Preliminary study: routine use of videolaryngoscopy as a clinical risk mitigator in tracheal intubation of pediatric patients. The risk management experience of E. Profili Hospital in Fabriano

Abstract

Introduction Airway management in tracheal intubation represents one of the crucial issues in current anaesthesiological practice, in which risk management plays an essential role. At the moment, videolaryngoscopy is considered the main technique to facilitate tracheal intubation and re- duce its complications. In the operating block of Profili Hospital in Fabriano videolaryingoscopy has been the routine practice since November 2021. Objectives Evaluation of the routine use of videolaryngoscopy as a mitigator of clinical risk and unexpected difficulties oc- curring during tracheal intubation in the pediatric surgical setting. Comparison between Fremantle Videolaryngo- scope Scoring System and the Colorado Pediatric Airway Score, a score predicting difficult intubation in children.Material and Methods Preliminary prospective observational study of 64 pedi- atric patients (aged from 3 to 16 years of age) undergoing surgery, assessed through the previously mentioned scores and classifications. Results First attempt tracheal intubation achieved in 93,75% of children, without using any additional device. No intuba- tion was impossible, regardless of the difficulties pre- dicted by the Colorado Pediatric Airway Score and the videolaryngoscopic view obtained. All difficult tracheal intubations not predicted by parameters and scores were successfully performed (3,44% in our case series). Conclusion Routinary use of videolaryngoscopy has encouraged and optimised teamwork, including training; reduced the time spent in the operating room and the use of additional de- vices for managing difficult airways; completely de- creased clinical risk of difficult intubations, eliminating the impossible ones; made it possible to overcome the limits of the Colorado Pediatric Airway Score, a score predicting difficult intubation in children, allowing us to manage easily any unexpected difficult airways; permit- ted the hypothesis of abandoning, for the near future, scores and parameters predicting difficult intubation, with huge benefits in terms of time spent on surgical pa- tient preoperative evaluation.

Keywords

• routine videolaringoscopy; videolaringoscopy; pediatric airways risk management; clinical risk; pediatric tracheal intubation; pediatric airways management; anesthesia clinical risk management