Crisis management during anaesthesia: obstruction of the natural airway.
BACKGROUND
Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient.


OBJECTIVE
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia.


METHODS
The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.


RESULTS
There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases.


CONCLUSIONS
Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist's clinical practice requirements.
Visvanathan
T
T
Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Kluger
M T
MT
Webb
R K
RK
Westhorpe
R N
RN
D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D000465:Algorithms; D000758:Anesthesia / Q000009:adverse effects*; D000776:Anesthesiology / Q000379:methods* / Q000592:standards; D001315:Australia; D004630:Emergencies; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D016343:Monitoring, Intraoperative; D012308:Risk Management; D013647:Task Performance and Analysis