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Awake endotracheal intubation

Azho Kezo, Rajendra D Patel, Shraddha Mathkar, Sonal Butada
BACKGROUND: We report the management of two patents from the Indian subcontinent with extrahepatic portal vein obstruction presenting with anticipated difficult airway. A Macintosh blade was used to secure the airway after using various instruments designed for difficult airway. To the best of our knowledge, no case has previously been reported in which a Macintosh blade was used successfully in patients with extrahepatic portal vein obstruction with a difficult airway. CASE PRESENTATION: Two women (case 1 and case 2) of South Asian ethnicity with extrahepatic portal vein obstruction presented for an elective splenorenal shunt...
2016: Journal of Medical Case Reports
Martin Krause, Bahareh Khatibi, Jacklynn F Sztain, Pariza Rahman, Anna B Shapiro, NavParkash S Sandhu
We describe a novel technique of real-time ultrasound-guided superior laryngeal nerve and translaryngeal blocks in 4 patients with anticipated difficult airways. All patients had altered neck anatomy, and 1 had a prior unsuccessful awake fiberoptic bronchoscopic intubation. For block performance, an 11-mm broadband curved array transducer with a scanning frequency between 8 and 5 MHz (Sonosite, Bothell, WA) was used for anatomical structure identification, needle guidance toward each superior laryngeal nerve and through the cricothyroid membrane, and deposition of local anesthetic in the appropriate location...
September 2016: Journal of Clinical Anesthesia
Ting Xu, Min Li, Cheng Ni, Xiang-Yang Guo
BACKGROUND: The purpose of this study was to compare the efficacy and safety of dexmedetomidine versus remifentanil for sedation during awake intubation using a Shikani optical stylet (SOS). METHODS: Sixty-eight patients with cervical trauma or severe cervical spondylosis undergoing cervical spinal surgery were enrolled in this prospective study. They were randomly assigned to receive dexmedetomidine (Group D) or remifentanil (Group R). In Group D, the patients received an intravenous loading dose of dexmedetomidine 1 μg · kg(-1) over 10 min followed by a continuous infusion of 0...
2016: BMC Anesthesiology
Dechao Jiao, Xinwei Han, Gang Wu, Jianzhuang Ren, Zhen Li, Ling Wang
BACKGROUND: For patients having a severe larynx or tracheal stenosis, emergency endotracheal intubation (EEI) may be needed due to respiratory failure. PURPOSE: To evaluate the feasibility and effectiveness of awake EEI using a fluoroscopy-guided sheath-assisted technique for adult patients having a malignant tracheal stenosis. MATERIAL AND METHODS: From October 2009 to May 2015, 219 patients having a malignant tracheal stenosis causing dyspnea or asphyxia required EEI...
July 8, 2016: Acta Radiologica
Zehra İpek Arslan, P Ozdal, D Ozdamar, H Agır, M Solak
We experienced a case of successful nasotracheal intubation using the X-Blade of the McGrath MAC in a 28-year-old woman with a 2.5-cm mouth opening. She had no teeth on the right side, her neck movement was limited, her mandibular protrusion was grade C, and her Mallampati could not be evaluated. Her tongue was fixed to the left wall during a previous surgery. We evaluated the awake glottic view using the McGrath MAC X-Blade and topical oral anesthesia. We obtained a Cormack-Lehane grade II view and then decided to administer general anesthesia...
October 2016: Journal of Anesthesia
Abbey G Herman, Michael E Mahla
Intubating laryngeal mask airways can be used to provide continuous ventilation throughout intubation. This is a case of a morbidly obese (body mass index = 58) 65-year-old woman with T10 and T11 compression fractures. Optimal positioning for airway management was hindered by her unstable spine, minimal neck range of motion, and extreme pain with any movement. An intubating laryngeal mask airway was placed in the awake, topically anesthetized patient, and the laryngeal mask airway and endotracheal tube combination was left in place throughout surgery...
August 2016: Journal of Clinical Anesthesia
Vladimir Dolinaj, Sanja Milošev, Dušanka Janjević
Laryngeal chondrosarcoma is a rare mesenchymal tumor, most frequently affecting cricoid cartilage. The objective of this report is to present successful video laryngoscope usage in a patient with anticipated difficult airway who refused awake fiberoptic endotracheal intubation (AFOI). A 59-year-old male patient was admitted in our hospital due to difficulty breathing and swallowing. On clinical examination performed by ENT surgeon, preoperative endoscopic airway examination (PEAE) could not be performed properly due to the patient's uncooperativeness...
March 2016: Acta Clinica Croatica
Asako Matsuda, Toshiyuki Mizota, Tomoharu Tanaka, Hajime Segawa, Kazuhiko Fukuda
We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased...
April 2016: Masui. the Japanese Journal of Anesthesiology
Diego Gonzalez-Rivas
The development of thoracoscopy has more than one hundred years of history since Jacobaeus described the first procedure in 1910. He used the thoracoscope to lyse adhesions in tuberculosis patients. This technique was adopted throughout Europe in the early decades of the 20(th) century for minor and diagnostic procedures. It is only in the last two decades that interest in minimally invasive thoracic surgery was reintroduced by two key technological improvements: the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers...
