Method Of Airway Management Research Articles

Airway management algorithm during circular tracheal resection in adult patients with cicatricial stenosis (a single-center study)

The objective was to present the experience of airway management algorithm in patients with different localization of stenosis during circular tracheal resection.Materials and methods. The retrospective analysis included 84 patients with grade II cicatricial stenosis who underwent circular tracheal resection at the period from 2018 to 2023. The patients were divided into two groups: group 1 with long-segment tracheal stenosis and group 2 with short-segment tracheal stenosis (39 and 45 patients, respectively). The age of patients in group 1 was 43 years [28–55] versus 48 [35–61] years in group 2 (p = 0.19). The patients in the groups were comparable in terms of the main parameters: gender, the ratio of women to men, BMI, class of cardiological risk, degree of risk of respiratory complications and pneumonia, degree of disability. Airway management control during surgery was provided by tracheal intubation with the installation of an endotracheal tube (ETT) proximal to tracheal stenosis or with a supraglottic airway device (laryngeal mask) i-gel (LM) before the main stage, followed by the application of the «apnea-ventilation-apnea» technique at the main stage. In patients with tracheostomy, airway management was performed by inserting endotracheal tube (ETT) into the tracheostomy opening using the «apnea-ventilation-apnea» technique until the completion of the main stage, followed by tracheal intubation through the mouth using a bronchoscope. All patients included in this study underwent tracheoplasty; patients with preserved tracheostomy were not included in the study. The choice of the method of airway management was determined after a joint discussion of the patient with the operating surgeon, endoscopists, as well as after evaluating the predictors of difficult airways and the presence of a tracheostomy in the patient.Results. The incidence of patients with tracheostomy in group 1 – 23 (59%) was higher than in group 2 – 9 (16%) (OR 5.75, 95% CI 2.18–15.17; p < 0.0001), which influenced the choice of tactics for airway management, since LM tracheostomy was not used in this group of patients. The choice of tactics for airway management algorithm also depended on the extent of stenosis, so LM was used more often in group 2 – 28 (62.2%) than in group 1 – 12 (30.8%) (p = 0.004). We associate such differences with the presence of a large number of patients with tracheostomy in group 1. For airway management during surgery, LM was used in 90% of cases with cervical localization of stenosis. In group 1, the time of anesthesia and mechanical ventilation increases compared to group 2: 245 [210–275] versus 215 [180–240] min (p = 0.022) and 265 [220–400] versus 210 [180–320] min (p = 0.015), respectively. The frequency of waking up in the operating room and regaining the ability to breathe independently was higher in patients in group 2: 35 (77.8%) than in group 1 22 (56.4%) (OR 2.7, 95% CI 1.05–6.97; p = 0.036). No difference in length of hospital stay was observed in the extent of stenosis and the chosen airway management algorithm.Conclusion. The choice of airway management algorithm during circular tracheal resection in patients with grade II cicatricial stenosis is depended on the localization and extent of tracheal stenosis. The choice of laryngeal mask i-gel as the airway management algorithm is safe and alternative algorithm with tracheal intubation with short-segment cervical stenosis and absence of tracheostomy.

Successful resection of bilateral parafalcine meningioma with unilateral interhemispheric and contralateral transfalcine approach under nonintubated spontaneous breathing conditions: illustrative case.

The best surgical approach for resecting bilateral parafalcine meningioma, as well as the optimal anesthesia and airway management for craniotomy in patients with interstitial pneumonia (IP) for preventing postsurgical exacerbation, remains unclear. A 66-year-old female with a history of multiple relapses of IP underwent craniotomy for resection of a 4.5-cm bilateral parafalcine meningioma located just beneath the inferior sagittal sinus. To avoid mechanical ventilation or high-concentration oxygenation, the entire procedure was performed under nonintubated spontaneous breathing conditions with a supraglottic airway/laryngeal mask airway (SGA/LMA) device. Half of the tumor was resected using the ipsilateral interhemispheric approach, while the remaining half was resected using the contralateral transfalcine approach (CTA). No brain retractors were required. Preoperative embolization contributed toward reducing blood loss and surgery duration. During most of the operation, additional oxygen administration was not required. The postoperative course was uneventful, without exacerbation of the IP. This case demonstrated the utility and feasibility of a unilateral interhemispheric approach combined with CTA for resection of a bilateral parafalcine meningioma. Additionally, this case provides an alternative method of airway and anesthesia management with an SGA/LMA device and nonintubated spontaneous breathing for the prevention of postoperative acute exacerbation of IP.

