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Difficult airway

Jörn Grensemann, Lars Eichler, Nuowei Wang, Dominik Jarczak, Marcel Simon, Stefan Kluge
BACKGROUND: For critically ill patients, effective airway management with a high first-attempt success rate for endotracheal intubation is essential to prevent hypoxic complications during securing of the airway. Video guidance may improve first-attempt success rate over direct laryngoscopy (DL). METHODS: With ethics approval, this randomised controlled trial involved 54 critically ill patients who received endotracheal intubation using a tube with an integrated video camera (VivaSight™-SL tube, VST, ETView Ltd...
September 22, 2018: Critical Care: the Official Journal of the Critical Care Forum
Takeo Sugita, Hirofumi Arisaka
Epiglottic cysts often cause difficulty in airway management, with potential serious life-threatening complications. 1 This case report describes a patient with an epiglottic cyst in whom mask ventilation became difficult after induction of anesthesia. Immediately, an AirWay Scope™ (TMAWS-S100; Pentax, Japan) was inserted orally, and the location of the epiglottis was clarified to assess the reason for difficulty with ventilation. This case demonstrates usefulness of the AirWay Scope in patients with epiglottic cyst...
2018: Anesthesia Progress
Kevin J Kovatch, Allison R Powell, Kevin Green, Chelsea L Reighard, Glenn E Green, Virginia T Gauger, Deborah M Rooney, David A Zopf
BACKGROUND: Pediatric-specific difficult airway guidelines include algorithms for 3 scenarios: unanticipated difficult tracheal intubation, difficult mask ventilation, and cannot intubate/cannot ventilate. While rare, these instances may require front-of-neck access (FONA) to secure an airway until a definitive airway can be established. The aim of this study was to develop a pediatric FONA simulator evaluated by both anesthesiology and otolaryngology providers, promoting multidisciplinary airway management...
September 18, 2018: Anesthesia and Analgesia
Steven H Cataldo, Samhati Mondal, Laeben C Lester, Nadia B Hensley
Upper airway obstruction during anesthesia is the leading cause of complications during sedation, intubation, and emergence. Devices to support oxygenation and ventilation are costly, require capital equipment, and cannot be used during transport. We present a 46-year-old man with sleep apnea and anticipated difficult airway undergoing a cardiac ablation under general endotracheal intubation. The SuperNO2VA nasal mask provided high-flow nasal oxygen and positive pressure during awake fiberoptic intubation and on extubation, maintaining airway patency in the operating room, during transport, and in recovery...
September 18, 2018: A&A practice
Ruggero M Corso, Chiara De Fazio, Emanuele Ornigotti, Stefano Maitan, Emanuele Piraccini, Massimiliano Sorbello
No abstract text is available yet for this article.
September 13, 2018: Minerva Anestesiologica
Wei Yu, Zijian Wang, Dapeng Gao, Wei Zhang, Wen Jin, Xuesong Ma, Sihua Qi
BACKGROUND: A right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient's airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus...
September 18, 2018: BMC Anesthesiology
Alkis Togias, Peter J Gergen, Jack W Hu, Denise C Babineau, Robert A Wood, Robyn T Cohen, Melanie M Makhija, Gurjit K Khurana Hershey, Carolyn M Kercsmar, Rebecca S Gruchalla, Andrew H Liu, Emily Wang, Haejin Kim, Carin I Lamm, Leonard B Bacherier, Dinesh Pillai, Steve M Sigelman, James E Gern, William W Busse
BACKGROUND: Rhinitis and asthma are linked, but substantial knowledge gaps in this relationship exist. OBJECTIVE: To determine the prevalence of rhinitis and its phenotypes in children and adolescents with asthma, assess symptom severity and medication requirements for rhinitis control, and investigate associations between rhinitis and asthma. METHODS: 749 children with asthma participating in the Asthma Phenotypes in the Inner-City study received baseline evaluations and were managed for 1 year with algorithm-based treatments for rhinitis and asthma...
