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Difficult intubation prediction

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https://www.readbyqxmd.com/read/29349354/awake-intubation-in-a-patient-with-huge-orocutaneous-fistula-a-case-report
#1
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/29331494/a-novel-difficult-airway-prediction-tool-for-emergency-airway-management-validation-of-the-heaven-criteria-in-a-large-air-medical-cohort
#2
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/29306118/diagnostic-accuracy-of-radiology-ct-x-ray-us-for-predicting-difficult-intubation-in-adults-a-meta-analysis
#3
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/29284863/evaluation-of-effectiveness-of-dexmedetomidine-and-fentanyl-midazolam-combination-on-sedation-and-safety-during-awake-fiberoptic-intubation-a-randomized-comparative-study
#4
Abida Yousuf, Basharat Ahad, Aabid Hussain Mir, Abdul Waheed Mir, Juvera Gul Wani, Sheikh Quyoom Hussain
Background: Awake fiberoptic intubation (AFOI) is a recommended technique for anticipated difficult airway. An ideal regime should provide patient comfort, cooperation, amnesia, hemodynamic stability, and blunt airway reflexes and maintain a patent airway with spontaneous ventilation. The aim of our study was to compare intubation conditions between dexmedetomidine and fentanyl-midazolam combination during AFOI. Methods: This prospective, randomized study was conducted on a total of sixty patients of the American Society of Anesthesiologists physical status I and II of either sex, in the age group of 18-60 years having predicted difficult intubation undergoing elective surgeries and the patients were allocated to two groups of thirty patients each...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29262440/who-is-safe-to-extubate-in-the-neuroscience-intensive-care-unit
#5
Julian Bösel
Patients admitted to the neuroscience intensive care unit (NICU) may have respiratory compromise from either central or peripheral neurological pathology, and may hence require intubation and mechanical ventilation for very diverse reasons. Liberation from invasive ventilation, that is, extubation, at the earliest possible time is a widely accepted principle in intensive care. For this, classic extubation criteria have been established in the general critical care setting, mainly targeting pulmonary function and cooperativeness of the patient...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29242648/enhancing-airway-assessment-of-patients-with-head-and-neck-pathology-using-virtual-endoscopy
#6
Imran Ahmad, Oliver Keane, Sarah Muldoon
Studies have demonstrated that poor assessment and planning contribute to airway complications and that current airway assessment strategies have a poor diagnostic accuracy in predicting difficult intubation in the general population. Patients with head and neck pathology are at higher risk for difficulties during airway management and are more likely to need emergency surgical access. Therefore, thorough assessment of this group of patients is mandatory. The addition of virtual endoscopy (VE) to clinical history and computerised tomography imaging has been shown to improve diagnostic accuracy for supraglottic, glottic and infraglottic lesions and has a positive influence in formulating a more cautious and thorough airway management strategy in this high-risk group of patients...
October 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29216230/a-comprehensive-scoring-system-in-correlation-with-perioperative-airway-management-for-neonatal-pierre-robin-sequence
#7
Ning Yin, Lei Fang, Xiaohua Shi, Hongqiang Huang, Li Zhang
PURPOSE: To evaluate a comprehensive scoring system which combines clinical manifestations of Pierre Robin Sequence (PRS) including severity of breathing difficulties, body weight and preoperative Cormack-Lehane grade, for its correlation with perioperative PRS airway management decision. DESIGN: Forty PRS children were retrospectively recruited after surgery. Specialists examined all subjects and scored for clinical manifestations (1´ - 4´), weight gain (1´- 4´), dyspnea scores (1´- 4´), and Cormack-Lehane grade (1´- 4´)...
2017: PloS One
https://www.readbyqxmd.com/read/29205678/perioperative-management-of-gastrostomy-tube-placement-in-duchenne-muscular-dystrophy-adolescent-and-young-adult-patients-a-role-for-a-perioperative-surgical-home
#8
Ariane Boivin, Richard Antonelli, Navil F Sethna
BACKGROUND: In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. AIMS: The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity...
