From the Department of Anaesthesia, Edinburgh Royal Infirmary, Edinburgh (JDC, CF, EK, CAT, NA), the Department of Anaesthesia, St John's Hospital, Livingston (PW), The Departments of Anaesthesia, Western General and St John's Hospital, Edinburgh, UK (AFM).
Eur J Anaesthesiol. 2023 Nov 1;40(11):826-832. doi: 10.1097/EJA.0000000000001897. Epub 2023 Aug 23.
Guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society state that 'a videolaryngoscope should be immediately available for all obstetric general anaesthetics'.
To report the incidence of videolaryngoscopy use, and other airway management safety interventions, in an obstetric population before and after various quality improvement interventions.
Prospective data collection was undertaken over 18 months, divided into three separate 6-month periods: June to November 2019; March to August 2021; January to June 2022. These periods relate to evaluation of specific quality improvement interventions.
The project was carried out in a large tertiary referral obstetric unit.
We identified 401 pregnant women (> 20 weeks' gestation) and postnatal women (up to 48 h post delivery) undergoing an obstetric surgical procedure under general anaesthesia.
To standardise practice, an intubation checklist was introduced in December 2020 and multidisciplinary staff training in August 2021.
Primary outcome measures were use of a Macintosh-style videolaryngoscope and tracheal intubation success. Secondary outcome measures were use of an intubation checklist; low flow nasal oxygen; and ramped patient positioning.
Data from 334 tracheal intubations (83.3% of cases) were recorded. Videolaryngoscope use increased from 60% in 2019, to 88% in 2021, to 94% in 2022. Tracheal intubation was successful in all patients, with 94% first pass success overall and only 0.9% requiring three attempts. Use of secondary outcome measures also increased: low flow nasal oxygen from 48% in 2019 to 90% in 2022; ramped positioning from 95% in 2021 to 97% in 2022; and checklist use from 63% in 2021 to 92% in 2022.
We describe the successful adoption of simple safety measures introduced into routine practice. These comprised videolaryngoscopy, ramped positioning and low flow nasal oxygen. Their introduction was supported by the implementation of an intubation checklist and multidisciplinary team training.
产科麻醉医师协会和困难气道学会的指南指出，“所有产科全身麻醉都应立即配备视频喉镜”。
报告在各种质量改进干预措施前后，在产科人群中使用视频喉镜和其他气道管理安全干预措施的发生率。
前瞻性数据收集在 18 个月内进行，分为三个单独的 6 个月期：2019 年 6 月至 11 月；2021 年 3 月至 8 月；2022 年 1 月至 6 月。这些时期与评估特定的质量改进干预措施有关。
该项目在一家大型三级转诊产科单位进行。
我们确定了 401 名接受全身麻醉的孕妇（妊娠 20 周以上）和产后妇女（分娩后 48 小时内）进行产科手术。
为了规范实践，我们在 2020 年 12 月引入了插管检查表，并在 2021 年 8 月对多学科工作人员进行了培训。
主要观察指标是使用 Macintosh 式视频喉镜和气管插管成功。次要观察指标包括使用插管检查表；低流量鼻氧；和斜坡患者定位。
记录了 334 例气管插管（83.3%的病例）的数据。视频喉镜的使用率从 2019 年的 60%上升到 2021 年的 88%，再到 2022 年的 94%。所有患者的气管插管均成功，总首次通过成功率为 94%，仅 0.9%需要三次尝试。次要观察指标的使用率也有所增加：2019 年低流量鼻氧从 48%上升到 2022 年的 90%；2022 年斜坡定位从 95%上升到 97%；2021 年检查表使用率从 63%上升到 2022 年的 92%。
我们描述了在常规实践中成功采用的简单安全措施。这些措施包括视频喉镜、斜坡定位和低流量鼻氧。它们的引入得到了插管检查表和多学科团队培训的支持。
