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Warwick E, Yoon S, Ahmad I. Awake Tracheal Intubation: An Update. Int Anesthesiol Clin 2024; 62:59-71. [PMID: 39233572 DOI: 10.1097/aia.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Awake tracheal intubation (ATI) remains the "gold standard" technique in securing a definitive airway in conscious, self-ventilating patients with predicted or known difficult airways and the procedure is associated with a low failure rate. Since its inception a variety of techniques to achieve ATI have emerged and there have been accompanying advancements in pharmaceuticals and technology to support the procedure. In recent years there has been a growing focus on the planning, training and human factors involved in performing the procedure. The practice of ATI, does however, remain low around 1% to 2% of all intubations despite an increase in those with head and neck pathology. ATI, therefore, presents a skill that is key for the safety of patients but may not be practised with regularity by many anesthetists. In this article we therefore aim to highlight relevant guidance, recent literature and provide an update on the practical methods fundamental for successful ATI. We also discuss the crucial aspects of a safe airway culture and how this can help to embed training and maintenance of skills.
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2
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Gupta A, Mohanty CR, Barik AK, Radhakrishnan RV. In Response to Oropharyngeal Swelling and Airway Obstruction from Environmental Cold Exposure: A Case Report. Wilderness Environ Med 2024; 35:374-375. [PMID: 38549354 DOI: 10.1177/10806032241240449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2024]
Affiliation(s)
- Anju Gupta
- Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Amiya Kumar Barik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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3
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Merola R, Vargas M, Marra A, Buonanno P, Coviello A, Servillo G, Iacovazzo C. Videolaryngoscopy versus Fiberoptic Bronchoscopy for Awake Tracheal Intubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:3186. [PMID: 38892899 PMCID: PMC11173084 DOI: 10.3390/jcm13113186] [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: 04/25/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Background: In recent years, videolaryngoscopy has increasingly been utilized as an alternative to fiberoptic bronchoscopy in awake intubation. Nonetheless, it remains uncertain whether videolaryngoscopy represents a viable substitute for fiberoptic bronchoscopy. We conducted this systematic review with a meta-analysis to compare videolaryngoscopy and fiberoptic bronchoscopy for awake intubation. Methods: We systematically searched for all randomized controlled trials (RCTs) comparing videolaryngoscopy and fiberoptic bronchoscopy for awake intubation. The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and MEDLINE were systematically queried through August 2023. Our primary outcome measure was the duration of intubation. Secondary outcomes encompassed the rate of successful intubation on the initial attempt, failed intubation, patient-reported satisfaction, and any complications or adverse events potentially stemming from the intubation procedure. The Cochrane Risk of Bias Tool for RCTs was employed to evaluate all studies for evidence of bias. The GRADE approach was utilized to gauge the certainty of the evidence. Results: Eleven trials involving 873 patients were ultimately included in our review for data extraction. Meta-analysis demonstrated that videolaryngoscopy decreased the duration of intubation compared to fiberoptic bronchoscopy (SMD -1.9671 [95% CI: -2.7794 to -1.1548] p < 0.0001), a finding corroborated in subgroup analysis by the type of videolaryngoscope (SMD -2.5027 [95% CI: -4.8733 to -0.1322] p = 0.0385). Additionally, videolaryngoscopy marginally lowered the risk of experiencing a saturation below 90% during the procedure (RR -0.7040 [95% CI: -1.4038 to -0.0043] p = 0.0486). No statistically significant disparities were observed between the two techniques in terms of failed intubation, initial successful intubation attempt, or sore throat/hoarseness. With regard to patient-reported satisfaction, a pooled analysis was precluded due to the variability in evaluation methods employed across the trials to assess this outcome. Lastly, trial sequential analysis (TSA) conducted for intubation time (primary outcome) affirmed the conclusiveness of this evidence; TSA performed for secondary outcomes failed to yield conclusive evidence, indicating the necessity for further trials. Conclusions: Videolaryngoscopy for awake tracheal intubation diminishes intubation time and the risk of experiencing a saturation below 90% compared to fiberoptic bronchoscopy.