December 5, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29201360/are-physician-assistant-and-patient-airway-assessments-reliable-compared-to-anesthesiologist-assessments-in-detecting-difficult-airways-in-general-surgical-patients
#9
Erin Payne, Jacqueline Ragheb, Elizabeth S Jewell, Betsy P Huang, Angela M Bailey, Laura M Fritsch, Milo Engoren
Background: Airway management remains one of the most important responsibilities of anesthesiologists. Prediction of difficult airway allows time for proper selection of equipment, technique, and personnel experienced in managing patients with difficult airway. Face to face preoperative anesthesia interviews are difficult to conduct as they necessitate patients traveling to the clinics, and, in practice, are usually conducted in the morning of the procedure by the anesthesiologist, when identification of predictors of difficult intubation may lead to schedule delays or case cancelations...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/29191205/different-effects-of-cardiac-and-diaphragm-function-assessed-by-ultrasound-on-extubation-outcomes-in-difficult-to-wean-patients-a-cohort-study
#10
Ling Luo, Yidan Li, Xiukai Chen, Bing Sun, Wenxiong Li, Wei Gu, Shuo Wang, Song Zhao, Yanwei Lv, Mulei Chen, Jingen Xia, Feng Sui, Xue Mei, Huanzhong Shi, Zhaohui Tong
BACKGROUND: Ultrasound is a convenient tool to evaluate cardiac and diaphragm function. The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography (TTE) and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed in predicting extubation outcomes independently, however their different roles in the weaning process have not been determined until now. METHODS: We designed a cohort study to preform diaphragm ultrasound and TTE before and after the spontaneous breathing trial (SBT) in difficult-to-wean patients...
December 1, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/29162293/-difficult-laryngoscopy-and-tracheal-intubation-observational-study
#11
Rebeca Gonelli Albanez da Cunha Andrade, Bruno Luís Soares Lima, Douglas Kaíque de Oliveira Lopes, Roberto Oliveira Couceiro Filho, Luciana Cavalcanti Lima, Tania Cursino de Menezes Couceiro
INTRODUCTION: Since anesthesia complications associated with unexpected difficult airway are potentially catastrophic, they should be avoided. The modified Mallampati test and jaw-thrust maneuver enable the identification of difficult airway. The aim of this study was to associate the modified Mallampati test and the jaw-thrust maneuver with laryngoscopy (Cormack-Lehane) in an attempt to identify a better predictor of difficult airway in an adult population undergoing elective surgery...
November 20, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29151413/-effects-of-mechanical-ventilation-on-diaphragmatic-contractile-function-in-patients-with-aecopd
#12
Feifei Wang, Xiaoping Zhu, Changjing Zhang, Hui Zhu, Yu Feng, Yang Liu, Shaolin Ma
OBJECTIVE: To study diaphragmatic strength in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) during mechanical ventilation (MV), and to explore the predictive value of maximal transdiaphragm pressure (Pdi max) for successful extubation. METHODS: A prospective study was conducted. Twenty-one patients with AECOPD receiving MV admitted to intensive care unit (ICU) of Shanghai East Hospital of Tongji University of School Medicine from February 2015 to May 2017 were enrolled...
November 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29113010/comparison-of-four-methods-of-endotracheal-tube-passage-in-simulated-airways-there-is-room-for-improved-techniques
#13
Kirsten Kingma, Ross Hofmeyr, Irene Suilan Zeng, Christin Coomarasamy, Andrew Brainard
OBJECTIVE: Endotracheal intubation requires laryngoscopy followed by passage of the endotracheal tube (ETT). Tube passage can be difficult, but there is little evidence to support which adjunct for tube passage is most effective. METHODS: The four tube passage adjuncts tested were the naked ETT, stylet ETT, railroaded bougie and preloaded bougie. Participants completed pre- and post-test surveys identifying demographics, experience and method preference. After instruction, participants completed eight intubations on manikins with 'easy' and 'difficult' airways...
November 7, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29109635/correlation-between-preoperative-ultrasonographic-airway-assessment-and-laryngoscopic-view-in-adult-patients-a-prospective-study
#14
Aruna Parameswari, Mithila Govind, Mahesh Vakamudi
Background and Aims: Difficult tracheal intubation is associated with serious morbidity and mortality and cannot be always predicted based on preoperative airway assessment using conventional clinical predictors. Ultrasonographic airway assessment could be a useful adjunct, but at present, there are no well-defined sonographic criteria that can predict the possibility of encountering a difficult airway. The present study was conducted with the aim of finding some correlation between preoperative sonographic airway assessment parameters and the Cormack-Lehane (CL) grade at laryngoscopic view in adult patients...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28987399/review-of-difficult-airway-management-in-thoracic-surgery
#15
M Granell, M J Parra, M J Jiménez, L Gallart, A Villalonga, O Valencia, M C Unzueta, A Planas, J M Calvo
The management of difficult airway (DA) in thoracic surgery is more difficult due to the need for lung separation or isolation and frequent presence of associated upper and lower airway problems. We performed an article review analysing 818 papers published with clinical evidence indexed in Pubmed that allowed us to develop an algorithm. The best airway management in predicted DA is tracheal intubation and independent bronchial blockers guided by fibroscopy maintaining spontaneous ventilation. For unpredicted DA, the use of videolaryngoscopes is recommended initially, and adequate neuromuscular relaxation (rocuronium/sugammadex), among other maneuvers...
