O Langeron1, J-L Bourgain2, D Francon3, J Amour4, C Baillard5, G Bouroche2, M Chollet Rivier6, F Lenfant7, B Plaud8, P Schoettker6, D Fletcher9, L Velly10, K Nouette-Gaulain11. 1. Department of anaesthesia and intensive care, Surgical Intensive Care Unit, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75013 Paris, France. Electronic address: olivier.langeron@aphp.fr. 2. Department of anaesthesia, institut Gustave-Roussy, 94800 Villejuif, France. 3. Department of anaesthesia and intensive care, institut Paoli-Calmettes, 13273 Marseille, France. 4. Department of anaesthesia and intensive care, Heart institute, hôpital de la Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75013 Paris, France. 5. Service d'anesthésie-réanimation, hôpital Cochin Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 75014 Paris, France. 6. Department of anaesthesiology, Lausanne University Hospital CHUV, Lausanne, Switzerland. 7. Department of surgical anaesthesia and intensive care, hôpital de Cannes, 06400 Cannes, France. 8. Department of surgical anaesthesia and intensive care, hôpital Lariboisière-Saint-Louis, Assistance publique-Hôpitaux de Paris, université Paris-Diderot, 75010 Paris, France. 9. Department of anaesthesia, hôpital Ambroise-Paré, Assistance publique-Hôpitaux de Paris, université Versailles Saint-Quentin, 92100 Boulogne-Billancourt, France. 10. Department of anaesthesia and intensive care, hôpital de la Timone, université Aix-Marseille, 13000 Marseille, France. 11. Department of anaesthesia and intensive care, centre hospitalier universitaire de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
Abstract
OBJECTIVE: To provide an update to French guidelines about "Difficult intubation and extubation in adult anaesthesia 2006". DESIGN: A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Few recommendations were ungraded. METHODS: The panel focused on 6 questions: 1) Why must oxygen desaturation be avoided during intubation and what preoxygenation and oxygenation techniques should be used to prevent it? 2) Should videolaryngoscopes be used instead of standard laryngoscopy with or without a long stylet to achieve a better success rate of intubation after the first attempt during anticipated difficult intubation off fiberoptic intubation? 3) Should TCI or target controlled inhalation anaesthesia (TCIA) be used instead of bolus sedation for airway control in the event of suspected or proven difficulty in a patient spontaneously breathing? 4) What mode of anaesthesia should be performed in patients with difficult intubation criteria and potentially difficult mask ventilation? 5) In surgical patients, what criteria predict difficulties encountered during postoperative tracheal extubation? 6) Should decision trees and algorithms be employed to direct decision-making for the management of difficult intubation, whether foreseen or not? (based on the information from the preceding five issues). Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology. RESULTS: The SFAR Guideline panel provided 13 statements on difficult intubation and extubation in adult anaesthesia. After two rounds of discussion and various amendments, a strong agreement was reached for 99% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), 8 have a low level of evidence (Grade 2±). No recommendation was provided for one question. CONCLUSIONS: Substantial agreement exists among experts regarding many strong recommendations for the best care of patients with difficult intubation and extubation in adult anaesthesia.
OBJECTIVE: To provide an update to French guidelines about "Difficult intubation and extubation in adult anaesthesia 2006". DESIGN: A consensus committee of 13 experts was convened. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Few recommendations were ungraded. METHODS: The panel focused on 6 questions: 1) Why must oxygen desaturation be avoided during intubation and what preoxygenation and oxygenation techniques should be used to prevent it? 2) Should videolaryngoscopes be used instead of standard laryngoscopy with or without a long stylet to achieve a better success rate of intubation after the first attempt during anticipated difficult intubation off fiberoptic intubation? 3) Should TCI or target controlled inhalation anaesthesia (TCIA) be used instead of bolus sedation for airway control in the event of suspected or proven difficulty in a patient spontaneously breathing? 4) What mode of anaesthesia should be performed in patients with difficult intubation criteria and potentially difficult mask ventilation? 5) In surgical patients, what criteria predict difficulties encountered during postoperative tracheal extubation? 6) Should decision trees and algorithms be employed to direct decision-making for the management of difficult intubation, whether foreseen or not? (based on the information from the preceding five issues). Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE® methodology. RESULTS: The SFAR Guideline panel provided 13 statements on difficult intubation and extubation in adult anaesthesia. After two rounds of discussion and various amendments, a strong agreement was reached for 99% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), 8 have a low level of evidence (Grade 2±). No recommendation was provided for one question. CONCLUSIONS: Substantial agreement exists among experts regarding many strong recommendations for the best care of patients with difficult intubation and extubation in adult anaesthesia.
Authors: I Ahmad; K El-Boghdadly; R Bhagrath; I Hodzovic; A F McNarry; F Mir; E P O'Sullivan; A Patel; M Stacey; D Vaughan Journal: Anaesthesia Date: 2019-11-14 Impact factor: 6.955
Authors: Samir Jaber; Amélie Rolle; Boris Jung; Gerald Chanques; Helena Bertet; David Galeazzi; Claire Chauveton; Nicolas Molinari; Audrey De Jong Journal: BMJ Open Date: 2020-10-07 Impact factor: 2.692