1
|
Razmjoo S, Shahbazian H, Hosseini SM, Feli M, Mohammadian F, Bagheri A. Therapeutic and prophylactic effects of radiation therapy in the management of recurrent granulation tissue induced tracheal stenosis: a review on the role of Endobronchial brachytherapy and external beam radiation therapy. Brachytherapy 2023; 22:389-399. [PMID: 36922243 DOI: 10.1016/j.brachy.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Granulation tissue-induced tracheal stenosis (mainly secondary to intubation or lung transplantation) is one of the most common etiologies of benign airway obstructions. Recurrence rates after standard treatment options (surgical resection and/or endobronchial interventions) can inadvertently worsen the stricture through the stimulation of more granulation tissue generation (via increased fibroblast activity and roliferation). Low-dose radiotherapy could be a promising tool to prevent granulation tissue formation after surgery and/or endobronchial interventions regarding its established role in the treatment of keloids or hypertrophic scars, two benign diseases with similar a pathophysiology to tracheal stenosis. This study reviews case reports and small series that used endobronchial brachytherapy (EBBT) or external beam radiotherapy (EBRT) for the management of refractory granulation tissue-induced tracheal stenosis after surgery and/or endobronchial interventions. METHODS AND MATERIALS Case reports and series (published up to October 2022) that reported outcomes of patients with recurrent granulation tissue-induced tracheal stenosis (after surgery and/or endobronchial interventions) treated by EBBT or EBRT (in definitive or prophylactic settings) were eligible. RESULTS Sixteen studies (EBBT: nine studies including 69 patients, EBRT: seven studies including 32 patients) were reviewed. The pooled success rate across all studies was 74% and 97% for EBBT and EBRT, respectively. CONCLUSIONS Radiation therapy appears to be effective in the management of selected patients with recurrent/refractory tracheal stenosis. Response to this treatment is usually good, but further studies with a larger number of patients and long-term followup are necessary to determine the optimal technique, dose, and timing of radiation therapy, late complications, the durability of response, and criteria for patient selection.
Collapse
Affiliation(s)
- Sasan Razmjoo
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hodjatollah Shahbazian
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed-Mohammad Hosseini
- Department of Clinical Oncology and Clinical Research Development Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Feli
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Mohammadian
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Bagheri
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
2
|
Vanden Eede H, Norris E, Torfs M, Vanderveken O. Life threatening abscess in the visceral space with penicillin and metronidazole resistant Prevotella Denticola following use of a laryngeal mask airway: case report. BMC Anesthesiol 2021; 21:102. [PMID: 33820534 PMCID: PMC8020545 DOI: 10.1186/s12871-021-01322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Laryngeal mask airways (LMA) are commonly used for airway management. Complications with this device are rare. However, when they do occur, there is a high risk for respiratory problems, necessitating early diagnosis and treatment. We present the first case of a life-threatening abscess spreading in the visceral space caused by a penicillin and metronidazole resistant Prevotella Denticola after the use of an LMA. Case presentation A female patient was admitted to our day care centre for bunion surgery. A single use LMA size 3 (Solus®, intersurgical, Wokingham, Berkshire, United Kingdom) was successfully inserted. After surgery, the patient complained of a sore throat and amoxicillin was prescribed by the general practitioner. Three days after surgery the patient was admitted to the Intensive Care Unit (ICU) for obstructive breathing, due to an abscess in the visceral space. Retropharyngeal and certainly parapharyngeal abscesses in adults are already rare. This case however, is unique because it is the first case of abscess spreading into the visceral space after the use of an LMA. Amoxicillin/clavulanate and vancomycin were started. The abscess was incised 5 days later and microbiology showed 3 positive cultures of the anaerobe Prevotella denticola, resistant for penicillin and metronidazole, but sensitive for amoxicillin/clavulanate. The patient fully recovered. Conclusion LMA’s are easy to use and are established, safe tools to support ventilation of the airway. In this case, the authors hypothesise a small wound in the lateral pharyngeal wall probably created an opening into the visceral space causing infection with Prevotella denticola, supporting the idea that the pharyngeal mucosal space must be part of the visceral space. Additionally, early recognition and treatment of an LMA induced abscess is necessary to prevent evolution of complications leading to airway obstruction.
