Document Detail

Management of the difficult airway: a closed claims analysis.
MedLine Citation:
PMID:  15983454     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this study was to identify the patterns of liability associated with malpractice claims arising from management of the difficult airway. METHODS: Using the American Society of Anesthesiologists Closed Claims database, the authors examined 179 claims for difficult airway management between 1985 and 1999 where a supplemental data collection tool was used and focused on airway management, outcomes, and the role of the 1993 Difficult Airway Guidelines in litigation. Chi-square tests and multiple logistic regression analysis compared risk factors for death or brain damage (death/BD) from two time periods: 1985-1992 and 1993-1999. RESULTS: Difficult airway claims arose throughout the perioperative period: 67% upon induction, 15% during surgery, 12% at extubation, and 5% during recovery. Death/BD with induction of anesthesia decreased in 1993-1999 (35%) compared with 1985-1992 (62%; P < 0.05; odds ratio, 0.26; 95% confidence interval, 0.11-0.63; P = 0.003). In contrast, death/BD associated with other phases of anesthesia did not significantly change over the time periods. The odds of death/BD were increased by the development of an airway emergency (odds ratio, 14.98; 95% confidence interval, 6.37-35.27; P < 0.001). During airway emergencies, persistent intubation attempts were associated with death/BD (P < 0.05). Since 1993, the Airway Guidelines were used to defend care (8%) and criticize care (3%). CONCLUSIONS: Death/BD in claims from difficult airway management associated with induction of anesthesia but not other phases of anesthesia decreased in 1993-1999 compared with 1985-1992. Development of additional management strategies for difficult airways encountered during maintenance, emergence, or recovery from anesthesia may improve patient safety.
Gene N Peterson; Karen B Domino; Robert A Caplan; Karen L Posner; Lorri A Lee; Frederick W Cheney
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  103     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-28     Completed Date:  2005-08-23     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  33-9     Citation Subset:  AIM; IM    
Department of Anesthesiology, University of Washington, Seattle 98195-6540, USA.
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MeSH Terms
Hypoxia, Brain / epidemiology,  mortality
Insurance Claim Review / statistics & numerical data*
Intubation, Intratracheal / adverse effects*,  mortality,  statistics & numerical data*
Middle Aged
Monte Carlo Method
Perioperative Care / adverse effects,  mortality,  statistics & numerical data*
Comment In:
Anesthesiology. 2006 Mar;104(3):615-6; author reply 616-7   [PMID:  16508412 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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