on the patient for when the patient is getting on the table and before the rst lasering. I would turn the HFNO off during lasering and only turn it on again once lasering is complete.
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Airway Expert 2: History, examination, investigation always
rst with these patients. Previous surgery, presenting
degree of airway symptoms and what did the last FNE look like. Team plan - the management of these patients solely depends on your surgeons and your skill set. You may use an MLT placed asleep, an ATI to place the MLT, or a tubeless eld with HFNO or highpressure source jet ventilation (HFJV).
How would your strategies differ if the lesion is subglottic/tracheal? Team planning crucial here. Management depends on how subglottic the lesion is which will be determined by pre-op FNE and imaging. Your plan may then be as for a glottic lesion (above) or require cardiothoracic input.
How would your strategies differ in case of a patient with severe airway compromise? With severe airway compromise consider a double set-up (see Canadian Airway Focus Group guidelines 2021). Induce in theatre with surgeons prepared for a FONA. Manage as in section 1 with the best anaesthetic and surgical operator doing the rst attempt.
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Airway Expert 3: How would your strategies differ if the lesion is subglottic/tracheal? This is a common clinical scenario on our airway list, especially following the COVID pandemic where many patients underwent prolonged intubations and tracheostomy related complications, resulting in subglottic stenosis. The key airway considerations are: 1. Inability to intubate, therefore a tubeless technique will need to be considered, and 2. a laser safe technique will need to be planned. Options available are: [1] apnoeic oxygenation using a THRIVE technique [2] supra-glottic jet ventilation using manual jet ventilator via the suspension laryngoscope [3] supra-glottic HFJV using a jet ventilator like the Twinstream or Monsoon [4] Sub-glottic HFJV via a laserjet catheter and a jet ventilator My preferred technique would be: Start the patient on HFNO using Opti ow Switch nasal prongs and compatible humidi er TIVA technique for the anaesthesia Induce anaesthesia in theatre Theatre team already primed and ready Once patient is asleep and paralysed, FMV can be started over the Switch, until suspension laryngoscope has been successfully positioned Commence HFJV via the suspension laryngoscope Turn off the HFNO Reduce the FiO2 to 30-40% Can commence laser, once all safety checks completed How would your strategies differ in case of a patient with severe airway compromise? This makes the whole process a lot more challenging and the airway technique chosen will depend on the reason for / location of the airway compromise. If this is because of the stenosis then you may need to consider placing a SGA so that one can ventilate through this via the anaesthetic machine or using the Twinstream jet ventilator during the laser treatment (which will have to be via a exible CO2 laser). If the cause is supra-glottic, then I would use a 2 stage technique. Stage 1 is to safely secure the airway and stage 2 is to safely perform the surgery. I would initially perform an awake nasendoscopy in theatre, assess the level of the airway obstruction and subglottic stenosis and decide whether it would be possible to intubate this patient. If possible then I would like to do this awake. Once intubated, then I would induce anaesthesia and consider the best options for stage 2. This could be any of the techniques mentioned above, but obviously the ETT would have to be removed to allow for surgical access. If I decided that it is not possible to intubate from above then I would consider a tracheostomy. I would also warn the patient that they may require a surgical tracheostomy, regardless of the level of the airway compromise
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WHAT'S NEW ABOUT CICO AND EFONA? | Paul Baker | Pre-hospital FONA
Introduction
A recent systematic literature
The concept of emergency front
search of prehospital FONA
of neck access (FONA) is not
attempts found an overall
new. There have been plenty of
crude mean success rate of
name changes and variations in
100%.2 This was a review of
techniques through the
69 studies and 1229 patients.
centuries, but the basic concept
The study included patients
remains the same. If a person
after 2017 when a UK pre-
cannot breathe because their
hospital practice guideline
airway is obstructed, and reasonable attempts have failed to relieve that obstruction above the neck, the inevitable life-saving manoeuvre requires establishment of an airway below the obstruction. Success is determined by rapid application of knowledge, skill and behaviour by the rescuer. The outcome from this
promoted a scalpel bougie technique.3 In this review, pooled overall FONA median success rate was 88%, surgical technique success was 100%, and needle success was 50%. Paediatric results were insuf cient to reach any conclusion about optimum technique in this age group.
