Prehospital Surgical Airway Management: An NAEMSP Position Statement and Resource Document

Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

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A retrospective study of surgical airway management in prehospital settings

Journal of the Japanese Society of Intensive Care Medicine ◽

10.3918/jsicm.22.105 ◽

2015 ◽

Vol 22 (2) ◽

pp. 105-111

Author(s):

Kazuaki Shigemitsu ◽

Hirotaka Sawano ◽

Tomoaki Natsukawa ◽

Yasuyuki Hayashi ◽

Tatsuro Kai

Keyword(s):

Retrospective Study ◽

Airway Management ◽

Surgical Airway

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Airway Management in Accident and Emergency

10.5772/intechopen.96477 ◽

2021 ◽

Author(s):

Kemal Tolga Saracoglu ◽

Gul Cakmak ◽

Ayten Saracoglu

Keyword(s):

Airway Management ◽

Rapid Sequence Intubation ◽

Training Materials ◽

Accident And Emergency ◽

Rapid Sequence ◽

Surgical Airway ◽

Tracheobronchial Injury ◽

Airway Devices ◽

Stabilization Technique ◽

Extraglottic Airway Devices

Accidents are associated with airway complications. Tracheobronchial injury, pneumothorax, pneumomediastinum, atelectasis, and subcutaneous emphysema can be observed. Therefore airway management in emergency medicine requires skills and equipment. Rapid-sequence intubation, effective preoxygenation, apneic oxygenation, manual inline stabilization technique should be used properly. Rapid-sequence intubation consists of sedation, analgesia, and muscle paralysis components. Videolaryngoscopes, supraglottic and extraglottic airway devices, bougie and surgical airway tools are among training materials. A range of training materials have been described to improve providers’ understanding and knowledge of patient safety. In conclusion providing oxygenation, minimizing the risk of complications and choosing the appropriate devices constitute the airway management’s pearls.

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