The Difficult Airway

2020 ◽  
pp. 93-108
Author(s):  
Rachael Craven ◽  
Rachel McKendry
Keyword(s):  
Decision Making ◽  
Airway Management ◽  
Difficult Airway ◽  
Nasal Intubation ◽  
Practical Advice ◽  
Ketamine Anaesthesia ◽  
Resource Poor ◽  
Difficult Airways ◽  
Management Techniques ◽  
Spontaneously Breathing

The difficult airway can be challenging to deal with in any setting. In resource-poor environments pathologies are often advanced, specialist equipment may be absent and trained assistance may be lacking, adding to the challenge. The chapter offers practical advice on assessment, planning, and management of difficult airways under these circumstances. Useful techniques considered include spontaneously breathing ketamine anaesthesia, airway topicalization for awake airway management techniques, blind nasal intubation, and awake tracheostomy. Common airway pathologies that may be encountered are described. Practical considerations regarding decision making for tracheostomy, care of tracheostomy on the ward, and management of tracheostomy emergencies are also discussed.

scholarly journals Application of Gum Elastic Bougie to Nasal Intubation

2010 ◽  
Vol 57 (3) ◽  
pp. 112-113 ◽  
Author(s):  
Hirofumi Arisaka ◽  
Shigeki Sakuraba ◽  
Munetaka Furuya ◽  
Kazutoshi Higuchi ◽  
Hitoshi Yui ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Tracheal Tube ◽  
Oral Surgery ◽  
Nasotracheal Intubation ◽  
Nasal Intubation ◽  
Difficult Airway Management ◽  
Dental Procedures ◽  
Difficult Airways

Abstract Gum elastic bougie (GEB), a useful device for difficult airway management, has seldom been used for nasotracheal intubation. Among 632 patients undergoing dental procedures or oral surgery, GEB was used successfully in 16 patients in whom conventional nasal intubation had failed because of anatomical problems or maldirection of the tip of the tracheal tube. We recommend that GEB should be applied from the first attempt for nasal intubation in patients with difficult airways.

scholarly journals Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Tolga Totoz ◽  
Kerem Erkalp ◽  
Sirin Taskin ◽  
Ummahan Dalkilinc ◽  
Aysin Selcan
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Pediatric Patient ◽  
Reconstructive Surgery ◽  
Management Technique ◽  
Anesthesia Induction ◽  
Nasal Intubation ◽  
Stepwise Approach ◽  
Patient Cooperation ◽  
Trial Phase

Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.

Difficult airway management for the anaesthetist

2019 ◽  
Vol 80 (8) ◽  
pp. 432-440 ◽  
Author(s):  
J Hews ◽  
K El-Boghdadly ◽  
I Ahmad
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Emergency Situation ◽  
Difficult Airway Management ◽  
Timely Manner ◽  
Management Techniques ◽  
Current Guidelines

This article reviews the key considerations when managing a patient with a difficult airway. The difficult airway may be anticipated from preassessment allowing time for investigations and preparation. Alternatively, the unanticipated difficult airway can present in an emergency situation, or unexpectedly during a routine anaesthetic. The main airway management techniques are discussed with a description of their advantages and limitations. Current guidelines are included that demonstrate how the techniques are incorporated into an overall strategy with a plan A–D when failure occurs. It is critical to progress through such an algorithm in a timely manner to prevent the onset of hypoxia.

scholarly journals Cuffed Oropharyngeal Airway for Difficult Airway Management

2014 ◽  
Vol 61 (3) ◽  
pp. 107-110
Author(s):  
Kazumi Takaishi ◽  
Shinji Kawahito ◽  
Shigemasa Tomioka ◽  
Satoru Eguchi ◽  
Hiroshi Kitahata
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Oral Surgery ◽  
Fiberoptic Bronchoscopy ◽  
Face Mask ◽  
Nasal Intubation ◽  
Difficult Airway Management ◽  
Oropharyngeal Airway ◽  
Controlled Ventilation ◽  
Retrograde Intubation

Abstract Difficulties with airway management are often caused by anatomic abnormalities due to previous oral surgery. We performed general anesthesia for a patient who had undergone several operations such as hemisection of the mandible and reconstructive surgery with a deltopectoralis flap, resulting in severe maxillofacial deformation. This made it impossible to ventilate with a face mask and to intubate in the normal way. An attempt at oral awake intubation using fiberoptic bronchoscopy was unsuccessful because of severe anatomical abnormality of the neck. We therefore decided to perform retrograde intubation and selected the cuffed oropharyngeal airway (COPA) for airway management. We inserted the COPA, not through the patient's mouth but through the abnormal oropharyngeal space. Retrograde nasal intubation was accomplished with controlled ventilation through the COPA, which proved to be very useful for this difficult airway management during tracheal intubation even though the method was unusual.