emergency depends on the speed of
The study concluded that success rate for
treatment. A closed claims study in the USA
FONA is high, with surgical techniques for
found that in over 60% of cases where there
FONA appearing to be more successful than
was a cannot intubate, cannot oxygenate
needle techniques. This conclusion supports
(CICO) event, a surgical airway was
current guidelines from the UK and other
obtained, but was too late to avoid a poor
countries.4-6 More research is required to
outcome.1
determine the most effective paediatric
This article aims to provide an update on
FONA technique.
emergency FONA. The content will include
These latest remarkable success rates with
an overview of adult and paediatric
scalpel bougie technique in prehospital
recommendations, and a discussion of the
patients have not been replicated in the
important issues surrounding this subject.
hospital environment. However, a success rate of 100% has been reported before by Lockey et al, from the London Air Ambulance service.7 In a BJA podcast, Lockey
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Table 1. Keys to FONA success. Taken from BJA podcast, D Lockey
discussed the keys to the FONA success.
was detected with some skills declining as
(Table 1).
early as one month. The authors recommended a FONA skill “brush-up” at three months. This type of training is
Other tools used by pre-hospital clinicians to
particularly important for infrequent high
optimise FONA success include check lists
stakes events such as CICO, where skills
and standardisation.8 By reducing choices
cannot be maintained by normal daily clinical
and standardising the operator reacts faster.
activity.11
Increasing choice increases reaction time. According to the Hick-Hyman Law, increasing the number of choices will increase the decision time logarithmically. Reaction time increases by 35% when a choice increases from one to two.9,10 This is an argument to remove the menu of emergency FONA devices, and standardise to one technique.
Human factors Clinician behaviour is another important aspect of emergency airway management. Human factor issues have recently been highlighted with two comprehensive reviews of human factors associated with airway management.12,13 Many airway practitioners will see out their entire career without ever having to perform an emergency airway.
Education
Unless regular training is used to simulate
As with any procedural skill, regular practice
this life-threatening event, the average airway
is required to maintain pro ciency. A recent
practitioner may nd themselves thrown into
study of eFONA performance found retention
this unexpected event, unprepared. Regular
of this single technical skill was up to three
training for adult and paediatric patients is
months. After this period some loss of skill
recommended. Practitioners’ stress and
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Table 2. Strategies to improve task management during stressful situations. Taken from Kelly FE, Frerk C, Bailey CR, et al. Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Dif cult Airway Society and the Association of Anaesthetists: Guidelines from the Dif cult Airway Society and the Association of Anaesthetists. Anaesthesia. 2023;78(4):458-478.
anxiety can be modi ed to improve task
a baby in airway distress can be particularly
management in these stressful situations.
daunting. Due to the maldistribution of paediatric healthcare in some countries, specialist adult airway practitioners may nd
Paediatric FONA
themselves called in an emergency. Prior
Approximately 25% of the world’s population
training for paediatric FONA is therefore
are children, aged 15 yrs or less. In
recommended for all airway practitioners.
underdeveloped countries the percentage
A practice guideline for infants and neonates
increases to 40%. This group, particularly the
has recently been published.14 Although it
neonate and infant age group, is under-
states that there is little evidence to support a
represented in the literature. When
strong recommendation, the guideline
considering CICO and FONA some airway
proposes that a surgical tracheostomy
guidelines omit infants and neonates. These
represents the preferred emergency access
babies can be some of the most demanding
to the trachea in neonates and infants. This is
patients for airway management due to their
based on dif culty inserting needles into an
unique anatomy and physiology. Airway
infant’s trachea, the compliant nature of the
management for these patients also requires
infant trachea and the contraindication of a
age dependent equipment and modi ed
cricothyroidotomy, due to the risk of trauma,
techniques. For airway practitioners who
small dimensions and the location which is
specialise in adults, being called to manage
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relatively high in the neck and anteriorly
application of any airway management
inclined.
technique or tool in three or more attempts
Animal studies have de ned the details of a
without deviation or change, or the return to a
FONA for infants and neonates. One
technique or tool that was previously
publication includes a helpful video.15
unsuccessful.” This common fault was
Another study compares two similar scalpel
identi ed in 25% of closed claims in the
techniques, concluding that a scalpel-bougie
latest ASA study.20
tracheotomy was slightly faster, more popular
Considerable progress has recently been
and associated with fewer tracheal injuries.16
reported concerning FONA. Lessons can be
The other consideration for infant FONA is
learnt from this research. The next important
ventilation. This becomes more important if
step is to adopt and implement new
the chosen option is a cannula. A recent
recommendations.21 Over to you!
bench study demonstrated excessively high pressures and ows consistent with barotrauma, or inadequate ow when using
Paul A Baker
most recommended cannula ventilation
Associate Professor, Department of
devices.17 When completing FONA, it is
Anaesthesiology, University of Auckland
important to consider the safety of
President, Society for Airway Management
subsequent ventilation. Cannula ventilation, with most recommended devices, requires a high-pressure ventilation source which needs
Link to references
to be regulated and monitored in the interest of safety.
