Airway Management, General Anesthesia, Intubation Complications, Tracheal Intubation
Conditions
Brief summary
Airway management is one of the most critical steps of anesthesia, and its complications can be life-threatening. Reduced staffing, differences in personnel experience, and physical and mental fatigue during off-hours (evenings, nights, weekends, and holidays) may affect the quality of care and patient safety - a phenomenon described in the literature as the "after-hours effect." While this effect has been studied for outcomes such as cardiac arrest and intensive care mortality, evidence specific to airway management safety remains limited. This prospective observational cohort study aims to evaluate the effect of shift timing on the safety and efficiency of tracheal intubation in adult surgical patients undergoing general anesthesia at a single center. Based on the actual start time of anesthesia, patients will be categorized into an in-hours group (08:00-16:00) or an off-hours group (16:01-07:59), without any investigator-assigned intervention. The frequency and type of intubation-related complications, intubation duration, and the pre-intubation sleepiness level of the performing anesthesiologist (assessed using the Karolinska Sleepiness Scale) will be compared between groups. The investigators hypothesize that intubations performed during off-hours are associated with a higher complication rate and longer intubation duration than those performed during in-hours. Approximately 1000 patients will be enrolled over a period of up to 2 years.
Interventions
PROCEDURETracheal Intubation
Standard tracheal intubation performed as part of routine general anesthesia care. The procedure itself is not assigned or altered by the investigators; all patients receive the same standard clinical care, and groups differ only in the timing of the procedure (in-hours vs. off-hours).
Sponsors
Merve Yazici Kara
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients older than 18 years of age * undergoing surgery under general anesthesia * ASA physical status I, II, or III
Exclusion criteria
* Patients arriving to the operating room already intubated * Patients who do not provide written or verbal consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Tracheal Intubation-Related Complications | At the time of tracheal intubation (single procedural assessment, during the induction of anesthesia). | Frequency and type of intubation-related complications (e.g., difficult intubation, multiple attempts, desaturation, esophageal intubation) compared between the in-hours and off-hours groups. |
| Tracheal Intubation Duration | At the time of tracheal intubation (single procedural assessment, during the induction of anesthesia). | Time elapsed from the first attempt to insert the airway device to the first capnographic waveform confirming successful tracheal intubation, measured in seconds. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pre-Intubation Sleepiness Level of the Performing Anesthesiologist | Immediately before the intubation attempt. | Subjective sleepiness level of the physician performing the intubation, assessed immediately before the procedure using the Karolinska Sleepiness Scale (KSS, 1-9), to explore the association between fatigue and shift-related differences in intubation outcomes. |
Contacts
CONTACTMerve Yazici Kara, M.D.
CONTACTMehmet Yilmaz, M.D.
Outcome results
None listed