New guidelines to help make anaesthesia safer
New guidelines published today (15 November) in the journal Anaesthesia will help anaesthetists perform safer airway management for patients undergoing general anaesthesia.
In the UK, anaesthetists are responsible for delivering 3–5 million general anaesthetics each year.1 One of the primary goals of anaesthesia is to ensure an adequate supply of oxygen to vital organs, such as the brain. To do this, anaesthetists ‘manage the patient’s airway’ in a variety of ways – by holding on a face mask, placing a mask just over the opening to the lungs, or by passing a tube into the trachea (windpipe). Some patients have airways that are difficult to manage for a range of reasons and in these situations managing the airway before being asleep (under general anaesthesia) is the safest thing to do. These new guidelines, the first of their kind worldwide, aim to encourage more anaesthetists to manage a patient’s airway before they have been anaesthetised. This technique, known as Awake Tracheal Intubation (ATI) is low risk and avoids the consequences of difficult airway management in an anaesthetised patient.
Difficult airway management is estimated to occur in 100,000 patients per year,2 and many patients are thought to die or suffer permanent brain damage because of complications in managing the airway. The ATI technique can reduce this risk. Despite the high success rate and safety profile of the ATI technique, it is often underused, often due to a lack of training, experience or confidence.
These new ATI guidelines aim to standardise the training and practice of this technique, benefitting thousands of patients a year who would otherwise be at risk of complications.
Dr Kariem El-Boghdadly, Secretary of the guidelines group and Consultant Anaesthetist at Guy’s and St Thomas’ NHS Foundation Trust in London, said: “These new guidelines aim to make this important technique more available to all patients by providing direct guidance on how to safely manage at-risk patients. In the long-term we hope that this will improve the care of patients undergoing surgery anywhere in the world.”
Dr Imran Ahmad, Chairperson of the guidelines group, Consultant Anaesthetist at Guy’s and St Thomas’ NHS Foundation Trust and Honorary Secretary for the Difficult Airway Society said: “The Difficult Airway Society has a long tradition of producing guidelines that increase patient safety; we hope these guidelines will continue this tradition by encouraging anaesthetists to perform this technique when indicated and avoid potential complications in at-risk patients.”
1 Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM. Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics. Br J Anaesth. 2017 Aug 1;119(2):249-257.
2 Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31.
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Notes for editors:
For media enquiries, embargoed copies of the guidelines and interview opportunities, please contact:
Amelia Lyons, press officer, Association of Anaesthetists, on: 07989 748 477 or email: [email protected]. Or, Stephanie Addington, marketing and communications manager, Association of Anaesthetists, on: +44 (0) 20 7631 8854 or email [email protected]
Difficult Airway Society Guidelines for Awake Tracheal Intubation (ATI) in adults is published in the journal Anaesthesia on 15 November 2019 and is available at https://onlinelibrary.wiley.com/doi/10.1111/anae.14904
Authors of the report are:
I. Ahmad,1,2 K. El-Boghdadly,1,2 R. Bhagrath,3 I. Hodzovic,4,5 A. F. McNarry,6 F. Mir,7 E.P. O’Sullivan,8 A. Patel,9 M. Stacey10 and D. Vaughan11
1 Anaesthetic Consultant, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
2 Honorary Senior Lecturer, King’s College London, UK
3 Anaesthetic Consultant, Barts Health NHS Trust, London, UK
4 Senior Lecturer, Cardiff University School of Medicine, Cardiff, UK
5 Honorary Anaesthetic Consultant, Aneurin Bevan University Health Board, Newport, UK
6 Anaesthetic Consultant, NHS Lothian, Edinburgh, UK
7 Anaesthetic Consultant, St. George's University Hospital NHS Foundation Trust, London, UK
8 Anaesthetic Consultant, St James's Hospital, Dublin, Ireland
9 Anaesthetic Consultant, Royal National Throat Nose and Ear Hospital and University College London Hospitals NHS Foundation Trust, London, UK
10 Anaesthetic Consultant, Cardiff and Vale NHS Trust (HEIW), Cardiff, UK
11 Anaesthetic Consultant, Northwick Park Hospital, London, UK
About the journal Anaesthesia
Anaesthesia is the official journal of the Association of Anaesthetists of Great Britain and Ireland and is international in scope and comprehensive in coverage. It publishes original, peer-reviewed articles on all aspects of general and regional anaesthesia, intensive care and pain therapy. Its Impact Factor for 2018 is 5.4 and it is 3rd out of 31 (Anaesthesiology) in the ISI Journal Citation Reports© Ranking.
About the Association of Anaesthetists
As the professional membership organisation for over 11,000 anaesthetists in the UK, Republic of Ireland and internationally, the Association of Anaesthetists promotes patient care and safety, and advances anaesthesia through education, publications, research and international work. The Association maintains an active programme of support for anaesthesia worldwide, especially in low- and middle-income countries. Its motto in somno securitas (‘Safe in Sleep’) encapsulates the major focus of the Association: safety in anaesthesia. www.anaesthetists.org
About the Difficult Airway Society
The Difficult Airway Society (DAS) is a UK-based medical specialist society formed to further the management of the airway of patients by anaesthetists and other critical care practitioners. The core aims of the society are the advancement of public education in the science and practice of difficult or unusual airway problems and the promotion and publication of research and new techniques in dealing with airway problems. The society is internationally recognised for its airway guidelines.
www.das.uk.com