Summary Simple concepts for airway management include maintaining oxygenation and avoiding trauma.18 In adult and paediatric patients where CICO leads to FONA, these simple concepts need to be kept in mind. A recent systematic review with meta-analysis con rmed that apnoeic oxygenation in children during tracheal intubation increases rst-pass success and helped maintain stable conditions by sustaining normal oxygenation.19 Avoiding trauma could apply to perseveration which is de ned in the 2019 ASA Closed Claims Analysis as “the consistent
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ANAESTHETIC MANAGEMENT FOR PATIENTS LIVING WITH OBESITY IT IS EVERY ANAESTHETIST’S JOB | Eleanor Warwick | Becky Black | BMI have an Background
increased risk
Patients living with
of airway,
obesity are
breathing,
increasingly
circulatory
presenting for
and metabolic
anaesthesia in all
complications,
surgical
this has also
specialities.1
been
Regardless of
previously
where anaesthetists
reported. In
work, we are all going to be managing the
the BIGAA study those patients living with
care of these patients and, as such need to
obesity were signi cantly more likely to
be able to do this safely. The 7th National
experience complications when undergoing
Audit Project (NAP 7) was published in
anaesthesia than their non obese
November 2024 and quoted that 1 in 3
counterparts, unsurprisingly the
patients presenting to anaesthetists are living
complications increased with the class of
with obesity. Worryingly the increases in BMI
obesity.3
are most prevalent in the higher classes of obesity (>35 kg m2) and the trends in
Anaesthesia and those living with obesity
increased BMI in those presenting for anaesthesia are above that of population
As anaesthetists the management of the
trends.2 These
airway is at the forefront of everything we do
ndings con rm previous
study results where the incidence of obesity
and safe prediction and planning for dif cult
in those presenting for surgery was found to
airway management is key to delivering care
be 32%,3 compared to an incidence in the
to our patients. The 4th National Audit Project
general population of 26%.4 The prevalence
(NAP 4)6 stated that too often obesity is not
of obesity is also greatest in deprived areas
identi ed as an airway risk factor and
(33%) whereas it falls to 20% in the least
anaesthetic technique is not modi ed and
deprived areas4 and the rates of childhood
with NAP 7 citing more airway complications,
obesity are rising; over 10% of reception age
what does this actually mean for airway
children are classed as obese and this
management? Is a high BMI associated with
increases to over 23% by age ten.5 NAP 7
dif cult intubation? Studies have shown that
highlighted the fact that patients with a high
this is not the case,7,8 but this doesn’t mean
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Dif cult Airway Society E-Zine
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we can be complacent. By far the most
can also provide up to date patient
common airway complication is desaturation.
information12 and initiate shared decision
Without appropriate planning, a patient living
making conversations about treatment
with obesity can end up with hypoxia and
options. Patient facing language and a non-
other airway complications such as
stigmatising stance is absolutely key13,14 in all
reintubation, aspiration, failed face mask
the interactions perioperatively, not only for
ventilation, airway trauma, and oesophageal
the success of the procedure but also
intubation. All of these events can make
because positive patient health interactions
ultimately securing the airway more dif cult
may improve a patient’s health in the long
and more stressful for those involved. We all
term.15
dread the perilous sound of a dropping saturation monitor and avoiding this for the safety of our patients and our own
Planning for airway management and
performance is key. So, what can we do?
optimisation Perhaps of most interest to the readers of this
Robust perioperative planning and risk assessment
article, when presented with patients with a high BMI we need to think about the airway and how we are going to safely manage this.
