Major Airway Complications of Anaesthesia Dr Nick Woodall NAP4 Wednesday July 13th 2011 Introduction   Thanks for giving me the opportunity to talk about NAP four, This project has been a massive undertaking, And I will be talking on behalf of the whole project It has involved every UK anaesthetist in this room. You have all contributed to the census of airway management activity , you have all funded the project through DAS the RCoa You have contributed data to the snapshot or and most importantly some you have contributed cases. Others have had a more direct organisational role in the project and many you have all made made essential contributions some of us submitted reports the important contribution of those who reported cases to the project as LRs a moderator review panel members. An mosyt of you through DAS the RCoa or a specialist society have made a financial contribution. many DAS members have been central to the planning and organisation of the project 2

207 Reports 79 withdrawn after discussion with moderator or RCoA lead IC speeded up the process by n excess of 3 months

184 Reports by Inclusion Criteria

Inclusion Criteria all Areas Inclusion citeria differed markedly

Final Outcome There were 10 late deaths and 2 were attributable to the airway problem. Of all patients submitted with brain damage

Demographic Data 62% of anaesthesia cases were males thus the chance of an event was 50% higher in males

Age 61% of patients were less than 60 years old

Habitus A BMI of over 30 was reported in 40% of cases and less than 20 in 11%

Location of Event

Most events involved multiple anaesthetists often with an ICU consultant involvement too. 5% of events took place in the presnce of locums

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

Primary Airway Management Device

Primary Airway Problem

Final Outcome

Incidence of Complications

Clustering by Hospital 35% of cases came from 6.5% of hospitals 50% of cases came from 12% of hospitals The majority submitted no cases

Date of Event 197 Stats suggested this is compatible with complete capture

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 646reports V 133 received 1 in 4

Events per Anaesthetist 133 events during 2.9m 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