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difficult airway management

Ashwant Kumar Vadepally, Ramen Sinha, A V S S Subramanya Kumar
Background: Patients with limited mouth opening (LMO) often associated with difficult intubation. Retrograde intubation is an alternative technique of establishing definitive airway in these patients when blind nasal intubation fails and fiberoptic bronchoscope is not available. We tested the retrograde intubation through nasal route in patients with LMO less than 2 cm. Materials and methods: The procedure was performed with some modification with regard to retrograde guide on 18 patients requiring maxillofacial surgical procedures to increase mouth opening...
January 2018: Journal of Oral Biology and Craniofacial Research
Sarah-Hélène Müller, Jérôme M Defosse, Mark U Gerbershagen, Torsten Loop
Difficult airway management in thoracic anesthesia has rarely been addressed in current guidelines. However, difficult airway management may be a challenge in thoracic anaesthesia: Achieving lung separation and collapse in combination of potentially distorted upper airway anatomy (difficult upper airway), the presence of subglottic pathologies (difficult lower airway) and the need for one-lung ventilation (difficult lung separation). This review will focus on identification of patients at risk, recommendations and algorithms for the airway management in the anticipated and unexpected difficult in-/extubation, and choice of devices for lung separation in this context...
March 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Tomotaka Kawayama, Takashi Kinoshita, Kazuko Matsunaga, Yoshiko Naito, Jun Sasaki, Yoshikazu Tominaga, Tomoaki Hoshino
Asthma is an allergic disease characterized by chronic airway inflammation, airway hyperresponsiveness (AHR), reversibility and remodeling. Inhaled corticosteroids (ICS) are effective in many patients with asthma. However, ICS are a controlling, but not but curative treatment, and there are still many patients with refractory and difficult-to-treat asthma. The evaluation of airway inflammation by induced sputum, non-specific AHR by methacholine, and asthmatic reactions by specific allergen challenge techniques are useful not only to investigate the pathogenesis of asthma but also to help develop new drugs for asthma management...
March 16, 2018: Kurume Medical Journal
Helmut Trimmel, Christoph Beywinkler, Sonja Hornung, Janett Kreutziger, Wolfgang G Voelckel
BACKGROUND: Competence in emergency airway management is key in order to improve patient safety and outcome. The scope of compulsory training for emergency physicians or paramedics is quite limited, especially in Austria. The purpose of this study was to review the difficult airway management performance of an emergency medical service (EMS) in a region that has implemented a more thorough training program than current regulations require, comprising 3 months of initial training and supervised emergency practice and 3 days/month of on-going in-hospital training as previously reported...
March 16, 2018: International Journal of Emergency Medicine
Fernando González-Magaña, Héctor Omar Malagón-Hidalgo, Eugenio García-Cano, Roberto Vilchis-López, Adriana Fentanes-Vera, Fernan-Alejandra Ayala-Ugalde
Objectives: Airway management in patients with panfacial trauma is complicated. In addition to involving facial lesions, such trauma compromises the airway, and the use of intermaxillary fixation makes it difficult to secure ventilation by usual approaches (nasotracheal or endotracheal intubation). Submental airway derivation is an alternative to tracheostomy and nasotracheal intubation, allowing a permeable airway with minimal complications in complex patients. Materials and Methods: This is a descriptive, retrospective study based on a review of medical records of all patients with facial trauma from January 2003 to May 2015...
February 2018: Journal of the Korean Association of Oral and Maxillofacial Surgeons
Kazuchika Suzuki, Hiroaki Sakai, Kenji Takahashi
We herein report anesthetic management during aortic valve replacement for aortic valve regurgitation in a patient with adult mucopolysaccharidosis type II (MPS type 2) (Hunter syndrome). This disorder is rare and related to the accumulation of a mucopolysaccharide in lysosomes. It affects various organs, including the airways, heart, and central nerves. In children with MPS type 2, the risk of airway obstruction during anesthesia/sedation is high, and the degree of difficulty increases with aging. The patient described herein was a 33-year-old male without mental retardation...
