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Difficult airways

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https://www.readbyqxmd.com/read/29349776/effect-of-palpable-vs-impalpable-cricothyroid-membranes-in-a-simulated-emergency-front-of-neck-access-scenario
#1
C F Pairaudeau, C Mendonca, C Hillermann, I Qazi, P A Baker, R E Hodgson, S Radhakrishna
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate...
January 19, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29349680/ultrasound-evaluation-of-the-airway-in-the-ed-a-feasibility-study
#2
Elizabeth A Hall, Ibrahim Showaihi, Frances S Shofer, Nova L Panebianco, Anthony J Dean
BACKGROUND: Recognition of the difficult airway is a critical element of emergency practice. Mallampati score and body mass index (BMI) are not always predictive and they may be unavailable in critically ill patients. Ultrasonography provides high-resolution images that are rapidly obtainable, mobile, and non-invasive. Studies have shown correlation of ultrasound measurements with difficult laryngoscopy; however, none have been performed in the Emergency Department (ED) using a consistent scanning protocol...
January 18, 2018: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/29349422/hybrid-management-of-a-ruptured-right-subclavian-artery-aneurysm-dissection
#3
David Drullinsky, Heather Gill, Jason P Bayne, Jean-Francois Morin, Daniel Obrand
Aberrant right subclavian artery is the most common congenital malformation of the aortic arch (0.4%-2.0%). Aneurysms of aberrant subclavian arteries are extremely rare. This results in little experience with their treatment. We describe a case of a patient who presented to the emergency department with a dissection of an aberrant right subclavian artery that later progressed to rupture. Besides hemodynamic instability, this caused an acute superior vena cava syndrome, making airway control difficult. In the operating room, we obtained proximal control through thoracic endovascular aortic repair; median sternotomy was performed for distal control and evacuation of massive hemomediastinum...
December 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29349354/awake-intubation-in-a-patient-with-huge-orocutaneous-fistula-a-case-report
#4
Hye-Jin Kim, So-Hyun Kim, Tae-Heung Kim, Ji-Young Yoon, Cheul-Hong Kim, Eun-Jung Kim
Mask ventilation, the first step in airway management, is a rescue technique when endotracheal intubation fails. Therefore, ordinary airway management for the induction of general anesthesia cannot be conducted in the situation of difficult mask ventilation (DMV). Here, we report a case of awake intubation in a patient with a huge orocutaneous fistula. A 58-year-old woman was scheduled to undergo a wide excision, reconstruction with a reconstruction plate, and supraomohyoid neck dissection on the left side and an anterolateral thigh flap due to a huge orocutaneous fistula that occurred after a previous mandibulectomy and flap surgery...
December 2017: Journal of Dental Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29342420/-use-of-bronchial-blocker-in-emergent-thoracotomy-in-presence-of-upper-airway-hemorrhage-and-cervical-spine-fracture-a-difficult-decision
#5
Carlos Almeida, Maria João Freitas, Diogo Brandão, José Pedro Assunção
Female, 85 y.o., weighting 60kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage...
January 13, 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29338895/feasibility-of-total-intravenous-anesthesia-by-cardiologists-with-the-support-of-anesthesiologists-during-catheter-ablation-of-atrial-fibrillation
#6
Takanori Yamaguchi, Yusuke Shimakawa, Shinji Mitsumizo, Akira Fukui, Yuki Kawano, Toyokazu Otsubo, Yuya Takahashi, Kei Hirota, Takeshi Tsuchiya, Kenichi Eshima
BACKGROUND: The optimal methodology for sedation and anesthesia during atrial fibrillation (AF) ablation has not been well established. We assessed the feasibility of total intravenous anesthesia (TIVA) by cardiologists with support from anesthesiologists during AF ablation and quality of pulmonary vein isolation (PVI) and single procedure success rate at 12 months. METHODS: TIVA was performed by cardiologists using IV propofol and fentanyl under controlled ventilation via i-gel™ without neuromuscular blocking drugs in 160 consecutive patients (80 nonparoxysmal) with no anticipated difficult airway or other severe diseases...