October 4, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28984098/role-of-flexible-fiberoptic-laryngoscopy-in-predicting-difficult-intubation
#16
Ying Guo, Yufang Feng, Hui Liang, Rubo Zhang, Xiaolan Cai, Xinliang Pan
BACKGROUND: The ability to precisely predict which intubations will be difficult during administration of anesthesia is an importantpart of preoperative preparation. This study's goal is to accurately identify patients who will be difficult to intubate using the number of tracheal rings observed preoperatively by fiberoptic laryngoscopy. METHODS: We enrolled 994 adult patients in our study who required general anesthesia and orotracheal intubation for their elective surgeries...
October 4, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28975073/usefulness-of-ultrasound-view-of-larynx-in-pre-anesthetic-airway-assessment-a-comparison-with-cormack-lehane-classification-during-direct-laryngoscopy
#17
Sussan Soltani Mohammadi, Alireza Saliminia, Nasim Nejatifard, Roxana Azma
BACKGROUND: One of the main challenges in anesthesiology is difficult intubation. There are many anatomical parameters for evaluating the feasibility of tracheal intubation; one that can reliably predict a difficult intubation is the Cormack-Lehane classification obtained during direct laryngoscopy. This is an invasive procedure that cannot be performed in an awake patient or for pre-anesthetic airway assessments in patients with no prior history of tracheal intubation. Recently, ultrasound has been successfully used for several airway-related applications...
December 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/28930848/nociceptive-stimulation-during-macintosh-direct-laryngoscopy-compared-with-mcgrath-mac-videolaryngoscopy-a-randomized-trial-using-indirect-evaluation-using-an-automated-administration-of-propofol-and-remifentanil
#18
RANDOMIZED CONTROLLED TRIAL
Rathvirak Ing, Ngai Liu, Thierry Chazot, Julien Fessler, Jean François Dreyfus, Marc Fischler, Morgan Le Guen
BACKGROUND: Decrease of the nociceptive stimulation induced by laryngoscopy could be an advantage for patients without risk of difficult intubation. The present study aimed to compare the difference in nociceptive stimulation between the use of a conventional laryngoscope or of a videolaryngoscope. Amount of nociception was assessed indirectly using the peak remifentanil concentration determined by a closed-loop administration of propofol and remifentanil with bispectral index (BIS) as the input signal (target 50)...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28918615/predicting-difficult-laryngoscopy-and-intubation-with-laryngoscopic-exam-test-a-new-method
#19
Mahmood Akhlaghi, Mohammadreza Abedinzadeh, Ali Ahmadi, Zohre Heidari
Airway assessment is fundamental skill for anesthesiologists and failure to maintain a patient's airway is the tremendous cause of anesthesia-related morbidity and mortality. None of the tests which have recommended for predicting difficult intubation stands out to be the best clinical test or have high diagnostic accuracy. Our study aimed to determine the utility of a new test as "laryngoscopic exam test (LET)" in predicting difficult intubation. Three hundred and eleven patients aged 16-60 years participated and completed the study...
July 2017: Acta Medica Iranica
https://www.readbyqxmd.com/read/28913492/incorporating-airway-examination-photography-into-the-electronic-record
#20
Joshua W Sappenfield, Nik Gravenstein, Judith M Wishin, Chukwudi Obiora Chiaghana, David Smyth, Brenda G Fahy, Terrie Vasilopoulos, Laurie Davies, F Kayser Enneking
BACKGROUND: Photography of the airway has been used in research to validate preoperative airway assessment and the likelihood of identifying the difficult-to-mask ventilate and/or intubate patient. Up till now, no study has demonstrated the perceived utility of incorporation of airway photographs into the anesthesia preassessment. METHODS: The University of Florida Health Presurgical Clinic routinely incorporates three photographs of all adult patients during their preanesthesia visit...
April 2017: Romanian Journal of Anaesthesia and Intensive Care
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