Airway Management In Patients Research Articles

Difficult intubation of a patient with progressive multifocal leukoencephalopathy and muscle spasticity - A case report -

Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease characterized by neurological deficits, including cognitive impairment, altered mental status, and muscle spasticity. Preoperative evaluation and intraoperative airway management of the airway is difficult in patients with this disease. In this report, the authors describe a 62-year-old man with PML and spastic hemiparesis, who was scheduled for video-assisted thoracic bullectomy under general anesthesia. A preoperative airway evaluation, including Mallampati classification, could not be performed due to lack of patient cooperation. Additionally, the anesthesiologist did not perform diverse physical assessments of the airway or prepare an adequate airway management strategy. During induction of general anesthesia, difficulty with intubation was encountered because of limited mouth opening. This case emphasizes that anesthesiologists should have thorough knowledge of airway assessment and management strategies, and perform a comprehensive assessment to implement appropriate airway management in patients with this disease. Keywords: Intubation; Muscle spasticity; Progressive multifocal leukoencephalopathy

A randomized controlled trial comparing gastro-laryngeal tube with endotracheal intubation for airway management in patients undergoing ERCP under general anaesthesia

BackgroundGastro laryngeal tube (GLT) is a newly introduced device. It is an advanced purpose specific design (essentially a modified laryngeal tube) which especially provides a separate wide channel specifically designed for the introduction of a gastroscope for endoscopic retrograde cholangio-pancreatography (ERCP), simultaneously functioning as a supra-glottic airway device for ventilation. MethodsIn a randomized controlled trial on 100 patients undergoing ERCP under GA, GLT was compared with endotracheal tube as an alternative airway device. Device insertion conditions, oxygenation and ventilation parameters were recorded. ResultsGLT was found to be comparable with ETT. Success rate of insertion of GLT was high (92%) and the insertion time of GLT was significantly shorter 42 (20–210)s vs. 206 (176–320)s – median (range). Both the devices were equally effective in normal oxygenation and ventilation. The recovery time was significantly shorter and postoperative complications such as hoarseness and dysphonia were less common in GLT group. Inserting conditions for the duodenoscope were better in GLT group. ConclusionIn this study, likely to be first of its kind, it is concluded that the GLT is a suitable and better alternative to ETT as it allows adequate ventilation and is associated with faster recovery times and minimal extubation-related complications while enhancing operative conditions for gastroenterologists. Its regular use in patients undergoing ERCP is strongly recommended.

Airway Management in Thoracic Anesthesia with Double-Lumen Tube

Lung separation and isolation with accomplished one-lung ventilation plays a key role in the airway management for thoracic surgery. Spectrum of indication contains thoracic surgery, procedure- and patient-dependent factors. Usually lung isolation is achieved with a double-lumen tube or a bronchial blocker. Knowledge in tracheobronchial anatomy is routinely requested for anesthesiologists just as the standard use of flexible fibreoptic bronchoscope. This review would give an overview and discussion about the airway management in patients during thoracic anesthesia with double-lumen tubes and recommendations for the clinical routine.

Airway management of maxillofacial and neck trauma patients

Background Airway injury has been commonly seen after maxillofacial trauma and neck trauma, and this complication increases mortality in patients. Therefore, airway management is crucial to prevent death in patients with maxillofacial and neck trauma. Objective To review the characteristics of maxillofacial trauma and neck trauma, and the management of injured airway in these conditions. Content Different from maxillofacial trauma, neck trauma often causes damage in cervical nerve and spine, which complicates airway management. In patient with maxillofacial trauma, tracheal ventilation can be achieved through a tubing from nose, mouth, submentum, and an incision in trachea. In patients with neck trauma, tracheal ventilation should be under the guidance of laryngoscope or optical fiber to avoid further damages in airway, and appropriate strategies may be required to stabilize the tubing. Trend Mechanical ventilation is an important procedure in airway management in patients suffered from maxillofacial and neck trauma. Strategies and devices to maintain adequate ventilation in patients should be the focuses of the future studies. Key words: Maxillofacial and neck trauma; Airway management

Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review

Study objectiveThe association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway. DesignThe OVID Medline in process, Medline (vis Pub Med), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched up to April 2016 using specific keywords. Inclusion criteria were: [1] airway management in patients with a diagnosis of OSA, [2] comparison of airway management between OSA and non-OSA patients, [3] publications or abstracts in the English language. The incidence of difficult airway between OSA and non-OSA patients was compared using Chi-square analysis or Fisher's exact test. Main resultsTen studies were included in the final review. Overall, the incidence of difficult tracheal intubation was higher in OSA patients versus non-OSA patients [56/386 (14.5%) vs. 69/897 (7.7%); P=0.0002]. OSA patients also have a higher incidence of difficult mask ventilation [115/4626 (2.5%) vs. 471/64,684 (0.7%); P<0.0001]. Compared to non-OSA patients, OSA was not associated with difficulty in the use of a supraglottic airway (SGA) device [10/663 (1.5%) vs. 162/15,171 (1.1%); P=0.38]. No studies compared difficult surgical airway in OSA and non-OSA patients. ConclusionsOSA was found to be a risk factor associated with difficult tracheal intubation and difficult mask ventilation. There was no association between OSA and difficult SGA use.

Airway management in the presence of cervical spine instability: A cross-sectional survey of the members of the Indian Society of Neuroanaesthesiology and Critical Care.

Background and Aims:There is a paucity of clinical practice guidelines for the ideal approach to airway management in patients with cervical spine instability (CSI). The aim of this survey was to evaluate preferences, perceptions and practices regarding airway management in patients with CSI among neuroanaesthesiologists practicing in India.Methods:A 25-item questionnaire was circulated for cross-sectional survey to 378 members of the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) by E-mail. We sent four reminders and again submitted our survey to non-responders during the 2017 annual ISNACC meeting. Apart from demographic information, the survey captured preferred methods of intubation and airway management for patients with CSI and their justification. Regression analysis was used to identify factors associated with the use of indirect technique for intubation.Results:Only 122 out of the 378 anaesthesiologists responded to our survey. Most respondents were senior consultants, working in training hospitals, and performed ≥25 intubations per year for CSI patients. The majority of neuroanaesthesiologists (78.7%; n = 96) preferred indirect techniques for elective intubation. However, 45 anaesthesiologists (36.9%) preferred indirect techniques for emergency intubation. In an adjusted analysis, preference for patients to be conscious during intubation was significantly associated with the use of indirect techniques (odds ratio = 3.79; confidence interval = 1.52–9.49, P < 0.01).Conclusions:Among ISNACC members, indirect techniques are preferred for elective intubation of patients with CSI, while direct laryngoscopy is preferred for emergency intubation.

Successful ventilation through a R\xfcsch intubation guide catheter in severe laryngotracheal stenosis

BackgroundProviding adequate ventilation may remain complex in patients with severe proximal laryngotracheal stenosis, especially when the airway is shared with the surgeon during tracheal resection surgery. We describe an effective alternative to standard endotracheal intubation using a Rüsch flexible intubation guide catheter.MethodsIn two patients undergoing tracheal repair surgery, we failed to insert a 5.0 inner diameter endotracheal tube (6.9 mm outer diameter) or a 6.0 mm outer diameter endoscope through the laryngotracheal stenosis. However, using indirect laryngoscopy, a 6.0 outer diameter Rüsch flexible intubation guide catheter was passed successfully through the vocal cords and then through the stenosis. Controlled ventilation was achieved by means of the Rüsch guide, provided with its two large Murphy’s eyes. When the trachea was opened, the Rüsch guide was removed just enough for the surgeons to place a Montandon tracheal tube, at that point taking over ventilation. A 7.0 inner diameter endotracheal cuffed tube had been inserted onto the Rüsch guide and left pending upstream from the vocal cords. Once the posterior tracheal wall was sutured, this endotracheal cuffed tube was slid along the Rüsch guide through the vocal cords with the cuff placed beyond the tracheal sutures.ResultsControlled ventilation through the Rüsch flexible intubation guide catheter showed satisfying and stable ventilatory parameters in both patients. Inspiratory pressures of 25–30 mmHg were enough to reach adequate tidal volumes around 450 ml. End tidal CO2 was kept between 35 and 40 mmHg (PaCO2 showed similar values). Standard endotracheal intubation at the end of the tracheal resection was easy and safe thanks to the Rüsch guide still in place between the vocal cords.ConclusionsWe suggest an effective and reliable method using a Rüsch flexible intubation guide catheter for airway management in patients suffering from laryngotracheal stenosis in the setting of tracheal repair surgery.