Palliative Management of Tracheal Stenosis Caused by Anaplastic Thyroid Carcinoma Transformed from Papillary Thyroid Carcinoma: A Case Report

Tracheal stenosis due to invasion of thyroid malignancy is a rare entity. Management of the airway in such a patient is a critical step in palliative care. We discuss the successful management of tracheal stenosis due to anaplastic transformation of papillary thyroid carcinoma in an 84-year-old female. There are several methods for airway management in tracheal stenosis. Self-expanding stent placement is a less invasive, efficient procedure for tracheal stenosis.

Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study

ObjectiveTo review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management.MethodWe searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients’ disease course and follow-up records were analyzed and summarized.ResultsThe airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia.ConclusionDuring the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®

PurposePrehospital airway management in trauma is a key component of care and is associated with particular risks. Endotracheal intubation (ETI) is the gold standard, while extraglottic airway devices (EGAs) are recommended alternatives. There is limited evidence comparing their effectiveness. In this retrospective analysis from the TraumaRegister DGU®, we compared ETI with EGA in prehospital airway management regarding in-hospital mortality in patients with trauma.MethodsWe included cases only from German hospitals with a minimum Abbreviated Injury Scale score ≥ 2 and age ≥ 16 years. All patients without prehospital airway protection were excluded. We performed a multivariate logistic regression to adjust with the outcome measure of hospital mortality.ResultsWe included n = 10,408 cases of whom 92.5% received ETI and 7.5% EGA. The mean injury severity score was higher in the ETI group (28.8 ± 14.2) than in the EGA group (26.3 ± 14.2), and in-hospital mortality was comparable: ETI 33.0%; EGA 30.7% (27.5 to 33.9). After conducting logistic regression, the odds ratio for mortality in the ETI group was 1.091 (0.87 to 1.37). The standardized mortality ratio was 1.04 (1.01 to 1.07) in the ETI group and 1.1 (1.02 to 1.26) in the EGA group.ConclusionsThere was no significant difference in mortality rates between the use of ETI or EGA, or the ratio of expected versus observed mortality when using ETI.

Placement of bronchial occluder outside the tracheal tube in a patient combined with airway compression undergoing mediastinal tumors resection: a case report

BackgroundMediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway obstruction, which in severe cases can lead to cardiac arrest. We reported a case of anesthetic management using a bronchial blocker placed outside the tracheal tube. In this case report, the patient’s trachea was so severely compressed that the airway was extremely narrow, only 4 mm at its narrowest point. By reporting the anesthetic management of this patient, we intend to provide an unusual approach for airway management.Case presentationA 52-year-old male patient was admitted to the hospital due to cough and expectoration for one year. Additionally, the patient experienced chest tightness and asthma after physical activity. The enhanced computed tomography revealed there existed an irregular soft tissue mass in the right upper mediastinum, which significantly compressed the trachea and esophagus. The results of the mediastinal puncture pathology showed the presence of mesenchymal tumors. According to the results above, the patient was diagnosed with a mediastinal tumor and scheduled to undergo tumor resection under general anesthesia. We used a bronchial occluder outside the tracheal tube for general anesthesia. After surgery, the patient received thorough treatment and was subsequently discharged from the hospital.ConclusionIn patients with severe airway compression from a mediastinal tumor airway compression, positioning a bronchial occluder externally to the tracheal tube is an effective method of airway management. However, we still need more clinical practice to help the process become more standardized.

Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching.

