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Crisis management during anaesthesia: obstruction of the natural airway

¹ Staff Specialist, Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
² Senior Staff Specialist, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
³ Senior Staff Specialist, Department of Anaesthesia and Intensive Care, The Townsville Hospital, Douglas, Queensland, Australia
⁴ Deputy Director, Department of Paediatric Anaesthesia and Pain Management, Royal Children’s Hospital, Parkville, Victoria, Australia

Correspondence to:
Professor W B Runciman
President, Australian Patient Safety Foundation, GPO Box 400, Adelaide, South Australia 5001, Australia; research{at}apsf.net.au Background: Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient.

Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia.

Methods: The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.

Results: There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases.

Conclusion: Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist’s clinical practice requirements.

Keywords: anaesthesia complications; crisis management; pulmonary aspiration; pulmonary oedema; desaturation; hypoxia; cricothyrotomy

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