Letters

Costs that would be incurred in establishing “difficult airway register” could be better spent

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7069.1399b (Published 30 November 1996) Cite this as: BMJ 1996;313:1399
  1. Edmund Morris,
  2. Antony Osborne,
  3. Claire Jewkes
  1. Senior house officer Registrar Consultant Department of Anaesthetics, Frenchay Hospital, Bristol BS16 1LE

    EDITOR,—J B Liban proposes that a national “difficult airway register” should be established to identify and store information on those patients in whom airway management has been problematic.1 Several points should be considered before such a scheme is proceeded with.

    Liban states that “about 41% of all deaths attributable to anaesthesia are related to difficulties with endotracheal intubation.” These data, from the confidential inquiries into maternal deaths, refer only to obstetric anaesthesia. The overall proportion of anaesthetic deaths related to difficult intubation is not cited in recent reports of national confidential inquiries into non-obstetric perioperative deaths, but the actual numbers are likely to be small. In a 1987 British retrospective study of non-obstetric failed intubations six out of 13 380 patients could not be intubated, and all survived.2 Since these studies were undertaken the laryngeal mask airway has been introduced into routine anaesthetic practice and has been used effectively in the management of difficult intubation.3

    Accessing a patient register would be time consuming and would depend on patients identifying themselves, either orally or (as Liban proposes) by means of a Medic Alert bracelet. We suggest that sufficient information to identify the patient's problem could almost always be fitted into the bracelet itself—for example, “Only intubatable with fibreoptics, but mask ventilation easy—J Bloggs, consultant anaesthetist, Smalltown General.” Many anaesthetists already provide written details of critical incidents to patients and their general practitioners postoperatively. Further registration with a national information store would take time and involve additional paperwork, which would almost certainly lead to non-compliance.

    We could find no published evidence that the use of a centralised agency in the United States has reduced mortality due to airway problems. There is evidence that use of a strategy or algorithm facilitates successful airway management and leads to fewer adverse outcomes.4 The time and cost involved in establishing, running, and accessing a national database might be better spent on increasing awareness of, and rigorous training in, strategies for managing patients with a difficult airway. Summoning senior or more experienced help is as important as knowing the exact details of previous attempts at intubation.

    References

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