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Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Pansini 5, 80100 Naples, Italy; (M.V.); (A.M.); (P.B.); (A.C.); (G.S.); (C.I.)
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4
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:207-247. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitary Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Emergency Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Campbell BA, Dziuba A, Perala H, Pollard JE. Awake endotracheal intubation using a hyperangulated video laryngoscope with a Total Control Introducer in a patient with a history of difficult intubation. BMJ Case Rep 2023; 16:e252110. [PMID: 37793849 PMCID: PMC10551975 DOI: 10.1136/bcr-2022-252110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
We report the first use of a fully articulating introducer called the Total Control Introducer (TCI) in combination with a hyperangulated video laryngoscope (VL) to perform an awake intubation in a patient with a history of difficult intubation. After appropriate airway topicalisation, a VL with a hyperangulated blade was inserted to visualise the glottis. A TCI articulating introducer was then used to dynamically navigate through the oropharynx into the trachea. Under indirect visualisation, an endotracheal tube was then passed over the TCI. The TCI was removed and the endotracheal tube was secured. General anaesthesia was induced after confirmation of intubation with capnography and auscultation. The patient was successfully intubated on the first attempt without complications.
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Affiliation(s)
- Blake A Campbell
- Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Adam Dziuba
- Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
| | - Hunter Perala
- A T Still University-Kirksville College of Osteopathic Medicine, Kirksville, Missouri, USA
| | - Jacob E Pollard
- Anesthesiology, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA
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Marchis IF, Zdrehus C, Pop S, Radeanu D, Cosgarea M, Mitre CI. Awake nasotracheal intubation with a 300-mm working length fiberscope: a prospective observational feasibility trial. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:556-562. [PMID: 34843803 PMCID: PMC10533966 DOI: 10.1016/j.bjane.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Awake fiberoptic tracheal intubation is an established method of securing difficult airways, but there are some reservations about its use because many practitioners find it technically complicated, time-consuming, and unpleasant for patients. Our main goal was to test the safety and efficacy of a 300-mm working length fiberscope (video rhino-laryngoscope) when used for awake nasotracheal intubation in difficult airway cases. METHODS This was a prospective, single-center study involving adult patients, having an ASA physical status between I and IV, with laryngopharyngeal pathology causing distorted airway anatomy. Awake nasotracheal intubation, using topical anesthesia and light sedation, was performed using a 300 mm long and 2.9 mm diameter fiberscope equipped with a lubricated reinforced endotracheal tube. The primary outcomes were the success and duration of the procedure. Patients' periprocedural satisfaction and other incidents were recorded. RESULTS We successfully intubated all 25 patients included in this study. The mean ±SD duration of the procedure, starting from the passage of the intubating tube through one of the nostrils until the endotracheal intubation, was 76 ± 36 seconds. Most of the patients showed no discomfort during the procedure with statistical significance between the No reaction Group with the Slight grimacing Group (95%CI 0.13, 0.53, p = 0.047) and the Heavy grimacing Group (95%CI 0.05, 0.83, p = 0.003). The mean ±SD satisfaction score 24 hours post-intervention was 1.8 ± 0.86 - mild discomfort. No significant incidents occurred. CONCLUSIONS Our study showed that a 300-mm working length flexible endoscope is fast, safe, and well-tolerated for nasotracheal awake intubation under challenging airways.
