The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists to analyze current clinical practice and review the training system in the Russian Federation. Review

A.A. Andreenko1, E.L. Dolbneva2, V.I. Stamov3

1 FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, St. Petersburg, Russia

2 FGBNU “RNCH named by acad. B.V. Petrovsky”, Moscow, Russia

3 UKB № 2 FGAOU VO “Moscow State Medical University named after I.M. Sechenov” Ministry of Health of Russia, Moscow, Russia

For correspondence: Aleksander A. Andreenko — Cand. Med. Sciences, Assistant Professor, Deputy Head of the Department of Anesthesiology and Resuscitation FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, St. Petersburg; e-mail: aaa010803@gmail.com

For citation: Andreenko AA, Dolbneva EL, Stamov VI. The problem of “difficult airways” — multicenter studies of Federation of anaesthesiologists and reanimatologists  to analyze current clinical practice and review the training system in the Russian Federation. Review. Annals of Critical Care. 2019;3:34–41.

DOI: 10.21320/1818-474X-2019-3-34-41


Abstract

“Difficult airways” situations continue to be one of the main causes of anesthetic mortality and morbidity. Current requirements of patient safety during anesthesia determine the need for the necessary equipment and compliance with existing clinical guidelines. The situation with the equipment of hospitals in the Russian Federation with different airway devices and medical equipment, as well as the approaches used by anesthesiologists are regularly reviewed by the FAR Committee of Difficult Airways by distributing a questionnaire. During the last 10 years there has been a positive trend in the level of hospital equipment with supraglottic airways, there has been an increase in the awareness of specialists about the existing clinical guidelines. An updated version of the survey was developed to examine the current situation in the Russian Federation, to analyze the effectiveness of the approaches used to solve the problem of “difficult airways” and to evaluate the role of the existing recommendations of the FAR.

The role of the human factor is decisive in the development of a significant part of critical situations during anesthesia. A modern training program for clinical residents in anesthesiology should include training in upper airways assessment, performing basic maneuvers of airways management, working out techniques for using various devices, as well as using existing algorithms of actions during “difficult airways” situations. The ability to apply theoretical knowledge and act requires training in a high-fidelity simulation and subsequent analysis of residentʹs performance. The newly developed survey is devoted to the analysis of the situation with airways management training in the clinical residency. Based on the results of the survey, it is planned to develop a draft national airways management training program for anesthesia residents.

Keywords: airways management, difficult airways, human factor, critical situations, airways management training, national survey of airways management.

Received: 22.07.2019

Accepted: 03.09.2019


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Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018)

A.A. Andreenko1, E.L. Dolbneva2, V.I. Stamov3

1 FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, Saint-Petersburg

2 FGBNU RNCH named by acad. B.V. Petrovsky, Moscow

3 UKB № 2 FGAOU VO “Moscow State Medical University named after I.M. Sechenov” Ministry of Health of Russia, Moscow

For correspondence: Aleksander A. Andreenko — Cand. Med. Sciences, Assistant Professor, Deputy Head of the Department of Anesthesiology and Resuscitation, FGBVOU VO “Military Medical Academy named after S.M. Kirov” Ministry of Defence of Russia, Saint-Petersburg; e-mail: aaa010803@gmail.com

For citation: Andreenko AA, Dolbneva EL, Stamov VI. Airway management in hospital. Russian Federation of anesthesiologists and reanimatologists guidelines (second edition, 2018). Alexander Saltanov Intensive Care Herald. 2019;2:7-31.

DOI: 10.21320/1818-474X-2019-2-7-31


The review presents the clinical guidelines of the Federation of Anaesthesiology and Resuscitation specialists of Russia, revised in 2018. The recommendations are based on a review of publications and modern international guidelines of the Difficult Airway Society (DAS, 2015), American Society of Anesthesiologists (ASA, 2013), the European Society of Anesthesiologists (ESA, 2018).

“Difficult airways” are encountered relatively infrequently in modern anesthesia practice, but if it is impossible to ensure adequate oxygenation of patients, they lead to post-hypoxic brain damage or circulatory arrest. Current requirements for patient safety during anesthesia determine the need for a thorough assessment of patients before surgery, identification of prognostic signs of difficult ventilation through a face mask or supraglottic airway device, difficult laryngoscopy and tracheal intubation, difficult cricothyrotomy. As a result of the examination, the anesthesiologist is obliged to formulate the main and reserve action plan, prepare the necessary equipment, and involve specialists if necessary.

The recommendations provide evidence of the effectiveness of modern devices for ventilation and tracheal intubation. Algorithms for making decisions and actions in various situations with predictable and unpredictable “difficult airways” in patients with different risks of aspiration are proposed. An algorithm for preparing, predicting possible complications and performing extubation of the trachea is also proposed. The recommendations presented in the review are aimed at achieving the goal of increasing patient safety during general anesthesia by reducing the risk of developing critical disorders of gas exchange due to airway management problems.

Keywords: tracheal intubation, difficult airways, difficult mask ventilation, difficult laryngoscopy, difficult intubation, supraglottic airway devices, cricothyrotomy, failed intubation

Received: 25.02.2019


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The features of anesthesia in bariatric surgery

E.Y. Garbuzov, G.A. Ovsyannikov, S.G. Sherbak

City Hospital № 40, Saint-Petersburg

For correspondence: Evgenii Garbuzov — MD, head of Department of anesthesiology and intensive care of Saint-Petersburg clinical hospital № 40, Saint-Petersburg; e-mail: eugarbouzov@mail.ru

For citation: Garbuzov EY, Ovsyannikov GA, Shcherbak SG. The features of anesthesia in bariatric surgery. Alexander Saltanov Intensive Care Herald. 2018;2:31–5.

DOI: 10.21320/1818-474X-2018-2-31-35


Nowadays obesity is a worldwide problem. Changes associated with the obesity commonly increase risks of perioperative complications that could be fatal. The increasing of fat tissue influences significantly on pharmacokinetic of intravenous drugs, nevertheless effects of inhaled anesthetics remain more predictable. Structural changes of upper airways, sleep apnea obstructive syndrome, cervical osteochondrosis reduce visualization in direct laryngoscopy. Frequency of difficult tracheal intubation in patients with body weight index more than 40 kg/m2 reaches 13–24 %. In some cases awake tracheal intubation is necessary, that changes a traditional induction plan. Morbid obesity patients have often cardiovascular diseases, respiratory system disorders and increased intra-abdominal pressure, therefore they need a differentiated approach for ventilation strategy for safe anesthesia. Knowledge of the pathophysiology of these changes allows to take measures to prevent serious complications. Nowadays in the general surgery department of the Saint-Petersburg City Hospital № 40 we perform two types of bariatric operations: sleeve — resection and gastric-bypass. In this article we have presented our experience of perioperative management of morbid obese patient for bariatric surgery.

Keywords: anesthesia, morbid obesity, bariatric surgery, laparoscopic surgery, difficult airways, inhaled anesthetics, monitoring of neuromuscular block

Received: 20.12.2017


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