Airway Management In Patients Research Articles

High-flow nasal cannula improves clinical efficacy of airway management in patients undergoing awake craniotomy

BackgroundAwake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. Currently, limited number of literatures on the application of high-flow nasal cannula (HFNC) in the anesthetic management for awake craniotomy has been reported. Hence, we carried out a prospective study to assess the safety and efficacy of humidified high-flow nasal cannula (HFNC) airway management in the patients undergoing awake craniotomy.MethodsSixty-five patients who underwent awake craniotomy were randomly assigned to use HFNC with oxygen flow rate at 40 L/min or 60 L/min, or nasopharynx airway (NPA) device in the anesthetic management. Data regarding airway management, intraoperative blood gas analysis, intracranial pressure, gastric antral volume, and adverse events were collected and analyzed.ResultsPatients using HFNC with oxygen flow rate at 40 or 60 L/min presented less airway obstruction and injuries. Patients with HFNC 60 L/min maintained longer awake time than the patients with NPA. While the intraoperative PaO2 and SPO2 were not significantly different between the HFNC and NPA groups, HFNC patients achieved higher PaO2/FiO2 than patients with NPA. There were no differences in Brain Relaxation Score and gastric antral volume among the three groups as well as before and after operation in any of the three groups.ConclusionHFNC was safe and effective for the patients during awake craniotomy.Trial registrationChinese Clinical Trial Registry, CHiCTR1800016621. Date of Registration: 12 June 2018.

Recommendations for Prehospital Airway Management in Patients with Suspected COVID-19 Infection.

In light of the rapid spread of coronavirus disease 2019 (COVID-19) across the United States, the Centers for Disease Control and Prevention (CDC) and hospitals nationwide have developed new protocols to address infection control as well as the care of critical patients. Airway management has been particularly difficult; the challenge of quickly establishing an airway in patients must be balanced by the risk of aerosolizing respiratory secretions and putting the provider at risk of infection. Significant attention has been given to developing protocols for the emergency department and critical care units, but little guidance regarding establishing airway and respiratory support for patients in the prehospital setting has been made available. While some of the recommendations can be extrapolated from hospital guidelines, other factors such as environment and available resources make these protocols unfeasible. Through review of current literature the authors established recommendations regarding airway management and the provision of respiratory support to patients developing respiratory failure related to COVID-19.

The Comparison of Direct Laryngoscopy and Video Laryngoscopy in Pediatric Airways Management for Congenital Heart Surgery: A Randomized Clinical Trial.

BackgroundAirway management in patients with hereditary heart disease is an important therapeutic intervention.ObjectivesThe purpose of this study was to compare direct laryngoscopy (DL) with video laryngoscopy (VL) in pediatric airways management for congenital heart surgery.MethodsThis study was designed as a prospective randomized clinical trial. Two consecutive groups of 30 patients undergoing elective noncyanotic congenital heart surgery. The patients were divided into direct laryngoscopy versus video laryngoscopy for intubation of the trachea. The main outcomes were the number of success rate in the first attempt, and the secondary outcomes were the duration of successful intubation and complications, such as desaturation and bradycardia.ResultsIntubation procedure time was measured as 51.13 ± 17.88 seconds for the group with direct laryngoscopy and 59.66 ± 45.91 seconds for group with VL that was significant (P = 0.006). In DL group, 22 patients were intubated on the first attempt, 8 patients on the second attempt, and 6 patients on the third attempt, compared to 24, 6, and 2 respectively, in VL group. The differences were significant only in the third attempt between groups (P = 0.033). The important difference established in heart rate (HR) and SpaO2 amounts between the two groups at any time (P < 0.05).ConclusionsVL can produce better visualization for intubation of trachea in congenital heart disease, but this is time-consuming. Indeed, training in the use of the VL should be increased to reduce the time required for performance. Moreover, further studies are recommended to approve these helpful findings.