The current evidence on the use of laryngeal mask airway (LMA) as an airway management technique for general anesthesia (GA) during atrial fibrillation (AF) catheter ablation (CA) is insufficient. This study aims to compare the feasibility, safety, and clinical benefits of LMA and endotracheal intubation (ETI) for airway management in AF CA. One hundred fifty-two consecutive patients with AF who underwent CA under GA were included and divided into two groups based on different airway management methods (66 in the LMA group, 86 in the ETI group). After propensity score matching, a final analysis cohort of 132 patients was obtained to compare procedural parameters, adverse events, and prognosis between the two groups. The LMA group exhibited significantly shorter total procedural time (p = 0.039), anesthesia induction time (p = 0.015), and recovery time (p = 0.006) compared to the ETI group. The mean arterial pressure (MAP) and heart rate were significantly lower in the LMA group during extubation and 1-min post-extubation (p < 0.05). Furthermore, the LMA group demonstrated lower MAP levels during intubation (p = 0.029). The incidences of intraoperative hypotension (p = 0.017) and bradycardia (p = 0.032) were significantly lower in the LMA group. The incidences of delayed recovery or delirium (p = 0.027), laryngeal or airway injury (p = 0.016), cough or bucking (p = 0.001), and sore throat (p < 0.001) were significantly lower in the LMA group. There were no statistically significant differences in catheter stability parameters and sinus rhythm maintenance rates between the two groups (p > 0.05). LMA is feasible, safe, and effective in AF CA as an optimized airway management technique for GA.

Traumatic retropharyngeal hematoma: A systematic review of reported cases.

To study the mechanisms of injury, clinical manifestations, radiological findings, management, and outcomes of traumatic retropharyngeal hematoma (RH). We used the Preferred Reporting Items of Systematic Reviews guidelines to carry out a systematic literature review to identify all published cases of traumatic RH by searching the PubMed database. Articles published between 1988 and 2022 that reported traumatic RH were included. However, articles that reported non-traumatic RHs and non-English articles were excluded from this study. Of the 62 articles screened, 56 were included. Most patients (55%) were above the mean age of 61.7. The majority of patients were male (69.7%). The main symptom was dyspnea (66.6%) and symptoms usually presented within 24 hours. Among the patients, 90.9% did not take anticoagulants or have coagulation disorders, and the main injury mechanism was falling (54.5%). Most of the computed tomography findings reported retropharyngeal (38%) and prevertebral (15%) hematoma. Meanwhile, magnetic resonance imaging revealed 2 masses in the retropharyngeal space and 2 RHs. With several treatment modalities, more than 50% of the cases were only observed (44 cases), and endotracheal intubation was the most commonly used airway management method (n=35). Traumatic RH is often caused by falls, particularly in elderly patients. Dyspnea is the primary symptom, usually appearing within 24 hours. Cervical vertebral fractures are the leading cause, and observation is the most common treatment approach.PROSPERO Reg. No.: CRD42022349010.

Can Laryngeal Mask Airway be the First Choice for Tracheal Stenosis Surgery? A Historical Cohort Study.

To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity. Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively. Patients with lost data or primary tracheal malignancy were excluded. Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI. Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively. The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0. 014, p=0. 031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0. 007). The postoperative mortality rates were similar in both groups. Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI. In this study, LMA was successfully applied in all patients. Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study.

Safety and effectiveness of interventional bronchoscopy under general anesthesia in the elderly patients with central airway stenosis: a retrospective study

We retrospectively reviewed the clinical data of patients aged 65 years and older with central airway stenosis who underwent therapeutic bronchoscopy under general anesthesia in Beijing Tiantan Hospital from January 2012 to September 2022. A total of 167 patients were included in the study. One or more comorbidities were present in 151 patients. The number of operation procedure was 230 times. Laryngeal mask ventilation under general anesthesia and electrotomy was the most common method of airway management and operation. The incidence of major complications was 5.2%. One patient with granular cell tumor died of major bleeding during stent removal. The primary malignant lesion, number of comorbidities, electrolyte disturbances and rigid bronchoscopy were risk factors for major complications, and the difference was statistically significant. The overall response rate was 99.4%. The airway stenosis grade, dyspnea score and KPS value were improved, and the differences were statistically significant. Interventional bronchoscopy under general anesthesia appeared to be safe and effective in patients aged 65 years and older with central airway stenosis. Age should not be a contraindication to interventional bronchoscopy.

