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Mohamed Naguib, Lara Brewer, Cristen LaPierre, Aaron F Kopman, Ken B Johnson
BACKGROUND: An unanticipated difficult airway during induction of anesthesia can be a vexing problem. In the setting of can't intubate, can't ventilate (CICV), rapid recovery of spontaneous ventilation is a reasonable goal. The urgency of restoring ventilation is a function of how quickly a patient's hemoglobin oxygen saturation decreases versus how much time is required for the effects of induction drugs to dissipate, namely the duration of unresponsiveness, ventilatory depression, and neuromuscular blockade...
July 2016: Anesthesia and Analgesia
Kong E You-Ten, Catherine Wong, Cristian Arzola, Jessica Cheung, Zeev Friedman, Sev Perelman, Naveed Siddiqui
PURPOSE: Simulation is an important alternative to evaluate cricothyrotomy, a rare life-saving procedure. This crossover study aimed to determine whether contextualization of a crisis scenario would impact the performance of a cricothyrotomy procedural task. METHODS: Sixty-five anesthesia assistants and emergency medicine and anesthesia residents underwent a teaching session in surgical cricothyrotomy using one of two sets of cricothyrotomy kits: the Portex 6.0 and Melker 3...
October 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tomoko Mine, Minori Wada, Ai Hashimoto, Kotaro Minami, Tetsuro Nikai, Noritaka Imamachi, Yoji Saito
A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. After adenotonsillectomy, upper airway obstruction due to hemorrhage and oropharyngeal swelling can be life-threatening requiring emergent airway management...
November 2014: Masui. the Japanese Journal of Anesthesiology
Satoko Noguchi, Futoshi Kimura, Takenori Sasaki, Anna Matsumoto, Toshinori Kasai, Kei Jinushi, Kazuyoshi Hirota, Hironori Ishihara
A 38-year-old man (BMI 31) underwent bilateral tonsillectomy for sleep apnea syndrome under general anesthesia without any airway difficulty. On the fifth post-operative day excessive bleeding occurred suddenly. Emergency tracheostomy was planned, not under local anesthesia but general anesthesia in the presence of otolaryngologists for urgent tracheostomy, since the patient could not lie in the supine position. Tracheal intubation was tried using rapid sequence technique. However, excessive bleeding in the oral cavity did not allow successful direct laryngoscopy, resulting in CICV situation...
October 2014: Masui. the Japanese Journal of Anesthesiology
David T Wong, Arpan Mehta, Amanda D Tam, Brian Yau, Jean Wong
INTRODUCTION: The purpose of this survey was to determine the equipment that anesthesiologists prefer in difficult tracheal intubation and "cannot intubate, cannot ventilate" (CICV) situations. METHODS: A questionnaire was e-mailed to members of the Canadian Anesthesiologists' Society to ascertain their preferences, experience, and comfort level with regard to their use of airway equipment in difficult intubation and CICV situations in adult patients. A Chi square test was used to analyse the data...
August 2014: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Nobuko Tachibana, Yukitoshi Niiyama, Michiaki Yamakage
PURPOSE: The purpose of this study was to investigate the incidence of cannot intubate-cannot ventilate (CICV) during general anesthesia during a 3-year period in a network of university hospitals and to evaluate the events related to it. METHODS: A retrospective multicenter questionnaire survey of CICV, based on medical record review, was conducted over a 3-year period (January 2010-December 2012) in Hokkaido, Japan. All cases were assessed in terms of the suspected risk factors of CICV, the clinical course during anesthesia, and the prognosis...
June 2015: Journal of Anesthesia
Kuniko Morishima, Satoshi Kurita, Yoshihiro Yamama, Keiji Nakatani
The first case was a 69-year-old woman with rheumatoid arthritis undergoing posterior occipito-cervical fusion. Although the operation was successfully performed, airway obstruction developed immediately after extubation. Her upper airway obstruction probably came from pharyngolaryngeal edema. The second case was a 59-year-old man with diabetes mellitus undergoing anterior cervical fusion. The day of surgery, he complained of dyspnea and his neck was swollen with hematoma. We used cricothyrotomy tubes (Mini-Trach II) in these two patients with postoperative upper airway obstruction and performed assist-ventilation via the tube...
