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Sánchez Roldán MÁ, Duque H, Masso B, Moncho D, Vilallonga R, Armengol M, González Ó. The Effects of Nebulized Lidocaine on the Laryngeal Adductor Reflex. Laryngoscope 2024. [PMID: 38529708 DOI: 10.1002/lary.31406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
The laryngeal adductor reflex (LAR) is a brainstem reflex that closes the vocal fold and constitutes a new method for continuously monitoring the vagus and laryngeal nerves during different surgeries. Previous reports concluded that topical lidocaine in spray inhibited LAR responses. However, topical anesthesia in the upper airway may be necessary in awake intubation. We present six patients who underwent neck endocrine surgery due to an intrathoracic goiter that compromised the airway. Before awake intubation, a nebulization of lidocaine 5% was applied for at least 10 min. The intubation procedure was well tolerated, and bilateral LAR with suitable amplitudes for monitoring was obtained in all cases. In our series, the nebulization of lidocaine 5% did not affect the laryngeal adductor reflex. Laryngoscope, 2024.
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Affiliation(s)
- M Ángeles Sánchez Roldán
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Héctor Duque
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Bernat Masso
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dulce Moncho
- Clinical Neurophysiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ramón Vilallonga
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of General Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Armengol
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of General Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Óscar González
- Department of General Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
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2
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Grăjdieru O, Petrișor C, Bodolea C, Tomuleasa C, Constantinescu C. Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study. J Clin Med 2024; 13:1321. [PMID: 38592177 PMCID: PMC10931942 DOI: 10.3390/jcm13051321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. METHODS This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. RESULTS Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5-2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. CONCLUSIONS This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.
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Affiliation(s)
- Olga Grăjdieru
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Cristina Petrișor
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Constantin Bodolea
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
| | - Ciprian Tomuleasa
- Department of Hematology, Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Cătălin Constantinescu
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (O.G.); (C.P.); (C.B.)
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3
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Martins Lima P, Adams M, Pinto SG, Mexedo C. Synergic Difficulties in an Anticipated Physiologically and Anatomically Difficult Airway in a Trauma Patient: A Case Report. Cureus 2023; 15:e50735. [PMID: 38234950 PMCID: PMC10792343 DOI: 10.7759/cureus.50735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/19/2024] Open
Abstract
The American Society of Anesthesiologists (ASA) defines a difficult airway as a clinical situation in which a physician who is trained in anesthesiology experiences difficulty or fails in either face mask ventilation, laryngoscopy, using a supraglottic airway, tracheal intubation, extubation, or front-of-neck airway. Classically, this has been defined in relation to anatomic factors, but the concept of a physiologically difficult airway has been growing in relevance, in which physiologic factors, such as hypoxemia and hypercapnia, act to reduce safe apnea times. The case reports on a trauma patient with an unstable thoracic vertebral fracture requiring correction via the posterior approach. Our patient had multiple anatomical difficult airway predictors, namely, a short neck, greatly limited neck mobility, and a Mallampati class IV airway, among others, and multiple physiological difficult airway predictors, such as a baseline hypoxemic respiratory failure and severe sleep apnea, in addition to the restrictions on mobility imposed by the fracture itself. We describe a successful perioxygenation strategy, using high-flow nasal oxygen (HFNO) during the preoxygenation, intubation, extubation, and post-anesthesia care phases, and with an awake fiberoptic intubation technique for securing the airway.