March 2016: Annals of Cardiothoracic Surgery
Thomas T Joseph, Jonathan S Gal, Samuel DeMaria, Hung-Mo Lin, Adam I Levine, Jaime B Hyman
BACKGROUND: Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure...
July 2016: Anesthesiology
Michal Nowakowski, Stephan Williams, Jason Gallant, Monique Ruel, Arnaud Robitaille
BACKGROUND: Endotracheal intubation is commonly performed via direct laryngoscopy (DL). However, in certain patients, DL may be difficult or impossible. The Bonfils Rigid Fiberscope® (BRF) is an alternative intubation device, the design of which raises the question of whether factors that predict difficult DL also predict difficult BRF. We undertook this study to determine which demographic, morphologic, and morphometric factors predict difficult intubation with the BRF. METHODS: Four hundred adult patients scheduled for elective surgery were recruited...
June 2016: Anesthesia and Analgesia
Eunjin Moon, Hyungmo Jeong, Junyoung Chung, Jaewoo Yi
Ankylosing spondylitis (AS) can be challenging for anesthesiologists because central venous access can be difficult, and the airway can be blocked due to the fixed flexion deformity of the spine. In this case, we attempted central access via the right subclavian vein, but the catheter was repeatedly inserted into the azygos vein, which was confirmed by radiology. After several attempts, the catheter position was corrected at the superior vena cava-atrial junction. Although several useful devices have been developed to address difficult intubation, in this case, fiberoptic bronchoscopy was the only applicable safe alternative because of the patient's extremely severe chin on chest deformity and temporomandibular joint disease...
2015: International Journal of Clinical and Experimental Medicine
Kathleen N Johnson, Daniel B Botros, Leanne Groban, Yvon F Bryan
There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube...
2015: Clinical Interventions in Aging
Jayan George, Jishar Abdul Kader, Sivasundari Arumugam, Anthony Murphy
We describe a case of a very difficult intubation which was safely navigated through careful planning. Our patient presented initially with increasing hoarseness and shortness of breath over a 6-month period. This was investigated and the patient was found to have a large vocal cord mass and was referred for urgent microlaryngoscopy and vocal cord polypectomy. On the day of surgery the obstruction was noted and awake fiberoptic bronchoscopy was used with a remifentanil infusion. Given the mass was large and increased in size with expiration, the time frame to pass the tube was extremely short...
2015: BMJ Case Reports
Chitra Sivasankar, Rolf A Schlichter, Dimitry Baranov, W Andrew Kofke
Awake craniotomies have been performed regularly at the University of Pennsylvania since 2004. Varying approaches to airway management are described for this procedure, including intubation with an endotracheal tube and use of a laryngeal mask airway, simple facemask, or nasal cannula. In this case series, we describe the successful use (i.e., no need for endotracheal intubation related to inadequate gas exchange) of bilateral nasopharyngeal airways in 90 patients undergoing awake craniotomies. The use of nasopharyngeal airways can ease the transition between the asleep and awake phases of the craniotomy without the need to stimulate the airway...
February 2016: Anesthesia and Analgesia
Preet Mohinder Singh, S Rajeshwari, Anuradha Borle, Valluvan Rangasamy
Airway-related tumors in pediatrics are always challenging for anesthesiologists. We present 2 cases of friable, bleeding large tumors in the oral cavity where conventional methods of securing the airway were not possible. Induction of general anesthesia could potentially lead to complete airway collapse and catastrophic obstruction in such cases. Awake fibrotic intubation is limited in pediatric patients. We describe the innovative use of an endotracheal tube inserted blindly as a nasopharyngeal airway guided by end-tidal carbon dioxide trace...
2015: Anesthesia Progress
Arun Kalava, Kirpal Clark, John McIntyre, Joel M Yarmush, Teresita Lizardo
A 64-year-old male had an awake right nasal fiber-optic intubation with an endotracheal tube for open reduction and internal fixation of bilateral displaced mandibular fractures. After induction of anesthesia, an 18 Fr nasogastric tube (NGT) was inserted through the left nostril and was secured. The patient required high flow rates to deliver adequate tidal volumes with the ventilator. A chest x-ray done in the postanesthesia care unit revealed a malpositioned NGT in the left lower lobe bronchus, which was immediately removed...
2015: Anesthesia Progress
F J Alonso-García, J Navarro-Martínez, C Gálvez, M J Rivera-Cogollos, C Sgattoni, I M Tarí-Bas
Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery...
March 2016: Revista Española de Anestesiología y Reanimación
Gloria Villalba, Susana Pacreu, Juan Luis Fernández-Candil, Alba León, Laura Serrano, Gerardo Conesa
The incidence and causes that may lead to an early end (unfinished cortical/subcortical mapping) of awake surgery for language mapping are little known. A study was conducted on 41 patients with brain glioma located in the language area that had awake surgery under conscious sedation. Surgery was ended early in 6 patients. The causes were: tonic-clonic seizure (1), lack of cooperation due to fatigue/sleep (4), whether or not word articulation was involved, a decreased level of consciousness for ammonia encephalopathy that required endotracheal intubation (1)...
January 2016: Neurocirugía
Maurizio Rosati, Silvia Bramante, Fiorella Conti, Maria Rizzi, Antonella Frattari, Tullio Spina
INTRODUCTION: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. CASE DESCRIPTION: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia...
July 2015: JSLS: Journal of the Society of Laparoendoscopic Surgeons
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