SFAR updated guideline on difficult intubation and extubation in adult anesthesia

The French National Society of Anaesthesia and Intensive Care Medicine (Société française d’anesthésie et de réanimation – SFAR) has released an update to French guidelines on ‘‘Difficult intubation and extubation in adult anaesthesia 2006."

A consensus committee of 13 experts, consisting of Olivier Langeron, Department of anaesthesia and intensive care, Surgical Intensive Care Unit, Sorbonne Université, Pris, France, and colleagues, was constituted to develop the guideline.

Tracheal extubation and intubation are inseparable and routine techniques in intensive care and anesthesia. Their importance must not be underappreciated despite the fact that they are commonly applied. At times in some cases, extubation and intubation are challenging and can be a major cause of mortality and morbidity in anesthesiology.

The guidelines has been published in the journal Anaesthesia Critical Care & Pain Medicine.

Read Also: AIDAA guidelines for tracheal Intubation in ICU

Key Recommendations:

• Anaesthetists must prevent arterial oxygen desaturation during tracheal intubation or supra-glottic device insertion manoeuvres because of the risk of morbidity and mortality.


• To definitively prevent arterial desaturation during tracheal intubation or insertion of a supra-glottal device, perform a pre-oxygenation procedure (3 min/8 deep inspirations), including for the management of emergencies.


• In some cases, combining apnoeic oxygenation with specific techniques is recommended to prevent arterial oxygen desaturation.


• The use of videolaryngoscopes is recommended first in patients where mask ventilation is possible and who present at least two criteria for difficult intubation during scheduled surgery.


• The use of videolaryngoscopes is not recommended in case of rapid sequence induction for patients with a full stomach.


• The use of videolaryngoscopes is recommended as a second attempt device in patients with a Cormack and Lehane grade III or IV, if mask ventilation is possible,if difficult intubation is not foreseen.


• Use of videolaryngoscopes is recommended as an alternative airway control technique, instead of the fiberscope, in spontaneous ventilation patients for anticipated difficult or impossible planned intubation and difficult mask ventilation.


• Maintain a deep level of anesthesia using rapidly reversible agents in order to optimize conditions of mask ventilation and intubation.


• If difficult intubation is anticipated, administration of a muscle relaxant is recommended in order to improve the conditions of mask ventilation and intubation.


• Use a short-acting muscle relaxant or one that can be rapidly inactivated during routine monitoring.


• Since reintubation is a source of morbidity and mortality, adapting the airway management to risk factors associated with extubation failure is recommended.


• The risk factors for failure prior to extubation must be explored.


• Extubating patients following a rigorous strategy in the presence of extubation risk factors, implement preventive measures.


• It is wise to use decision trees and algorithms to optimize the management of difficult airway control.

For further information follow the link: https://doi.org/10.1016/j.accpm.2018.03.013