January 12, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29336401/bleeding-in-the-lung-complicates-a-routine-intracardiac-repair-what-went-wrong
#7
Neeti Makhija, Rohan Magoon, Minati Choudhury, Sivasubramanian Ramakrishnan
Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29331616/paediatric-video-laryngoscopy-and-airway-management-what-s-the-clinical-evidence
#8
Xue Fu-Shan, Liu Ya-Yang, Li Hui-Xian, Yang Gui-Zhen
The major complications of paediatric airway management are uncommon, but the outcomes are often severe. Over the last decade, additions and advancements in the devices and technology have significantly improved our ability to manage difficult paediatric airways safely. Videolaryngoscopy involves the use of video and optical technology to facilitate indirect visualisation of the larynx during intubation and has been seen as an evolutionary step in intubation technology. Over the past few years, video laryngoscopes have been receiving plenty of attention as new airway devices for use in paediatric patients...
January 10, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29331494/a-novel-difficult-airway-prediction-tool-for-emergency-airway-management-validation-of-the-heaven-criteria-in-a-large-air-medical-cohort
#9
Edward Kuzmack, Travis Inglis, David Olvera, Allen Wolfe, Kona Seng, Daniel Davis
BACKGROUND: Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. OBJECTIVE: To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort...
January 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29328747/critical-incident-analysis-equip-to-avoid-failure
#10
Naomi Potts, Daphne Se Martin, Leontia Hoy
This work is set in the context of perioperative practice in difficult airway management. It integrates a root cause analysis and fish bone technique to investigate a critical incident in temporary yet crucial equipment failure. Risk management and incident reporting is analysed alongside human factors in the operating theatre environment. Finally, recommendations for risk reduction, vigilance and checking vital airway equipment are made in anaesthetic practice.
April 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29322502/systematic-review-of-benefits-or-harms-of-routine-anaesthetist-inserted-throat-packs-in-adults-practice-recommendations-for-inserting-and-counting-throat-packs-an-evidence-based-consensus-statement-by-the-difficult-airway-society-das-the-british-association
#11
REVIEW
V Athanassoglou, A Patel, B McGuire, A Higgs, M S Dover, P A Brennan, A Banerjee, B Bingham, J J Pandit
Throat packs are commonly inserted by anaesthetists after induction of anaesthesia for dental, maxillofacial, nasal or upper airway surgery. However, the evidence supporting this practice as routine is unclear, especially in the light of accidentally retained throat packs which constitute 'Never Events' as defined by NHS England. On behalf of three relevant national organisations, we therefore conducted a systematic review and literature search to assess the evidence base for benefit, and also the extent and severity of complications associated with throat pack use...
January 10, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29317119/noninvasive-ventilation-during-endoscopic-procedures-rationale-clinical-use-and-devices
#12
REVIEW
Marina Pieri, Giovanni Landoni, Luca Cabrini
Endoscopic procedures, such as transesophageal echocardiography, gastroscopy, and airway fibroscopy, routinely are performed in a heterogenous population of patients for diagnostic/interventional purposes (eg, transfemoral aortic valve replacement, airway fibroscopies, and intubation). Sedation frequently is administered to achieve an appropriate degree of patient compliance and procedure success. Patients with reduced respiratory reserve or those who are overly sedated, however, may develop hypoxia and respiratory failure during endoscopies, necessitating premature termination of the examination itself...
September 27, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29315046/supraglottic-airway-devices-current-and-future-uses
#13
Lloyd E Kwanten, Pradeep Madhivathanan
Supraglottic airway devices have increasingly been used in anaesthesia since their invention in 1982. Now over half of general anaesthetic cases in the UK use them, and they have vital roles in difficult airway algorithms, pre-hospital use and emergency medicine. This article presents the current evidence regarding the complications of these devices, and compares these devices and endotracheal intubation. The technology of the newer generation devices has improved the safety profile, and they may be considered a better choice than endotracheal tubes in some cases...
January 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29311012/anesthetic-management-of-mosaic-turner-s-syndrome-posted-for-elective-cesarean-delivery-after-spontaneous-pregnancy
#14
K Kalopita, L Michala, C Theofanakis, D Valsamidis
Turner's syndrome, one of the most common sex chromosome abnormalities in females, is caused by loss of part or all of an X chromosome. We report a case of mosaic Turner's syndrome, posted for elective cesarean delivery under low-dose sequential combined spinal epidural anesthesia. The unique features of this case were the combination of an anticipated difficult airway and both short stature and scoliosis in the lumbar region. A titrated combined spinal-epidural technique was performed in order to avoid hemodynamic instability, which could have been exacerbated in the presence of cardiovascular deformities that accompany this syndrome in many cases...