Collapse
Affiliation(s)
- Hervé Vanden Eede
- Department of anaesthesiology and intensive care, AZ Rivierenland, Rumst, Belgium.
| | | | - Michaël Torfs
- Department of radiology, AZ Rivierenland, 's Herenbaan 172, 2840, Rumst, Belgium
| | - Olivier Vanderveken
- Head of the department Nose Throat Ear surgery, University hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| |
Collapse
|
3
|
Young LK, Mitrev LV, Rost JA, Timmerman T, Gaughan J, van Helmond N, Koshkareva YA. Videolaryngoscopic intubation may have a higher risk of severe oropharyngeal injury than intubation under direct laryngoscopy: A review of 30,633 intubations. J Clin Anesth 2019; 58:91-92. [PMID: 31136918 DOI: 10.1016/j.jclinane.2019.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren K Young
- Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| | - Ludmil V Mitrev
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jonathan A Rost
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Thomas Timmerman
- Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| | - John Gaughan
- Cooper Research Institute, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Yekaterina A Koshkareva
- Department of Otolaryngology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, USA
| |
Collapse
|
4
|
Small-incision cholecystectomy (through a cylinder retractor) under local anaesthesia and sedation: a prospective observational study of five hundred consecutive cases. Langenbecks Arch Surg 2018; 403:733-740. [DOI: 10.1007/s00423-018-1707-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/31/2018] [Indexed: 01/03/2023]
|
5
|
Kavakli AS, Kavrut Ozturk N, Karaveli A, Onuk AA, Ozyurek L, Inanoglu K. [Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients]. Rev Bras Anestesiol 2017; 67:578-583. [PMID: 28546013 DOI: 10.1016/j.bjan.2017.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. MATERIAL AND METHODS 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. RESULTS Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. CONCLUSION Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.
Collapse
Affiliation(s)
- Ali Sait Kavakli
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey.
| | - Nilgun Kavrut Ozturk
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Arzu Karaveli
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Asuman Arslan Onuk
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Lutfi Ozyurek
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| | - Kerem Inanoglu
- Antalya Training and Research Hospital, Department of Anesthesiology and Reanimation, Antalya, Turkey
| |
Collapse
|
6
|
SÁNCHEZ-TABERNERO Á, PARDAL-REFOYO JL, CUELLO-AZCÁRATE JJ. Bloqueo de la vía aérea tras la extubación. Revisión bibliográfica. REVISTA ORL 2017. [DOI: 10.14201/201781.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
7
|
Ong J, Lee CL, Huang SJ, Shyr MH. Comparison between the Trachway video intubating stylet and Macintosh laryngoscope in four simulated difficult tracheal intubations: A manikin study. Tzu Chi Med J 2016; 28:109-112. [PMID: 28757736 PMCID: PMC5442912 DOI: 10.1016/j.tcmj.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/07/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES It remains to be determined whether the TVI-4000 Trachway video intubating (TVI) stylet (Markstein Sichtec Medical Corp, Taichung, Taiwan), an airway device for novices, improves airway management practice by experienced anesthesiologists. The aim of this study was to evaluate the feasibility of using the TVI stylet in difficult tracheal intubation situations compared with that of using the Macintosh laryngoscope on an airway manikin. MATERIALS AND METHODS Ten anesthesiologists (with 3-21 years' experience), including three senior residents, participated. We compared tracheal intubation in four airway scenarios: normal airway, tongue edema, cervical spine immobilization, and tongue edema combined with cervical spine immobilization. The time of tracheal intubation (TTI), success rate, and perceived difficulty of intubation for each scenario were compared and analyzed. RESULTS The TTI was significantly shorter in both the tongue edema and combined scenarios with the TVI stylet compared with the Macintosh laryngoscope (21.60 ± 1.45 seconds vs. 24.07 ± 1.58 seconds and 23.73 ± 2.05 seconds vs. 26.6 ± 2.77 seconds, respectively). Success rates for both devices were 100%. Concomitantly, participants rated using the TVI stylet in these two scenarios as being less difficult. CONCLUSION The learning time for tracheal intubation using the TVI stylet in difficult airway scenarios was short. Use of the TVI stylet was easier and required a shorter TTI for tracheal intubation in the tongue edema and combined scenarios.
