Novel Techniques for Difficult Airway Management in Various Clinical Scenarios: Case Series and Review of Literature (original) (raw)
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Unanticipated Difficult Airway in Anesthetized Patients
Anesthesiology, 2004
Background: Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management.
Three difficult airway management strategies in the same patient at three different times
Anaesthesia, Pain & Intensive Care, 2020
Unpredictable difficult intubation is a commonly faced clinical issue and one of the most important reasons of morbidity related to anesthesia. We present a case of a 50 y old, 100 kg, 1.8 m tall (BMI=37) male patient, taken to OR (transoral robotic) for a planned biopsy because of a mass in his larynx. Videolaryngoscope was used two times but still intubation was unsuccessful.
Anesthesiology Clinics, 2015
Awake tracheal intubation is commonly used when ordinary intubation (for example, attempting direct laryngoscopy after the induction of general anesthesia) is expected to be difficult or hazardous. 1-8 Possible examples include patients with large glottic tumors, patients with unstable cervical spines, patients known to be difficult to intubate by virtue of previous anesthetic misadventures, and numerous other conditions. 9-15 This is an updated, reorganized and expanded version of an earlier article published in the 7th Annual Anesthesiology News Guide to Airway Management. August 2014.
One way to ventilate patients during fibreoptic intubation
Acta Anaesthesiologica Scandinavica, 2001
Occasionally anaesthesiologists find themselves in situations where ventilation during intubation with a fibreoptic bronchoscope (FOB) is desirable. In order to ventilate the patient during the FOB intubation, we used a 90ae angle swivel connector, normally used for fibreoptic bronchoscopia in an intubated patient. After a nasotracheal tube is placed with the tip in the oropharynx, ventilation of the patient is possible via this tube by closing the mouth and other nostril. The fibrescopic procedure is done through the right-angle connector with suction port and the tube is used to guide the tip of the FOB to the aditus laryngis. The method has been used in 7 patients who were im-F IBREOPTIC bronchoscope intubation (FOI) is one solution to manage the difficult airway. The classical approach with this technique is to have an awake or sedated spontaneously breathing patient, even though it is possible to intubate with the fibreoptic bronchoscope (FOB) in apnoea. The spontaneous breathing will provide the anaesthesiologist with enough time to perform the intubation safely, especially if he or she is inexperienced in manoeuvring the FOB. Nevertheless, if the difficulty of the intubation has not been recognised prior to the anaesthetic induction and if a non-depolarising muscle relaxant was used to facilitate the intubation, FOI during spontaneous breathing is not possible within a reasonable time. Besides this, there may be other reasons not to perform the FOI in apnoea.
A New Technique for Difficult Intubations
Anaesthesia and Intensive Care, 2001
A Macintosh laryngoscope was modified to allow a rigid fibreoptic scope to be attached. Our purpose was to determine if Cormack and Lehane scores could be improved using the described fibreoptic technique, thus allowing easier intubating conditions. In order to assess its value for intubation, a study was performed on 53 patients. Thirty-three of these patients were classified to be difficult intubations (suspected or unanticipated). The Cormack and Lehane scores were improved by the use of the modified laryngoscope by one to three grades compared to the standard laryngoscopy. Significantly improved intubating condition were observed. The assessment demonstrates that many patients with Mallampati scores of III and IV can be successfully managed by this technique.
Management of General Anesthesia in Difficult Airway: A Case Report
Journal of Agromedicine and Medical Sciences
When dealing with clinical disorders known as difficult airways, airway management during general anesthesia still presents challenges. A cross-sectional study done in Indonesia in 2016 found that 28 out of 250 patients receiving general anesthesia had respiratory problems. The existing algorithm must be properly and effectively managed in order to resolve this issue. This case report discusses a 14-month-old pediatric patient with right preauricular lymphoma who will undergo tumor biopsy surgery using general anesthesia. The size of the tumor mass that has grown and covered the patient's airway makes it difficult to manage the airway during general anesthesia, making intubation impossible. To overcome this, bagging was carried out by improvising the technique of reversing the position of the mask cover on the patient during the operation. The patient can be saved and allowed to go home after treatment. Appropriate management during perioperative especially related to airway man...
Brazilian Journal of Anesthesiology, 2023
Difficult airway management represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The Brazilian Society of Anesthesiology presents a report with updated recommendations for the management of difficult airway in adults. These recommendations were developed based on the consensus of a group of expert anesthesiologists, aiming to provide strategies for managing difficulties during tracheal intubation. They are based on evidence published in international guidelines and opinions of experts. The report underlines the essential steps for proper difficult airway management, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and maintaining arterial oxygenation. Additional strategies for using advanced tools, such as video laryngoscopy, flexible bronchoscopy, and supraglottic devices, are discussed. The report considers recent advances in understanding crisis management, and the implementation seeks to further patient safety and improve clinical outcomes. The recommendations are outlined to be uncomplicated and easy to implement. The report underscores the importance of ongoing education, training in realistic simulations, and familiarity with the latest technologies available.
Unexpected difficult intubation: A case report
Trends in Anaesthesia and Critical Care, 2018
Background and goal of the study: We report of a case of unexpected difficult intubation despite preoperative evaluation. Ă Methods: A 67 years male patient scheduled for laparoscopic prostatectomy went for preoperative evaluation with the following findings: moderate obesity (BMI32), adequate mouth opening and thyromental distance, Mallampati III, history of snoring. In perspective of difficult mask ventilation he was requested to remove beard. Results: After routine monitoring and anesthesia induction, with NMBA administration following ventilability check, a first laryngoscopy revealed a Cormack-Lehane grade 3 view with limited room for airway instrumentation. After one failed conventional laryngoscopy two attempts with Airtraq (Prodol, Spain) failed because of view of sole epiglottis. Ventilation remained satisfactory thorough attempts, and a #4 LMA-fastrach (Teleflex, Ireland) was positioned resulting in poor ventilation and no view of laryngeal inlet with fiberoptic bronchoscope. Patient was then reverted to spontaneous breathing (atropine+neostigmine) and a spontaneous breathing fiberoptic intubation with a reinforced 6.5 mm OD endotracheal tube was successful, using the spray-as-you-go technique for airway topicalization. Surgery was performed and the patient received a protected extubation over airway catheter Conclusions: Our case highlights importance of ventilation over intubation, importance of preoperative evaluation (the patient, deferred to pneumologist, was diagnosed severe OSAS), possibility of failure of videolaryngoscopy, importance of avoidance of fixation error and fundamental role of fiberoptic, with spontaneous breathing, for difficult airway management. References