It is key when presented with patients with a
To do this, we must consider the impact of a
high BMI in the elective or emergency
high BMI on a patient’s anatomy and
situation, time is taken to appreciate the BMI
physiology and what implications this has on
of the patient and the impact this may have
airway management. As we have stated
on comorbidities, and them as an individual.
earlier, intubation may not necessarily be
Effectively managing the airway and safety of
more dif cult but to set ourselves up for safe
the patient is integrally linked to this. With
airway management, thought must be given
over 7.6 million patients on elective surgical
to optimising our chances of success. A brief
waiting lists,9 there is time preoperatively to
revision of the FRCA is needed here. Patients
start treating obesity as a chronic disease,10
living with obesity have anatomical changes:
recognise concordant comorbidities like
increased deposition of fat in the upper
diabetes, hypertension, cardiovascular
airway; particularly the tongue and
disease, and obstructive sleep apnoea
pharyngeal walls and increased fat
(OSA) and use the time preoperatively to
deposition in the upper back, neck and
plan anaesthetic management of these
chest. We know these changes can make
patients in an evidenced based way
preoxygenation and bag mask ventilation a
(guidelines currently under review).11 The
lot harder so we should be prepared for this.
time preoperatively should also be used to
The functional residual capacity (FRC)
instigate appropriate risk assessment,
reduces exponentially with body mass
regardless of whether the patient is waiting 1
index16 and the FRC may become less than
hour for surgery or over 1 year. Risk
the closing capacity (CC) causing airway
assessment is something that was identi ed
collapse, atelectasis and increased risk of
as missing in this patient group in NAP 7. We
hypoxia. The relationship between FRC and
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Dif cult Airway Society E-Zine
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CC is further exacerbated by anaesthesia
continued for apnoeic oxygenation after
and the supine position. Patients with a high
induction, can be successful.17 It is important
BMI have an increased basal metabolic rate
to remember that HFNO does not allow
and work of breathing.16 Taking these
measurement of ETO2, relies on a patent
anatomical and physiological facts together
airway, and any desired PEEP effect also
in clinical terms, simply means those living
needs the patient to have their mouth closed.
with obesity have a smaller reserve of oxygen and they use it quicker. This, coupled with the fact that they may be harder to preoxygenate and/or or mask ventilate when asleep, means desaturation can occur rapidly. So, what do we do? The good news is that simple modi cations can make a huge difference. 1)
Anaesthetise your patient in the
operating theatre. Position your patient on the operating table in a ramped position. Sit the table up, use a wedge like the oxford pillow or use pillows underneath the shoulders and head. Positioning on the operating table also means the patient does not need to be supine for transfer from the bed and can position themselves to help protect pressure areas. Consider a hover mattress under the patient to aid with transfer at the end. You will also need a stool to access the airway so make sure one of these is handy. 2)
Preoxygenate your patient thoroughly
and effectively. There is no gold standard technique and different anaesthetists will do this in a variety of ways but know what works for you. Five minutes via a good tting face mask with ve vital capacity breaths prior to induction is many bariatric anaesthetist’s technique of choice, with the option to add
3)
Induce anaesthesia basing most
drugs on ideal or lean body weight (IBW or LBW) and titrate to effect as you would for any other anaesthetic. However, check drug dosing and whether you should use IBW, LBW or, actual body weight using the SOBA app. 4)
Have an aggressive ventilation
strategy to maintain oxygenation after induction of anaesthesia and paralyse the patient effectively and rapidly. Strategies for ventilation include use of an immediate Guedel, two hand mask technique and using the ventilator or an assistant to ventilate for you, monitoring tidal volumes. A top tip is to also have a second-generation laryngeal mask (LMA) handy as this may make ventilation prior to intubation a lot easier. As we mentioned above, HFNO can be used in the apnoeic stage in experienced hands, with a patent airway and in the correct position. 5)
Plan and execute intubation: Use a
videolaryngoscope as PLAN A provided airway assessment has not agged up any indications for warranting another technique. Brief the anaesthetic team about plans for failure.