Collapse
Affiliation(s)
- Jimmy Ong
- Department of Anaesthesiology, Sarawak General Hospital, Malaysia
| | - Chia-Ling Lee
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Shen-Jer Huang
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Ming-Hwang Shyr
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
8
|
Go J, Kim H, Kim S, You JS, Kim MJ, Chung HS, Chung SP, Lee HS. Guidewire-Assisted Nasogastric Tube Insertion in Intubated Patients in an Emergency Center. Korean J Crit Care Med 2013. [DOI: 10.4266/kjccm.2013.28.4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin Go
- Department of Emergency Medicine, Yonsei University Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunjong Kim
- Department of Emergency Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Korea
| | - Seunghwan Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hahn Shick Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Cooper RM, Khan S. Extubation and Reintubation of the Difficult Airway. BENUMOF AND HAGBERG'S AIRWAY MANAGEMENT 2013. [PMCID: PMC7158180 DOI: 10.1016/b978-1-4377-2764-7.00050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
10
|
Forces applied by the laryngoscope blade onto the tongue during intubation attempts: a comparison between Mackintosh, AirTraq and Pentax AWS in a mannequin study. Eur J Anaesthesiol 2011; 28:463-4. [DOI: 10.1097/eja.0b013e328345a42b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Pang G, Edwards MJ, Greenland KB. Vocal Cords-Carina Distance in Anaesthetised Caucasian Adults and its Clinical Implications for Tracheal Intubation. Anaesth Intensive Care 2010; 38:1029-33. [DOI: 10.1177/0310057x1003800611] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous work has assessed vocal cords-carina distance in Chinese patients and compared it to commonly used tracheal tubes. In addition, an attempt was made to identify surface anatomy measurements with short tracheas. We have examined the length of tracheas in Caucasian patients and compared it with currently used tracheal tubes. We have investigated a wider range of surface anatomy measurements in an attempt to correlate measurements with vocal cords-carina distance and identifying patients who may be at risk of endobronchial intubation. In this study, the vocal cords-carina distance was measured in 150 anaesthetised Caucasian patients with a fibreoptic bronchoscope. We also attempted to correlate height and various surface anatomy measurements on the patients’ chest, neck and limb regions to predict those patients at risk of endobronchial intubation. The mean vocal cords-carina distance was 12.7 cm (standard deviation 1.6 cm). The best predictors in our study of vocal cords-carina distance less than 11.3 cm were a height of ≤182 cm, an ulnar length of ≤31.2 cm or a thyroid to xiphisternum distance of ≤31.8 cm. This correlation is poor however, and prediction of vocal cords-carina distance remains difficult clinically. It was therefore concluded that surface anatomy measurements are a poor predictor of vocal cords-carina distance.
Collapse
Affiliation(s)
- G. Pang
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Staff Anaesthetist, Department of Intensive Care Medicine
| | - M. J. Edwards
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - K. B. Greenland
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
12
|
Teoh WHL, Sia ATH, Fun WLL. A prospective, randomised, cross-over trial comparing the EndoFlex®and standard tracheal tubes in patients with predicted easy intubation. Anaesthesia 2009; 64:1172-7. [DOI: 10.1111/j.1365-2044.2009.06058.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
13
|
Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200806010-00006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
14
|
Abstract
PURPOSE Two cases are presented wherein the GlideScope videolaryngoscope (GVL) facilitated laryngeal exposure and successful endotracheal intubation, but resulted in pharyngeal injury. CLINICAL FEATURES GlideScope videolaryngoscopy was performed in two female patients, whose airways were anticipated to present difficulties for direct laryngoscopy. In the first case, following induction of anesthesia, moderate difficulty was encountered in directing the endotracheal tube (ETT) into the patient's larynx. In the second case, minimal difficulty with the GVL was experienced, and no problems were identified with airway instrumentation until the drapes covering the patient's face were removed. In both instances, the ETT had passed through the right palatopharyngeal arch, requiring suturing in the first patient, and electrocautery in the second patient. CONCLUSION There have been no previously published reports of injuries related to GlideScope laryngoscopy, but perforation of the palatopharyngeal arch occurring in two patients demonstrates a rare but potentially important complication of the GVL. Strategies to minimize this complication are considered.