Airway management in patients with tracheobronchial mass: challenges and solutions

Airway management in patients with tracheobronchial mass: challenges and solutions

Airway management through submental derivation: a safe and easily reproduced alternative for patients with complex facial trauma.

ObjectivesAirway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients.Materials and MethodsThis is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015. In total, 31 patients with complex factures requiring submental airway derivation were included. No complications such as bleeding, infection, vascular, glandular, or nervous lesions were presented in any of the patients.ResultsThe use of submental airway derivation is a simple, safe, and easy method to ensure airway management. Moreover, it allows an easier reconstruction.ConclusionBased on these results, we concluded that, if the relevant steps are followed, the use of submental intubation in the treatment of patients with complex facial trauma is a safe and effective option.

Neck fat volume as a potential indicator of difficult intubation: A pilot study.

Background:Direct laryngoscopy is the gold standard of the airway management in patients without predicted difficulties. If unpredicted difficulties are encountered instead, different algorithms to follow have been developed. To date, no single predictor is sufficiently valid. In clinical practice, it is used a combination of them to enhance the estimate, and despite the variety of parameters used, not all the difficult intubations are predicted. The aim of this work is to retrospectively analyze neck computed tomography scans of 37 patients who have had tracheal intubation and search for anatomic neck fat compartments that correlate with the intubation difficulty, and eventually find a suitable, clinical parameter that can potentially enhance the prediction of a difficult airway when used in combination of the preexisting scores.Materials and Methods:the patients are divided by direct laryngoscopy view into two groups: Group A (n = 31): Normal airway, with a Cormack Lehane, Score I or II; Group B (n = 6): Difficult airway, with a Cormack Lehane Score III or IV. In the zone of interest, it was measured the neck volume parameter and other subparameters.Results:Despite a positive trend is shown for anterior fat volume (AFV) (P = 0.23) and fat volume (FV) (P = 0.28), statistically significant differences (P < 0.05) were not found between Group A and B in any of the measurements acquired.Conclusions:According to the literature, our results confirmed that there is still no single element that can predict a difficult intubation. Although no statistical significance was found, the AFV and FV have shown to have a potential predictive role for difficult intubation. Further studies with bigger samples are advisable to confirm this encouraging result.

Prospects for the future of an airway management in patients with out-of-hospital cardiac arrest (OHCA): An overview of the existing data

Prospects for the future of an airway management in patients with out-of-hospital cardiac arrest (OHCA): An overview of the existing data

Emergency Airway Management in Neck Trauma

Airway management in patients who have sustained direct trauma to the airway is among the most challenging problems for emergency clinicians. Blunt or penetrating injuries to the head, oropharynx, neck, or upper chest can result in immediate or delayed airway obstruction. Immediate, definitive airway management is needed when the patient cannot protect his airway or is unable to sufficiently oxygenate or ventilate. Emergent or urgent airway management is specified when a patient develops respiratory distress or when symptoms are progressing rapidly. In addition, airway management often is indicated when the patient appears clinically stable, but the clinician anticipates clinical decline (e.g., smoke inhalation, edema, subcutaneous air, hematoma) or feels that an unprotected airway presents a risk to the patient who requires transport to another facility or to radiology for extensive diagnostic studies. The higher rate of complicated airways in this population mandates that the clinician has to be prepared to use advanced airway techniques, including a surgical airway.

