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Andrew Norton

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I'm working through the adverse airway event terminology requests following the meeting in Bratislava.
A couple of questions for consideration;
1) Have not found much to help with definitions for "difficult supraglottic airway device insertion" and " Failed supraglottic airway device insertion". Any thoughts, suggestions, suitable references please let me know.

2) Emergency Front of neck access - are there any other procedures to include as well as tracheostomy and cricothyroidotomy?

Contributors (3)

9 Comments

  1. James Palmer

    Hello Andrew.

    Point 2 first.

    Cricothyroidotomy may be needle (Ravussin) or cannula (Melker), or be  categorised as tube over bougie  https://www.das.uk.com/files/das2015intubation_guidelines.pdf

    Both of the first two techniques may also be performed as elective procedures alhough Melker rarely is!

    Point 1. https://www.ncbi.nlm.nih.gov/pubmed/7486037

    https://www.ncbi.nlm.nih.gov/pubmed/8494147

    are the best i can find. I will ask Tim Cook.

    best.

    J

  2. Zac Whitewood-Moores

    Do you wish to include as part of this work a review of concepts related to clearance of airway and suctioning e.g. Mini Trach?

  3. James Palmer

    It might not be a bad plan but would it get too big? Mini trach is rarely used now and airway suction might be anything from blind soft nasal suction (physio) to rigid suction (Yankauer) by anaesthetist, to rigid endotracheal suction (ENT surgeon). I would have thought that keeping to the critical incident framework would be a good start. What are your feelings?

    J

  4. Zac Whitewood-Moores

    Cant comment on frequency now, apart from coded frequency and actual may be completely different, see http://www.ncepod.org.uk/2014report1/downloads/OnTheRightTrach_FullReport.pdf Whilst this refers to the classification coding many of the points made in the paper may well help prioritise.  Apologies I was not intending to extend the scope to suctioning necessarily, but I am interested that the mini trach is now out of favour, I wonder if this depends on where in the world.

  5. Andrew Norton

    James, Zac

    Thanks for the useful comments on this debate.  We did discuss types of cricothyroidotomy (needle, cannula, scalpel) in Bratislava and the consensus of those present was that we would not request differing procedure terms for the different types of cricothyroidotomy. However, if anyone feels differently, we can of course discuss it again at our next Zoom meeting on 28th November.

    Also thanks for the references - I have done the draft requests for the difficult and failed supraglottic airway ventilation terms, but hopefully we will get a bit nearer to useful definitions after our next meeting.

    Zac - I had not really considered adverse events related to tracheostomy care, and confess the NCEPOD report on tracheostomy care had slipped my mind, but agree it would be something worth coming back to, but would like to get the current scope adverse event terms - i.e. fundamentally related to anaesthesia completed first.

    Another interesting little question - is there any difference between 173067007 Cricothyroidotomy (procedure)  qualifier = emergency and 398142004 Emergency cricothryotomy (procedure) (note the misspelling in SNOMED).  It will need to be considered when I do the requests for FONA (front of neck access) and the procedures to be included within that axis.  I mention it as emergency cricothyrotomy really needs to be changed/ retired as it's parent term is 78817002 Construction of anastomosis (procedure) which the Anesthesia CRG regards as incorrect. Cricothyroidotomy is an "incision of larynx" which is fine.



    1. Zac Whitewood-Moores

      https://emedicine.medscape.com/article/1830008-overview suggests they are the same and the emergency is pre or post-coordinated.  Suggest just correcting the modelling so that its parenting gets sorted.  Incision seems sensible

  6. Andrew Norton

    Another thought - should we think of differentiating failed / difficult supraglottic airway insertion and ventilation - There is already a longstanding SNOMED CT term for failed laryngeal mask insertion.

  7. Zac Whitewood-Moores

    Failed and difficult are different as is the airway insertion and ventilation.  One may cause the other but it doesn't make them the same.

  8. James Palmer

    //dd-mm-yyyyJust come to these comments.

    1. I agree that failed/difficult SAD insertion is not the same as failed/difficult ventilation (which may not involve a SAD at all)
    2. I agree with both of you that the misspelled term for cricothyrotomy should be retired and 173067007 Cricothyroidotomy (procedure)  qualifier = emergency remain. Could I ask though that a future review considers equating the two words for the same term as they are both in common use? The trouble is that successive authors of papers on the subject seem to wish to create novel ways of describing the same thing which then causes problems for terminology! I see the acronym FONA (emergency or elective) as being the parent of a large number of procedures including tracheostomy, cannula cricothyrotomy/roidotomy, needle cricothyrotomy and incision cricowhateverotomy. However, since cricothyroidotomy (laryngeal incision) and tracheostomy (tracheal incision) presumably are separate this leave FONA a bit lost.
    3. Agree with Andrew that we leave suction/tracheostomy (and indeed laryngectomy) care for later but THEY ARE VERY IMPORTANT AND NEED WORK!
      JP