Airway management in patient with retractable scar in neck: a case report

Airway management in patient with retractable scar in neck: a case report

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Endovascular Therapy for Patients With Acute Ischemic Stroke During the COVID-19 Pandemic: A Proposed Algorithm.

Airway Management Recommendations in Coronavirus Disease 2019 (Covid-19) Patients

Coronavirus pandemic (COVID-19) is a public health problem, in which the aerosol generation place the anaesthesiologist in a high risk of contagion and in a high level of stress. In the following review we make recommendations on best practice in airway management in patients suspected of COVID-19.

Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists.

SummarySevere acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

751 Airway Management of Patients Burned While Smoking on Oxygen: Intubation Rates and Associated Risks

Abstract Introduction A growing population among burn units across the country includes those burned while smoking on oxygen, occasionally resulting in resulting in complications such as full thickness burns requiring grafting, COPD exacerbations and arguably the most serious among this population, inhalation injury. First responders assess the respiratory status of these patients, occasionally choosing to intubate based on signs of respiratory distress. Due to the high proportion of intubated patients in our burn center and the risks of unnecessary intubation, this study will look at trends for patients burned while smoking on oxygen, especially regarding airway management. Methods A retrospective chart review was performed for all patients who were treated by referring providers prior to transfer to our Burn Center between July 2012 – August 2014. A subset analysis was performed on patients whose mechanism was injury resulting from smoking on oxygen. Demographics, airway management, and outcome data were measured. Results 33 of 623 total patients who were treated by referring providers met the inclusion criteria for this study. Twenty-one (64%) were intubated prior to arrival at the Burn Center. Of those intubated, twelve patients (57%) were extubated within 24 hours. Only four patients (19%) were found to have inhalation injury. Overall mortality rate for these patients was 18%, over four times as high as our total mortality rate for transfer patients. Length of stay (LOS) for those who survived their hospital stay without being intubated (3.45 days) was less than those who survived after being intubated (4 days). Conclusions The relatively low proportion of inhalation injury and high rates of extubation within 24 hours indicate the necessity of education improvements regarding risks of unnecessary intubation for regional first responders and physicians. The low incidence of inhalation injury and high rates of extubation by hospital day 1 support previously published reports of overintubation among this patient population. These patients have mortality rates despite small TBSA burns. Further study is warranted to further describe the unique attributes of this high-risk patient population to develop appropriate treatment algorithms. Applicability of Research to Practice Dissemination of this information to first responders and pre-Burn Center hospitals will help reduce the morbidity and mortality associated with overintubation, especially in a medically fragile patient population such as those who are on supplemental oxygen.

New Device For Submental Endotracheal Intubation.

The submental intubation is a well-described technique as an alternative for the tracheostomy in the airway management in patients with contraindications for the nasotracheal and cannot remain in the orotracheal position due to the need to maintain the intermaxillary fixation. Residents and young oral and maxillofacial surgeons could have experienced some difficulty performing the technique first described by Altemir (1986). This report aims to describe a new device designed to facilitate and simplify the technique helping surgeons on the submental endotracheal intubation.

Suggestions on infection control for performing endotracheal intubation in patients with coronavirus disease 2019: based on literature review of airway management in patients with SARS

In order to effectively prevent infection or severe acute respiratory syndrome coronavirus 2 transmission among medical staff during tracheal intubation in patients with suspected or confirmed coronavirus disease 2019(COVID-19), and to ensure the safety of personnel who will perform the endotracheal intubation, we made a literature review to analyze the airway management for SARS patients from China and abroad in 2003 Relevant documents, consensus of diagnosis and therapy for patients with COVID-19 from the National Health Commission, and guidelines of relevant academic societies were also reviewed Thus, we provide suggestions on infection control for performing endotracheal intubation in patients with COVID-19 mainly as follows Medical staff should fully understand the infection risk of COVID-19 and strengthen the training before the procedure It is suggested that the indication of endotracheal intubation should be properly defined, and the need for intubation as emergent or elective should be evaluated early with preparation made in advance During the implementation of endotracheal intubation, the procedure should be completed by the most experienced personnel in airway management using the tools they master best, and a rapid sequential induction of endotracheal intubation is recommended © 2020 Chinese Medical Association

Emerging trends, techniques, and equipment for airway management in pediatric patients.