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Affiliation(s)
- Ioan Florin Marchis
- University of Medicine and Pharmacy "Iuliu Hatieganu", Anaesthesia and Intensive Care Department, Cluj- Napoca, Romania.
| | - Claudiu Zdrehus
- University of Medicine and Pharmacy "Iuliu Hatieganu", Anaesthesia and Intensive Care Department, Cluj- Napoca, Romania
| | - Sever Pop
- University of Medicine and Pharmacy "Iuliu Hatieganu", Otorhinolaryngology Department, Cluj- Napoca, Romania
| | - Doinel Radeanu
- University of Medicine and Pharmacy "Iuliu Hatieganu", Otorhinolaryngology Department, Cluj- Napoca, Romania
| | - Marcel Cosgarea
- University of Medicine and Pharmacy "Iuliu Hatieganu", Otorhinolaryngology Department, Cluj- Napoca, Romania
| | - Calin Iosif Mitre
- University of Medicine and Pharmacy "Iuliu Hatieganu", Anaesthesia and Intensive Care Department, Cluj- Napoca, Romania
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7
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Kamga H, Frugier A, Boutros M, Bourges J, Doublet T, Parienti JJ. Flexible nasal bronchoscopy vs. Airtraq ® videolaryngoscopy for awake tracheal intubation: a randomised controlled non-inferiority study. Anaesthesia 2023. [PMID: 37188387 DOI: 10.1111/anae.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
Videolaryngoscopy is a suitable alternative to flexible bronchoscopy to facilitate awake tracheal intubation. The relative effectiveness of these techniques in clinical practice is unknown. We compared flexible nasal bronchoscopy with Airtraq® videolaryngoscopy in patients with an anticipated difficult airway scheduled for awake tracheal intubation. Patients were allocated randomly to flexible nasal bronchoscopy or videolaryngoscopy. All procedures were performed with upper airway regional anaesthesia blockade and a target-controlled intravenous infusion of remifentanil. The success rate with the allocated technique was the primary outcome. A non-inferiority analysis with a predefined limit of 8% was planned. Seventy-eight patients were recruited, allocated randomly and analysed. The rate of successful intubation was 97% and 82% in the flexible bronchoscopy and videolaryngoscopy groups, respectively, p = 0.032. The median (IQR [range]) time to tracheal intubation was shorter with the Airtraq, 163 (105-332 [40-1004]) vs. 217 (180-364 [120-780]) s, p = 0.030. There were no significant differences for complications found between the groups. The median visual analogue scale for ease of intubation was 8 (7-9 [0-10]) for Airtraq vs. 8 (7-9 [0-10]) for flexible bronchoscopy, p = 0.710. The median visual analogue scale for patient comfort for Airtraq was 8 (6-9 [2-10]) vs. 8 (7-9 [3-10]) for flexible bronchoscopy, p = 0.370. The Airtraq videolaryngoscope is not non-inferior to flexible bronchoscopy for awake tracheal intubation in a clinical setting when awake tracheal intubation is indicted. It may be a suitable alternative when judged on a case-by-case basis.
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Affiliation(s)
- H Kamga
- Centre Hospitalier Universitaire de Caen, Caen, France
| | - A Frugier
- Centre Hospitalier Universitaire de Caen, Caen, France
| | - M Boutros
- Centre Hospitalier Universitaire de Caen, Caen, France
| | - J Bourges
- Centre Hospitalier Universitaire de Caen, Caen, France
| | - T Doublet
- Centre Hospitalier Universitaire de Caen, Caen, France
| | - J J Parienti
- Centre Hospitalier Universitaire de Caen, Caen, France
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Römer T, Büttner C, Ossowski R, Mutlak H, Muellenbach RM. Atemwegsmanagement in der Intensivmedizin – Schritt für Schritt. Pneumologie 2023; 77:37-46. [PMID: 36716795 DOI: 10.1055/a-1906-6984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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9
