Introduction: Anesthesia applications for increasingly complex procedures outside the operating room have increased significantly in recent years. In order to maintain high levels of safety and quality, it is essential to understand the characteristics of this population. The purpose of this audit is to describe the characteristics of the airway examination and the incidence of difficult airway in the anesthetic population of our institution, in order to anticipate and improve the care provided to the patient.
Methods: Implementation of anesthetic recording in all places outside the operative room. Prospective audit of these anesthetic records during the years 2014 and 2015. Variables analyzed: Sociodemographic (age, sex), clinical (comorbidities, allergies, smoking), airway evaluation (AE), ASA-PS score. Descriptive statistics.
Results: The total number of patients anesthetized at remote sites was 2821: Gastroenterology (45.9%), Cardiology (24.5%), Neuroradiology (13.9%), Magnetic resonance imaging (11.8%), evoked potentials (0.8%) and others (3.2%). 60% as ambulatory procedures, 33% with hospital admission and 7% as emergent procedures. 10% of patients younger than 15 years, 69% older than 50. 22.5% of the patients were obese, 4% had a BMI greater than 40 kg / m2. 40% ASA III score, 4.5% ASA score 4 and two ASA V patients. 18% had respiratory disease. Incidence of difficult airway of 5.8%. Airway evaluation: 6.5% thyromental distance <6.5cm, 11.5% Mallampati score> 2, 4.4% reduction in mouth opening, 10.6% with cervical extension <90°, 17.2% with cervical diameter> 40cm, 19.5% with upper lip bite test> 1, 28% with oral prosthesis. 97% maintained spontaneous ventilation during the procedure. 4.4% with orotracheal intubation, 5.2% with supraglottic device. Laryngoscopy Grade III (Cormack Lehane) in 3.5% and grade IV in 8.6%.
Discussion: Most procedures outside the operative block were performed under continuous monitoring anesthetic technique and the patients maintained spontaneous breathing. We found a significant incidence of difficult airway predictors, despite the subjectivity inherent in this evaluation. Although most procedures require only mild to moderate sedation, a significant number of cases required general anesthesia and orotracheal intubation, with laryngoscopy grade greater than 2 in 12%. These findings highlight the need to improve safety and preparation parameters, especially in the possible resolution of difficult VA cases.


03 / Airway approach characteristics in anaesthetized patients outside the operating room