Skip to main content
SpringerLink
Log in
Book cover

Catastrophic Perioperative Complications and Management pp 161–176Cite as

Airway and Respiratory System Damaging Events

  • Chapter
  • First Online:

Abstract

Airway and respiratory are among the most common perioperative complications with adverse outcomes. Despite improved monitoring methods, these complications continue to occur in the perioperative period. Association of airway and respiratory complications with certain predisposing risk factors is well recognized. The airway and respiratory events in the perioperative period can be very common, simple, and easily manageable to rare, complex, and difficult to manage situations with potentially grave consequences. A thorough understanding of the various airway and respiratory issues that can occur in the perioperative period is the key to successful management and avoidance of serious adverse outcomes and fatalities. This chapter “Airway and respiratory system damaging events” discusses different types of perioperative airway and respiratory events including PACU (postanesthesia care unit) complications, airway trauma, the risk factors for such events in general among all age groups with focus on children and obese patient populations, and steps involved in prevention, preparation, prompt recognition, and treatment. The chapter also delves into the airway management of rare but fatal complications such as airway fire and trauma. This chapter also touches on the importance of monitoring a vigilant anesthesia provider and on the legality of the perioperative respiratory complications.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 2: intensive care and emergency departments†. BJA Br J Anaesth. 2011;106(5):632–42.

    Article  CAS  PubMed  Google Scholar 

  2. Burks C, et al. Evaluation of pulmonary complications in robotic-assisted gynecologic surgery. J Minim Invasive Gynecol. 2017;24(2):280–5.

    Article  PubMed  Google Scholar 

  3. Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP. Critical respiratory events in the postanesthesia care unit. Anesthesiology. 1994;81(2):410–8.

    Article  CAS  PubMed  Google Scholar 

  4. Karcz M, Papadakos PJ. Respiratory complications in the postanesthesia care unit: a review of pathophysiological mechanisms. Can J Respir Ther CJRT = Rev Can la Ther Respir RCTR. 2013;49(4):21–9.

    Google Scholar 

  5. O’Connor BS, Vender JS. Oxygen therapy. Crit Care Clin. 1995;11(1):67–78.

    Article  PubMed  Google Scholar 

  6. Lundquist H, Hedenstierna G, Strandberg Å, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol. 1995;36(4–6):626–32.

    Article  CAS  PubMed  Google Scholar 

  7. West JB. Pulmonary pathophysiology : the essentials. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2012.

    Google Scholar 

  8. Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20(3):248–54.

    Article  CAS  PubMed  Google Scholar 

  9. Wahba RWM. Perioperative functional residual capacity. Can J Anaesth. 1991;38(3):384–400.

    Article  CAS  PubMed  Google Scholar 

  10. Agostoni E. Mechanics of the pleural space. In:Comprehensive physiology. Hoboken: John Wiley & Sons, Inc.; 2011.

    Google Scholar 

  11. Aldrich TK, Prezant DJ. Indications for mechanical ventilation. In:Principles and Practice of Mechanical Ventilation. New York: McGraw-Hill; 1994. p. 155–89.

    Google Scholar 

  12. Morton CP, Drummond GB. Change in chest wall dimensions on induction of anaesthesia: a reappraisal. Br J Anaesth. 1994;73(2):135–9.

    Article  CAS  PubMed  Google Scholar 

  13. Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology. 1974;41(3):242–55.

    Article  CAS  PubMed  Google Scholar 

  14. Warner DO, Warner MA, Ritman EL. Human chest wall function while awake and during halothane anesthesia. I. Quiet breathing. Anesthesiology. 1995;82(1):6–19.

    Article  CAS  PubMed  Google Scholar 

  15. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606–17.

    Article  CAS  PubMed  Google Scholar 

  16. Berg H, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications a prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41(9):1095–103.

    Article  CAS  PubMed  Google Scholar 

  17. Smetana GW, Lawrence VA, Cornell JE. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581.

    Article  PubMed  Google Scholar 

  18. Fulmer JD, Snider GL, Albert RK. ACCP-NHLBI national conference on oxygen therapy. Chest. 1984;86(2):234–47.

    Article  Google Scholar 

  19. Huerta S, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after roux-en-Y gastric bypass. J Gastrointest Surg. 2002;6(3):354–8.