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Affiliation(s)
| | - Mariana Adams
- Anesthesiology and Critical Care, Centro Hospitalar Universitário do Porto, Porto, PRT
| | - Sérgio G Pinto
- Anesthesiology, Centro Hospitalar Universitário São João, Porto, PRT
| | - Carlos Mexedo
- Anesthesiology and Critical Care, Centro Hospitalar Universitário do Porto, Porto, PRT
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4
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Karlsen KAH, Gisvold SE, Nordseth T, Fasting S. Incidence, causes, and management of failed awake fibreoptic intubation-A retrospective study of 833 procedures. Acta Anaesthesiol Scand 2023; 67:1341-1347. [PMID: 37587618 DOI: 10.1111/aas.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Abstract
Awake fibreoptic intubation has been considered a gold standard in the management of the difficult airway. However, failure may cause critical situations. The aim of this study was to investigate the incidence and causes of failed awake fibreoptic intubation at a tertiary care hospital. The study was conducted at St. Olav University Hospital in Trondheim, Norway. Problems occurring during anaesthesia are routinely recorded in the electronic anaesthesia information system (Picis Clinical Solutions Inc.), including difficult intubations. We applied text search on all anaesthesia records between 2011 and 2021 and identified 833 awake fibreoptic intubations. The anaesthesia records were examined to identify failed awake fibreoptic intubations, the cause of failure and how the airway ultimately was secured. Among 233,938 patients who received anaesthesia, 90,397 received tracheal intubation and 833 received awake fibreoptic intubation. Twenty-nine of the procedures failed. In nine patients the failure caused loss of airway control with desaturation and hypoventilation. The major causes of failure were dislodged tube after induction of general anaesthesia (n = 8), patient distress (n = 5), tube not able to pass (n = 5), and airway bleeding (n = 3). The situations were primarily solved using direct laryngoscopy, with or without bougie, or with video laryngoscopy. Tracheostomy was performed in four patients. Awake fibreoptic intubation failed in 3.5% of patients, most often due to dislocation, problems passing the tracheal tube, or patient discomfort. The failure rate was higher than in previous studies.
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Affiliation(s)
| | - Sven Erik Gisvold
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging. Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Trond Nordseth
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging. Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sigurd Fasting
- Department of Anaesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging. Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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5
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Wakabayashi R. Airway Management of a Patient With Penetrating Maxillofacial Trauma Caused by Chainsaw Kickback: A Case Report. Cureus 2023; 15:e45064. [PMID: 37842509 PMCID: PMC10567539 DOI: 10.7759/cureus.45064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Anesthesiologists rarely experience airway management in patients with maxillofacial injuries caused by a chainsaw. A 36-year-old male was referred to our hospital because of maxillofacial injuries caused by chainsaw kickback. There were deep lacerations of the right eyelid, medial canthus, cheek, and jaw with venous bleeding. The laceration of the cheek reached the oral cavity and looked like a "second mouth." The patient was taken to the operating room for urgent laceration repair under general anesthesia. Despite a poor laryngeal view, awake orotracheal intubation with a videolaryngoscope was successful on the second attempt without complications. Oxygenation was optimized by supplemental oxygen administration via a suction catheter inserted from the "second mouth" throughout the airway management. The present case highlights the importance of airway management strategies according to the nature of the trauma in patients with penetrating maxillofacial trauma caused by a chainsaw.
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Affiliation(s)
- Ryo Wakabayashi
- Department of Anesthesia, Nagano Red Cross Hospital, Nagano, JPN
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6
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Bozych M, Smith E. An Awake Flexible Scope Intubation for a Patient With Trisomy 21, COVID-19, and Ludwig's Angina. Cureus 2023; 15:e44370. [PMID: 37779784 PMCID: PMC10540482 DOI: 10.7759/cureus.44370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
For patients with known or suspected atlantoaxial instability, awake flexible scope intubation is often an attractive option for safely securing the airway. Due to the challenges of consent and cooperation, patients with trisomy 21 are generally considered to be poor candidates for this technique. However, in rare instances, such as the case of this patient with co-existing Ludwig's angina and COVID-19 pneumonia, the benefits of proceeding with an awake flexible scope intubation may outweigh the potential risks.