5cmH2O positive end expiratory pressure (PEEP) via the APL valve. This also allows for
Extubation and postoperative recovery
end tidal oxygen measurement. However,
planning
studies have shown that the use of high ow nasal oxygen (HFNO), which can then be
NAP 7 has highlighted an increase in postoperative events in patients living with
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Dif cult Airway Society E-Zine
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obesity2 and anaesthetists must be alert to airway complications in the postoperative period. Often, extubation and post operative
Conclusions
destination are overlooked. This is not to say
Whether or not you anaesthetise for
every patient living with obesity requires
metabolic surgery, the reality is we are all
Level 2 or 3 care, day surgery may well be
becoming bariatric anaesthetists. We have
appropriate, but attention must be paid to
highlighted the key areas where we feel
planning the appropriate post operative
anaesthetists must focus their efforts when
destination.
caring for those living with obesity: robust
The same attention to detail is needed at extubation as it is at intubation, and this is not unique to those living with obesity. 1)
Make sure that you have a patient
preoperative evaluation and risk assessment; planning for airway management; and optimsation of extubation and post operative destination. The techniques suggested are practical and effective and can be done by
who is optimally positioned, sat up and
anyone regardless of level of training and
already transferred to their bed. This will
institution. With the ever increasing rates of
avoid any movement and lying the patient at
obesity, it really is time to make optimal care
when their airway is no longer secure.
of these patients a priority for all
2)
anaesthetists.
Ensure the neuromuscular blockade
is fully reversed and we would advocate routine use of sugammadex. 3)
Dr Eleanor Warwick
Ventilate the patient with 100%
oxygen until they are awake and cooperative, bearing in mind patients with a high BMI
ST6 Anaesthetics and SOBA Trainee representative
tolerate spontaneous ventilation poorly in the supine position.
Dr Becky Black
4)
Consultant Anaesthetist and Vice President of
Only remove the endotracheal tube
when you are sure the patient can maintain
SOBA
their own airway. Consider extubation onto HFNO or CPAP depending on the patient’s Link to references
history. 5)
Ensure continuous postoperative
monitoring as per guidelines18 and set clear
View the Society for Obesity and Bariatric
targets for recovery. Review patients for any
Anaesthesia (SOBA) one page guidance
concerning signs postoperatively. If things
sheet here
have not gone to plan or you are concerned about a patient, re-evaluate the original postoperative plan.
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DAS WEBINARS 2024 | Gunjeet Dua | Tom Lawson | Moon-Moon Majumdar | Nisha Abraham-Thomas |
After excellent feedback from last year's webinars, in 2024 we are planning further events! Watch this space for upcoming webinars on... • NAP 7 • Oxygenation • Patient information • Top airway management publications from the journal Anaesthesia For all members of the multidisciplinary team #LearnTogether @dastrainees #DASeducation
Members will be emailed details of upcoming webinars including registration details from the DAS Secretariat. Please ensure your email address is up to date so as not to miss information on events.
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metrics will de ned by your SMART aim but
often shared at the team Tuesday meeting.
have agreed to help with a mentoring service, for future patients, which is in development. ✦ Wider Organisation
Those stakeholders funding your service will need a clear business plan alongside the vision for your service.
Celebrating wins within the team is vital in
Empower Action
maintaining drive and enthusiasm but
Establishing overall service goals and setting
should also be widely shared to sustain
aims empowers all members of the team to
change.
drive new services forward.
Leverage and Sustaining Change
Assigning
smaller projects, based on speci c aims, and
Leverage Wins to Drive Change
regular meetings to discuss progress allows individuals to work independently but within a
The prehabilitation service successes have
supportive team environment.
been presented in forums ranging from local presentations to inter national
Celebrate Quick Wins
meetings. Demonstrating value increases
Some project outcomes may take months or
credibility and creates leverage when
years to become apparent, for example
redesigning aspects of your service or
changes in length of stay or mortality.
when persuading other teams to engage.
It is
therefore important to consider what demonstrates success in the short term. This could be as simple as receiving the
rst
referrals and interacting with the rst patient cohort.
Celebrating achievements maintains drive, encourages others to adopt practices and is one step towards embedding the process in culture so that engagement becomes the norm rather than the
An early ‘win’ experienced by the UCLH team was the
rst quanti able improvement in
CPET results seen in a patient who had
exception. Embed in Culture
The sense of
Sustaining change can be just as
achievement helped unite and motivate the
challenging as implementing a new
team.
service.
completed the programme.
Conviction in the service was further
compounded by patient feedback which was
Projects which rely on a single
individual or have unintended adverse consequences are especially vulnerable. The UCLH prehabilitation service bene ts f ro m h a v i n g a t e a m o f m o t i v a t e d colleagues such that when individuals are not available the service continues to run. Planning future developments can also
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#JANUAIRWAY 2022 THE COMPILATION | freely available and downloadable on issuu |
AVAILABLE HERE!