Airway management of patients with temporomandibular joint disorder: A 12-year retrospective review in ABUTH Zaria

Background: Temporomandibular joint (TMJ) ankylosis is a condition associated with restricted mouth opening. Following induction of general anesthesia, airway obstruction may occur leading to “can't ventilate and can't intubate scenario.” The anticipation of difficult airway and choice of appropriate intubation techniques usually prevent anesthetic morbidity and mortality. Patients and Methods: Both the surgeons' and the anesthetic review, as well as the anesthetic chart of the 36 patients managed at Ahmadu Bello University Teaching Hospital between January 2006 and December 2017, were studied. Data collected were bio-data of the patients, extent of mouth opening, and the techniques of intubation used. Results: The mean age of the patients was 26.9 ± 1.64, with a male to female ratio of 1:1.1. There were more male 19 (52.8%) than female 17 (47.2%). Tracheal intubation was achieved with the aid of nasal fiberoptic technique in 22 (61.1%) patients, 8 patients (22.2%) were intubated by tracheostomy, 4 patients (11.1%) were intubated by blind nasal intubation, while 2 patients (5.6%) required endotracheal intubation through conventional oral laryngoscopy. The interincisor gap was between 0 and <1 cm in all the patients which indicated significantly restricted mouth opening, with an average of zero interincisor gap. Conclusion: Fiberoptic intubation was the most used approach of achieving tracheal intubation in patients with TMJ disorder.

Progress in studies on artificial airway management in patients with inhalation injury in China

This paper summarizes the latest progress in studies on artificial airway management in patients with inhalation injury in China, including evaluation and identification of injury degrees, practice of choosing artificial airway, management of crucial links, and new models of airway management, and makes proposals for future research. Key words: Burns, inhalation; Airway management; Artificial airway; Summarization

Research progress of the application of ultrasonic technology in airway management

Background The assessment and management of airway is still a continuously updated clinical science. The application of ultrasonic technology in recently years provides a dynamic monitoring tool for airway management of patients in the perioperative period, emergency and intensive care unit. Objective Our study represents a review about of the application of ultrasonic technology in airway management. Content The ultrasonic anatomical structure of the respiratory tract is described and the application of ultrasound in airway management during the perioperative period is summarized. Trend Ultrasound in the perioperative management of airway can be described as a milestone in the transformation of airway management. We expect there will be broad application of this technique in the future. Key words: Ultrasound; Airway management; Tracheal intubation; Laryngeal mask

The use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in 17 cases of subglottic stenosis.

Shared airway management in patients with subglottic stenosis (SGS) is challenging for both the anaesthetist and surgeon. Various methods of airway management have been described but currently no gold standard exists. Jet ventilation has been described as the preferred technique despite a UK National Survey highlighting potential complications including pneumothorax, pneumomediastinum, surgical emphysema, hypoxia and death. This article is protected by copyright. All rights reserved.

Efficacy of gastroscope laryngeal mask airway for airway management in patients undergoing upper gastrointestinal endoscopic submucosal dissection

Efficacy of gastroscope laryngeal mask airway for airway management in patients undergoing upper gastrointestinal endoscopic submucosal dissection

Laryngeal tube suction II or endotracheal intubation for laparoscopic radical prostatectomy in a head down position: A randomised controlled trial.