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Affiliation(s)
- Marc Bozych
- Anesthesiology, Nationwide Children's Hospital, Columbus, USA
- Anesthesiology, Kaweah Health Medical Center, Visalia, USA
| | - Emily Smith
- Anesthesiology, Kaweah Health Medical Center, Visalia, USA
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Silwal S, Shrestha D, Neupane G, Rana R, Bhurtel S, Adhikari P, Khadka N. Awake tracheal intubation in a patient with a post-burn contracture performed via direct laryngoscopy in a resource-limited setting. Anaesth Rep 2023; 11:e12265. [PMID: 38058474 PMCID: PMC10696405 DOI: 10.1002/anr3.12265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- S. Silwal
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - D. Shrestha
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - G. Neupane
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - R. Rana
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - S. Bhurtel
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - P. Adhikari
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
| | - N. Khadka
- Department of AnaesthesiologyBharatpur HospitalChitwanNepal
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8
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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9
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Kristensen MS, Hesselfeldt R, Brinkenfeldt HK, Biro P. Infrared flashing light through the cricothyroid membrane as guidance to awake intubation with a flexible bronchoscope: A randomised cross-over study. Acta Anaesthesiol Scand 2023; 67:432-439. [PMID: 36690598 DOI: 10.1111/aas.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND In case of distorted airway anatomy, awake intubation with a flexible bronchoscope can be extremely difficult or even impossible. To facilitate this demanding procedure, an infrared flashing light source can be placed on the patient's neck superficial to the cricothyroid membrane. The light travels through the skin and tissue to the trachea, from where it can be registered by the advancing bronchoscope in the pharynx and seen as flashing white light on the monitor. We hypothesised that the application of this technique would allow more proximal and easier identification of the correct pathway to the trachea in patients with severe airway pathology. METHODS As part of awake intubation, patients underwent insertion of a flexible video bronchoscope via the mouth into the trachea. The procedure was performed twice, in random order in each patient, with and without the aid of the transcutaneous flashing infrared light. All insertions were video recorded to determine at which anatomical landmark within the airway the correct pathway was identified. The videos are accessible via this link: https://airwaymanagement.dk/infrared_comparative. The predefined landmarks were in successive order: oral cavity, oro-pharynx, tip of epiglottis, arytenoid cartilages, false cords, vocal cords and trachea, as well as the spaces between them. RESULTS Twenty-two patients had a total of 44 awake insertions with the flexible bronchoscope. The median anatomical level, at which correct identification of the trachea was obtained on the monitor, was, past the epiglottis, with the conventional technique, and at the level of the oropharynx, when using the infrared flashing light (p = .005). The time until the flashing light or the vocal cords were seen was 21 (22) S, mean (SD), and 48 (62) S, during the insertion with and without infrared flashing light activated, respectively (p = .005). Endoscopists rated it easier (p = .001) to recognise the entrance to the trachea in the infrared-group. CONCLUSION During awake intubation of patients with airway pathology, the application of trans-cricothyroid infrared flashing light to guide the insertion of a flexible bronchoscope significantly facilitated the recognition of the pathway into the trachea and the correct advancement of the flexible endoscope. REGISTRATION OF CLINICAL TRIAL NCT03930550.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rasmus Hesselfeldt
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning K Brinkenfeldt
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Biro
- Faculty of Medicine, Zurich University, Zurich, Switzerland
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10
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Dash S, Bhalerao N, Gaurkar A, P S, Chandak A. Anaesthetic Challenges in a Case of Oral Carcinoma With Anticipated Difficult Airway Posted for Tumour Excision and Reconstruction Surgery. Cureus 2023; 15:e34599. [PMID: 36883095 PMCID: PMC9985923 DOI: 10.7759/cureus.34599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Mandibular surgery, edentulous jaw, denture wear, and ageing are all risk factors for persistent mandibular ridge resorption and weakening. The tongue occludes the upper airway due to the mandible's edentulous condition. All of these factors contribute to the difficulties in regulating the airway. An adequate preoperative review assisted in classifying this index patient as having a high risk of difficult airway management, and appropriate actions were made to facilitate effective airway care. A 60-year-old male presented to casualty with a complaint of squamous cell carcinoma of the right buccal mucosa and was posted for wide local excision of the tumour, segmental mandibulectomy, bilateral modified radical neck dissection, and reconstruction with a fibular free flap. He had a restricted mouth opening and a heavy jaw, with Mallampati grade 4 and had an anticipated difficult airway. Hence, awake endotracheal intubation was done by flexible fibreoptic bronchoscope following airway blocks and an 8.0 mm cuffed flexometallic armoured tube was secured at 28 cm at the angle of the nose. Bilateral modified radical neck dissection and wide local excision of the tumour were done followed by mandibulectomy and its reconstruction by fibular free flap and anastomosis was performed. Tracheostomy was performed and the patient was shifted to the intensive care unit and kept knocked out with injection vecuronium and injection midazolam infusion. The patient was gradually weaned off the ventilator the following day and discharged on postoperative day 12 with minimal postoperative complications. A thorough pre-anaesthetic plan, simple and skilled anaesthetic management strategy, and well-organized teamwork aided in the effective anaesthetic care of this challenging airway patient.