Pediatric patients present unique anatomic and physiologic considerations in airway management, which impose significant physiologic limits on safe apnea time before the onset of hypoxemia and subsequent bradycardia. These issues are even more pronounced for the pediatric difficult airway. In the last decade, the development of pediatric sized supraglottic airways specifically designed for intubation, as well as advances in imaging technology such that current pediatric airway equipment now finally rival those for the adult population, has significantly expanded the pediatric anesthesiologist's tool kit for pediatric airway management. Equally important, techniques are increasingly implemented that maintain oxygen delivery to the lungs, safely extending the time available for pediatric airway management. This review will focus on emerging trends and techniques using existing tools to safely handle the pediatric airway including videolaryngoscopy, combination techniques for intubation, techniques for maintaining oxygenation during intubation, airway management in patients at risk for aspiration, and considerations in cannot intubate cannot oxygenate scenarios.

&lt;p&gt;Submental Intubations in Panfacial Fractures&lt;/p&gt;

IntroductionAirway management in patients with panfacial fracture remains a challenge to anesthesiologists and surgeons. Submental intubation is an effective and less invasive alternative to tracheostomy during intraoperative airway management where orotracheal and nasotracheal intubation are not appropriate options. In addition, submental intubation allows proper access to oronasal airways and occlusion during intraoperative management.MethodsThe descriptive retrospective study was carried out and evaluated the outcomes of submental intubation in the management of panfacial fracture, complex maxillary or mandible fracture associated with nasal bone fracture and naso-orbito-ethmoid (NOE) fracture. The medical records of 23 patients who received submental endotracheal intubation were reviewed at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal from March 2014 to December 2018. The following parameters were evaluated: mode of trauma, time required for intubation, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay, post-operative complications, such as the healing of submental scars both intraorally and extraorally.ResultsThe submental intubation was successfully done in all patients with minimal obvious post-operative complications. The mode of trauma for majority of cases of panfacial fracture who underwent submental intubation was road traffic accident (69.56%). The mean time required for intubation was 8.43 (±0.84) minutes. No accidental extubations occurred. Accidental perforation of the pilot balloon was seen in one patient (4.35%) during tube manipulation which was managed successfully by changing the tube. The healing of submental scars was uneventful intraorally and extraorally in almost every case. The mean period of hospital stay in patients with submental intubation was 7.95 (±1.49) days.DiscussionSubmental intubation is an effective and safe method as it is not associated with complications of tracheostomy during management of panfacial fracture, NOE fracture and craniofacial fracture. In addition, it does not interfere with IMF during intraoperative period.

The challenge of airway management in patients with “chin-on-chest” deformities undergoing spinal fixation

The challenge of airway management in patients with “chin-on-chest” deformities undergoing spinal fixation

Guiding Flexible-Tipped Bougie Under Videolaryngoscopy: An Alternative to Fiberoptic Nasotracheal Intubation in Maxillofacial Surgeries.

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. 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. 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. 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. 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.

