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Difficult intubation prediction

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https://www.readbyqxmd.com/read/27900760/choice-of-anaesthesia-for-category-1-caesarean-section-in-women-with-anticipated-difficult-tracheal-intubation-the-use-of-decision-analysis
#1
A J Krom, Y Cohen, J P Miller, T Ezri, S H Halpern, Y Ginosar
A predicted difficult airway is sometimes considered a contra-indication to rapid sequence induction of general anaesthesia, even in an urgent case such as a category-1 caesarean section for fetal distress. However, formally assessing the risk is difficult because of the rarity and urgency of such cases. We have used decision analysis to quantify the time taken to establish anaesthesia, and probability of failure, of three possible anaesthetic methods, based on a systematic review of the literature. We considered rapid sequence induction of general anaesthesia with videolaryngoscopy, awake fibreoptic intubation and rapid spinal anaesthesia...
November 30, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27891428/fiberoptic-guided-retrograde-intubation-in-an-anticipated-difficult-airway-revival-of-an-antiquated-technique
#2
Samarjit Dey, Marie Ninu, Md Yunus, Newstar Syiemiong
Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation...
October 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27887736/use-of-clarus-video-system-%C3%A2-in-expected-difficult-airway-in-a-patient-with-rett-syndrome
#3
L España Fuente, R E Méndez Redondo, J L González González
Difficult airway management remains one of the key points in our specialty, as the difficulty or impossibility of tracheal intubation is the main cause of morbidity/mortality attributable to anaesthesia. Rett syndrome is a severe and incapacitating neurological disease. We present the case of a 21-year-old girl affected by this syndrome, with significant psychomotor retardation and difficult airway predictors, who was scheduled to have a laparoscopic cholecystectomy under general anaesthesia. We decided on one attempt of Clarus Video System(®) fiberoptic intubation as primary intervention...
November 22, 2016: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27882541/prediction-of-difficult-mask-ventilation-using-a-systematic-assessment-of-risk-factors-vs-existing-practice-a-cluster-randomised-clinical-trial-in-94-006-patients
#4
A K Nørskov, J Wetterslev, C V Rosenstock, A Afshari, G Astrup, J C Jakobsen, J L Thomsen, L H Lundstrøm
We compared implementation of systematic airway assessment with existing practice of airway assessment on prediction of difficult mask ventilation. Twenty-six departments were cluster-randomised to assess eleven risk factors for difficult airway management (intervention) or to continue with their existing airway assessment (control). In both groups, patients predicted as a difficult mask ventilation and/or difficult intubation were registered in the Danish Anaesthesia Database, with a notational summary of airway management...
November 24, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27871545/fiberoptic-guided-intubation-after-insertion-of-the-i-gel-airway-device-in-spontaneously-breathing-patients-with-difficult-airway-predicted-a-prospective-observational-study
#5
Julian Arévalo-Ludeña, Jose Juan Arcas-Bellas, Rafael Alvarez-Rementería, Luis Enrique Muñoz Alameda
STUDY OBJECTIVE: To assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway. DESIGN: Prospective observational study. SETTING: Operating room in a tertiary care hospital. PATIENTS: Eighty-five adult patients with at least 3 difficult airway predictors or difficult airway management history were included...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27871527/two-lost-airways-and-one-unexpected-problem-undiagnosed-tracheal-stenosis-in-a-morbidly-obese-patient
#6
Miguel A Cobas, Nicole D Martin, Heather B Barkin
Anesthetic care of the morbidly obese is complex due to anatomic and physiologic alterations. Airway management in particular can be challenging. High body mass index is predictive of difficult ventilation and possibly difficult intubation. Other airway anomalies, such as tracheal stenosis, add to the complexity of airway management. Tracheal stenosis, a form of central airway obstruction, may be challenging to diagnose, especially in the obese. Comorbidities can mask the diagnosis and routine imaging may fail to identify the pathology...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27866310/prediction-of-difficult-laryngoscopy-using-spirometry-a-pilot-study
#7
Serkan Dogru, Tugba Karaman, Aynur Sahin, Hakan Tapar, Serkan Karaman, Semih Arici, Mustafa Suren, Ziya Kaya, Battal Tahsin Somuk
Prediction of difficult laryngoscopy is still the uncovered secret of anesthetic practice. This pilot study is aimed to assess the efficacy of spirometry measurements in predicting difficult laryngoscopy compared with conventional airway assessment techniques. We enrolled 202 adults, ages 18-40 years, with an American Society of Anaesthesiologists score of I or II, scheduled for elective surgery and undergoing general anesthesia. Spirometry was used for lung capacity measurements before the operation. The Mallampati classification, neck circumference, sternomental distance, thyromental distance, maximum mouth-opening measurement, and upper lip bite test of the subjects were measured...