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Affiliation(s)
- Sambit Dash
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikhil Bhalerao
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aditi Gaurkar
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shiras P
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Aruna Chandak
- Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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McCutchen TM, Johnson KN, Fowler JG, Fanelli JE, Anzola SC, Bost SJ, Templeton TW, Saha AK. A Prospective Observational Comparison of Two Approaches to Anesthetizing the Trachea for Awake Intubation. Cureus 2022; 14:e22440. [PMID: 35371796 PMCID: PMC8941967 DOI: 10.7759/cureus.22440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Multiple techniques have been described for anesthetizing the lower glottis and trachea prior to awake fiberoptic intubation. The primary aim of this study is to evaluate whether direct application of local anesthetic to the lower airway via an epidural catheter under direct vision is equally efficacious when compared to use of a transtracheal block in adult patients with an anticipated difficult airway. Methods: Patients age >18 years requiring awake fiberoptic intubation who underwent upper and lower airway topicalization were observed prospectively. Following topicalization of the upper airway, patients underwent either a transtracheal block or had their trachea and lower glottis anesthetized under direct vision via dispersion of local anesthetic through a multi-orifice epidural catheter. Choice of technique was at the discretion of the attending anesthesiologist. The primary outcome was defined as the degree of coughing observed at the time of intubation based on a 4-point ordinal scale. Results: Awake intubations in 88 patients were observed with 44 patients undergoing transtracheal block and 44 patients undergoing the epidural catheter technique. Degree of coughing with intubation was similar for each approach with a coughing score of (0, IQR (0,1)) versus (0, IQR (0,1)) in the epidural catheter and transtracheal groups respectively (p = 0.385). Duration of procedure was less in the transtracheal group (1.35 ± 1.54 min) vs. epidural catheter approach (2.86 ± 2.20 min) (p< 0.001). Conclusion: The epidural catheter and transtracheal approach appear to be equally effective at preventing coughing with intubation during awake fiberoptic intubation.
