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Awake intubation

Joanne F Irons, Lachlan F Miles, Kaustuv R Joshi, Andrew A Klein, Marco Scarci, Piergiorgio Solli, Guillermo Martinez
OBJECTIVE: General anesthesia with endobronchial intubation and one-lung positive-pressure ventilation always has been considered mandatory for thoracic surgery. Recently, there has been interest in nonintubated techniques for video-assisted thoracoscopic surgery (VATS) in awake and sedated patients. The authors' center developed a nonintubated technique with spontaneous ventilation with the patient under general anesthesia using a supraglottic airway device. The authors believe that this was the first study to compare a nonintubated general anesthetic technique with an intubated general anesthetic technique for VATS...
July 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Lakshmi N Kurnutala, Gurneet Sandhu, Sergio D Bergese
A 62-year-old man with a left temporal lobe tumor was scheduled for a semiurgent craniotomy for tumor excision. Previously, the patient had a laryngeal carcinoma that was resected and treated with chemotherapy and radiotherapy and a history of laryngeal biopsy with awake fiberoptic intubation. Because a difficult airway was anticipated, awake fiberoptic nasopharyngoscopy of the airway was performed under topical anesthesia in the operating room. This revealed a narrow glottic opening with no supraglottic pathology or friable tissue...
November 2016: Journal of Clinical Anesthesia
Maarten J J B Vehmeijer, Naomi Verstoep, Jan E H Wolff, Engelbert A J M Schulten, Bas van den Berg
BACKGROUND: Over the last decades, dental implants have become increasingly popular in the prosthetic rehabilitation of patients. This has subsequently led to an increase of perioperative complications. Obstruction of the airway as a result of a floor of mouth hematoma after dental implant surgery is a rare but life-threatening complication. CASE REPORT: A 62-year-old man presented to the emergency department with a compromised airway caused by a hematoma in the floor of the mouth that occurred during dental implant surgery in the edentulous anterior mandible...
September 26, 2016: Journal of Emergency Medicine
Ian Yuan, Benjamin B Bruins, Eleanor P Kiell, Luv R Javia, Jorge A Galvez
Awake tracheostomy is indicated for acute upper airway obstruction, when other methods of securing the airway, such as intubation and cricothyrotomy, have failed or are inappropriate. This option is rarely considered in pediatrics because of the concerns of patient cooperation and safety and has not been described in the literature. We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus.
September 23, 2016: A & A Case Reports
Fangfan Ye, Gaoyin Kong, Jia Huang
INTRODUCTION: Scleroderma is a progressive fibrotic disorder of connective tissue which can present multiple anesthetic challenges to anesthetists, especially airway management. Awake intubation with fiberoptic bronchoscope is widely accepted and implemented for progressive systematic scleroderma patients. With the development and improvement of intubation devices these years, there is no report addressing other intubation methods for sclerotic patients. CASE DESCRIPTION: A 47 year-old, 42-kg man with 1-year history of localized scleroderma was scheduled for the operation of inner fixation after 6 days of his acetabular fracture...
2016: SpringerPlus
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
Matilde Zaballos, María Dolores Ginel, Maite Portas, María Barrio, Ana María López
BACKGROUND AND OBJECTIVES: The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. CASE REPORT: A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation...
September 2016: Brazilian Journal of Anesthesiology
Kati Knudsen, Ulrica Nilsson, Marieann Högman, Ulrika Pöder
BACKGROUND: Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. METHODS: A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation...
2016: BMC Anesthesiology
Duraiswamy Sankar, Radhika Krishnan, Muthusubramanian Veerabahu, Bhaskara Pandian Vikraman, J A Nathan
AIM: The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients. SETTINGS AND DESIGN: A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications. MATERIALS AND METHODS: Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients...
January 2016: Annals of Maxillofacial Surgery
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
Scott Masson, Matthew Villerot, Bhavinkumar Dalal
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room...
August 22, 2016: A & A Case Reports
Lei Heng, Ming-Yu Wang, Hou-Liang Sun, Shan-Shan Zhu
Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia.Sixty-two patients (ASA physical status I-II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure...
August 2016: Medicine (Baltimore)
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
Lovro Suhodolčan, Marko Mihelak, Janez Brecelj, Rok Vengust
We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation...
July 18, 2016: World Journal of Orthopedics
H J Holldack, K J Morandell
No abstract text is available yet for this article.
July 2016: Anaesthesia and Intensive Care
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
Soo Young Cho, Jae Hee Woo, Yoon Jin Kim, Eun Hee Chun, Jong In Han, Dong Yeon Kim, Hee Jung Baik, Rack Kyung Chung
Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method.We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective...
July 2016: Medicine (Baltimore)
Chao Sun, Fu Shan Xue, Rui-Ping Li, Gao-Pu Liu
No abstract text is available yet for this article.
August 2016: European Journal of Anaesthesiology
F T Mendonça, I Barreto de Moura, D Pellizzaro, B J Grossi, R Carvalho Diniz
OBJECTIVE: We report the anesthesia management of a 15 years-old patient with neurofibromatosis type 1, scheduled for resection of a tumor located in the occipitocervical region. In addition, we review the pertaining literature, emphasizing the anesthetic implications of neurofibromatosis manipulation. CASE : A 15-years-old female patient, with Neurofibromatosis type 1 was diagnosed with a large tumor in occipitocervical region suggestive of a plexiform neurofibroma. She presented with cervical instability, difficulty in positioning due to the large cervical mass and other predictors of airway difficulty...
2016: Acta Anaesthesiologica Belgica
Thomas Langer, Alessandro Santini, Nicola Bottino, Stefania Crotti, Andriy I Batchinsky, Antonio Pesenti, Luciano Gattinoni
Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier in the time course of respiratory failure. Furthermore, some centers are starting to use ECMO as a first line of treatment, i.e., as an alternative to invasive mechanical ventilation in awake, non-intubated, spontaneously breathing patients with respiratory failure ("awake" ECMO)...
June 30, 2016: Critical Care: the Official Journal of the Critical Care Forum
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