December 2013: Masui. the Japanese Journal of Anesthesiology
Carrie F P Wong, Vivian M Yuen, Gordon T C Wong, Jensen To, Michael G Irwin
INTRODUCTION: Limited information is available on the management of the 'cannot intubate, cannot ventilate' (CICV) situation in infants. We compared the time to achieve adequate oxygenation following rescue ventilation using the Enk oxygen flow modulator (OFM) with a jet ventilator in a simulated CICV situation using the rabbit as an infant respiratory model. METHODS: Following institutional ethics committee approval, needle cricothyrotomy was performed under direct vision in nine anesthetized rabbits following surgical exposure of the larynx...
February 2014: Paediatric Anaesthesia
Robert Walker, Kumar G Belani, Elizabeth A Braunlin, Iain A Bruce, Henrik Hack, Paul R Harmatz, Simon Jones, Richard Rowe, Guirish A Solanki, Barbara Valdemarsson
This paper provides a detailed overview and discussion of anaesthesia in patients with mucopolysaccharidosis (MPS), the evaluation of risk factors in these patients and their anaesthetic management, including emergency airway issues. MPS represents a group of rare lysosomal storage disorders associated with an array of clinical manifestations. The high prevalence of airway obstruction and restrictive pulmonary disease in combination with cardiovascular manifestations poses a high anaesthetic risk to these patients...
March 2013: Journal of Inherited Metabolic Disease
R Curtis, S Lomax, B Patel
A 78-yr-old woman presented for a panendoscopy to investigate dysphonia and dysphagia. Intubation was anticipated to be difficult but possible, and mask ventilation was anticipated to be possible. After induction of anaesthesia and after three attempts at intubation, a 'can't intubate, can ventilate' situation deteriorated to a 'can't intubate, can't ventilate' (CICV) situation. Rocuronium-induced neuromuscular block was successfully reversed with sugammadex, as evidenced by the restoration of diaphragmatic movement, the ability of the patient to move her limbs, and the presence of a train-of-four nerve stimulation with no fade; however, ventilation was still not possible...
April 2012: British Journal of Anaesthesia
S Boet, B C R Borges, V N Naik, L W Siu, N Riem, D Chandra, M D Bould, H S Joo
BACKGROUND: Simulation has been shown to be effective in teaching complex emergency procedural skills. However, the retention of these skills for a period of up to 1 yr has not been studied. We aimed to investigate the 6 month and 1 yr retention of the complex procedural skill of cricothyroidotomy in attending anaesthetists using a high-fidelity-simulated cannot intubate, cannot ventilate (CICV) scenario. METHODS: Thirty-eight attending anaesthetists participated individually in a high-fidelity-simulated CICV scenario (pretest) that required a cricothyroidotomy for definitive airway management...
October 2011: British Journal of Anaesthesia
J Fabregat-López
Following hemi-glossectomy and right neck dissection a 63-year-old female patient presented as an emergency with a large neck hematoma. There were significant concerns over difficulty in intubation and mask ventilation leading to deterioration into a cannot intubate cannot ventilate (CICV) situation. After careful discussion and planning with the surgical team, who planned a tracheostomy, the situation was salvaged using a ProSealTM Laryngeal Mask Airway (PLMA). The PLMA enabled rapid establishment of a clear airway early in anesthetic induction, controlled ventilation and safe airway maintenance during a difficult tracheostomy...
May 2012: Minerva Anestesiologica
Maria M Zestos, Dima Daaboul, Zulfiqar Ahmed, Nasser Durgham, Roland Kaddoum
We describe a novel non surgical technique to maintain oxygenation and ventilation in a case of difficult intubation and difficult ventilation, which works especially well with poor mask fit. Can not intubate, can not ventilate" (CICV) is a potentially life threatening situation. In this video we present a simulation of the technique we used in a case of CICV where oxygenation and ventilation were maintained by inserting an endotracheal tube (ETT) nasally down to the level of the naso-pharynx while sealing the mouth and nares for successful positive pressure ventilation...