September 10, 2018: Journal of Allergy and Clinical Immunology
Lina Wang, Li Zhang, Deli Li, Chunyan Li, Yan Wang, Man Gao, Hang Liang, Fanzheng Meng
RATIONALE: Bronchial foreign body aspiration is a critical condition that jeopardizes the respiratory function of children. Prompt diagnosis and removal of the foreign body can reduce occurrence of foreign body complications and mortality. Aspiration of spherical plastic beads is rare, and the bead is difficult to retrieve. PATIENT CONCERNS: An 8-year-old girl developed cough, transient throat wheezing, and intermittent cough after she accidentally inhaled a plastic bead 7 hours ago...
September 2018: Medicine (Baltimore)
Piotr Palczynski, Szymon Bialka, Hanna Misiolek, Maja Copik, Anna Smelik, Lukasz Szarpak, Kurt Ruetzler
BACKGROUND: Predicting difficult intubation is of high clinical interest. METHODS: 237 patients aged ≥18 years were included in the study. Preoperative airway evaluation included: Mallampati test, thyromental distance, sternomental distance and thyromental height test. During direct laryngoscopy Cormack & Lehane classification was graded. We calculated the ROC AUC, sensitivity and specificity for thyromental height test as a primary end point of our study...
2018: PloS One
Swapnil Y Parab, Prashant Kumar, Jigeeshu V Divatia, Kailash Sharma
Background: With ability of lung ultrasound (LUS) to identify regional lung ventilation and collapse, we hypothesize that LUS can be a better method than auscultation to assess lung isolation in determination of position of double lumen tube (DLT). Methods: A randomized controlled study was conducted in cancer institute from November 2014 to December 2015, in hundred adult patients undergoing elective thoracic surgeries. Patients with tracheostomy, difficult airway and pleural-based pathologies were excluded...
September 12, 2018: Korean Journal of Anesthesiology
Mahesh Nagappa, Yamini Subramani, Frances Chung
PURPOSE OF REVIEW: The perioperative outcome in obstructive sleep apnea (OSA) patients undergoing ambulatory surgery can be potentially impacted by the type of anesthetic technique, fluid management and choice of anesthetic agents. This review highlights the best perioperative practices in the management of OSA patients undergoing ambulatory surgical procedures. RECENT FINDINGS: A recent meta-analysis found that STOP-Bang might be used as a perioperative risk stratification tool...
September 7, 2018: Current Opinion in Anaesthesiology
Haribalan Kumar, Ravi Jain
Nasal surgery improves symptoms in a majority of patients for whom medical treatment has failed. In rhinosinusitis patients, endoscopic sinus surgery aims to alleviate obstruction and re-establish mucociliary clearance. Surgery alters the structure-function relationship within the nasal passage, which is difficult to assess clinically. Computational modelling has been used to investigate this relationship by simulating air flow and environmental variables inside realistic three-dimensional models of the human nasal airway but many questions remain unanswered and need further investigation...
February 8, 2018: Clinical Biomechanics
Anaïs Rameau, Ellen Wang, Anirudh Saraswathula, Natalie Pageler, Shanna Perales, Douglas R Sidell
OBJECTIVE: Difficult intubations are not uncommon in tertiary care children's hospitals, and effective documentation of the difficult airway is a fundamental element of safe airway management. The primary goal of our quality improvement initiative was to improve access to airway information via an alert and documentation system within the electronic medical record (EMR). METHODS: We created a difficult airway alert within the EMR, linking common airway evaluation templates used by specialists involved in airway management...
September 8, 2018: Laryngoscope
Riccardina Tesse, Giorgia Borrelli, Giuseppina Mongelli, Violetta Mastrorilli, Fabio Cardinale
Asthma is a common chronic inflammatory disorder of the lower respiratory airways in childhood. The management of asthma exacerbations and the disease control are major concerns for clinical practice. The Global Strategy for Asthma Management and Prevention, published by GINA, updated in 2017, the British Thoracic Society/Scottish Intercollegiate Guideline Network, revised in 2016, the National Institute for Health and Care Excellence asthma guideline consultation, available in 2017, are widely accepted documents, frequently implemented, with conflicting advices, and different conclusion on asthma definition and treatment...