    Article  PubMed  Google Scholar 

  20. Hillberg RE, Johnson DC. Noninvasive Ventilation. N Engl J Med. 1997;337(24):1746–52.

    Article  CAS  PubMed  Google Scholar 

  21. Tiret L, Desmonts JM, Hatton F, Vourc’h G. Complications associated with anaesthesia - a prospective survey in France. Can Anaesth Soc J. 1986;33(3 Pt 1):336–44.

    Article  CAS  PubMed  Google Scholar 

  22. The 1999 report of the National Confidential Enquiry into peri-operative deaths. Extremes of Age. London: Disk to Print Ltd; 1999.

    Google Scholar 

  23. Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg. 1990;70(2):160–7.

    Article  CAS  PubMed  Google Scholar 

  24. Keenan RL, Boyan CP. Cardiac arrest due to anesthesia. A study of incidence and causes. JAMA. 1985;253(16):2373–7.

    Article  CAS  PubMed  Google Scholar 

  25. Keenan RL, Shapiro JH, Kane FR, Simpson P. Bradycardia during Anesthesia in Infants: an epidemiologic study. Anesthesiology. 1994;80:976–82.

    Article  CAS  PubMed  Google Scholar 

  26. Olsson GL, Hallén B. Cardiac arrest during anaesthesia. A computeraided study in 250 543 anaesthetics. Acta Anaesthesiol Scand. 1988;32(8):653–64.

    Article  CAS  PubMed  Google Scholar 

  27. Murat I, Constant I, Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24 165 anaesthetics over a 30-month period. Pediatr Anesth. 2004;14(2):158–66.

    Article  Google Scholar 

  28. Mamie C, Habre W, Delhumeau C, Barazzone Argiroffo C, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Pediatr Anesth. 2004;14(3):218–24.

    Article  Google Scholar 

  29. Parnis SJ, Barker DS, Van Der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Pediatr Anesth. 2001;11(1):29–40.

    Article  CAS  Google Scholar 

  30. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit U. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95:299–306.

    Article  CAS  PubMed  Google Scholar 

  31. Tay CLM, Tan GM, Ng SBA. Critical incidents in paediatric anaesthesia: an audit of 10 000 anaesthetics in Singapore. Pediatr Anesth. 2001;11(6):711–8.

    Article  CAS  Google Scholar 

  32. Morray JP, Geiduschek JM, Caplan RA, Posner KL, Gild WM, Cheney FW. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993;78(3):461–7.

    Article  CAS  PubMed  Google Scholar 

  33. Cohen MM, Cameron CB. Should you cancel the operation when a child has an upper respiratory tract infection? Anesth Analg. 1991;72(3):282–8.

    Article  CAS  PubMed  Google Scholar 

  34. Laxenaire MC. Again and always allergy. Ann Fr Anesth Reanim. 1999;18(8):831–3.

    Article  CAS  PubMed  Google Scholar 

  35. Bordet F, et al. Risk factors for airway complications during general anaesthesia in paediatric patients. Pediatr Anesth. 2002;12(9):762–9.

    Article  Google Scholar 

  36. Skolnick ET, Vomvolakis MA, Buck KA, Mannino SF, Sun LS. Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Anesthesiology. 1998;88(5):1144–53.

    Article  CAS  PubMed  Google Scholar 

  37. Chen J-C, Holinger LD. Acquired laryngeal lesions: pathologic study using serial macrosections. Arch Otolaryngol – Head Neck Surg. 1995;121(5):537–43.

    Article  CAS  PubMed  Google Scholar 

  38. James I. Cuffed tubes in children. Pediatr Anesth. 2001;11(3):259–63.

    Article  CAS  Google Scholar 

  39. Murat I. Cuffed tubes in children: a 3-year experience in a single institution. Paediatr Anaesth. 2001;11(6):748–9.

    Article  CAS  PubMed  Google Scholar 

  40. Weiss M, Dullenkopf A, Fischer JE, Keller C, Gerber AC. Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children#. BJA Br J Anaesth. 2009;103(6):867–73.

