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Jhuang BJ, Luk HN, Qu JZ, Shikani A. Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10112175. [PMID: 36360516 PMCID: PMC9690160 DOI: 10.3390/healthcare10112175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022] Open
Abstract
Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.
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Affiliation(s)
- Bo-Jyun Jhuang
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
- Bio-Math Laboratory, Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
- Correspondence:
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alan Shikani
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, MD 21218, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
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Matek J, Kolek F, Klementova O, Michalek P, Vymazal T. Optical Devices in Tracheal Intubation-State of the Art in 2020. Diagnostics (Basel) 2021; 11:diagnostics11030575. [PMID: 33810158 PMCID: PMC8004982 DOI: 10.3390/diagnostics11030575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/28/2022] Open
Abstract
The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.
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Affiliation(s)
- Jan Matek
- 1st Department of Surgery—Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12800 Prague, Czech Republic;
- Medical Faculty, Masaryk University, 62500 Brno, Czech Republic
| | - Frantisek Kolek
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
| | - Olga Klementova
- Department of Anesthesiology and Intensive Medicine, University Hospital Olomouc, I.P. Pavlova 185, Nová Ulice, 77900 Olomouc, Czech Republic;
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 499/2, 12808 Praha, Czech Republic;
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK
| | - Tomas Vymazal
- Department of Anesthesiology and Intensive Medicine, University Hospital Motol, V Úvalu 84, 15000 Praha, Czech Republic;
- Correspondence: ; Tel.: +420-606-413-489
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Huang AS, Hajduk J, Rim C, Coffield S, Jagannathan N. Focused review on management of the difficult paediatric airway. Indian J Anaesth 2019; 63:428-436. [PMID: 31263293 PMCID: PMC6573050 DOI: 10.4103/ija.ija_250_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Management of the difficult paediatric airway management may be associated with a high rate of complications. It is important that clinicians understand the patient profiles associated with difficult airway management, and the equipment and techniques available to effectively manage these children. The goal of this focused review is to highlight key airway management concepts when managing the paediatric difficult airway. This includes understanding the advantages and limitations of various airway equipment designed for children and reviewing the difficult airway algorithm with its unique considerations for the paediatric patient. Early recognition of known risk factors and thorough preparation may be helpful in reducing the risk of complications during difficult airway management in children.
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Affiliation(s)
- Andrea S Huang
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John Hajduk
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Catherine Rim
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Sarah Coffield
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Narasimhan Jagannathan
- Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Mukaihara K, Godai K, Yamada T, Hasegawa-Moriyama M, Kanmura Y. Successful airway management using a MultiViewScope handle with a stylet scope in a patient with Schwartz-Jampel syndrome. JA Clin Rep 2016; 2:36. [PMID: 29492431 PMCID: PMC5813770 DOI: 10.1186/s40981-016-0062-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022] Open
Abstract
Schwartz–Jampel syndrome (SJS) is a rare disorder characterized by micrognathia, kyphoscoliosis, and myotonia. The greatest challenge in the anesthetic management of patients with SJS is performing tracheal intubation. The MultiViewScope (MVS) is a video laryngoscope system in which the video monitor handle can be attached to a stylet scope, laryngoscope blade, or fiberscope. We report a 21-month-old boy with SJS who required general anesthesia. Direct laryngoscopy was impossible because of his limited mouth opening; however, his trachea was easily intubated using an MVS handle with a stylet scope. The MVS is useful for managing difficult airways associated with SJS.
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Affiliation(s)
- Keika Mukaihara
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Kohei Godai
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Tomotsugu Yamada
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Maiko Hasegawa-Moriyama
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - Yuichi Kanmura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
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Yang D, Tong SY, Jin JH, Tang GZ, Sui JH, Wei LX, Deng XM. Shikani optical stylet-guided intubation via the intubating laryngeal airway in patients with scar contracture of the face and neck. ACTA ACUST UNITED AC 2014; 28:195-200. [PMID: 24382219 DOI: 10.1016/s1001-9294(14)60001-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility of the Shikani Optical Stylet (SOS)-guided intubation through a new Intubating Laryngeal Airway (ILA) in anticipated difficult airways caused by scar contracture of the face and neck. METHODS Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. RESULTS The ILA provided an effective airway in all patients. Intubation was successful at the first attempt on 22/33(66.7%) occasions and at the second attempt on 6/33 (18.2%). Intubation failed in 5 (15.1%) patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients' tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. CONCLUSIONS The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.
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Affiliation(s)
- Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Shi-yi Tong
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Jin-hua Jin
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Geng-zhi Tang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Jing-hu Sui
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Ling-xin Wei
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
| | - Xiao-ming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100144, China
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Bocanegra JC, Ríos Medina ÁM, Aguirre Ospina ÓD. Intubación de paciente despierto con fibroscopio rígido bajo sedación con remifentanil. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2010. [DOI: 10.1016/s0120-3347(10)83011-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
Endotracheal intubation in the pediatric emergency department can be challenging. Direct laryngoscopy is the primary intubation technique used in pediatric emergency intubations. However, cases arise where abnormalities of the upper airway prevent a direct view of the laryngeal opening. Under these circumstances, indirect means of visualization of the laryngeal opening using fiberoptic and videoscopic devices can be used to successfully achieve intubation. A wide range of instruments including flexible, rigid, and semirigid devices are available. Those who practice emergency medicine should be aware of these devices and be skilled in their use and aware of their limitations.
