Surveillance of and Risk Fztors for Difficult Intubation At Srinagarind Hosipital

ABSTRACT

Objective:  To identify the incidence of, and risk factors for, difficult intubation during anesthesia at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.Design:  Descriptive, prospective study.Methods:  Our study was part of a multi-center study conducted in 2003 by the Thai Royal College of Anesthesiologists aimed at surveillance of anesthetic-related complications in Thailand.  We collected the data from all of the cases receiving anesthesia service at Srinagarind Hospital between January 1 and December 31, 2003, to document cases of difficult intubation during anesthesia and to determine the cause(s), that the quality of service might be improved.  Patient data, corrective method, contributing factors, factors minimizing incidence and suggested corrective strategies were recorded on the ‘Difficult Intubation Record Form’.Results:  A total of 10 607 patients were included.  The incidence of difficult intubations during anesthesia was 20 (18.86 per 10 000; 95%CI 11.52, 29.11).  Corrective methods included  stylet use, straight laryngoscope blade and intubation laryngeal mask airway.  Only minor physiological disturbances occurred in most patients.  The common contributing factors were  insufficient knowledge, inexperience and insufficient equipment.  Suggested corrective strategies could include  additional training, quality assurance activity, and purchase of equipment.Conclusion:  The incidence of difficult intubation was 18.86 per 10 000.  None of the patients experienced any major complications, perhaps because of standard anesthesia care.  The causes and corrective strategies comprised patient character, personnel-associated, knowledge and equipment.  Additional equipment and training as well as quality assurance activity would probably help to reduce the incidence of difficult intubation.