2018: JA Clin Rep
Bernar Tan Wen Sheng, Patrick Wong, Constance Teo Ee Hoon
INTRODUCTION: Recurrent respiratory papillomatosis results in hoarseness, stridor and airway obstruction. Management is surgical, with most surgeons using microdebrider or laser. Transoral robotic surgery (TORS) has been successfully utilised for the excision of oropharyngeal malignancies and paediatric airway surgery. This is the first case report of TORS being used for the excision of laryngeal papillomas. CASE REPORT: A 36 year old Chinese female was diagnosed with juvenile onset recurrent respiratory papillomatosis...
March 3, 2018: American Journal of Otolaryngology
Ji-Ming Wang, Er-Li Ma, Qing-Ping Wu, Ming Tian, Yan-Yan Sun, Jing Lin, Liang Peng, Qiang Xu, Wei Wei, Hong Tan, Cen Yang, Xiao-Qiang Li, Yun-Xia Zuo, Jin Liu
Background: Patients with potential difficult mask ventilation (DV) and difficult intubation (DI) are often managed with awake intubation, which can be stressful for patients and anesthesiologists. This prospective randomized study evaluated a new approach, fast difficult airway evaluation (FDAE). We hypothesized that the FDAE approach would reduce the need for awake intubation. Methods: After obtaining informed consent, 302 patients with potential DV/DI undergoing elective surgeries were randomly assigned to the FDAE group (Group E) and the control group (Group C)...
March 20, 2018: Chinese Medical Journal
Roman Dudaryk, Danielle B Horn, J Marshall Green
A patient with recent jaw reconstruction presented for treatment of postoperative oropharyngeal hemorrhage. Asleep nasal fiberoptic intubation was attempted, but a rare and unanticipated complication ensued: rupture of right facial artery pseudoaneurysm. The difficult airway algorithm was followed up to the point of surgical airway. While nasal or oral fiberoptic intubation is often perceived as the safest approach for management of a difficult airway, we discuss alternative treatment strategies for patients with a facial pseudoaneurysm...
2018: Anesthesia Progress
Chia-Chih Liao, Fu-Chao Liu, Allen H Li, Huang-Ping Yu
Video laryngoscopy-assisted tracheal intubation devices have become alternatives to traditional laryngoscopes in recent years. This review will provide information on commonly used video laryngoscopes, and their clinical applications in airway management. Areas covered: In this review, the differences between video laryngoscopy and direct laryngoscopy, and the utilization of video laryngoscopes in specific clinical settings are discussed. Expert Commentary: Video laryngoscopy should be embraced as an initial approach to intubation in patients with suspected difficult airway...
March 5, 2018: Expert Review of Medical Devices
Gemma Malpas, Orlando Hung, Ainslie Gilchrist, Chrison Wong, Blaine Kent, Gregory M Hirsch, Robert D Hart
While extracorporeal membrane oxygenation (ECMO) is an effective method of oxygenation for patients with respiratory failure, further refinement of its incorporation into airway guidelines is needed. We present a case of severe glottic stenosis from advanced thyroid carcinoma in which gas exchange was facilitated by veno-arterial ECMO prior to achieving a definitive airway. We also conducted a systematic review of the MEDLINE, EMBASE, CINAHL, and Web of Science databases, using the keywords "airway/ tracheal obstruction", "anesthesia", "extracorporeal", and "cardiopulmonary bypass" to identify reports where ECMO was initiated as the a priori method of oxygenation during difficult airway management...
March 1, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Patricia Jabre, Andrea Penaloza, David Pinero, Francois-Xavier Duchateau, Stephen W Borron, Francois Javaudin, Olivier Richard, Diane de Longueville, Guillem Bouilleau, Marie-Laure Devaud, Matthieu Heidet, Caroline Lejeune, Sophie Fauroux, Jean-Luc Greingor, Alessandro Manara, Jean-Christophe Hubert, Bertrand Guihard, Olivier Vermylen, Pascale Lievens, Yannick Auffret, Celine Maisondieu, Stephanie Huet, Benoît Claessens, Frederic Lapostolle, Nicolas Javaud, Paul-Georges Reuter, Elinor Baker, Eric Vicaut, Frédéric Adnet
Importance: Bag-mask ventilation (BMV) is a less complex technique than endotracheal intubation (ETI) for airway management during the advanced cardiac life support phase of cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest. It has been reported as superior in terms of survival. Objectives: To assess noninferiority of BMV vs ETI for advanced airway management with regard to survival with favorable neurological function at day 28...