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Affiliation(s)
| | - Kathleen N Johnson
- Anesthesiology, George Washington School of Medicine, Washington, DC, USA
| | - Jacob G Fowler
- Anesthesiology, Tulane University School of Medicine, New Orleans, USA
| | | | - Saskia C Anzola
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Sarah J Bost
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, USA
| | | | - Amit K Saha
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, USA
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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: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Mørkenborg ML, Kristensen MS. Tube tip in pharynx-a conduit for awake oral intubation in patients with extremely restricted mouth opening. Can J Anaesth 2021. [PMID: 34907504 DOI: 10.1007/s12630-021-02174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Awake flexible bronchoscope-guided intubation is challenging in patients with extremely limited mouth opening (when there is inadequate space for an oropharyngeal airway), especially when nasal access is unavailable. Alternatives include awake front of neck access, which is an invasive procedure and not suitable for elective surgery. We present a novel technique to facilitate flexible bronchoscope-guided oral intubation in these patients. CLINICAL FEATURES Tube tip in pharynx (TTIP) is a technique for establishing a patent airway if ventilation is difficult or has failed using a face mask, supraglottic airway, or endotracheal tube. The technique involves placing the tip of the endotracheal tube in the pharynx, 10-14 cm past the teeth, filling the cuff with air, closing the mouth and nose of the patient, and then initiating ventilation. The TTIP method thus combines the function of an oropharyngeal airway and a face mask akin to a supraglottic airway device, but is more flexible with regard to insertion depth and cuff inflation and demands only minimal mouth opening. We have adapted the TTIP technique for awake flexible bronchoscope-guided oral intubation and report the technique illustrated with three cases where mouth opening was so restricted that it precluded insertion of an oropharyngeal airway. CONCLUSION By placing an endotracheal tube with the tip in the pharynx, TTIP can establish a conduit for awake oral flexible bronchoscope-guided intubation in patients with extremely limited mouth opening and unavailable nasal access. This technique requires equipment that is readily available and may help avoid unnecessary awake tracheostomy.
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15
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Wang Z, Yang Y, Chen Y, Yi B, Lu K, Chen B. Fiberoptic-guided tracheal intubation under precise anesthesia and topicalization with spontaneous respiration preservation for an uncooperative patient with severe postburn mentosternal contracture. Clin Case Rep 2021; 9:e05208. [PMID: 34934504 PMCID: PMC8650747 DOI: 10.1002/ccr3.5208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Airway management of patients with difficult airways is a challenge to the anesthesiologists and awake tracheal intubation is the recommended strategy. Successful fiberoptic-guided tracheal intubation under precise anesthesia and topicalization with spontaneous respiration preservation was achieved in an uncooperative patient with severe postburn mentosternal contracture scheduled for release of contracture.
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Affiliation(s)
- Zhi Wang
- Department of AnesthesiaSouthwest HospitalArmy Military Medical UniversityChongqingChina
| | - Yong Yang
- Department of AnesthesiaSouthwest HospitalArmy Military Medical UniversityChongqingChina
| | - Yang Chen
- Department of AnesthesiaSouthwest HospitalArmy Military Medical UniversityChongqingChina
| | - Bin Yi
- Department of AnesthesiaSouthwest HospitalArmy Military Medical UniversityChongqingChina
| | - Kaizhi Lu
- Department of AnesthesiaSouthwest HospitalArmy Military Medical UniversityChongqingChina
| | - Bing Chen
- Department of AnesthesiaThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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16
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Abstract
Airway topicalization is frequently utilized by anesthesiologists to facilitate open airway procedures, aid intubation for a difficult airway, and prevent adverse respiratory events. This review article summarizes the techniques available for airway topicalization for a patient who is deemed to be difficult to intubate. We focus on the indications for use, local anesthetic maximum dosages and safety profiles, sedation techniques, and trials and pitfalls during airway topicalization for difficult intubation.
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Affiliation(s)
- Piotr Kostyk
- Anesthesiology, Westchester Medical Center, Valhalla, USA
| | - Karen Francois
- Anesthesiology, Westchester Medical Center, Valhalla, USA
| | - Irim Salik
- Anesthesiology, Westchester Medical Center, Valhalla, USA
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17
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Zhou Z, Zhao X, Zhang C, Yao W. Preoperative four-dimensional computed tomography imaging and simulation of a fibreoptic route for awake intubation in a patient with an epiglottic mass. Br J Anaesth 2020; 125:e290-e292. [PMID: 32654748 DOI: 10.1016/j.bja.2020.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Zhiqiang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuanhan Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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18
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Affiliation(s)
- M F Aziz
- Department of Anesthesiology and Peri-operative Medicine, Oregon Health and Science University, Portland, OR, USA
| | - M S Kristensen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University Hospital of Copenhagen, Denmark
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19
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Jiang J, Ma DX, Li B, Wu AS, Xue FS. Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation - a systematic review and meta-analysis of randomized controlled trials. Ther Clin Risk Manag 2018; 14:1955-1963. [PMID: 30410341 PMCID: PMC6197207 DOI: 10.2147/tcrm.s172783] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation. Methods The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes. Results Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; P=0.99; high-quality evidence). There was no heterogeneity among studies (I2=0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; P=1.00; high-quality evidence) and oral intubations (RR, 1.00; P=0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, −40.4 seconds; P<0.01; low-quality evidence). There were no differences between groups for other outcomes (P>0.05). Conclusion For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB.