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Difficult airway management in a patient with upper airway obstruction due to alkali ingestion: A case report. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Ren F, Ruan D, Hu W, Xiong Y, Wu Y, Huang S. The Effectiveness of Supportive Psychotherapy on the Anxiety and Depression Experienced by Patients Receiving Fiberoptic Bronchoscope. Front Psychol 2022; 13:960049. [PMID: 35959048 PMCID: PMC9358213 DOI: 10.3389/fpsyg.2022.960049] [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: 06/02/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives As the largest cohort of healthcare workers and nurses can practice as psychotherapists to integrate the psychotherapeutic interventions as part of routine care. The present study aims to evaluate the effectiveness of supportive psychotherapy (SPT) on patients who had been scheduled to undergo a fiberoptic bronchoscopy (FOB) procedure. Methods This study retrospectively analyzed 92 patients who underwent FOB, which was divided into the SPT group and usual-care group based on whether patients were given SPT interventions or not. The Patient Health Questionnaire-9 (PHQ-9) and Hospital Anxiety and Depression Scale (HADS) were used to determine the severity of depression and anxiety, as well as the 36-Item Short-Form Health Survey questionnaire (SF-36) to evaluate the health-related quality of life (HRQoL). Moreover, the patients' satisfaction was assessed based on the Likert 5-Point Scale. Results The baseline status of anxiety, depression, and HRQoL in patients was similar in the SPT group and the usual-care group with no significant difference. Both PHQ-9 score and HADS-D score in the SPT group after intervention were lower than that in the usual-care group, accompanied by the deceased HADS-A subscale. Moreover, the improved HRQoL was found in the patients undergoing FOB after SPT interventions as compared to those receiving conventional nursing care using the SF-36 score. Additionally, the patient satisfaction in the SPT group was higher than in the usual-care group. Conclusions The study demonstrated that anxiety and depression, as negative emotions, can be reduced by supportive psychotherapy in patients receiving FOB with improved mental health and satisfaction with nursing care.
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11
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Gupta A, Singh M, Munda A, Gupta N. Awake videolaryngoscopy in a child with a predicted difficult airway due to a large craniofacial vascular tumour. Anaesth Rep 2022; 10:e12202. [PMID: 36504728 PMCID: PMC9722398 DOI: 10.1002/anr3.12202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- A. Gupta
- Department of Anaesthesiology, Pain Medicine and Critical CareAll India Institute of Medical SciencesNew DelhiIndia
| | - M. Singh
- Department of Anaesthesiology, Pain Medicine and Critical CareAll India Institute of Medical SciencesNew DelhiIndia
| | - A. Munda
- Department of Anaesthesiology, Pain Medicine and Critical CareAll India Institute of Medical SciencesNew DelhiIndia
| | - N. Gupta
- Department of Anaesthesiology, Pain Medicine and Critical CareAll India Institute of Medical SciencesNew DelhiIndia
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12
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Liu Y, Zhang Y, Zhu B, Xu W, Yang Y, Zou Z. Development of endotracheal intubation devices for patients with tumors. Am J Cancer Res 2022; 12:2433-2446. [PMID: 35812038 PMCID: PMC9251697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023] Open
Abstract
The incidence and mortality of malignant tumors are rapidly increasing in the world. Patients with malignant tumors often need surgery for treatment. Endotracheal intubation is a necessary technique for surgical patients undergoing general anesthesia. It is also an important procedure for critically ill patients in the emergency room or ICU. Most patients with head and neck tumors and some specific patients have difficult airways, so the operator may need to use a variety of intubation devices. The commonly used devices for endotracheal intubation include endotracheal tube, direct laryngoscope, video laryngoscope, introducer, optical stylet, fiberoptic bronchoscope. With the advancement in science and technology, the endotracheal intubation devices have been improved, and new devices have been developed. These devices are safer and more feasible in clinical practice. In this review, we summarized the features and applications of some of the currently used devices. Each device has its own uniqueness and meets different needs. The devices and their respective properties are strongly suggested to be mastered by the anesthesiologists as well as related staffs, so as to select the appropriate device for intubation.
