Safety First - Pre-emptive Fiberoptic or Safety Last - LMA
Abstract Number: 196
Abstract Type: Original Research
Introduction: The incidence of failed intubation (FI) remains at 1/300 for the past three decades. Equipment surveys reveal LMAs are stocked in 100% of obstetrical units, while fiberoptic bronchoscopes in only 8%.This promotes the use of the LMA for rescue. What other factor accounts for an unchanged rate of FI?
Methods:A meta-analysis of difficult airway predictors (Mallampati, thyromental, interincisor) was conducted to determine the area under the composite receiver –operator curve(AUCROC). A review of our general anesthesia c-section database was used to determine our current trend in airway management.
Results: The AUCROC for composite scores was 0.8. The incidence of FI in our obstetric unit for the years 1984-2004 was 1/2500 with a prophylactic fiberoptic rate(PFO) of 14%. The FI for the years 2005-2008 was 1/100 with a PFO of under 10%.
Discussion: To prevent 50% of FI would require a PFO of 15%(figure), unachievable in 92% of obstetrical units.
References: Bullough,IJOA(2009)18;342-45, Shiga, Anesthesiology(2005)103;429-37