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Need for emergency airway surgery for hard-to-intubate patients reduced
Date:11/17/2009

Be prepared, that old Boy Scout motto, is being applied with great success to operating room patients whose anatomy may make it difficult for physicians to help them breathe during surgery, Johns Hopkins researchers report in a new study.

When patients undergo general anesthesia, they stop breathing on their own and anesthesiologists must quickly insert a tube into the airway as a first step in machine-assisted breathing. The researchers showed that a comprehensive program designed to help physicians quickly identify and treat anesthetized patients in which placement of this tube is difficult has dramatically reduced the need for high-risk emergency surgical procedures to open obstructed airways.

At the heart of the program is a rolling cart armed with most any supply a physician would need to navigate a difficult airway and restart breathing, from flexible scopes and long catheters to medications and a surgical airway kit, just in case. While it may sound simple, the standardized cart cuts out the need for operating room staff to race here and there during a crisis to track down the gear needed to get oxygen flowing again, says Lauren C. Berkow, M.D., one of the study's leaders.

"It seems an obvious solution, but it's not what people are used to doing," says Berkow, an assistant professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "People had to run to five different places to get the right equipment.

"The stakes are pretty high. Oxygen is vital. Time is of the essence. You want to make sure you have everything you need and know how to use it when that patient with an emergency rolls through the door."

During the four years before Johns Hopkins put its difficult airway program into place, an average of 6.5 patients a year needed to have their airways opened surgically. Over the 11 years that followed ending in December 2006 an average of just 2.2 patients a ye
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Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
Source:Eurekalert

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