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Affiliation(s)
- Yang Liu
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
| | - Yang Zhang
- Department of Anesthesiology, Tianjin Fourth Central HospitalNo. 1 Zhongshan Road, Tianjin 300140, China
| | - Bin Zhu
- Department of Anesthesiology, The People’s Hospital of Suzhou New DistrictNo. 95 Huashan Road, Suzhou 215129, Jiangsu, China
| | - Wenyun Xu
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
| | - Yi Yang
- Department of Anesthesiology, The People’s Hospital of Suzhou New DistrictNo. 95 Huashan Road, Suzhou 215129, Jiangsu, China
| | - Zui Zou
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
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13
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Utada S, Okano H, Miyazaki H, Niida S, Horiuchi H, Suzuki N, Otsuka T, Furuya R. Awake intubation with videolaryngoscopy and fiberoptic bronchoscope. Clin Case Rep 2022; 10:e05274. [PMID: 35035964 PMCID: PMC8752456 DOI: 10.1002/ccr3.5274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022] Open
Abstract
By combining video laryngoscopy and fiberoptic bronchoscopy, awake intubation can be performed more safely.
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Affiliation(s)
- Shusuke Utada
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Hiromu Okano
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Hiroshi Miyazaki
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Shoko Niida
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Hiroshi Horiuchi
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Naoya Suzuki
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Tsuyoshi Otsuka
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
| | - Ryosuke Furuya
- Department of Critical Care and Emergency MedicineNational Hospital Organization Yokohama Medical CenterYokohamaJapan
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14
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Desai N, Ratnayake G, Onwochei DN, El-Boghdadly K, Ahmad I. Airway devices for awake tracheal intubation in adults: a systematic review and network meta-analysis. Br J Anaesth 2021; 127:636-647. [PMID: 34303493 DOI: 10.1016/j.bja.2021.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Awake tracheal intubation is commonly performed with flexible bronchoscopes, but the emerging role of alternative airway devices, such as videolaryngoscopes, direct laryngoscopes, and optical stylets, has been recognised. METHODS CENTRAL, CINAHL, EMBASE, MEDLINE, and Web of Science were searched for RCTs that compared flexible bronchoscopes, direct laryngoscopes, optical stylets and channelled or unchannelled videolaryngoscopes in adult patients having awake tracheal intubation were included. The co-primary outcomes were first-pass success rate and time to tracheal intubation. Continuous outcomes were extracted as mean and standard deviation, and dichotomous outcomes were converted to overall numbers of incidence. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. RESULTS Twelve RCTs were included, none of which evaluated direct laryngoscopes. The first-pass success rate was not different between flexible bronchoscopes, optical stylets, and channelled and unchannelled videolaryngoscopes, with the quality of evidence rated as moderate in view of imprecision. Optical stylets, followed by unchannelled videolaryngoscopes and then felxible bronchoscopes resulted in the shortest time to tracheal intubation, with the quality of evidence rated as high. No differences were shown between the airway devices with respect to the incidence of oesophageal intubation, change of airway technique, oxygen desaturation, airway bleeding, or the rate of hoarseness and sore throat. CONCLUSIONS Flexible bronchoscopes, optical stylets, and channelled and unchannelled videolaryngoscopes were clinically comparable airway devices in the setting of awake trachela intubation and the time to tracheal intubation was shortest with optical stylets and longest with flexible bronchoscopes.
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Affiliation(s)
- Neel Desai
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK.
| | - Gamunu Ratnayake
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Desire N Onwochei
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK
| | - Imran Ahmad
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK
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Shruthi AH, Dinakara D, Chandrika YR. Role of videolaryngoscope in the management of difficult airway in adults: A survey. Indian J Anaesth 2021; 64:855-862. [PMID: 33437073 PMCID: PMC7791425 DOI: 10.4103/ija.ija_211_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/21/2020] [Accepted: 08/16/2020] [Indexed: 01/17/2023] Open
Abstract
Background and Aims A number of videolaryngoscopes (VLs) have flooded the Indian market. As per All India Difficult Airway Association 2016 guidelines, all anaesthesiologists should have access to a VL and must be trained to use it. We conducted an electronic survey to know the perception of Indian anaesthesiologists, who are members of the Indian Society of Anaesthesiologists (Karnataka State Chapter) towards the role of VL in the management of difficult airway (DA) and factors governing their use. Methods An electronic survey was sent to 2580 ISA members to know the availability, use and attitude towards VLs in the management of DA in adults. The survey was open for a period of 2 months and responses analysed. Results The response rate was 25.8% (666 out of 2580). A total of 280 (42%) respondents had access to VL. The respondents rated VL as 4th preference for anticipated DA and 1st for unanticipated DA (if available). The most widely used VLs were C-MAC, Airtraq, and Kingvision. As per 133 respondents (20%), access to VL in institutes was restricted only to consultants and the main reason being cost. The clarity of the image was the most important factor the respondents expected in a VL. Conclusions Less than half of respondents had access to VLs. Most of them having access to it worked in corporate hospitals. The high cost of the device and steep learning curve are still barriers against its widespread use. We conclude that low-cost devices, with increased clarity may make usage of VLs frequent and available to residents.