@dastrainees @vapourologist #DASeducation
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TRAINEE COMPETITION | Infographic competition | We are pleased to announce the 2024 DAS Trainee Competition:
DESIGN A DAS INFOGRAPHIC! The winner will receive £100 in prize money, will have their work published in the DAS E-
zine, and displayed at the 2024 DAS ASM. Infographics are an innovative way to display information and explain concepts clearly and memorably. We invite you to design an infographic on any topic related to dif cult airway
management. Consider how you can present this in a visual format and create your infographic! Infographics should be visually appealing and generally contain little text. Any images used should be cited (creative commons, public domain, or personally taken or designed). Infographics must be original work. 1.
Entries are invited on any dif cult airway management topic, but must be original. The author/creator must be a DAS member and trainee.
2.
Members of the DAS committee will judge anonymised entries.
3.
We will be judging infographics based on content and relevance to DAS, depth of information conveyed and ease of interpretation, and how visually pleasing they are/ calibre of artistry/originality.
4.
Label your le ‘DAS Trainee Infographic Competition’. The name of the author/creator, author/creator’s institution or other identi able information should NOT be included in the le title or content.
5.
Please submit les in .jpeg or .pdf format in high resolution, as one page/image only
6.
Please send in your infographic to trainee@das.uk.com, along with a completed submission form which can be requested from trainee@das.uk.com or downloaded from the DAS website.
7.
Prize money of £100 and a certi cate will be awarded to the rst prize winner. The infographic will be published in the DAS E-zine, as well as displayed at the 2024 DAS ASM.
8.
Winners will be contacted by email.
9.
Deadline for receipt of emailed infographics: Midnight on 14th April 2023
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JOURNAL CLUB | Recommended Reads | Welcome to the DAS Journal Club - Recommended Reads. Papers are chosen by members of the DAS committee, with short citations/summaries by members of the ezine editorial team. This edition's recommended reads come from Kariem El-Boghdadly with summaries by Moon-Moon Majumdar. We welcome member feedback and thoughts on the papers featured and also what discussion occurred at your journal club - please get in touch @dastrainees or @dasairway or email us at ezine@das.uk.com.
✦ Baettig
SJ, Filipovic MG, Hebeisen M, Meierhans R, Ganter MT. Pre-operative gastric
ultrasound in patients at risk of pulmonary aspiration: a prospective observational cohort study. Anaesthesia. 2023 Nov;78(11):1327-1337. This study categorised patients undergoing elective or emergency surgery as 'low risk' (empty, gastric volume ≤1.5ml/kg of body weight) or 'high risk' (solid, mixed or gastric
uid volume
>1.5ml/kg body weight) and asked examiners whether they would make any changes to their aspiration risk management plan. Would you change your aspiration prevention plan based on a pre-operative gastric ultrasound?
✦ Broms J, Linhardt C, Fevang E, Helliksson F, Skallsjö G, Haugland H, Knudsen JS, Bekkevold
M, Tvede MF, Brandenstein P, Hansen TM, Krüger A, Rognås L, Lossius HM, Gellerfors M. Prehospital tracheal intubations by anaesthetist-staffed critical care teams: a prospective observational multicentre study. Br J Anaesth. 2023 Dec;131(6):1102-1111. This study looked at 422 drug-assisted tracheal intubations and examined rst-pass success for tracheal intubation. The rate of rst-pass success was 89.2% for intubations in-cabin vs 86.3% outside the cabin - is this a signi cant difference? Is the on-scene time affected by this decision? Read the article and make up your mind!
We would love to hear what transpired from your journal club! Get in touch @dastrainees or email ezine@das.uk.com
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AIRWAY LEADS UPDATE | Sandeep Sudan | question here by Monday 19
This is directed towards our Airway
February 2024. You may be
Leads (AWLs) network.
selected to present for three
It was great to catch up with some
minutes at the online event on
of you in Birmingham - and maybe
your topic for discussion. If there
we can make this a regular item at
are multiple submissions on the
DAS ASMs. In the meantime, RCoA
same theme, then we may only
and DAS are delighted to announce
take one speaker, selected at
the 7th Airway Leads Day to be
random.
held online on Friday 15 March 2024. This is a free event but does require advance booking, which you can do here.