2018: Frontiers in Pediatrics
Elnaz Faramarzi, Hassan Soleimanpour, Zahid Hussain Khan, Ata Mahmoodpoor, Sarvin Sanaie
Background and Objective: Upper lip bite test (ULBT) is one of the various bedside tests used for prediction of difficult laryngoscopic intubation. However, its usefulness is not still very clear, and there is controversy regarding its accuracy. The aim of this systematic review was to determine the accuracy of the ULBT for predicting difficult airway including difficult laryngoscopy or difficult tracheal intubation. Method: We searched the databases of PubMed, Scopus, and Google scholar for prospective studies published up until October 2016 assessing the accuracy of ULBT in comparison to Cormack-Lehane grading...
July 2018: Pakistan Journal of Medical Sciences Quarterly
Ji-Ming Wang, Er-Li Ma, Yun-Xia Zuo, Jing Lin, Peng Liang, Xiao-Qiang Li
Objective: To compare glottis exposure of the same patients with potentially difficult tracheal intubation (PDTI) subjected to Airtraq laryngoscopy and Macintosh laryngoscopy under consciousness and topical anesthesia. Methods: A total of 147 PDTI patients with American Society of Anesthesiologists (ASA) I-III were subjected to Airtraq and Macintosh laryngoscopy performed by experienced anesthesiologists under consciousness and topical anesthesia. Results: All patients were successfully intubated...
July 2018: Pakistan Journal of Medical Sciences Quarterly
Javier H Campos, Eli D Musselman, Satoshi Hanada, Kenichi Ueda
OBJECTIVES: Lung isolation techniques are designed to facilitate surgical exposure in thoracic surgical patients and provide one-lung ventilation (OLV). Some patients have a tracheostomy in situ, which makes the management of the airway and OLV difficult. The objective of this retrospective study was to review cases that had a tracheostomy prior to thoracic surgery and evaluate the clinical use and efficiency with the airway management and lung isolation devices. DESIGN: This was a retrospective data analysis...
June 19, 2018: Journal of Cardiothoracic and Vascular Anesthesia
T L Brunckhorst, W Grimmett, M M Mun-San Kwan
No abstract text is available yet for this article.
September 2018: Anaesthesia and Intensive Care
G Preece, I Ng, K Lee, P Mezzavia, R Krieser, D L Williams, O Stewart, R Segal
The Ambu®AuraGain™ laryngeal mask (LM) (Ambu A/S, Ballerup, Denmark) is one of the few readily available second-generation supraglottic airway devices (SADs) that offer a conduit for fibreoptic-guided endotracheal intubation. We aimed to compare fibreoptic intubation through this device with the LMA® (laryngeal mask airway) Fastrach™ (Teleflex Medical, Co. Westmeath, Ireland), which has been a recommended dedicated rescue device for the management of the unanticipated difficult airway. This randomised controlled trial compared a previously described fibreoptic score in 116 patients with no known airway pathology, who had asleep fibreoptic endotracheal intubation via either the AuraGain LM or the LMA Fastrach...
September 2018: Anaesthesia and Intensive Care
Sophia Villiere, Ko Nakase, Richard Kollmar, Hamid Arjomandi, Jason Lazar, Krishnamurthi Sundaram, Joshua B Silverman, Michael Lucchesi, David Wlody, Mark Stewart
Background: Acute laryngospasm sufficient to cause obstructive apnea is a medical emergency that can be difficult to manage within the very short time available for establishing an airway. We have presented substantial evidence that laryngospasm-based obstructive apnea is the cause of sudden death in epilepsy, and airway management is particularly challenging during seizure activity. Objective: We sought to determine if the transtracheal delivery of a bolus of oxygen or room air below the level of an obstruction to inflate the lungs could be an effective method to prolong the time available for responders seeking to establish a stable airway, and, if so, what could be learned about optimization of delivery parameters from a rat model...
August 2018: Laryngoscope Investigative Otolaryngology
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