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Affiliation(s)
- Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Da-Xu Ma
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Affiliated to Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China
| | - An-Shi Wu
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China,
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20
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Abstract
Tracheal intubation remains a life-saving procedure that is typically not difficult for experienced providers in routine conditions. Unfortunately, difficult intubation remains challenging to predict and intubation conditions may make the event life threatening. Recent technological advances aim to further improve the ease, speed, safety, and success of intubation but have not been fully investigated. Video laryngoscopy, though proven effective in the difficult airway, may result in different intubation success rates in various settings and in different providers’ hands. The rescue surgical airway remains a rarely used but critical skill, and research continues to investigate optimal techniques. This review highlights some of the new thoughts and research on these important topics.
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Affiliation(s)
- Joelle Karlik
- Oregon Health & Science University, Portland, OR, USA
| | - Michael Aziz
- Oregon Health & Science University, Portland, OR, USA
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21
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Abstract
BACKGROUND Many emergency physicians gain familiarity with the laryngeal anatomy only during the brief view achieved during rapid sequence induction and intubation. Awake laryngoscopy in the emergency department (ED) is an important and clinically underutilized procedure. DISCUSSION Providing benefit to the emergency physician through a slow, controlled, and deliberate examination of the airway, awake laryngoscopy facilitates confidence in the high-risk airway and eases the evolution to intubation, should it be required. Emergency physicians possess all the tools and skills required to effectively perform this procedure, through either the flexible endoscopic or rigid approaches. The procedure can be conducted utilizing local anesthesia with or without mild sedation, such that patients protect their airway. CONCLUSION We discuss two clinical scenarios, indications/contraindications, patient selection, and steps to performing two approaches to awake laryngoscopy in the ED.
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22
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Mendonca C, Mesbah A, Velayudhan A, Danha R. A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)(®) for awake oral tracheal intubation. Anaesthesia 2016; 71:908-14. [PMID: 27228959 DOI: 10.1111/anae.13516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
Abstract
We compared awake fibreoptic intubation with awake intubation using the Pentax Airway Scope(®) in 40 adult patients. Sedation was achieved using a target-controlled remifentanil infusion of 1-5 ng.ml(-1) and midazolam. The airway was anaesthetised with lidocaine spray and gargle. The total procedure time - a composite of sedation time, topical anaesthesia time and intubation time - was recorded. The operator's impression of the ease of the procedure and the patients' reported comfort were recorded on a 0-100 mm visual analogue scale. The median (IQR [range]) for total procedure time was 900 (739-1059 [616-1215]) s with the fibrescope and 651 (601-720 [498-900]) s with the Pentax Airway Scope (p = 0.0001). The median (IQR [range]) intubation time was 420 (283-480 [120-608]) s with the fibrescope and 183 (144-220 [107-420]) s with the Pentax Airway Scope (p = 0.0002). The median (IQR [range]) visual analogue scores for the operator's ease of intubation for the fibrescope and Pentax Airway Scope were 83.6 (72.0-98.0 [49.0-100.0]) and 86.8 (84.0-91.0 [61.0-100.0]), respectively (p = 0.3507). The median (IQR [range]) visual analogue score for patient comfort was 85.5 (81.0-97.0 [69.0-100.0]) and 79.4 (74.0-85.0 [59.0-100.0]) for the fibrescope and Pentax Airway Scope, respectively (p = 0.06). Total procedure time was significantly shorter with the Pentax Airway Scope compared with the fibrescope, with no difference in procedure difficulty or patient discomfort.