    Article  CAS  PubMed  Google Scholar 

  41. Dullenkopf A, Gerber AC, Weiss M. Fit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff. Acta Anaesthesiol Scand. 2005;49(2):232–7.

    Article  CAS  PubMed  Google Scholar 

  42. Newth CJL, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004;144(3):333–7.

    Article  PubMed  Google Scholar 

  43. Khine Henry H, et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology. 1997;86(3):627–31.

    Article  Google Scholar 

  44. Weiss M, Gerber AC. Cuffed tracheal tubes in children ? Things have changed. Pediatr Anesth. 2006;16(10):1005–7.

    Article  Google Scholar 

  45. Christoffersen JK, Holm-Nielsen A. Mønsteret af behan- dlingsskader og near misses pa ̊en kirurgisk afdeling. Ugeskr Læger. 2004;166:1760–3.

    Google Scholar 

  46. Hove LD, Steinmetz J, Christoffersen JK, Møller A, Nielsen J, Schmidt H. Analysis of deaths related to anesthesia in the period 1996–2004 from closed claims registered by the Danish patient insurance association. Anesthesiology. 2007;106(4):675–80.

    Article  PubMed  Google Scholar 

  47. Cooper JB, Newbower RS, Kitz RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology. 1984;60(1):34–42.

    Article  CAS  PubMed  Google Scholar 

  48. Bowdle TA. Drug Administration errors from the ASA closed claims project. ASA Newsletter. 2003;67:11–3.

    Google Scholar 

  49. Caplan Robert A, Posner Karen L, Ward Richard J, Cheney Frederick W. Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology. 1990;72(5):828–33.

    Article  Google Scholar 

  50. Cass NM. Medicolegal claims against anaesthetists: a 20 year study. Anaesth Intensive Care. 2004;32(1):47–58.

    CAS  PubMed  Google Scholar 

  51. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103(1):33–9.

    Article  PubMed  Google Scholar 

  52. Cheney Frederick W, Posner Karen L, Lee Lorri A, Caplan Robert A, Domino Karen B. Trends in anesthesia-related death and brain DamageA closed claims analysis. Anesthesiology. 2006;105(6):1081–6.

    Article  CAS  PubMed  Google Scholar 

  53. Posner K. Closed claims project shows safety evolution. AANA J. 1997;65:33–6.

    Google Scholar 

  54. Coté Charles J, et al. A single-blind study of combined pulse oximetry and capnography in children. Anesthesiology. 1991;74(6):980–7.

    Article  Google Scholar 

  55. Eichhorn John H. Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology. 1989;70(4):572–7.

    Article  Google Scholar 

  56. Tinker John H, Dull David L, Caplan Robert A, Ward Richard J, Cheney Frederick W. Role of monitoring devices in prevention of anesthetic MishapsA closed claims analysis. Anesthesiology. 1989;71(4):541–6.

    Article  Google Scholar 

  57. Larson SL, Jordan L. Preventable adverse patient outcomes: a closed claims analysis of respiratory incidents. AANA J. 2001;69:386–92.

    CAS  PubMed  Google Scholar 

  58. Rock P, Rich PB. Postoperative pulmonary complications. Curr Opin Anaesthesiol. 2003;16(2):123–31.

    Article  PubMed  Google Scholar 

  59. Regli A, von Ungern-Sternberg BS. Diagnosis and management of respiratory adverse events in the operating room. Curr Anesthesiol Rep. 2015;5(2):156–67.

    Article  Google Scholar 

  60. Ferreyra G, Long Y, Ranieri VM. Respiratory complications after major surgery. Curr Opin Crit Care. 2009;15(4):342–8.

    Article  PubMed  Google Scholar 

  61. von Ungern-Sternberg BS, et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet (London, England). 2010;376(9743):773–83.

    Article  Google Scholar 

  62. Devys JM, et al. Intubating conditions and adverse events during sevoflurane induction in infants. BJA Br J Anaesth. 2011;106(2):225–9.