The laryngeal tube suction II (LTS II) is a supraglottic airway device (SAD) with a gastric drainage tube and enhanced seal properties as compared with other SADs. Therefore, its use has been proposed in situations with an elevated risk of aspiration. To compare the safety and efficacy of airway management and controlled mechanical ventilation when using either an LTS II or an endotracheal tube for laparoscopic radical prostatectomy. Randomised, controlled, blinded and single-centre study. Academic tertiary care centre in Leipzig from April 2014 to May 2015. It was planned to include 100 patients but the study was stopped after 50 patients following an interim analysis. These 50 patients were randomised to either the LTS II group or the endotracheal tube group. All male patients aged more than 18 years for elective laparoscopic radical prostatectomy were eligible. Exclusion criteria included a BMI more than 30, American Society of Anesthesiologists class III or greater, a history of gastroesophageal reflux or other factors known to increase the risk of aspiration and a known difficult airway. All patients received general anaesthesia. Airway management was with either a LTS II or an endotracheal tube, according to the randomisation. The primary endpoint was successful insertion of the particular airway device during anaesthesia for laparoscopic radical prostatectomy. In 15 of the 28 patients randomised to LTS II, the device had to be removed and an endotracheal tube inserted, mainly because of an airway leak (n = 10) or swelling of the tongue (n = 3). Ventilation was successful in all patients (n = 22) randomised to endotracheal tube. Quality of ventilation was rated better in the endotracheal tube group. Our data suggest that LTS II should not be the preferred method of airway management in patients undergoing laparoscopic radical prostatectomy. DRKS00008985 (German Clinical Trials Register).

Submental intubation in complex craniomaxillofacial trauma cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Airway management in patient with craniomaxillofacial trauma is challenging due to disruption of components of upper airway. In complex panfacial trauma cases, especially involving naso-orbito-ethmoidal complex, the airway is shared between the maxillofacial surgeon and anaesthesiologist. Often in such severe trauma cases, both nasotracheal and orotracheal intubation are contraindicated. Previously in such situation tracheostomy was the method of choice. Though tracheostomy is time tested it has its fair share of complications, some even life threatening. Other methods were used such as retromolar intubation as an alternative, but it may not be suitable for all such cases. Another approach is submental intubation but not so much in routine practice. A retrospective study was designed to evaluate clinical criteria’s airway management in complex craniomaxillofacial trauma cases using submental intubation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Datasheets of 14 craniomaxillofacial trauma cases who were intubated with submental intubation method were reviewed. The factors like: ease of anaesthesiologist for carrying out general anaesthesia, ease of surgeon for performing surgery and average time taken during the procedure, intraoperative and postoperative complications were evaluated and charted. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Submental intubation provides intraoperative airway control, avoids use of both oral and nasal routes, and allows intraoperative manipulation of occlusion, intramaxillary and intermaxillary fixation. This technique has minimal complications and has better patient, anaesthetists and surgeons acceptability. The limitations of this technique include longer preparation time, inability to maintain long term postoperative ventilation and unfamiliarity of technique itself.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This submental intubation can be used with little modifications in a variety of complicated panfacial trauma cases. &lt;/p&gt;

Cervical spine movement during intubation

AbstractThere have been growing concerns following documented instances of neurological deterioration in patients with cervical spine injury as a result of intubation. A significant body of evidence has since evolved with the primary objective of ascertaining the safest way of securing the endotracheal tube in patients with suspected and proven cervical injury. The search for a mode of intubation producing the least movement at the cervical spine is an ongoing process and is limited by logistic and ethical issues. The ensuing review is an attempt to review available evidence on cervical movements during intubation and to comprehensively outline the movement at the cervical spine with a wide plethora of intubation aids. Literature search was sourced from digital libraries including PubMed, Medline and Google Scholar in addition to the standard textbooks of Anaesthesiology. The keywords used in literature search included ‘cervical spine motion,’ ‘neurological deterioration,’ ‘intubation biomechanics,’ ‘direct laryngoscopy,’ ‘flexible fibreoptic intubation,’ ‘video laryngoscopes’ and ‘craniocervical motion.’ The scientific information in this review is expected to assist neuroanaesthesiologists for planning airway management in patients with neurological injury as well as to direct further research into this topic which has significant clinical and patient safety implications.