Follow-Up Care of Patients Following a Difficult Tracheal Intubation
Injuries associated with airway interventions are a significant source of morbidity and mortality (28). In a closed claims analysis, Domino and co-workers (23) found that early signs of perforation, pneumothorax and subcutaneous emphysema, occuring in the immediate perioperative period were present in only about 50 percent of the perforations, whereas late sequel, retropharyngeal abscess, mediastinitis, or mediastinal abscess, occurred in 65 percent.
The follow-up care of patients with an experienced difficult airway (DA) is highly recommended by the American Society of Anesthesiologists task force (2); these patients at risk should be routinely observed for complaints and potential complications. With physical airway examination, some causes of the unanticipated DA, for example, the presence of lingual tonsil hyperplasia (39) or obstructive sleep apnea (16), will remain undetected without further consultations and examinations; in these patients, further follow-up care should be initiated to identify the cause(s) of the nonapparent DA.
Recommendations of the Austrian Working Group for Airway Management
We recommend that patients with an experienced DA should be routinely observed for complaints and potential complications associated with airway interventions. In patients with a nonapparent DA, consultations and examinations should be initiated to identify the cause(s) of the DA.
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