    Article  CAS  PubMed  Google Scholar 

  63. Oberer C, von Ungern-Sternberg BS, Frei FJ, Erb TO. Respiratory reflex responses of the larynx differ between sevoflurane and propofol in pediatric patients. Anesthesiol J Am Soc Anesthesiol. 2005;103(6):1142–8.

    Google Scholar 

  64. Burgoyne LL, Anghelescu DL. Intervention steps for treating laryngospasm in pediatric patients. Pediatr Anesth. 2008;18(4):297–302.

    Article  Google Scholar 

  65. Pedersen T, Viby-Mogensen J, Ringsted C. Anaesthetic practice and postoperative pulmonary complications. Acta Anaesthesiol Scand. 1992;36(8):812–8.

    Article  CAS  PubMed  Google Scholar 

  66. Forster JL, Jeffery RW, Schmid TL, Kramer FM. Preventing weight gain in adults: a pound of prevention. Health Psychol. 1988;7(6):515–25.

    Article  CAS  PubMed  Google Scholar 

  67. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:i–xii, 1–253.

    Google Scholar 

  68. Mallampati SR, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–34.

    Article  CAS  PubMed  Google Scholar 

  69. Kheterpal S, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105(5):885–91.

    Article  PubMed  Google Scholar 

  70. Ben-Noun L, Laor A. Relationship between changes in neck circumference and changes in blood pressure. Am J Hypertens. 2004;17(5):409–14.

    Article  PubMed  Google Scholar 

  71. Sood A. Altered resting and exercise respiratory physiology in obesity. Clin Chest Med. 2009;30(3):445–54., vii.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lin C-K, Lin C-C. Work of breathing and respiratory drive in obesity. Respirology. 2012;17(3):402–11.

    Article  PubMed  Google Scholar 

  73. Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128(3):501–6.

    Article  CAS  PubMed  Google Scholar 

  74. Lee M-Y, Lin C-C, Shen S-Y, Chiu C-H, Liaw S-F. Work of breathing in eucapnic and hypercapnic sleep apnea syndrome. Respiration. 2009;77(2):146–53.

    Article  PubMed  Google Scholar 

  75. Mandal S, Hart N. Respiratory complications of obesity. Clin Med (Northfield Il). 2012;12(1):75–8.

    Article  Google Scholar 

  76. Usmani ZA, Chai-Coetzer CL, Antic NA, McEvoy RD. Obstructive sleep apnoea in adults. Postgrad Med J. 2013;89(1049):148–56.

    Article  CAS  PubMed  Google Scholar 

  77. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109(6):897–906.

    Article  CAS  PubMed  Google Scholar 

  78. Akhtar N, Ansar F, Baig MS, Abbas A. Airway fires during surgery: management and prevention. J Anaesthesiol Clin Pharmacol. 2016;32(1):109–11. https://doi.org/10.4103/0970-9185.175710.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Lee J-Y, Park CB, Cho E-J, Kim CJ, Chea JS, Lee BH, Kim JO, Chung MY. Airway fire injury during rigid bronchoscopy in a patient with a silicon stent -a case report. Korean J Anesthesiol. 2012;62(2):184–7. https://doi.org/10.4097/kjae.2012.62.2.184.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthesia : a closed claims analysis. ASA. 1999;91:1703–11.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA

    Evangelyn Okereke, Shilpadevi Patil & Gregory Allred

Authors
  1. Evangelyn Okereke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shilpadevi Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory Allred
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evangelyn Okereke .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA

    Charles J. Fox, III

  2. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA

    Elyse M. Cornett

  3. Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA

    G. E. Ghali

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Okereke, E., Patil, S., Allred, G. (2019). Airway and Respiratory System Damaging Events. In: Fox, III, C., Cornett, E., Ghali, G. (eds) Catastrophic Perioperative Complications and Management. Springer, Cham. https://doi.org/10.1007/978-3-319-96125-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96125-5_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96124-8

  • Online ISBN: 978-3-319-96125-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation