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J Clin Anesth. 2016 Jun;31:106-10. doi: 10.1016/j.jclinane.2016.01.008. Epub 2016 Apr 13.

Estimating the number of difficult airway carts needed in an operating suite: Resource planning without compromising patient safety.

Author information

1
Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: udehc@ccf.org.
2
Department of Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: udehb@ccf.org.
3
Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: daltonj@ccf.org.

Abstract

STUDY OBJECTIVE:

To determine the number of difficult airway (DA) carts required based on the number of anesthetising locations and patients risk of DA.

DESIGN:

Binomial distributions.

SETTING AND PATIENTS:

Various hypothetical settings and patient cohorts.

INTERVENTIONS AND MEASUREMENTS:

Binomial distributions were used to calculate the number of distinct combinations of DAs by number of anesthetising locations assuming an average risk of 10%. The 'at least' number of DAs was calculated using cumulative probabilities of having exactly two plus more than 2 DAs up to the total number of simultaneously started anesthetising locations or until the cumulative probability exceeds the 50% threshold, therefore being more likely than not.

MAIN RESULTS:

The probability of encountering concurrent DAs increases as the number of simultaneously started anesthetising locations increases. For at least 2 concurrent DAs, the probability first exceeds 50% at 17 locations. The corresponding thresholds for at least 3 and 4 concurrent DAs, are 27 and 37 locations respectively. The probability of at least 2 concurrent DAs will exceed 50% when approximately 17 anesthetising sites are started simultaneously and a 10% worst case risk is assumed.

CONCLUSIONS:

With continuing resource constraints, proper planning of human and capital resources for DAs needs to be addressed without compromising patient safety. It is recommended that every block of 15-20 sites be equipped with a DA cart, that anaesthesia groups develop and rehearse DA algorithms with available equipment, and that preoperative anaesthesia clinics be used to identify DA therefore providing logistical leverage.

KEYWORDS:

Airway management; Anesthesia; Probability; Resource allocation

PMID:
27185687
DOI:
10.1016/j.jclinane.2016.01.008
[Indexed for MEDLINE]

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