Fiberoptic intubation

OBJECTIVE: Percutaneous dilatational tracheostomy (PDT) is a bedside applicable procedure in intensive care unit patients requiring long-term mechanical ventilation. Fiber optic bronchoscopy (FOB) makes it easier and reduces complications. Our study aimed to evaluate the indications, complications, and prognosis of PDTs performed with FOB. PATIENTS AND METHODS: Our study included 114 patients undergoing PDT through FOB-guided Griggs method in the Respiratory Intensive Care Unit between January 01, 2018, and January 31, 2023...

Stickler syndrome (SS) is a congenital autosomal dominant condition that affects the formation of collagen. Of primary importance to the anesthesia provider is the propensity for difficulties in managing the airway due to orofacial abnormalities associated with this syndrome. The authors present a two-year-old infant with SS who required anesthetic care for a cleft palate repair. The potential anesthetic implications of this syndrome are discussed and the importance of proper planning and preparation and the usefulness of ultrasound as an airway evaluation tool are highlighted...

Meningoencephalocele is a rare congenital midline defect of cranial bone fusion characterized by herniation of the brain and meninges through the skull. In addition to the challenges of managing a major neurosurgical procedure in a pediatric patient, airway management in this group of patients requires advanced skills, and a difficult airway should be anticipated from the start. Since awake intubation is not an option in most pediatric cases with airway anatomy abnormalities and maintaining an adequate seal with a pediatric face mask is often impossible, airway management in patients with these lesions is highly challenging...

Background: While dysphagia after anterior cervical spine surgery is common, a dural tear is a rare complication. Airway compromise resulting from cerebrospinal fluid collection is an even rarer complication that has only been described to occur in the first few days postoperatively. Case Report: A 55-year-old male presented with progressive dysphagia and respiratory compromise 3 weeks after anterior cervical discectomy and fusion surgery at C3-C6. Imaging demonstrated extensive fluid collection in the retropharyngeal space and lateral neck, resulting in displacement of the cricoid cartilage rightward and anteriorly while also narrowing the pharyngeal space...

Retropharyngeal hematoma is a rare disease triggered by neck trauma and can result in airway obstruction, requiring early recognition and consideration of tracheal intubation. We present a case of a 42-year-old woman brought to the emergency department with dyspnea after a traffic trauma, and a mild stridor was heard on cervical auscultation, indicating airway compromise. Contrast-enhanced computed tomography (CT) scan showed retropharyngeal hematoma. Considering her obesity and short neck, we performed awake fiberoptic intubation successfully without any complications...

A 60-year-old man intubated for airway protection after smoke inhalation, was found to have decompensated hypercapnic respiratory failure. Fiberoptic bronchoscopy revealed obstructive airway slough and pseudomembrane, a manifestation of severe inhalation injury. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was established for stabilization. The airway casts were removed successfully with periprocedural VV-ECMO support.

Necrotizing soft tissue infection (NSTI) is a rare, but life-threatening, complication of head and neck surgery. We present a 70-year-old male with a history of immunosuppression who presented with polymicrobial NSTI following parotidectomy and neck dissection for cutaneous squamous cell carcinoma. The objective of this report was to promote awareness for NSTI following parotidectomy and selective neck dissection and highlight the management measures that can optimize survival outcomes. We performed a database search that identified 1,025 citations, of which 5 articles described classified as craniocervical necrotizing fasciitis following major head and neck surgery...

BACKGROUND: Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematically analysed the opinions of an expert panel. Expert opinion was combined with available evidence to determine what constitutes appropriate and inappropriate judgement in the diagnosis and management of BII...

RATIONALE: Nemaline myopathy (NM) is a congenital disease characterized by nonprogressive or slowly progressing muscle weakness and may increase the risk of anesthesia in case of respiratory muscle or cardiac involvement. Care should be taken to prevent respiratory failure after surgery. PATIENT CONCERNS: A 35-year-old man with NM, who had difficult airway, restrictive ventilatory pattern, and pulmonary hypertension, required general anesthesia for surgery because of limited mouth opening...