February 27, 2018: JAMA: the Journal of the American Medical Association
Meredith Merz Lind, Marco Corridore, Cameron Sheehan, Melissa Moore-Clingenpeel, Tensing Maa
Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Gayle B Bodner, Ashley L Talbott
Preoperative evaluation helps identify patient comorbidities and surgical characteristics that increase perioperative risk, and also can help identify patients with potentially difficult airways. Identifying patients with difficult airways before surgery lets clinicians plan appropriate perioperative management and prepare for potential complications. This article focuses on management of a difficult airway in a patient undergoing surgery for a thyroid mass.
March 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
M G Gómez-Prieto, M R Míguez-Crespo, J R Jiménez-Del-Valle, M D González-Caro, I Marmesat-Ríos, J Garnacho-Montero
OBJECTIVE: To know organization, management and training in airway (AW) in Spanish Intensive Care Units (ICUs), with special interest in difficult airway (DAW). DESIGN: Descriptive cross-sectional study and χ2 subanalysis, conducted through a national survey from november 1th to december 15th, 2016. With the SEMICYUC's support, an online questionnaire of 27 items was sent to 179 ICUs. SETTING: ICUs of public, private centers, and consortia...
February 18, 2018: Medicina Intensiva
David J Olvera, David F E Stuhlmiller, Allen Wolfe, Charles F Swearingen, Troy Pennington, Daniel P Davis
INTRODUCTION: Airway management is a critical skill for air medical providers, including the use of rapid sequence intubation (RSI) medications. Mediocre success rates and a high incidence of complications has challenged air medical providers to improve training and performance improvement efforts to improve clinical performance. OBJECTIVES: The aim of this research was to describe the experience with a novel, integrated advanced airway management program across a large air medical company and explore the impact of the program on improvement in RSI success...
February 21, 2018: Prehospital Emergency Care
Olufunmilola Abraham, Jenny S Li, Kathy E Monangai, Alison M Feathers, Daniel Weiner
OBJECTIVES: To describe the critical need for pharmacists' involvement in outpatient care for people living with cystic fibrosis (CF). DATA SOURCES: Not applicable. SUMMARY: CF is a pulmonary condition that affects more than 30,000 children and adults in the United States and 70,000 people worldwide. Various complex medication regimens are given to patients with CF, some depending on the type of mutation they have in their CF transmembrane conductance regulator protein...
February 16, 2018: Journal of the American Pharmacists Association: JAPhA
Yumiko Nishio, Teruyuki Hiraki, Hiroko Taniguchi, Kazuo Ushijima
Background: Cleidocranial dysplasia is a type of skeletal dysplasia, which is primarily characterized by delayed ossification of skeletal structures. It causes facial and oral abnormalities, resulting in difficult airway management and neuraxial anesthesia. Case presentation: The patient was a 24-year-old primipara (height 138 cm, weight 42 kg) with a hypoplastic right clavicle, patent fontanelles, dental malalignment, and a high palate. She was diagnosed with cleidocranial dysplasia at birth, although gene examination has not been performed...
2018: JA Clin Rep
Harish Dharmarajan, Yi-Chun Carol Liu, Helena Karlberg Hippard, Binoy Chandy
INTRODUCTION: Pediatric otolaryngologists are frequently called to assist in difficult airway management in newborns with Pierre Robin Sequence (PRS) who have microretrognathia, glossoptosis, and an anterior larynx. The Bonfils fiberscope (BF) is a curved rigid scope designed to provide superior visualization in the anterior larynx. OBJECTIVE: (1) to assess whether BF provides an improvement in intubation success rate, time to intubation, or airway visualization as compared to rigid fiberscope (RF) in a difficult airway simulation setting and (2) to determine whether a training program for BF can improve time to intubation through practice trials...
February 2018: International Journal of Pediatric Otorhinolaryngology
Kazuma Yunoki, Ikuko Miyawaki, Kazuo Yamazaki, Hiroyuki Mima
No abstract text is available yet for this article.
January 6, 2018: Journal of Cardiothoracic and Vascular Anesthesia
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