Major Airway Complications of Anaesthesia Dr Nick Woodall

Major Airway Complications of Anaesthesia Dr Nick Woodall NAP 4 Wednesday July 13 th 2011

207 Reports

184 Reports by Inclusion Criteria 140 120 100 80 122 60 40 20 75 33 13 0 Deaths Brain Damage ESA ICU admission

Inclusion Criteria all Areas 100 90 80 70 Deaths 60 54 Brain Damage 50 ESA 40 ICU admission 30 20 10 16 14 6 6 10 12 11 3 10 1 0 Anaesthesia ICU Emergency Dept

Final Outcome

Demographic Data 200 Male 180 Female 160 71 140 120 100 51 80 60 40 113 82 15 20 5 21 ED IC 10 0 AA Total

Age 60 AA ED 50 IC 40 30 20 10 0 <1 1 -4 5 -10 11 -20 21 -40 41 -60 61 -80 >81 UK

Habitus

Location of Event 70 60 64 50 50 40 30 17 20 10 2 0 AR OR RR Transit

RCo. A UK Census 2007 Trainees 4488 36% Consultant 6233 49% SAS 1879 15%

Procedures • Elective or scheduled 54% • 00: 01 -08: 00 • 08: 01 -18: 00 • 18: 01 -24: 00 14% 69% 17%

Primary Airway Management Device

Primary Airway Problem

Final Outcome

Incidence of Complications

Clustering by Hospital

Date of Event 197

Local Reporters’ Complications • • 286 LRs Report origin provided in 130 LR was also the anaesthetist for 19 of 130 reports If all 6233 consultants behaved as LRs 6233/286 x 19 = 414 reports • 64% of reports came from consultants 100/64 x 414 = 646 reports • 646 reports V 133 received 1 in 4

Events per Anaesthetist • 133 events during 2. 9 m GA – 1: 22, 000 • Only 1 in 4 reported – 1: 5, 500 • Each event has 3 anaesthetists present – 1: 1, 800

Summary of Case Reviews • • Males, ASA 1 -2, age < 60 years Elective procedures Anaesthetised by consultants 25% of events occurred at emergence or in recovery Obesity implicated Airway obstructive lesions Crico-thyroidotomy by anaesthetists low success rate Omission or incorrect interpretation of capnography led to undiagnosed OI • Elements of poor management observed in most complications and deaths

The End