2011: Journal of Visualized Experiments: JoVE
C Murphy, S J Rooney, C H Maharaj, J G Laffey, B H Harte
BACKGROUND: Emergency cricothyroidotomy is a potentially life-saving procedure in the 'cannot intubate cannot ventilate (CICV)' scenario. Although surgical cricothyroidotomy remains the technique recommended in many 'CICV' algorithms, the insertion of a tracheostomy as a cannula over a trocar, or using the Seldinger method, may have advantages as they are more familiar to the anaesthetist. We compared the utility of three cuffed cricothyroidotomy devices: cuffed Melker®, Quicktrach 2®, and PCK® devices, with surgical cricothyroidotomy...
January 2011: British Journal of Anaesthesia
D Chambers, M Paulden, F Paton, M Heirs, S Duffy, J M Hunter, M Sculpher, N Woolacott
Sugammadex 16 mg kg⁻¹ can be used for the immediate reversal of neuromuscular block 3 min after administration of rocuronium and could be used in place of succinylcholine for emergency intubation. We have systematically reviewed the efficacy and cost-effectiveness and made an economic assessment of sugammadex for immediate reversal. The economic assessment investigated whether sugammadex appears cost-effective under various assumptions about the value of any reduction in recovery time with sugammadex, the likelihood of a 'can't intubate, can't ventilate' (CICV) event, the age of the patient, and the length of the procedure...
November 2010: British Journal of Anaesthesia
Masashi Kawamoto
Difficult airway management (DAM) including cannot intubate and cannot ventilate (CICV), and difficult mask ventilation is a life threatening issue during anesthesia care. Although American Society of Anesthesiologists (ASA) has presented the guideline for this purpose, it is still not available in this country. We as a specialist for airway management should be prepared this trouble any time by equipping a laryngoscope, fiberoptic bronchoscope, and novel devices such as Airway Scope and Airtraq.
September 2010: Masui. the Japanese Journal of Anesthesiology
Bruno C R Borges, Sylvain Boet, Lyndon W Siu, Heinz R Bruppacher, Viren N Naik, Nicole Riem, Hwan S Joo
PURPOSE: Although guidelines for difficult airway management have been published, the extent to which consultant anesthesiologists follow these guidelines has not been determined. The purpose of this study is to observe how consultant anesthesiologists manage a "cannot intubate, cannot ventilate" (CICV) scenario in a high-fidelity simulator and to evaluate whether a simulation teaching session improves their adherence to the American Society of Anesthesiologists (ASA) difficult airway algorithm...
July 2010: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Shinya Uchida, Koichi Nishikawa, Tatsuji Mizukami, Shigeru Saito
Myasthenia gravis (MG) is an autoimmune disorder characterized by loss of acetylcholine receptors (AChR) due primarily to the production of anti-AChR autoantibodies. We report here a case of anesthetic management of MG patient associated with difficult airway. A 58-year-old woman, 150 cm in height and 43 kg in weight, was scheduled for elective thymectomy. Preoperative evaluation using Mallampati classification, mouth opening, and thyromental distance did not predict airway difficulty. After anesthetic induction with propofol and sevoflurane, mask ventilation was performed easily...
July 2009: Masui. the Japanese Journal of Anesthesiology
Jorge E Zamora, Tarit K Saha
PURPOSE: The Combitube has been shown to be effective in many airway management scenarios. We describe its use as a rescue device in a "cannot intubate cannot ventilate" (CICV) situation that was encountered during a Cesarean delivery (CD) followed by transient cranial nerve dysfunction. CLINICAL FEATURES: A 24-yr-old gravida 4 para 1 (weight 112 kg, body mass index 44 kg.m(-2)) at 34 weeks gestation, with pregnancy induced hypertension and a prior history of uneventful airway management, presented for urgent CD...
November 2008: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
P M Kuduvalli, A Jervis, S Q M Tighe, N M Robin
This prospective study on a medium-fidelity simulator (SimMan, Laerdal Medical Corporation, Wappingers Falls, NY, USA) examined the management of unanticipated difficult airway by 21 anaesthetists and the effect of training in this context. There were two scenarios investigated: 'cannot intubate, can ventilate' (CI) and 'cannot intubate, cannot ventilate' (CICV). Following initial evaluation, volunteers underwent training in the 'Difficult Airway Society' (DAS) algorithms and associated technical skills. At 6-8 weeks and 6-8 months, performance was compared with the initial evaluation...
April 2008: Anaesthesia
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