Difficult Airway Identification and Management in Patients With Moebius Syndrome

Airway management in patients with Moebius syndrome can be difficult due to the presence of orofacial malformations. This paper aims to present our institution's experience in the evaluation and management of the upper airway in patients with Moebius syndrome METHODOLOGY:: The authors performed a retrospective study including every patient with Moebius syndrome submitted to surgery between 2012 and 2017. Difficult airway was defined as one requiring more than 2 attempts to achieve endotracheal tube placement, a Mallampati score equal or above III, a Cormack score equal or above III, or need of a fiberscope during intubation. Fifty-one patients were included, (39.3% males) requiring 172 procedures. Each patient required an average of 3.37 ± 1.94 anesthetic events. Average Body Mass Index (BMI) was 20.07 ± 6.06, 45.1% were overweight or obese. Four patients (7%) were considered as having a potentially difficult airway. Endotracheal intubation was achieved in all patients; 38 patients were intubated in a single attempt, while the rest were successfully intubated on a second try. Fiberscope was not necessary. Univariate analysis showed that overweight/obese patients were more likely to be considered as having a difficult airway (P = 0.03). Intubation can be difficult in patients with Moebius syndrome, but failure is rare. Overweight or obese patients are at risk of presenting a difficult airway. An extensive preoperative evaluation and adequate communication between the members of the multidisciplinary team in charge of these patients is paramount.

A prospective randomized controlled study to assess the efficacy of fentanyl and dexmedetomidine for conscious sedation in awake fiberoptic intubation

Background: Awake fiberoptic intubation (AFOI) is usually the primary method for airway management in patients with anticipated difficult airway. To achieve optimal conditions for AFOI, the pharmacological agents chosen for sedation should be short acting and have little suppression of spontaneous ventilation. Aims and Objectives: The aim of this study was to compare the efficacy between dexmedetomidine and fentanyl for conscious sedation in AFOI. The objectives were to assess the intubating conditions, intubation attempts, and the hemodynamic responses between the groups receiving the two drugs. Materials and Methods: This prospective randomized double-blind study was done in 40 patients of the American Society of Anesthesiologists physical statuses I, II, and III, aged between 20 and 65 years. One group received fentanyl 2 mcg/kg infusion over 10 min. The other group received dexmedetomidine 1 mcg/kg infusion over 10 min. AFOI was done in both groups when patients achieved Ramsay sedation score of three. Time to sedation and time to intubation were noted. Intubating conditions were assessed with cough score. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation were also monitored for 30 min with 3 min interval after starting the drug infusion. The number of intubation attempts was also noted. Results: We found that the time to sedation and the time to intubation were shorter with dexmedetomidine than with fentanyl. There were no significant differences in cough score, number of intubation attempts, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation between the groups. Conclusion: Both dexmedetomidine and fentanyl can be used to achieve adequate sedation for AFOI along with regional block and topical anesthesia. However, dexmedetomidine achieved target sedation faster compared to fentanyl enabling early intubation.

Airway Management in Patients with Malignant Lymphoma of the Thyroid

Airway Management in Patients with Malignant Lymphoma of the Thyroid

Airway Management in the Emergency Department During Coronavirus Disease (COVID-19).

Summary. Front-line health-care workers in the Emergency Department (ED) are at an increased risk of infection during the airway management of patients with known or suspected Emerging Viral Diseases (EVD) like Coronavirus Disease 2019 (COVID-19). The primary route for transmission of the virus from an infected patient to the ED staff is due to aerosolized droplets, and the transmission risk is high despite wearing adequate Personal Protective Equipment (PPE). There are limited evidence-based guidelines for airway management during these viral infections, especially with a focus on the principles of airway management in a busy, fast-paced ED. This article provides an overview of the principles of airway management in suspected or confirmed EVD patients, including COVID-19, particularly in the context of ED, and also considering strategies in resource limited setting. These principles should be adapted to suit your local department and hospital policy on airway management as well as national guidelines.

Ultrasonographic assessment of airway.

Ultrasound is gaining increasing popularity among anesthesiologists as it is readily available and provides real-time imaging for various procedures. It is considered as a “visual stethoscope” of the anesthesiologist. After establishing its use in regional blocks and central venous catheter insertion, it is now finding increasing use in anticipation of difficult airway and securing and maintaining it. It has challenged the classical approach of clinical assessment of airway and allows more dynamic bedside assessment. This article attempts to briefly outline the role of ultrasound and its applications for airway management in patients.