Collapse
Affiliation(s)
- Richard M Cooper
- Department of Anesthesia, University of Toronto, Toronto General Hospital, 200 Elizabeth St., 3EN-421, Toronto, Ontario M5G 2C4, Canada.
| |
Collapse
|
15
|
|
16
|
Chong DYC, Greenland KB, Tan ST, Irwin MG, Hung CT. The clinical implication of the vocal cords–carina distance in anaesthetized Chinese adults during orotracheal intubation. Br J Anaesth 2006; 97:489-95. [PMID: 16873383 DOI: 10.1093/bja/ael186] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have identified no strong correlation between patients' height and tracheal length in anaesthetized patients. We have attempted to compare vocal cords-carina distance (VCD) in Chinese patients with the dimensions of five commonly used tracheal tubes. In addition, we attempted to find a surface anatomy measurement that would identify patients with 'short tracheas'. METHODS We measured VCD in 130 anaesthetized Chinese patients with a fibreoptic bronchoscope. Also measurements were obtained of the distal ends of five commonly used tracheal tubes. We undertook various surface anatomy measurements on the patients' chest and neck region to predict those patients with short tracheas. RESULTS VCD averaged 12.6 (SD 1.4) cm. In seven patients (5%) this distance was particularly short (between 8.8 and 10.4 cm). Many of the commonly used tracheal tubes would be placed close to or beyond the carina when the black intubation guide mark(s) is (are) at the level of the vocal cords. The VCD of <or=11 cm (short trachea) could be predicted by patient height of <or=167.5 cm and a thyrosternal distance of <or=28.5 cm with limited reliability. CONCLUSIONS A significant number of patients with short VCD in our study group could be at risk of endobronchial intubation with many of the tracheal tubes. Patient height and thyrosternal distance can be useful in predicting short tracheas.
Collapse
Affiliation(s)
- D Y C Chong
- Department of Anaesthesiology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | | | | | | | | |
Collapse
|
17
|
Fuhrmeister J, Janelle J, Zhang RV. Apparent sialadenopathy of the sublingual glands after general anesthesia with placement of laryngeal mask airway. J Clin Anesth 2006; 17:650-4. [PMID: 16435449 DOI: 10.1016/j.jclinane.2005.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sialadenopathy, inflammation of the salivary glands, is a rare anesthetic complication. This case conference describes a patient who developed sialadenopathy of the sublingual glands after placement of a laryngeal mask airway during a brief surgical procedure. The patient's history is detailed, the surgical and anesthetic procedures are described, and a discussion follows, which describes the different causes of this inflammatory process. In the comment, the physiology of the salivary gland is described in detail.
Collapse
Affiliation(s)
- Joshua Fuhrmeister
- Department of Anesthesiology, University of Florida College of Medicine, Gainseville, Florida 32610-0254, USA
| | | | | |
Collapse
|
18
|
Maier WR, Cunningham PS. A new approach to securing a difficult airway. J Clin Anesth 2005; 17:286-9. [PMID: 15950854 DOI: 10.1016/j.jclinane.2004.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 09/09/2004] [Indexed: 01/15/2023]
Abstract
The ability to provide a patent airway for gas exchange is a mandatory skill for the anesthesiologist. Because of variations in the anatomy and physiology of patients, a technique used to intubate the trachea of one patient may not be successful for another. Thus, it is crucial that the anesthesiologist have multiple ways in which to approach an airway. We first describe a new technique for airway management that can be used electively or in an emergent situation to intubate the trachea of a patient during anesthesia. We then provide 2 detailed case reports in which the technique was found to be helpful. We have since used it in more than 60 patients, without any related complications.
Collapse
Affiliation(s)
- Ward R Maier
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | | |
Collapse
|
19
|
Burkle CM, Walsh MT, Harrison BA, Curry TB, Rose SH. Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital. Can J Anaesth 2005; 52:634-40. [PMID: 15983152 DOI: 10.1007/bf03015776] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The purpose of this single-centre database review was to establish the incidence of failure to intubate by direct laryngoscopy, to measure morbidity and mortality associated with this event, and to examine the use and efficacy of alternative airway devices. METHODS Difficult intubation via direct laryngoscopy at Mayo Clinic Rochester is recorded in an electronic database using a functional classification: 0 = no difficulty; 1 = mild to moderate difficulty; and 2 = severe difficulty often requiring a change in intubation technique. Using this database, the total number of intubations was determined for a selected review period and the incidence of failure to intubate by direct laryngoscopy was established. Abstraction of chart data allowed for determination of associated morbidity and mortality, success of alternative airway devices, and case cancellation rate. RESULTS During the period from August 1, 2001 through December 31, 2002, 37,482 patients underwent general anesthesia with attempted direct laryngoscopy. One hundred sixty-one patients (0.43%) could not be intubated by direct laryngoscopy alone. Morbidity associated with difficult intubation included soft tissue/dental damage (n = 8), intraoperative cardiac arrest (n = 1), and possible aspiration (n = 1). Three patients required intensive care unit admission. There was no associated mortality. The most commonly used alternative airway device was the flexible fibreoptic scope. Five case cancellations resulted from failure to intubate with alternative devices. CONCLUSION The rate of unexpected failure to intubate by direct laryngoscopy is essentially unchanged from earlier studies. While morbidity was low, continued education and early use of alternative difficult airway devices may further limit complications associated with this event.
