Incidence, characteristics and management of failed intubation in 28,092 surgical cancer patients

Failed intubation is a very rare event and has been poorly assessed. This is a retrospective study based on a computer clinical database assessing 28,092 anaesthetics. Data were obtained through sequential query language extraction. The incidence of failed intubation defined by the impossibility to perform tracheal intubation by the anaesthetist in charge was 0.16% (25 cases). It decreased to 0.04% (6 cases) after the contribution of a second anaesthetist and dropped to 0.02% (3 cases) after the intervention of a cervicofacial surgeon. Most of the patients with failed intubation had a history of cervicofacial tumors generally located in the oropharynx or mouth (17 patients). Eight patients out of 25 were scheduled for non-cervicofacial cancer surgery. Sixteen out of 25 had transient desaturation (range 80-93%). Three out of 17 cervicofacial cancer patients who could not be intubated with the help of the second anaesthetist or the surgeon had their airway controlled by rescue transtracheal jet ventilation (RTTJV), laryngeal mask (LM), or emergency tracheotomy. All scheduled procedures were carried on and no complications occurred. This study highlights the necessity to seek help very early as most failed intubations (76%) were resolved with the help of a second anaesthetist; however, the importance of cooperation with surgical teams was even greater. When anaesthetists failed to intubate, cervicofacial surgeons resolved the situation in 50% of the cases.