Airway Leads Day 2024 | 15 March 2024 Soapbox - have your say!
Programme coming soon but we will include
Please do consider contributing to this day
talks on the paediatric airway, sustainability,
in either format, especially if you haven't
NAP7, debrie ng and safety reports.
done so before.
Based on the positive response to the Best
If you have any queries about this day, or
Practice presentations delivered at past
indeed anything else related to your role,
Airway Leads days, we would again like to
please contact awl@rcoa.ac.uk. Which
invite submissions to be included in the
reminds me, any updates or omissions to
2024 programme. You are invited to submit
the AWLs network in your area, please do
1 page of A4 on an aspect of your role as
let us know so that we maintain an up to
an AWL. If there are aspects of your work
date database.
and role that are exemplary and could be
BW
bene cial to others, then don’t miss the chance to disseminate and showcase your work. Up to ve AWLs will be invited to
Sandeep Sudan RCoA-DAS Airway Lead Adviser
present for 10-minutes at the event, followed by a moderated discussion with the virtual audience around the issues raised. We would also like to invite questions for the ‘Soapbox – have your say!’ session. Do you have a pertinent question or an unresolved issue? Would you like to raise a topic that you think AWLs should be addressing? If so, then do submit your
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WORLD AIRWAY MANAGEMENT MEETING | Ellen O’Sullivan | Following on from the success of WAMM 1 in Dublin in 2015, and WAMM 2 in Amsterdam in 2019, WAMM 3 is set for 2025 in Florence! Register your interest today!
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WHAT'S NEW ABOUT CICO AND EFONA? | References 1/2 | 1. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the Dif cult Airway: A Closed Claims Analysis. Anesthesiology. 2005;103(1):33-39. 2. Morton S, Avery P, Kua J, O'Meara M. Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis. Br J Anaesth. 2023;130(5):636-644. 3. Lockey DJ, Crewdson K, Davies G, et al. AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2017;72(3):379-390. 4. Frerk C, Mitchell VS, McNarry AF, et al. Dif cult Airway Society 2015 guidelines for management of unanticipated dif cult intubation in adults. 2015;1(6):827-848. 5. Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the dif cult airway: part 1. Dif cult airway management encountered in an unconscious patient. Can J Anaesth. 2021;18:18. 6. Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the dif cult airway: part 2. Planning and implementing safe management of the patient with an anticipated dif cult airway. Can J Anaesth. 2021;08:08. 7. Lockey D, Crewdson K, Weaver A, Davies G. Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians. Br J Anaesth. 2014;113(2):220-225. 8. Burgess MR, Crewdson K, Lockey DJ, Perkins ZB. Prehospital emergency anaesthesia: an updated survey of UK practice with emphasis on the role of standardisation and checklists. Emerg Med J. 2018;35(9):532-537. 9. Hick WE. On the rate of gain of information. Quarterly Journal of Experimental Psychology. 1952;4(1):11-26. 10. Hyman R. Stimulus information as a determinant of reaction time. Journal of Experimental Psychology. 1953;45(3):188-196. 11. Nielsen MS, Lundorff SH, Hansen PM, et al. Anesthesiologists' skills in emergency cricothyroidotomy mandate a brush-up training after 3 months-A randomized controlled trial. Acta Anaesthesiol Scand. 2023;20:20. 12. Kelly FE, Frerk C, Bailey CR, et al. Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Dif cult Airway Society and the Association of Anaesthetists: Guidelines from the Dif cult Airway Society and the Association of Anaesthetists. Anaesthesia. 2023;78(4):458-478. 13. Kelly FE, Frerk C, Bailey CR, et al. Human factors in anaesthesia: a narrative review. Anaesthesia. 2023;78(4):479-490. 14. Disma N, Asai T, Cools E, et al. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. Br J Anaesth. 2024;132(1):124-144. 15. Berger-Estilita J, Wenzel V, Luedi MM, Riva T. A Primer for Pediatric Emergency Front-of-the-Neck Access. A A Pract. 2021;15(4):e01444. 16. Riva T, Goerge S, Fuchs A, et al. Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model. Paediatr Anaesth. 2023;10:10.
