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A 5.0 mm endotracheal tube (without a balloon) passed through the proseal laryngeal mask airway with a tube exchanger inserted within the endotracheal tube.
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A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but...
Context in source publication
Context 1
... properly. We passed a 5.0 mm endotracheal tube (ETT, without a balloon) through the LMA with the aid of a fiberoptic bronchoscope into the trachea. We then passed a tube exchanger with an outer diameter 3.7 mm (Cook Critical Care, Bloomington, Indiana, USA) through the 5.0 mm ETT in order to exchange the 5.0 mm ETT and LMA with a 7.5 mm ETT (Fig. 1). After successfully securing the airway, the patient was sedated with continuous infusion of midazolam and was mechanically ventilated over- night. The next day, extubation was carefully carried out by the anesthesiologist after examining cervical lateral radiographs for any signs of soft tissue edema. No further airway complications ...Similar publications
Background: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. Methods: A face-to-face questionnair...
Fibreoptic intubation and Intubating laryngeal mask airway are alternatives to conventional laryngoscopy. The objective of the study was to compare hemodynamic changes with the use of these two devices for tracheal intubation.Methods: It was a randomized, comparative and prospective study of two groups comprising of 50 patients each. Tracheal intub...
Introduction:
The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and "cannot intubate, cannot ventilate" (CICV) situations.
Methods:
A questionnaire was e-mailed to members of the Canadian Anesthesiologists' Society to ascertain their preferences, experience, and comfort level...
Background:
We compared the effectiveness and safety of endotracheal intubation using the GlideScope (GS) video laryngoscope, CTrach laryngeal mask airway (LMA), or Shikani optical stylet rigid laryngoscope (SOS) during elective cervical surgery.
Methods:
Forty-five patients undergoing elective cervical surgery were randomly and equally assigned...
Endobronchial interventions are used to alleviate symptoms of airway stenosis. The ventilatory management may be challenging during these procedures, and may influence the choice of airway device. We report our experiences from 902 procedures.
Patients undergoing interventional bronchoscopy procedures were consecutively registered from 1999 to 2012...
Citations
... Proper positioning is pertinent for induction of anaesthesia, securing the airway and surgical accessibility. In patients with anticipated difficult airway, fiberoptic intubation under spontaneous ventilation has been considered an effective and safe choice, taking into account that laryngoscopic intubation may worsen any difficult airway scenario [5] . We report a case of large lipoma over the back of neck that limits neck movements in a patient having adequate mouth opening but patient is edentulous which leads to difficulty during intubation. ...
... In this case, we tried to use the McGrath video laryngoscope with the fiberoptic intubation on standby. Several case reports demonstrated that fiberoptic bronchoscope-assisted intubation is a useful procedure both as a primary and as a rescue option for definitive airway management in various difficult airway cases (Hariharasudhan et al., 2016;Lim & Wong, 2019;Maeda et al., 2020;Pang et al., 2015;Sung et al., 2014). Sung et al. reported a case of successful fiberoptic nasotracheal intubation in temporomandibular ankylosis with minimal mouth opening (Sung et al., 2014). ...
... Several case reports demonstrated that fiberoptic bronchoscope-assisted intubation is a useful procedure both as a primary and as a rescue option for definitive airway management in various difficult airway cases (Hariharasudhan et al., 2016;Lim & Wong, 2019;Maeda et al., 2020;Pang et al., 2015;Sung et al., 2014). Sung et al. reported a case of successful fiberoptic nasotracheal intubation in temporomandibular ankylosis with minimal mouth opening (Sung et al., 2014). A few important things should be considered, such as epistaxis in nasotracheal intubation which can lead to poor visibility (Ahmad et al., 2020). ...