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Abstract
The anesthesiologist confronting the difficult pediatric airway is presented with a unique set of challenges. Adult difficult airway management techniques, such as awake or invasive approaches to airway management, often cannot be applied to children because of inadequate cooperation. Consequently, awake intubation in pediatrics is uncommon; most intubations are performed under general anesthesia or deep sedation. From a physiologic perspective, children have higher rates of oxygen consumption, significantly shortening the period of apnea that can be safely tolerated. Normal developmental anatomic differences of the pediatric airway and the presence of craniofacial dysmorphisms, presents additional challenges to tracheal intubation.
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Affiliation(s)
- John Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Lin TC, Soo LY, Chen TI, Lu IC, Hsu HT, Chu KS, Yen MK. Perioperative Airway Management in a Child with Treacher Collins Syndrome. ACTA ACUST UNITED AC 2009; 47:44-7. [DOI: 10.1016/s1875-4597(09)60021-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xue FS, He N, Luo MP, Liao X. Airway topical anesthesia using a rigid fiberoptic stylet in children with difficult airways. Paediatr Anaesth 2009; 19:187-9. [PMID: 19207916 DOI: 10.1111/j.1460-9592.2008.02824.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xue FS, Yang QY, Liao X, He N, Liu HP. Lightwand guided intubation in paediatric patients with a known difficult airway: a report of four cases. Anaesthesia 2008; 63:520-5. [DOI: 10.1111/j.1365-2044.2007.05433.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jansen AH, Johnston G. The Shikani Optical Stylet: a useful adjunct to airway management in a neonate with popliteal pterygium syndrome. Paediatr Anaesth 2008; 18:188-90. [PMID: 18184253 DOI: 10.1111/j.1460-9592.2007.02401.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The craniofacial abnormalities of popliteal pterygium syndrome present unique challenges to the pediatric anesthetist. Congenital fibrous bands between the maxilla and mandible limit mouth opening and the tongue may be fused to the palate. We describe the use of the Shikani Optical Stylet, a novel fiberoptic endoscope, in the airway management of a neonate with popliteal pterygium syndrome and syngnathia.
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Affiliation(s)
- Andrea H Jansen
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Foresterhill, Aberdeen, UK
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Kovacs G, Law AJ, Petrie D. Awake Fiberoptic Intubation Using an Optical Stylet in an Anticipated Difficult Airway. Ann Emerg Med 2007; 49:81-3. [PMID: 17141147 DOI: 10.1016/j.annemergmed.2006.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 02/27/2006] [Accepted: 03/20/2006] [Indexed: 11/19/2022]
Abstract
Numerous rigid indirect fiberoptic and video-based airway tools have been developed as potential alternatives to direct laryngoscopy for intubation. Compared with flexible fiberoptic bronchoscopes, these devices are less expensive and may be easier to use. The role of these rigid instruments in managing the difficult airway in the emergency department is yet to be defined. This article details the use of a rigid fiberoptic stylet to manage an anticipated difficult airway by using topical anesthetic without sedation.
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Affiliation(s)
- George Kovacs
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Evans A, Morris S, Petterson J, Hall JE. A comparison of the Seeing Optical Stylet and the gum elastic bougie in simulated difficult tracheal intubation: a manikin study. Anaesthesia 2006; 61:478-81. [PMID: 16674624 DOI: 10.1111/j.1365-2044.2006.04539.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Management of the difficult airway is one of the major challenges that anaesthetists face. The flexible fibreoptic scope is widely available but its use requires a level of skill, training and continued practice that is not universally found in all anaesthetists, particularly trainees. The Seeing Optical Stylet is a new, semirigid fibreoptic stylet 'scope. We compared the Seeing Optical Stylet with a gum elastic bougie in a simulated Cormack and Lehane Grade 3 laryngoscopy in a manikin. Forty-four anaesthetists were timed while intubating the manikin's trachea with both devices. The mean (SD) time taken with the Seeing Optical Stylet was 20.8 (9.3) s and with the bougie 30 (19.8) s (p = 0.001). Oesophageal intubation occurred six times with the bougie but did not occur with the Seeing Optical Stylet (p = 0.011). We conclude that the Seeing Optical Stylet may be superior to the bougie in difficult tracheal intubation. We feel that the results of this manikin trial are sufficiently encouraging to proceed to a clinical trial in patients.
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Affiliation(s)
- A Evans
- University Hospital of Wales, Cardiff, South Glamorgan, Heath Park, Cardiff, South Glamorgan, CF14 4XN, UK.
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Agrò FE, Antonelli S, Cataldo R. Use of Shikani Flexible Seeing Stylet for intubation via the Intubating Laryngeal Mask Airway. Can J Anaesth 2005; 52:657-8. [PMID: 15983162 DOI: 10.1007/bf03015786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Shukry M, Hanson RD, Koveleskie JR, Ramadhyani U. Management of the difficult pediatric airway with Shikani Optical Stylet. Paediatr Anaesth 2005; 15:342-5. [PMID: 15787929 DOI: 10.1111/j.1460-9592.2005.01435.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The airways of children with many craniofacial and mandibulofacial malformations often present unique challenges to the anesthesiologists. We report the application of Shikani Optical Stylet (SOS) in facilitating the tracheal intubation of four children with history of difficult airway management. The SOS combines the benefits of the lightwand and fiberoptic bronchoscope.
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Affiliation(s)
- Mohanad Shukry
- Department of Anesthesiology, Tulane University, New Orleans, LA, USA.
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