Dr. Michael Murphy Sees Airway “Cornerstones” Emerging
Recently published research was the impetus behind Dr. Michael Murphy’s new way of thinking about airway management for anesthesiologists. “If you put it all together, you can’t help but see a new paradigm emerging.” Doctor Murphy, Professor and Chair of Anesthesia and Pain Medicine at University of Alberta, and National Course Director for The Difficult Airway Course: Anesthesia™ sees three clear messages for anesthesiologists arising out of the research:
Awake intubation is cornerstone of successful difficult airway management. A staggering 97% of experts and 98% of ASA members recommend it when a difficult airway is identified.[i] “We all need to strive for efficient and effective topicalization, the foundation for successful awake intubation with a bronchoscope or video laryngoscope,” says Dr. Murphy.
Open cricothyrotomy is the cornerstone of successful failed airway management. Recent research, including NAP4[ii], points to open cricothyrotomy as the best response to a failed airway. “We’ve always viewed cricothyrotomy as an important part of the airway management plan. Now, we have key information about what works best,” says Dr. Murphy.
Airway exchange catheter is the cornerstone of successful difficult extubations. Pederson identified difficult extubation as a medical legal risk in his 2005 analysis[iii] of the closed claims database and NAP4 identified it as a major contributor in 1/3 of airway management disasters reported. Recent publications in Anesthesia and Analgesia[iv], Anaesthesia[v] and the Journal of Intensive Care Medicine[vi] reinforce the importance of these devices. “The research is clear, airway exchange catheters need to be part of the extubation experience.”
These cornerstones form the new paradigm that Dr. Murphy has been advocating in his teaching. “Such compelling evidence is exhilarating,” says Dr. Murphy. “It leads to better patient outcomes and presents great opportunities for educators to make a significant impact on the standard of care.”
[i] American Society of Anesthesiologists: Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Taskforce on the Management of the Difficult Airway. Anesthesiology. 2003; 98:1269–1277.
[ii] The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (http://www.rcoa.ac.uk/node/4211)
[iii] Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005 Jul;103(1):33-9.
[iv] Cavallone LF, Vannucci A. Extubation of the Difficult Airway and Extubation Failure. Anesth Analg 2013;116-368-83.
[v] Popat M, Mitchell V, David R, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012, 67, 318-340.
[vi] Faris K, Zayaruzny M, Spanakis S. Extubation of the Difficult Airway. Journal of Intensive Care Medicine 2011:26:261-266.
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