November 19, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27844477/videolaryngoscopy-versus-direct-laryngoscopy-for-adult-patients-requiring-tracheal-intubation
#8
REVIEW
Sharon R Lewis, Andrew R Butler, Joshua Parker, Tim M Cook, Andrew F Smith
BACKGROUND: Successful tracheal intubation during general anaesthesia traditionally requires a line of sight to the larynx attained by positioning the head and neck and using a laryngoscope to retract the tongue and soft tissues of the floor of the mouth. Difficulties with intubation commonly arise, and alternative laryngoscopes that use digital and/or fibreoptic technology have been designed to improve visibility when airway difficulty is predicted or encountered. Among these devices, a rigid videolaryngoscope (VLS) uses a blade to retract the soft tissues and transmits a lighted video image to a screen...
November 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27804108/tracheal-extubation-of-the-adult-intensive-care-patient-with-a-predicted-difficult-airway-a-narrative-review
#9
REVIEW
D J Sturgess, K B Greenland, S Senthuran, F A Ajvadi, A van Zundert, M G Irwin
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment...
November 2, 2016: Anaesthesia
https://www.readbyqxmd.com/read/27798767/practical-management-of-anaesthesia-in-the-elderly
#10
Camilla Strøm, Lars Simon Rasmussen, Jacob Steinmetz
The elderly population is rapidly growing and particularly diverse. Ageing leads to reduced organ function and a decline in physiologic reserve. Elderly patients are characterised by great inter-individual variability in physiological function with a high prevalence of chronic disease. In general, older patients have a higher risk of postoperative adverse outcomes, and frailty is a very important risk factor. This review article aims to provide a practical guide to anaesthetic management of the elderly surgical patient...
October 31, 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27697130/lack-of-national-consensus-in-preoperative-airway-assessment
#11
Anders K Nørskov, Charlotte V Rosenstock, Lars H Lundstrøm
INTRODUCTION: Difficult airway management is associated with an increased risk of morbidity and mortality. Several preoperative risk factors associated with airway management difficulties have been proposed; however, no clear guideline for airway assessments exists. We therefore hypothesised that Danish airway assessment was lacking uniformity. We aimed to examine whether multivariable risk assessment tools and predictors for difficult intubation and mask ventilation were used systematically...
October 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27687435/king-vision-video-laryngoscope-versus-lightwand-as-an-intubating-device-in-adult-patients-with-mallampatti-grade-iii-and-iv-patients
#12
Shadab Kamal, Qazi Ehsan Ali, Syed Hussain Amir, Sarfaraz Ahmed, Krochi Pal
STUDY OBJECTIVE: Anticipated and unanticipated difficult airways are often encountered by anesthesiologists in their clinical practice. There are various devices available in such situations. We aim to compare King Vision video laryngoscope and Lightwand for their performance as an intubating device in predicted difficult intubation. DESIGN: Prospective, randomized, single blind study. SETTING: Jawaharlal Nehru Medical College. PATIENTS: Sixty ASA 1 and 2 with Mallampati grade III and IV...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27684833/use-of-the-glidescope-video-laryngoscope-for-intubation-during-ex-utero-intrapartum-treatment-in-a-fetus-with-a-giant-cyst-of-the-4th-branchial-cleft-a-case-report
#13
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27592722/a-predictive-test-for-difficult-intubation-in-laryngeal-microsurgery-validation-study
#14
I Belda, M A Ayuso, X Sala-Blanch, M Luis, R Bergé
BACKGROUND: In 2003 a simple test to detect difficult intubation (DI) in patients underwent laryngeal microsurgery was described. The present study was conducted to validate the test. METHODS: Patients with laryngeal disease scheduled for laryngeal microsurgery were included. The variables evaluated were eleven parameters: Mallampati Score ≥III, thyromental distance <6.5cm, mouth opening <40mm, limitation of the temporomandibular joint, pathological dentition, arched paladet, maxillary deficiency, neck mobility <90°, body mass index, symptoms of laryngeal dysfunction, and tumour of supraglottic region...