Prevalence and severity of pediatric emergencies in a German helicopter emergency service: implications for training and service configuration

This study primarily aims to determine the frequency of life-threatening conditions among pediatric patients served by the DRF, a German helicopter emergency service (HEMS) provider. It also seeks to explore the necessity of invasive procedures in this population, discussing the implications for HEMS crew training and service configuration based on current literature. We analyzed the mission registry from 31 DRF helicopter bases in Germany, focusing on 7954 children aged 10 or younger over a 5-year period (2014–2018). Out of 7954 identified children (6.2% of all primary missions), 2081 (26.2%) had critical conditions. Endotracheal intubation was needed in 6.5% of cases, while alternative airway management methods were rare (n = 14). Half of the children required intravenous access, and 3.6% needed intraosseous access. Thoracostomy thoracentesis and sonography were only performed in isolated cases. Conclusions: Critically ill or injured children are infrequent in German HEMS operations. Our findings suggest that the likelihood of HEMS teams encountering such cases is remarkably low. Besides endotracheal intubation, life-saving invasive procedures are seldom necessary. Consequently, we conclude that on-the-job training and mission experience alone are insufficient for acquiring and maintaining the competencies needed to care for critically ill or injured children.What is Known:• Pediatric emergencies are relatively rare in the prehospital setting, but their incidence is higher in helicopter emergency medical services (HEMS) compared to ground-based emergency services.What is New:• On average, HEMS doctors in Germany encounter a critically ill or injured child approximately every 1.5 years in their practice, establish an IV or IO access in infants or toddlers every 2 years, and intubate an infant every 46 years.• This low frequency highlights the insufficiency of on-the-job training alone to develop and maintain pediatric skills among HEMS crews. Specific interdisciplinary training for HEMS crews is needed to ensure effective care for critically unwell pediatric patients.

Airway management under general anesthesia for infants and young children with the first and second branchial syndrome featuring unilateral mandibular dysplasia: A case series of 8 children

ObjectiveTo investigate and summarize the airway management methods for infants and young children of the first and second branchial syndrome featuring mandibular dysplasia, and to evaluate the auxiliary effect of direct laryngoscope and video laryngoscope during tracheal intubation. MethodsFrom March 2017 to March 2022, 8 cases with the first and second branchial syndrome featuring absent or hypoplastic mandibular ascending ramus that underwent cleft palate repair or transverse facial cleft repair under general anesthesia were retrospectively reviewed and summarized. The information such as demographic data, preoperative airway assessment, mask ventilation effect, anesthesia method, anesthesiologist's evaluation of laryngoscope exposure and intubation, operation method, operation time, and extubation time was collected. ResultsThe median age of the 8 children was 12 months; none of them had limitation of mouth opening, 4 had snoring during sleep, 2 had unilateral absence of the ascending ramus of the mandible, and 6 had partial absence. Of the 8 children, 3 underwent cleft palate repair, and 5 underwent transverse facial cleft repair. During anesthesia induction, 1 case of mask ventilation was graded as Grade 2, and the other 7 cases were graded as Grade 1; the Cormack-Lehane (C-L) grade of glottic exposure by direct laryngoscope was graded as Grade 3 (3 cases) and Grade 4 (5 cases), and the C-L grade by video laryngoscope was graded as Grade 1 (4 cases) and Grade 2 (4 cases). All the children completed video laryngoscope-assisted intubation successfully in one time. The extubation was completed smoothly, without complications related to anesthesia. The median operation time was 50 minutes, and the median time from end of operation to extubation was 240 seconds. ConclusionFor anesthesia of infants and children with the first and second branchial syndrome, especially those with hypoplasia of the mandible, a comprehensive preoperative assessment is needed, and direct laryngoscope may lead to difficulty in glottic exposure, and adequate planning for difficult airway management is necessary.

AB094. SOH23ABS_067. Revisiting the role of submental intubation in maxillofacial trauma cases

Background: Airway management in maxillofacial trauma cases can prove particularly challenging as often the conventional methods of intubation are unsuitable. Standard orotracheal intubation may be a hinderance to the surgeon who may need to perform intra-operative maxillomandibular fixation. Nasotracheal intubation, a commonly used alternative is often not appropriate either particularly if there is a nasal fracture or base of skull fracture present. Clear communication between the anaesthetist and surgeon is paramount for successful intubation as both parties are forced to share the same working space. In these types of trauma cases Submental Intubation provides an excellent choice for airway securement. The Submental Intubation technique as an alternative method of airway management was first described in 1986 by Hernandez Altemir. It is a safe and effective method of intubation with a low risk of morbidity. It provides access to maxillofacial fractures without interference from an anaesthetic tube enabling maxillomandibular fixation and access to naso-orbito-ethmoid fractures. It avoids the need for tracheostomy which has many reported complications including post-op bleeding, surgical emphysema, tracheostomy site infections, nerve injury, tracheal stenosis, poor scar aesthetics, tracheoarterial fistula and death. Submental intubation has no associated major complications when compared to tracheostomy.