November 26, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29310503/decision-making-for-position-dependent-obstructive-sleep-apnea-syndrome-on-the-basis-of-patient-information-and-physical-examinations-of-the-upper-airway-acquired-on-an-outpatient-basis
#15
Minoru Endo, Takahito Kondo, Rie Shimada, Kiyoaki Tsukahara
CONCLUSIONS: Patients with body mass index (BMI) < 25 kg/m2 and obstructive sleep apnea syndrome (OSAS) are highly suspicious for position-dependent OSAS. Diagnosis of position-dependent/position-independent OSAS can be difficult in patients satisfying both 'BMI >25 kg/m2' and 'any of tongue enlargement (TE), palatine tonsil hypertrophy (PTH) and obstruction by Muller's maneuver (OMM)'. Polysomnography is warranted in such patients. OBJECTIVES: The objective was to retrospectively elucidate criteria for differentiating position-dependent OSAS on the basis of patient information and physical examinations of the upper airway obtainable in clinics...
January 8, 2018: Acta Oto-laryngologica
https://www.readbyqxmd.com/read/29307915/ultrasonography-as-a-novel-airway-assessment-tool-for-preoperative-dynamic-airway-evaluation-in-an-anticipated-difficult-airway
#16
Ranjith Kumar Sivakumar, V K Mohan, Ranjana Venkatachalapathy, Pankaj Kundra
No abstract text is available yet for this article.
December 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29307902/a-randomised-controlled-trial-comparing-proseal-laryngeal-mask-airway-i-gel-and-laryngeal-tube-suction-d-under-general-anaesthesia-for-elective-surgical-patients-requiring-controlled-ventilation
#17
Bikramjit Das, Rahul Varshney, Subhro Mitra
Background and Aims: The ProSeal™ laryngeal mask airway (PLMA), i-gel™ and Laryngeal Tube Suction-D (LTS-D™) have previously been evaluated alone or in pair-wise comparisons but differing study designs make it difficult to compare the results. The aim of this study was to compare the clinical performance of these three devices in terms of efficacy and safety in patients receiving mechanical ventilation during elective surgical procedures. Methods: This prospective, randomised, double-blind study was conducted on 150 American Society of Anesthesiologists physical status I-II patients, randomly allocated into 3 groups, undergoing elective surgical procedures under general anaesthesia...
December 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29306264/management-of-right-main-bronchial-rupture-with-a-double-lumen-endotracheal-tube-in-a-patient-with-blunt-chest-trauma
#18
Seung Hwan Seol, Woon Jeong Lee, Seon Hee Woo, Dae Hui Kim, Jong Hui Suh
Tracheobronchial disruption is one of the most severe injuries caused by blunt chest trauma. It may cause airway obstruction and resulting life-threatening respiratory deficiency. However, the clinical presentations are variable and frequently difficult to diagnose. We report a case of a previously healthy 16-year-old man with complete right main bronchial transection sustained after a vehicular accident, who had progressive dyspnea, subcutaneous emphysema in the neck and anterior chest wall, and bilateral tension pneumothorax...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29306118/diagnostic-accuracy-of-radiology-ct-x-ray-us-for-predicting-difficult-intubation-in-adults-a-meta-analysis
#19
REVIEW
Chao Ji, Qiang Ni, Wurong Chen
OBJECTIVE: The aim of this study was to evaluate the overall accuracy of radiological measurements in prediction of difficult airway and compare the diagnostic value between the radiological measurements and the modified Mallampati score through a meta-analysis of published studies. METHODS: A comprehensive electronic search of related literature was performed in PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure. Meta-DiSc 1.4 and STATA 12...
January 3, 2018: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29305603/assessing-airflow-sensitivity-to-healthy-and-diseased-lung-conditions-in-a-computational-fluid-dynamics-model-validated-in-vitro
#20
Bora Sul, Zachary Oppito, Shehan Jayasekera, Brian Vanger, Amy Zeller, Michael Morris, Kai Ruppert, Talissa Altes, Vineet Rakesh, Steven Day, Risa J Robinson, Jaques Reifman, Anders Wallqvist
Computational models are useful for understanding respiratory physiology. Crucial to such models are the boundary conditions specifying the flow conditions at truncated airway branches (terminal flow rates). However, most studies make assumptions about these values, which are difficult to obtain in vivo. We developed a computational fluid dynamics (CFD) model of airflows for steady expiration to investigate how terminal flows affect airflow patterns in respiratory airways. First, we measured in vitro airflow patterns in a physical airway model, using particle image velocimetry...
January 5, 2018: Journal of Biomechanical Engineering
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