September 1, 2016: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27582532/effectiveness-and-validity-of-sonographic-upper-airway-evaluation-to-predict-difficult-laryngoscopy
#15
Pawel Andruszkiewicz, Jacek Wojtczak, Dorota Sobczyk, Orest Stach, Ilona Kowalik
OBJECTIVES: Our objective was to evaluate the effectiveness of 9 airway sonographic parameters imaged from the submandibular view as predictors of difficult laryngoscopy. Additionally, we aimed to evaluate the validity of the models of combined sonographic and clinical tests in predicting difficult laryngoscopy. METHODS: This study analyzed a sample of 199 patients who were categorized as having easy (grades 1 and 2) or difficult (grades 3 and 4) laryngoscopy during general anesthesia with endotracheal intubation based on the laryngoscopic criteria of Cormack and Lahane (Anaesthesia 1984; 39:1105-1111)...
October 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27576447/association-between-off-hour-presentation-and-endotracheal-intubation-related-adverse-events-in-trauma-patients-with-a-predicted-difficult-airway-a-historical-cohort-study-at-a-community-emergency-department-in-japan
#16
Yuko Ono, Takuya Sugiyama, Yasuyuki Chida, Tetsuya Sato, Hiroaki Kikuchi, Daiji Suzuki, Masakazu Ikeda, Koichi Tanigawa, Kazuaki Shinohara
BACKGROUND: A reduction in medical staff such as occurs in hospitals during nights and weekends (off hours) is associated with a worse outcome in patients with several unanticipated critical conditions. Although difficult airway management (DAM) requires the simultaneous assistance of several appropriately trained medical caregivers, data are scarce regarding the association between off-hour presentation and endotracheal intubation (ETI)-related adverse events, especially in the trauma population...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27555135/airway-risk-factors-for-the-miller-laryngoscope-blade
#17
William B Landry, Bobby D Nossaman
STUDY OBJECTIVE: The purpose of this study was to analyze previously reported airway risk factors in the performance of Miller laryngoscopy and orotracheal intubation. DESIGN: Prospective, observational study. SETTING: Operating rooms. PATIENTS: A total of 978 American Society of Anesthesiologists I-III adults requiring general orotracheal anesthesia for elective surgery. INTERVENTIONS: None. MEASUREMENTS: Nine previously reported airway risk factors used in predicting difficult laryngoscopy, modified McCormack-Lehane views observed during initial unaided Miller blade laryngoscopy, and number of attempts or need for alternate airway tools to facilitate orotracheal intubation...
September 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27529028/role-of-upper-airway-ultrasound-in-airway-management
#18
REVIEW
Adi Osman, Kok Meng Sum
Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27501601/the-performance-of-the-neck-circumference-for-a-difficult-laryngoscopy-in-obese-patients
#19
Arunotai Siriussawakul, Sirirat Rattana-arpa, Sukanya Jirachaipitak, Anan Chatsiriphattana, Akarin Nimmannit, Nujira Wong-in
BACKGROUND AND OBJECTIVE: There is conflicting evidence as to whether neck circumference (NC) is related to a difficult laryngoscopy in obese patients. The objectives of this study were to determine the performance of the NC in defining a difficult laryngoscopy, and to identify factors predicting a difficult laryngoscopy among those obese patients. MATERIAL AND METHOD: This prospective study was conducted in adult patients with a body mass index (BM) of greater or equal to 30 kg/m² who underwent conventional endotracheal intubation...
May 2016: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
https://www.readbyqxmd.com/read/27483183/hyomental-distance-in-the-different-head-positions-and-hyomental-distance-ratio-in-predicting-difficult-intubation
#20
Nevena Kalezić, Mirko Lakićević, Biljana Miličić, Marina Stojanović, Vera Sabljak, Dejan Marković
The hyomental distance ratio (HMDR) is the ratio between the hyomental distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI). A prospective study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI)...
August 2, 2016: Bosnian Journal of Basic Medical Sciences
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