Research Progress on Prevention and Treatment of Hypoxemia in Painless Gastroscopy: A Review Article

Compared to ordinary gastroscopy, painless gastroscopy has more advantages due to the application of anesthesia techniques such as sedation and analgesia, providing patients with comfort and a quick recovery. However, patients undergoing painless gastroscopy are often at risk of hypoxia, which can result in serious complications. Fortunately, more anesthesia providers have recognized this problem. Therefore, it is essential for anesthesia providers to identify risk factors to prevent hypoxemia. In conclusion, this review highlights the assessment of risk factors for hypoxemia in painless gastroscopy and common airway management methods to prevent and treat hypoxemia in high-risk populations during painless endoscopy.

A Study on Laryngeal Trauma Caused by External Damage

Objectives: Laryngeal trauma caused by external factors is rare. The treatment strategies for laryngeal trauma, including the optimal surgical approaches, airway management methods, and fixation materials to be used still remain under debate.Methods: We retrospectively analyzed the details of the management and clinical course of 16 patients with fresh laryngeal trauma treated between April 2000 and March 2020 at the Hiroshima University Hospital.Results: The causes of the laryngeal trauma included sports accident (n = 6), fall (n = 3), suicidal behavior (n = 2), labor accident (n = 2), and other (n = 3). Categorization of the severity and the treatment policy, including the surgical indications, were in accordance with the classification proposed by Umeno et al. We performed surgical repositioning of the fractured thyroid cartilage in 7 cases and repositioning or correction of arytenoid cartilage dislocation in 2 cases under general anesthesia. The fixation materials used varied depending on the need.Conclusion: The clinical features of laryngeal trauma were examined. Further studies on fixation methods, methods to restore the phonation ability, and appropriate surgical timing are required.

VOICE CONDITION FOLLOWING SHORT-TERM ENDOTRACHEAL INTUBATION IN HEAD AND NECK SURGERY: STUDY PROTOCOL FOR CLINICAL TRIAL.

Endotracheal intubation is an airway management procedure commonly performed under general anesthesia. It is linked with postoperative voice changes. The incidence and reasons of hoarseness and vocal cord injury are not very well investigated, especially after short-term anesthesia and intubation in head and neck surgery. The aim of the study is to identify the causes of voice changes after short endotracheal anesthesia in head and neck surgery. The study will include patients scheduled for head and neck surgery under general anesthesia with endotracheal intubation up to 3 hours. There will be 3 groups of patients, as follows: thyroid surgery, non-thyroid surgery, and control group undergoing surgery outside head and neck. Videostroboscopy will be recorded before and after surgery. Further diagnostic workup will include voice status; subjective voice self-analysis; perceptive and objective acoustic voice analysis at 4 time points (preoperatively, postoperative day 2, 2 weeks and 1 month after surgery). Endotracheal intubation is a safe method of airway management although it can temporarily alter a patient's voice quality. It is not known how much of this is the result of anesthesia, general condition of the patient, or surgery. This trial is expected to shed some light on this issue.

Comparison between Dexmedetomidine and Fentanyl on Intubating Condition to Facilitate Awake Oral Fibreoptic Intubation under Topical Anaesthesia – A Randomised Controlled Trial

Background and Aims: Awake fibreoptic intubation (AFOI) is the standard method of airway management in the anticipated difficult airway. While many drugs have been employed for sedation, there is no single drug that can be recommended as the drug of choice. Dexmedetomidine is characterised by effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, we hypothesised that dexmedetomidine should be suitable for AFOI and compared it to the control drug fentanyl. This study assesses the level of sedation and intubating conditions using dexmedetomidine or fentanyl during awake fibreoptic orotracheal intubation. Methods: Sixty adult patients, American Society of Anaesthesiology class I and II, who required orotracheal intubation during general anaesthesia with the normal airway were randomised to receive dexmedetomidine 0.6 μg/kg (Group A) or fentanyl 1.0 μg/kg (Group B) intravenous infusion for 10 min, after topical anaesthesia to the airway. A total of 60 patients were allocated, 30 patients in each group. The primary objective was to assess the intubating conditions with dexmedetomidine compared to fentanyl. Results: The intubation score for vocal cord movement (1.57 ± 0.68 in Group A vs 1.93 ± 0.75 in Group B) and cough (1.50 ± 0.78 in Group A vs 1.90 ± 0.72 in Group B), endoscopy score (2.17 ± 0.59 in Group A vs 2.47 ± 0.69 in Group B), sedation score (4.73 ± 0.5 in Group A vs 4.47 ± 0.57 in Group B) and patient satisfaction score (1.20 ± 0.41 in Group A vs 1.47 ± 0.68 in Group B) were statistically significant in patients receiving dexmedetomidine. During the procedure, there was a statistically and clinically significant increase in heart rate of 1.5% in Group A versus 22% in Group B, and an increase in mean arterial pressure of 1.95% in Group A versus and 10.27% in the Group B. Conclusion: Dexmedetomidine provided better intubation conditions than fentanyl, with greater haemodynamic stability, better sedation and greater patient satisfaction score compared to fentanyl during awake fibreoptic oral intubation.