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Affiliation(s)
- C Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Mesbah
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - A Velayudhan
- Department of Anaesthesia, Heart of England Foundation NHS Foundation Trust, Birmingham, UK
| | - R Danha
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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23
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Pirlich N, Lohse JA, Schmidtmann I, Didion N, Piepho T, Noppens RR. A comparison of the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia for awake fibreoptic intubation. Anaesthesia 2016; 71:814-22. [PMID: 27150724 DOI: 10.1111/anae.13496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 01/04/2023]
Abstract
We compared the Enk Fiberoptic Atomizer Set(™) with boluses of topical anaesthesia administered via the working channel during awake fibreoptic tracheal intubation in 96 patients undergoing elective surgery. Patients who received topical anaesthesia via the atomiser, compared with boluses via the fibreoptic scope, reported a better median (IQR [range]) level of comfort: 1 (1-3 [1-10]) vs. 4 (2-6 [1-10]), p < 0.0001; experienced a reduced total number of coughs: 6 (3-10 [0-34]) vs. 11 (6-13 [0-25]), p = 0.0055; and fewer distinct coughing episodes: 7% vs. 27% respectively, p = 0.0133. The atomiser technique was quicker: 5 (3-6 [2-12]) min vs. 6 (5-7 [2-15]) min, p = 0.0009; and required less topical lidocaine: 100 mg (100-100 [80-160]) vs. 200 mg (200-200 [200-200]), p < 0.0001. Four weeks after nasal intubation, the incidence of nasal pain was less in the atomiser group compared with the control group (8% vs. 50%, p = 0.0015). We conclude that the atomiser was superior to bolus application for awake fibreoptic tracheal intubation.
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Affiliation(s)
- N Pirlich
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - J A Lohse
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - I Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - N Didion
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - T Piepho
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
| | - R R Noppens
- Department of Anaesthesiology, University Medical Centre Mainz, Mainz, Germany
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24
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Abstract
Fiberoptic intubation (FOI) is an effective technique for establishing airway access in patients with both anticipated and unanticipated difficult airways. First described in the late 1960s, this approach can facilitate airway management in a variety of clinical scenarios given proper patient preparation and technique. This paper seeks to review the pertinent technology, clinical techniques, and indications for and complications of its use. The role of FOI in airway management algorithms is discussed. Evidence is presented comparing FOI to other techniques with regard to difficult airway management. In addition, we have reviewed the literature on training processes and skill development in FOI.
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Affiliation(s)
- Stephen R Collins
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.
| | - Randal S Blank
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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25
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Tsaousi G, Pourzitaki C, Amaniti E. Sevoflurane induction of anesthesia for a large epiglottic cyst removal when awake intubation is not an option. Hippokratia 2015; 19:94. [PMID: 26435660 PMCID: PMC4574600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- G Tsaousi
- Department of Anesthesiology and Intensive Care, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Ch Pourzitaki
- Department of Anesthesiology and Intensive Care, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - E Amaniti
- Department of Anesthesiology and Intensive Care, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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26
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Abstract
BACKGROUND AND AIMS Pentax airway scope (AWS) has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. METHODS We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade), total dose of local anaesthetic used, anaesthetists rating and patient's tolerance of the procedure were recorded. RESULTS The procedure was successful in 25 out of the 30 patients (83%). The mean (standard deviation) intubation time and total time to complete the tracheal intubation was 5.4 (2.4) and 13.9 (3.7) min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS). CONCLUSION Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.