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Affiliation(s)
- A H Shruthi
- Department of Anaesthesiolgy, IGICH, Bangalore, Karnataka, India
| | - Deevish Dinakara
- Consultant Plastic and Reconstructive Surgeon, Healios, Rajajinagar, Bangalore, Karnataka, India
| | - Y R Chandrika
- Department of Anaesthesiolgy, IGICH, Bangalore, Karnataka, India
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16
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Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth 2021; 68:1405-1436. [PMID: 34105065 PMCID: PMC8186352 DOI: 10.1007/s12630-021-02008-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient's tolerance for withdrawal of airway support and whether re-intubation might be difficult.
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Myatra SN, Gupta S, Pai PS. Anesthesia for oral surgeries during the COVID-19 pandemic. J Anaesthesiol Clin Pharmacol 2020; 36:S96-S104. [PMID: 33100656 PMCID: PMC7574004 DOI: 10.4103/joacp.joacp_355_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 11/05/2022] Open
Abstract
The severe acute respiratory syndrome corona virus 2(SARS-Cov2) virus replicates in the nasal cavity, nasopharynx, and the oropharynx. During oral surgery, the risk of viral transmission is high during instrumentation in these areas, while performing airway management procedures, the oral surgery itself, and related procedures. During the corona virus disease 2019 (COVID-19) pandemic, patients with an oral pathology usually present for emergency procedures. However, patients with oral cancer, being a semi-emergency, may also present for diagnostic and therapeutic procedures. When elective surgeries are resumed, these patients will come to the operating room. In asymptomatic patients, the false-negative rate can be as high as 30%. These patients are a source of infection to the healthcare workers and other patients. This mandates universal precautions to be taken for all patients presenting for surgery. Lesions along the airway, distorted anatomy secondary to cancer therapy, shared airway with the surgeon, surgical handling of the airway and the risk of bleeding, make airway management challenging in these patients, especially while wearing personal protective equipment. Airway management procedures, oral surgery, use of cautery, and other powered surgical instruments in the aero digestive tract, along with constant suctioning are a source of significant aerosol generation, further adding to the risk of viral transmission. Maintaining patient safety, while protecting the healthcare workers from getting infected during oral surgery is paramount. Meticulous advance planning and team preparation are essential. In this review, we discuss the challenges and recommendations for safe anesthesia practice for oral surgery during the COVID-19 pandemic, with special emphasis on risk mitigation.
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Affiliation(s)
- Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sushan Gupta
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Patwa A, Shah A, Garg R, Divatia JV, Kundra P, Doctor JR, Shetty SR, Ahmed SM, Das S, Myatra SN. All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic. Indian J Anaesth 2020; 64:S107-S115. [PMID: 32773848 PMCID: PMC7293372 DOI: 10.4103/ija.ija_498_20] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.