Appropriate management of difficult airway is imperative, particularly in cases with anticipated difficult airway. It customarily requires deliberate perioperative assessment. In this article we present a case of limited mouth opening along with restricted mobility of the temporomandibular joint secondary to mandibular abscess which requires surgical intervention. Preoperatively, difficult airway intubation was expected (based on LEMON mnemonic on preoperative evaluation). Therefore, Macintosh video laryngoscope and fiberoptic bronchoscope was prepared to aid in intubation. Due to the patient’s anxiety towards the procedure, the intubation was done while the patient is asleep. Preoxygenation was uneventfully. Following induction with general anesthesia, several attempts to conduct nasotracheal intubation using Macintosh video laryngoscope were made but all were abortive. This failed attempt is primarily due to the limited mouth opening and jaw mobility. Hence, fiberoptic bronchoscope-assisted nasotracheal intubation was conducted and was able to achieve airway patency. In conclusion, preoperative management holds great importance in selecting airway management strategy. To add, fiberoptic bronchoscope-assisted intubation is a safe option for intubation
... In patients with anticipated difficult airway, fiberoptic intubation under spontaneous ventilation has been considered an effective and safe choice, taking into account that laryngoscopic intubation may worsen any difficult airway scenario. [5] We report a case of huge lipoma over the back of neck that limits neck movements in a patient having mouth opening of one finger due to chronic tobacco chewing. ...
... However, awake fibreoptic intubation still remains the gold standard for anticipated difficult intubation. [3,4] Although blind nasal or oral intubation is a simple technique, it is associated with two major drawbacks such as infrequent success on the first pass and increasing tissue trauma with repeated attempts. Furthermore, the FOB provides a more definitive and less traumatic means to gain endotracheal access under vision. ...
... Although successful intubation is reported with various SADs, ILMA is considered as an ideal conduit for endotracheal intubation. [1][2][3][4] The factors such as higher cost, non-availability of paediatric sizes, need for specialized endotracheal tubes, reports of adverse events like oesophageal perforation and the hindrance to fibreoptic bronchoscope guided intubation by the epiglottis-bar makes it difficult for routine airway management. There has been a constant evolution in the designs of the intubating SADs with varying degrees of success to overcome the above said disadvantages. ...
... However, awake fibreoptic intubation still remains the gold standard for anticipated difficult intubation. [3,4] Although blind nasal or oral intubation is a simple technique, it is associated with two major drawbacks such as infrequent success on the first pass and increasing tissue trauma with repeated attempts. Furthermore, the FOB provides a more definitive and less traumatic means to gain endotracheal access under vision. ...
... Proseal LMA and Glidescope videolaryngoscope is also proposed as an alternative to fiberoptic bronchoscope (12). Baidya et al. (2) reported that cobra perilaryngeal airway (cobraPLA) was successfully applied after failed LMA application in patient with BS. ...
... [2] The LMA is an important option within the ASA difficult airway algorithm, and has been proved to be a highly useful aid to fiberoptic intubation with ETT. [3] Fiberoptic intubation under spontaneous ventilation remains the choice, in any anticipated difficult airway, considering that laryngoscopic intubation may be difficult and may possibly worsen any difficult airway scenario. [3] Awake fiberoptic intubation has recently gained acceptance with good intubating conditions found in awake patients because they can assist in clearing their own secretions, phonating, or panting. ...
... [3] Fiberoptic intubation under spontaneous ventilation remains the choice, in any anticipated difficult airway, considering that laryngoscopic intubation may be difficult and may possibly worsen any difficult airway scenario. [3] Awake fiberoptic intubation has recently gained acceptance with good intubating conditions found in awake patients because they can assist in clearing their own secretions, phonating, or panting. [4] Shaik et al. (2014), in a case report on anesthetic management of Ludwig's angina concluded that awake fiberoptic intubation under topical anesthesia is sophisticated and a less invasive method of securing airway in patients with deep neck infection. ...
Management of difficult airway is widely recognized as one of the important tasks of an anesthesiologist. The problems related to it are known to be primary causes of life-threatening consequences. Herewith, we present a case series of difficult airway scenarios managed successfully with different techniques and airway gadgets. The following cases were managed successfully with appropriate airway techniques: 1) Ludwig′s angina for drainage with awake fiberoptic intubation, 2) temporomandibular joint (TMJ) ankylosis for bilateral gap arthroplasty with fiberoptic intubation, 3) burn contractures for the release managed with intubating laryngeal mask airway (ILMA). Airway management is one of the vital aspects of clinical care provided by an anesthesiologist. The airway-related complications have significantly decreased due to better knowledge, skills of the anesthesiologist, and an array of airway gadgets. The three case scenarios of difficult airway were successfully managed with the appropriate airway gadgets suitable for each case without any untoward complication. Most airway problems can be solved with available gadgets and techniques, but clinical judgement borne of experience and expertise is crucial in implementing the skills in any difficult airway scenario.