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WHAT'S NEW ABOUT CICO AND EFONA? | References 2/2 |
17. Mann CM, Baker PA, Sainsbury DM, Taylor R. A comparison of cannula insuf ation device performance for emergency front of neck airway. Paediatric anaesthesia. 2021;11:11. 18. Henderson JJ, Popat MT, Latto IP, Pearce AC. Dif cult Airway Society guidelines for management of the unanticipated dif cult intubation. Anaesthesia. 2004;59(7):675-694. 19. Fuchs A, Koepp G, Huber M, et al. Apnoeic oxygenation during paediatric tracheal intubation: a systematic review and meta-analysis. Br J Anaesth. 2023;28:28. 20. Joffe AM, Aziz MF, Posner KL, Duggan LV, Mincer SL, Domino KB. Management of Dif cult Tracheal Intubation: A Closed Claims Analysis. 2019;1(4):818-829. 21. Kelly FE, Frerk C. Guidelines are only as effective as their uptake and implementation. 2023;1(7):918-919.
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ANAESTHETIC MANAGEMENT FOR PATIENTS LIVING WITH OBESITY IT IS EVERY ANAESTHETIST’S JOB | References 1/2 | 1. Kane AD, Soar J, Armstrong RA et al. Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey. Anaesthesia 2023; 78: 701–11. 2. NAP7 report on perioperative cardiac arrest | The Royal College of Anaesthetists.https://www.rcoa.ac.uk/news/nap7report-perioperative-cardiac-arrest (accessed January 3, 2024). 3. Shaw M, Waiting J, Barraclough L et al. Airway events in obese vs. non-obese elective surgical patients: a crosssectional observational study. Anaesthesia 2021; 76: 1585–92. 4. Overweight and obesity in adults. NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/ health-survey-for-england/2021/overweight-and-obesity-in-adults (accessed January 17, 2024). 5. Baker C. Obesity statistics. 2024 Jan 17. 6. NAP4: Major Complications of Airway Management in the United Kingdom | The Royal College of Anaesthetists.https://www.rcoa.ac.uk/research/research-projects/national-audit-projects-naps/nap4-majorcomplications-airway-management (accessed January 18, 2024). 7. Moon TS, Fox PE, Somasundaram A et al. The in uence of morbid obesity on dif cult intubation and dif cult mask ventilation. Journal of Anesthesia 2019; 33: 96–102. 8. Mehta AR, Maldonado Y, Abdalla M et al. Association between body mass index and dif cult intubation with a double lumen tube: A retrospective cohort study. Journal of Clinical Anesthesia 2022; 83: 110980. 9. NHS backlog data analysis. The British Medical Association is the trade union and professional body for doctors in the UK. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/nhs-backlog-data-analysis (accessed January 19, 2024). 10. RCP calls for obesity to be recognised as a disease. RCP London, 2019. https://www.rcplondon.ac.uk/news/rcpcalls-obesity-be-recognised-disease (accessed June 22, 2023). 11. Members of the Working Party, Nightingale CE, Margarson MP et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015; 70: 859–76. 12. Anaesthesia and your weight | The Royal College of Anaesthetists.https://www.rcoa.ac.uk/patients/patientinformation-resources/lea ets-video-resources/anaesthesia-your-weight (accessed January 3, 2024). 13. GUIDELINES. SOBA UK. https://www.sobauk.co.uk/guidelines-1 (accessed June 22, 2023). 14. Selak T, Selak V. Communicating risks of obesity before anaesthesia from the patient’s perspective: informed consent or fat-shaming? Anaesthesia 2021; 76: 170–3. 15. Moonesinghe SR. The Anesthesiologist as Public Health Physician. Anesthesia & Analgesia 2023; 136: 675. 16. Pelosi P, Croci M, Ravagnan I et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesthesia and Analgesia 1998; 87: 654–60.
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Dif cult Airway Society E-Zine
February 2024
ANAESTHETIC MANAGEMENT FOR PATIENTS LIVING WITH OBESITY IT IS EVERY ANAESTHETIST’S JOB | References 2/2 | 17. Schutzer-Weissmann J, Wojcikiewicz T, Karmali A et al. Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high- ow nasal oxygen delivery. British Journal of Anaesthesia 2023; 130: 103–10. 18. Klein AA, Meek T, Allcock E et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 2021; 76: 1212–23.
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Contents
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Dif cult Airway Society E-Zine
40
Winter 2019
Dif cult Airway Society www.das.uk.com @dasairway @dastrainees
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Dif cult Airway Society Newsletter