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Affiliation(s)
- Apeksh Patwa
- Chief Consultant Anesthesiologist, Kailash Cancer Hospital and Research Centre, Muni Ashram, Goraj, VINS, Vadodara, Gujarat, India
| | - Amit Shah
- Chief Consultant Anesthesiologist, Kailash Cancer Hospital and Research Centre, Muni Ashram, Goraj, VINS, Vadodara, Gujarat, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Kundra
- Department of Anaesthesiology, JIPMER, Puducherry, India
| | - Jeson Rajan Doctor
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sumalatha Radhakrishna Shetty
- Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology and Critical Care, J N Medical College, AMU, Aligarh, Uttar Pradesh, India
| | - Sabyasachi Das
- Professor of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Sorbello M, Di Giacinto I, Corso RM, Cataldo R. Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients. Br J Anaesth 2020; 125:e187-e188. [PMID: 32386832 PMCID: PMC7183937 DOI: 10.1016/j.bja.2020.04.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022] Open
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Kumar P, Sharma J, Johar S, Singh V. Guiding Flexible-Tipped Bougie Under Videolaryngoscopy: An Alternative to Fiberoptic Nasotracheal Intubation in Maxillofacial Surgeries. J Maxillofac Oral Surg 2020; 19:324-326. [PMID: 32346248 DOI: 10.1007/s12663-020-01327-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/04/2020] [Indexed: 11/27/2022] Open
Abstract
Background Maxillofacial surgeries are known to have difficulty in airway management due to anatomical and functional reasons. Tumors of maxillofacial region and diseases of TM joint limit mouth opening as well as airway space. Various methods have been tried with success for nasotracheal intubation including fiberoptic-aided as well as blind nasal and light-guided intubation. Video laryngoscopy-assisted intubation uses visualization of glottis without the need of alignment of all the three axes of airway. Purpose Video laryngoscopy is being considered to increase the success rate in various different setups including critical care, pre-hospital and operating rooms. Flexible-tipped bougie guided by a video laryngoscope was used in patients with limited airway space undergoing maxillofacial surgery. Methods In present study, airway of five patients posted for various maxillofacial surgeries was secured by passing flexible-tipped bougie through the nasopharyngeal airway and, once under the view of a McGrath videolaryngoscope, was advanced toward the glottis; the rotation of the bougie with the required flexion of the tip helped a quick redirection of bougie to enter the larynx at an angle. Results Our experience of five cases with anticipated difficult intubation normally judged to be manageable with fiberoptic bronchoscopic intubation were managed without awake fiberoptic bronchoscopy using flexible-tipped bougie under vision of videolaryngoscopy. All patients were successfully managed with this technique. Conclusion Flexible-tipped bougie could take the direction toward glottis under a videolaryngoscope in an anticipated difficult airway, making a place for airway management in patients with limited mouth opening.
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Affiliation(s)
- Prashant Kumar
- 1Department of Anaesthesiology and Critical Care, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Heath Sciences, 8FM/17, Medical Enclave, Rohtak, Haryana 124001 India
| | - Jyoti Sharma
- 1Department of Anaesthesiology and Critical Care, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Heath Sciences, 8FM/17, Medical Enclave, Rohtak, Haryana 124001 India
| | - Sanjay Johar
- 1Department of Anaesthesiology and Critical Care, Pt BD Sharma Post Graduate Institute of Medical Sciences, University of Heath Sciences, 8FM/17, Medical Enclave, Rohtak, Haryana 124001 India
| | - Virendra Singh
- 2Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, University of Heath Sciences, Rohtak, India
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Intubation of a Patient with a Large Goiter: The Advantageous Role of Videolaryngoscopy. Case Rep Anesthesiol 2019; 2019:1327482. [PMID: 31885930 PMCID: PMC6915117 DOI: 10.1155/2019/1327482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022] Open
Abstract
Fiberoptic bronchoscopy has long been considered the gold standard for patients who present with a difficult airway. In the case presented, a patient has a large palpable goiter and requires intubation. After the unsuccessful attempt to intubate with the use of fiberoptic bronchoscopy, the decision to switch to videolaryngoscopy afforded a positive result. We present this case to suggest that the utilization of videolaryngoscopy may be an alternative option for intubation when other methods have failed. It is imperative for anesthesiologists to understand the benefits that this modality may provide.
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Awake fibre-optic intubation in crisis? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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