2. 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

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79 withdrawn after discussion with moderator or RCoA lead IC speeded up the process by n excess of 3 months

4. 184 Reports by Inclusion Criteria

5. Inclusion Criteria all Areas
Inclusion citeria differed markedly

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

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

8. Age
61% of patients were less than 60 years old

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

10. Location of Event

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

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

14. Primary Airway Management Device

15. Primary Airway Problem

16. Final Outcome

17. Incidence of Complications

18. 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

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

20. 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

21. 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

22. 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

23. The End