Vascular anomalies of the head and neck frequently involve the upper aerodigestive tract and can cause some level of airway obstruction. It is important to fully evaluate the extent of a lesion and resultant functional impairment with a flexible fiberoptic laryngoscopy. Treating these lesions is difficult and considering how to manage the airway during a procedure is critical. A multidisciplinary approach should be used for airway management with alternative intubation plans established prior to induction of anesthesia...

BACKGROUND: Obesity is a well-recognized risk factor for difficult intubation. To safely manage and overcome airway challenges in severely obese patients with a suspected difficult airway, awake fiberoptic intubation is recommended. We aimed to investigate the utility of awake nasal fiberoptic intubation in severely obese patients with suspected difficult airway while positioning them in the lateral decubitus position. METHODS: This randomized controlled trial compared lateral and supine positions for awake nasal fiberoptic intubation in severely obese patients with an anticipated difficult airway by assessing the success rate, time needed to secure the airway, peri-procedural adverse events, and postoperative satisfaction of patients...

No abstract text is available yet for this article.

The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI...

STUDY OBJECTIVE: Videolaryngoscopes are widely used to visualize difficult airways. Our aim was to compare the GlideScope and C-MAC D-blade videolaryngoscopes for double-lumen tube (DLT) intubation in patients with difficult airways. DESIGN: A multi-center, prospective, randomized controlled trial. SETTING: Three comprehensive tertiary, high-volume hospitals from 5 December 2020 to 4 November 2021. PATIENTS: We included 348 adult patients with anticipated difficult airways who underwent elective thoracic surgery...

INTRODUCTION: Prolonged endotracheal intubation was found to be a risk factor for pulmonary aspiration following the extubation. In this study, we have tried to analyze the prevalence of airway penetration and aspiration among mechanically ventilated patient who received mechanical ventilation for a period of 48 hours or more. MATERIALS AND METHODS: This cross-sectional study was done among non-neurologic critically ill patients who had an endotracheal tube for more than 48 hours and who got extubated subsequently...

Airway clearance is crucial for successful fiberoptic intubation. We hypothesized that tongue retraction using a McIvor blade could facilitate fiberoptic intubation. This randomized clinical trial aimed to compare intubation time and airway condition between the jaw thrust maneuver and tongue retraction with the McIvor blade during fiberoptic intubation. Ninety-four adult patients scheduled for elective surgery were randomly assigned to one of two groups. During fiberoptic intubation, airway clearance was secured by applying the jaw-thrust maneuver (J group) or by tongue retraction using the McIvor blade (M group)...

The main objective of this systematic review and meta-analysis was to determine the safety and effectiveness of VivaSight double-lumen tubes (VS-DLTs) in one-lung ventilation (OLV) compared to conventional DLTs (c-DLTs). The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement's guidelines. From the database's inception to December 2022, we searched seven different databases. We included 364 patients from six randomized controlled trials who were scheduled to undergo surgery requiring OLV...

In specific clinical scenarios, fiberoptic intubation (FOI) may be the preferred technique for airway management and endotracheal intubation. In addition to topical anesthesia of the airway, sedation is frequently necessary, especially in younger patients, to facilitate the procedure. The goal is to facilitate the procedure by providing sedation, anxiolysis, and analgesia with maintenance of spontaneous ventilation. Remimazolam is a novel benzodiazepine with a short half-life and limited context sensitive half-life that can be titrated by continuous infusion...

Angioedema is a potentially life-threatening condition due to the risk of airway compromise leading to deterioration of respiratory function, hypoxia, and ultimately, cardiopulmonary arrest. It can be either unprovoked or triggered by pharmaceutical agents, emotional or physiologic factors, upper airway trauma, or surgical stress. A 46-year-old man previously prescribed perindopril developed angioedema of the tongue 4 h after being discharged from the Post Anesthesia Care Unit (PACU). A multidisciplinary team was called and they outlined an airway management strategy to use in the event of worsening...

Airway management in patients with maxillary carcinoma presents unique challenges. To ensure safety, a tailored and collaborative approach is essential. This is a case where anesthetic plan of awake fiberoptic oral endotracheal intubation was chosen.