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Awake intubation

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https://www.readbyqxmd.com/read/27903026/-severe-hypercapnic-respiratory-failure-in-acute-exacerbation-of-copd-significance-of-ventilation-and-extracorporal-co2-removal
#1
Michael Westhoff, Martin Bachmann, Stephan Braune, Christian Karagiannidis, Stefan Kluge, Philipp M Lepper, Thomas Müller, Bernd Schönhofer
In acute exacerbations of COPD with acute hypercapnic respiratory failure and a pH 7.25 - 7.35, the initiation of non-invasive ventilation is the gold standard. However, absolute and relative contraindications have to be taken into account. The implementation of non-invasive ventilation in case of a severe respiratory acidosis necessitates a skilled therapeutic team and a close monitoring in order to avoid or perceive a NIV failure in time. In this case, the intubation and invasive mechanical ventilation is recommended...
November 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27900760/choice-of-anaesthesia-for-category-1-caesarean-section-in-women-with-anticipated-difficult-tracheal-intubation-the-use-of-decision-analysis
#2
A J Krom, Y Cohen, J P Miller, T Ezri, S H Halpern, Y Ginosar
A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia...
November 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27884026/-awake-video-laryngoscopy-an-alternative-to-awake-fiberoptic-intubation
#3
Jana Lohse, Rüdiger Noppens
INTRODUCTION: Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Specific cases, in particular very limited mouth opening or sub-glottic masses, require awake flexible endoscopic intubation...
November 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27833500/c-mac-%C3%A2-video-laryngoscope-with-d-blade%C3%A2-and-frova-introducer-for-awake-intubation-in-a-patient-with-parapharyngeal-mass
#4
S Vinayagam, S Dhanger, P Tilak, R Gnanasekar
Parapharyngeal tumors are rare head and neck tumors which can present as an intraoral mass and can pose great challenge to anesthesiologists. The primary concern is the difficult airway due to gross anatomical distortion of the upper airway. Securing the airway in an awake state should be the primary goal of anesthesiologists to avoid catastrophic complications. Herewith, we report the successful use of C-MAC(®) video laryngoscope with the acute-angle D-BLADE™ in combination with Frova introducer for awake intubation in a patient with parapharyngeal mass after multiple attempts of failed fiber-optic intubation...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27833492/submandibular-intubation-in-awake-patient-of-panfacial-trauma
#5
S K Kamra, H K Khandavilli, P Banerjee
Maxillofacial trauma patients present with airway problems. Submandibular intubation is an effective means of intubation to avoid tracheostomy for operative procedures. Airway is secured with oral endotracheal intubation in paralyzed patient and tube is then transplaced in sub mental or submandibular region. However there may be instances when paralyzing such trauma patients is not safe and short term tracheostomy is the only airway channel available for conduction of anesthesia. We report a case of submandibular intubation in awake patient of maxillofacial trauma with anticipated intubation problems...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27821835/airway-obstruction-secondary-to-emphysematous-epiglottitis-a-case-report
#6
Marc R Rohrbach, Sepehr Shabani, Aaron Wieland
BACKGROUND Despite a shift in the epidemiology of epiglottitis following the introduction of the Haemophilus influenzae type B vaccine, acute infectious epiglottitis continues to be a relatively common and potentially life-threatening infection in adults. Epiglottitis complicated by abscess is rare, and emphysematous abscess is even less common. Early diagnosis and intervention is paramount in reducing morbidity and mortality. Although case reports exist, photographic depiction of this complication is not readily available...
November 8, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27692903/intubated-versus-nonintubated-general-anesthesia-or-video-assisted-thoracoscopic-surgery-a-case-control-study
#7
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
https://www.readbyqxmd.com/read/27687404/fiberoptic-nasopharyngoscopy-for-evaluating-a-potentially-difficult-airway-in-a-patient-with-elevated-intracranial-pressure
#8
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
https://www.readbyqxmd.com/read/27687173/airway-management-of-a-patient-with-an-acute-floor-of-the-mouth-hematoma-after-dental-implant-surgery-in-the-lower-jaw
#9
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...
December 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27669029/anesthetic-management-for-pediatric-awake-tracheostomy
#10
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.
December 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27652080/anesthetic-management-of-a-patient-with-localised-scleroderma
#11
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
https://www.readbyqxmd.com/read/27599477/use-of-a-macintosh-blade-in-extrahepatic-portal-vein-obstruction-with-difficult-intubation-two-case-reports
#12
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
https://www.readbyqxmd.com/read/27591470/awake-insertion-of-a-laryngeal-mask-airway-proseal%C3%A2-as-alternative-to-awake-fiberoptic-intubation-in-management-of-anticipated-difficult-airway-in-ambulatory-surgery
#13
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
https://www.readbyqxmd.com/read/27576876/awake-intubation-creates-feelings-of-being-in-a-vulnerable-situation-but-cared-for-in-safe-hands-a-qualitative-study
#14
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...
August 30, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27563608/retrospective-evaluation-of-airway-management-with-blind-awake-intubation-in-temporomandibular-joint-ankylosis-patients-a-review-of-48-cases
#15
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
https://www.readbyqxmd.com/read/27555201/ultrasound-guided-airway-blocks-using-a-curvilinear-probe
#16
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
https://www.readbyqxmd.com/read/27552239/a-rare-case-of-hydromorphone-induced-angioedema-effectively-managed-by-a-difficult-airway-response-team
#17
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
https://www.readbyqxmd.com/read/27512858/awake-nasotracheal-fiberoptic-intubation-and-self-positioning-followed-by-anesthesia-induction-in-prone-patients-a-pilot-observational-study
#18
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)
https://www.readbyqxmd.com/read/27484783/dexmedetomidine-versus-remifentanil-for-sedation-during-awake-intubation-using-a-shikani-optical-stylet-a-randomized-double-blinded-controlled-trial
#19
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
https://www.readbyqxmd.com/read/27458558/operative-stabilization-of-the-remaining-mobile-segment-in-ankylosed-cervical-spine-in-systemic-onset-juvenile-idiopathic-arthritis-a-case-report
#20
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
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