Dispnea sa letalnim ishodom - prikaz pacijentkinje sa inoperabilnim karcinomom štitnjače

Tumors of the thyroid gland, due to their localization in the neck, can as they grow pose a threat to the airway. Thyroid malignancies, aside from compression, can also infiltrate local tissue. The case presented is that of a female patient with advanced thyroid cancer that required urgent airway management, but due to the propagation of the malignancy into the mediastinum and consequent compression of distal trachea and lung tissue, the hospitalization ended with a fatal outcome regardless of the treatment undertaken. Even advanced airway management methods (endotracheal intubation or tracheotomy) are sometimes not enough to save our patients' lives.

The application of classic laryngeal mask airway combined with a self-created adaptor in interventional bronchoscopy for pediatric patients: A case series and literature review

PurposeTo verify the feasibility of classic laryngeal mask airways (cLMA) combined with self-created adaptors in the interventional bronchoscopy of subglottic lesions for pediatric patients.MethodsThree children who were diagnosed with upper airway lesions, subglottic stenosis (scar hyperplasia), and congenital laryngomalacia were respectively subjected to fiberoptic bronchoscopy (FOB) and therapeutic interventions. A classic laryngeal mask airway combined with a self-created adaptor was applied during the FOB procedures.ResultsIn our cases, the vocal cord, glottis, trachea, and lesions were easily exposed, which provided an effective ventilation or oxygenation for the patients. Furthermore, both surgeons and patients were comfortable with the technique. Vital signs were stable during the procedures, including blood pressure, heart rate, and the saturation of pulse oximetry.ConclusionBy retaining spontaneous breathing, the application of a classic laryngeal mask airway combined with a self-created adaptor is a feasible alternative method of airway management during FOB interventional procedures for pediatric patients.

Interactive effect of multi-tier response and advanced airway management on clinical outcomes after out-of-hospital cardiac arrest: a nationwide population-based observational study.

ObjectiveWe hypothesized that a multi-tier response (MTR) will provide high-quality cardiopulmonary resuscitation including airway management. However, the type of tier response system and airway management will have different interactive effects resulting in varying outcomes following out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the advanced airway management method has an effect on OHCA outcomes and to compare the size of the effect across MTR types.MethodsThis is a retrospective population-based observational study using the Korea OHCA Registry. Airway management methods were categorized into endotracheal intubation (ETI) and supraglottic airway (SGA) groups. The tier system was categorized into single-tier response (STR) or two types of MTR: ambulance-ambulance MTR or fire engine-ambulance MTR.ResultsIn total, 45,264 patients were analyzed among the 89,087 emergency medical service assessed OHCAs. The SGA group was significantly associated with a lower prehospital return of spontaneous circulation (ROSC) rate compared to the ETI group (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.72–0.88). Both MTR with an ambulance or fire engine were significantly associated with higher prehospital ROSC rates compared to STR (STR vs. MTR with an ambulance: aOR, 1.33; 95% CI, 1.21–1.47; STR vs. MTR with a fire engine: aOR, 1.43; 95% CI, 1.20–1.71). Prehospital SGA was significantly associated with poor neurological outcomes in MTR with fire engine (aOR, 0.71; 95% CI, 0.53–0.96).ConclusionIn this nationwide observational study, we observed that MTR was associated with higher prehospital ROSC than STR. Moreover, SGA is associated with a lower prehospital ROSC rate regardless of tier response type compared to ETI.