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Affiliation(s)
- Payal Kajekar
- Department of Anaesthesia, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
| | - Cyprian Mendonca
- Department of Anaesthesia, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
| | - Rati Danha
- Department of Anaesthesia, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
| | - Carl Hillermann
- Department of Anaesthesia, University Hospital Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom
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27
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Abstract
Intubation of patients with a supraglottic mass causing obstruction of the glottis remains a difficult problem for the experienced anesthesiologist. Awake fiberscopic endotracheal intubation is the recommended approach in such cases; however, use of a video laryngoscope for awake intubation can be an alternative to a fiberscope. Here we present two cases of awake intubation using a King Vision™ video laryngoscope in patients with a supraglottic mass, and a literature review on use of video laryngoscopes for awake intubation. After topical anesthesia and sedation with opioids, the patients were successfully intubated.
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Affiliation(s)
- Ewelina Gaszynska
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszynski
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
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28
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Akkaya A, Yıldız İ, Demirhan A, Tekelioğlu ÜY, Koçoğlu H. Awake Fibreoptic Intubation for Forearm Injury in a Patient with Occipito-Cervical Fixator. Turk J Anaesthesiol Reanim 2013; 41:182-4. [PMID: 27366367 DOI: 10.5152/tjar.2013.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/04/2012] [Indexed: 11/22/2022] Open
Abstract
A 23-year-old male patient with occipitocervical fixator was scheduled for surgery due to injury to the right forearm. The patient's thyromental distance was 5 cm, mouth opening grade II, sternomental distance 10 cm and Mallampati score 4. Loss of extension and rotation movements of the head was assessed as difficult intubation criteria. Anaesthetic procedures are almost always difficult in patients with occipitocervical fixation; the limited cervical extension complicated both intubation and ventilation. In this report, application of general anaesthesia using awake fibreoptic bronchoscopic intubation (FOB) is described. After routine monitoring of vital signs and premedication, hypopharyngeal topical anaesthesia was accomplished by instilling 10% lidocaine spray twice via the appropriate nostril. Superior laryngeal nerve block was performed with local anaesthetic infiltration of tissues 1 cm below the greater horns of the hyoid bone. Lingual and pharyngeal branches of the glossopharyngeal nerve were blocked. Transtracheal block was performed. Following completion of local anaesthesia, the patient was intubated using the awake FOB technique, on 5 L min(-1) of 100% O2. After muscle relaxation, the patient underwent a microsurgical operation to repair eight tendons, one artery, and one nerve. Surgery lasted for 5 hours. When the extubation criteria were met, the patient was extubated. In cases of occipitocervical fixation, which causes severe limitation of neck movements, the use of awake fibreoptic intubation should be considered.
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Affiliation(s)
- Akcan Akkaya
- Department of Anaesthesiology and Reanimation, Facult of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - İsa Yıldız
- Department of Anaesthesiology and Reanimation, Facult of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Abdullah Demirhan
- Department of Anaesthesiology and Reanimation, Facult of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Ümit Yaşar Tekelioğlu
- Department of Anaesthesiology and Reanimation, Facult of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Hasan Koçoğlu
- Department of Anaesthesiology and Reanimation, Facult of Medicine, Abant İzzet Baysal University, Bolu, Turkey
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29
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Medhat M, Aljuhani T. Awake intubation with Bonfil's retromolar fibroscope in a patient with hard and fixed swelling of the right side of the neck and the tonsillar tumor. Saudi J Anaesth 2012; 5:423-5. [PMID: 22144933 PMCID: PMC3227315 DOI: 10.4103/1658-354x.87275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bonfil's rigid fibroscope is an instrument used to perform tracheal intubation, proven to be effective both in patients with normal and in those with difficult airways. We use this device in awake intubation in a patient presenting with a large right neck mass and a tonsillar tumor which limited the mouth opening. Also, we describe our technique of insertion of Bonfil's retromolar fibroscope from the right side of the mouth across the tongue.
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Affiliation(s)
- Mamdouh Medhat
- Department of Anaesthesiology, King Abdulaziz Medical City, Saudi Arabia
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