Collapse
Affiliation(s)
- Christopher M Burkle
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
| | | | | | | | | |
Collapse
|
20
|
Thierbach A, Piepho T, Wolcke B, Küster S, Dick W. [Prehospital emergency airway management procedures. Success rates and complications]. Anaesthesist 2004; 53:543-50. [PMID: 15088093 DOI: 10.1007/s00101-004-0679-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oxygenation and ventilation as well as prevention of aspiration are of vital importance for emergency patients. Prehospital airway management is not comparable to clinical anaesthesia. However, prehospital data of the occurrence of potential life-threatening complications and less severe adverse events of airway management procedures by emergency physicians are not yet available. METHODS All airway management procedures predominantly performed by emergency physicians over a period of 36 months were recorded prospectively. RESULTS Data of 598 consecutive patients were collected, in all patients prehospital airway management could be accomplished successfully. Of the patients 98.5% were successfully intubated endotracheally with a maximum of 3 attempts, 84.6% of patients were intubated at the first attempt, and in 9 patients other techniques such as the Combitube were required. In more than 80% of procedures, no complications or adverse events were recorded and potentially life-threatening complications occurred in 9% of patients only. CONCLUSIONS Prehospital airway management by emergency physicians experienced in anaesthesia is associated with low complication and high success rates.
Collapse
Affiliation(s)
- A Thierbach
- Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Mainz.
| | | | | | | | | |
Collapse
|
21
|
Cavuslu S, Oncul O, Gungor A, Kizilkaya E, Candan H. A Case of Recurrent Subcutaneous Emphysema as a Complication of Endotracheal Intubation. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a case of subcutaneous cervicofacial emphysema in a 21-year-old man who had undergone endotracheal intubation while under general anesthesia 2 months earlier. The emphysema had arisen on the right side of the face and neck and extended to the right shoulder and the cubital fossa. The patient was hospitalized and treated with parenteral antibiotics and hyperbaric oxygen. On hospital day 10, he had improved sufficiently to warrant discharge on the next day. Two months later, the patient presented at a follow-up visit with a recurrence, and he was readmitted. By hospital day 28, his condition had improved and he was scheduled for discharge. However, he experienced another recurrence just before he was to leave the hospital. The circumstances of this second recurrence led us to suspect that the patient was able to produce these signs and symptoms on his own. He was referred for psychiatric evaluation, and findings were negative. He was then sent to the Ear, Nose, and Throat Service, where we confirmed that his subcutaneous emphysema could be brought on by Valsalva's maneuver. We performed suspension laryngoscopy and detected two orifices of fistular tracts next to the right vallecula and three at the root of the epiglottis. We repaired the injured mucosa and the orifices of the fistulae with absorbable sutures and cauterized the area. The swelling resolved completely within 4 days, and findings on a radiographic examination of the chest and neck 1 week later were normal. The patient was then lost to follow-up. The presence of air in the retropharyngeal and cervical subcutaneous spaces of the neck and shoulder without pneumomediastinum is an uncommon complication of endotracheal intubation. We discuss the clinical and radiographic findings associated with this complication, and we review diagnostic considerations and management.
Collapse
Affiliation(s)
- Saban Cavuslu
- Department of Infectious Diseases, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Oral Oncul
- Department of Infectious Diseases, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Atilla Gungor
- Ear, Nose, and Throat Service, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Esref Kizilkaya
- Department of Radiodiagnostic Radiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Hasan Candan
- Ear, Nose, and Throat Service, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| |
Collapse
|
22
|
Somerville NS, Fenlon S, Boorman J, Abbot M. Disruption of cleft palate repair following the use of the laryngeal mask airway. Anaesthesia 2004; 59:401-3. [PMID: 15023113 DOI: 10.1111/j.1365-2044.2004.03662.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 55-year-old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.
Collapse
Affiliation(s)
- N S Somerville
- Department of Anaesthesia, The Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK.
| | | | | | | |
Collapse
|