Management of the Difficult Airway

2018 ◽  
pp. 8-12
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Brain Damage ◽  
Retrospective Review ◽  
Historical Study ◽  
Difficult Airway Management ◽  
Management Planning ◽  
Review Analysis ◽  
Malpractice Claims ◽  
Difficult Airways

This chapter focuses on a study reviewing management of difficult airways to address the question: What are the patterns of liability associated with malpractice claims arising from cases involving difficult airway management? This was a historical study of cases of difficult airway claims occurring between 1985 and 1999, which were reviewed in conjunction with the success of the Difficult Airway Guidelines published in 1993. Although this is a retrospective review, analysis of difficult airway claims demonstrated a reduction in death or brain damage with induction of anesthesia in 1993–1999 compared with 1985–1992, suggesting that the Difficult Airway Guidelines published in 1993 improved airway management planning in cases with anticipated difficult airways.

scholarly journals ¿ Caminamos hacia el manejo del videolaringoscopio como primera opción en una vía aérea difícil?

2020 ◽  
Vol 12 (7) ◽  
pp. 1
Author(s):  
Juan José Correa Barrera ◽  
Mónica San Juan Álvarez ◽  
Blanca Gómez Del Pulgar Vázquez ◽  
Gholamian Ovejero Soraya
Keyword(s):  
Decision Making ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
The Other ◽  
Optimal Decision ◽  
Difficult Airway Management ◽  
Toma De Decisiones ◽  
Failed Airway ◽  
Optimal Decision Making

Determinar los factores predictivos de una vía aérea difícil constituye un reto para el médico anestesiólogo. La mayoría de guías actuales, sitúan los videolaringoscopios como elementos de rescate de una vía aérea fallida, tras una laringoscopia tradicional óptima. Establecer un algoritmo que en base a unas características físicas, permita determinar qué pacientes se beneficiarán del uso del videolaringoscopio como primera opción, puede suponer una ventaja y una disminución en los problemas relacionados con la vía aérea. Por otra parte, establecer cuáles de estos factores predicen con más fuerza una dificultad con el videolaringoscopio, nos ayudará a realizar mejores planes de abordaje y una óptima toma de decisiones sobre una vía aérea difícil. Este algoritmo ha sido capaz de conseguir la intubación traqueal de todos los pacientes en los que se ha previsto una laringoscopia difícil. ABSTRACT Moving towards videolaryngoscopy handling as first option in difficult airway management? Determining the predictors of a difficult airway is a challenge for the anesthesiologist. Most current guides place videolaryngoscopes as recue elements of a failed airway, after an optimal traditional laryngoscopy. Establishing an algorithm which, based on physical charcteristics, allows to determine which patients will benefit from the use of videolaryngoscopy as a first option, may lead to a potential advantage and a net decrease in airway related problems. On the other hand, establishing which of those factors predict in a more reliable way a difficulty with the videolaryngoscopy, will contribute to make better plans of approach as well as an optimal decision making on a difficult airway. This algorithm has been able to achieve tracheal intubation of all patients for which a difficult laryngoscopy is expected.

Formal Instruction in Difficult Airway Management: A Survey of Anesthesiology Residency Programs

1995 ◽  
Vol 83 (6) ◽  
pp. 1343-1346 ◽  
Author(s):  
James N. Koppel ◽  
Allan P. Reed
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management ◽  
Residency Programs ◽  
Formal Instruction ◽  
Difficult Airways ◽  
Mechanical Devices

Abstract Background Up to 30% of all deaths attributable to anesthesia are related to difficulties with airway management. The purpose of this study was to determine whether anesthesiology residents are receiving specialized instruction in the various techniques and mechanical devices currently recommended for airway management in patients with anticipated or unanticipated difficult airways.

scholarly journals A Survey of Residency Directors in Academic Trauma Centers for Policies on Airway Management in The Trauma Ward

2021 ◽  
Author(s):  
George Tewfik ◽  
Michal Gajewski ◽  
Jena Salem ◽  
Neil Borad ◽  
Michael Zales ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Improve Patient Care ◽  
The United States ◽  
Trauma Centers ◽  
Difficult Airways ◽  
Level I ◽  
Trauma Activation ◽  
Trauma Bay

Abstract Background Despite its presence as a critical procedure in the trauma setting, airway management is not performed uniformly, varying between institutions, particularly with personnel involved in decision-making. Past literature has noted a trend in which emergency medicine physicians assumed greater responsibility for primary management of airways in the trauma ward. In addition, many institutions have adopted tiered activation systems for traumas in order to improve patient care, deploying resources more effectively. In this study, a survey of residency directors was deployed to assess trends in airway management. Methods A validated survey was distributed to residency directors in anesthesiology, general surgery and emergency medicine in 190 Level I trauma centers in the United States. Questions assessed personnel management, complication tracking and difficult airway prediction factors, amongst other considerations for airway management in the trauma bay. Results Respondents completed the survey at a rate of 23.8% of those solicited. A majority of respondents indicated that emergency medicine physicians are primary airway managers in the trauma bay and that their institutions utilize tiered trauma activation systems at 77.4% and 95.6% respectively. Anesthesia providers were immediately available in 81% of respondent institutions with inconclusive data regarding protocols for delineating anesthesia involvement in difficult airways. More than a third of respondents indicated their institution either does not track airway complications or they did not know if complications were tracked. Finally, nine different criteria were used in varying degrees by respondents’ institutions to predict the presence of a difficult airway, including such factors as head/face trauma, airway fluid and obesity. Conclusion The trend towards airway management by emergency medicine physicians in the trauma bay continues, with anesthesia personnel available in many situations to assist in complicated patients. Complication tracking for airway management remains inconsistent, as does the criteria for prediction of the presence of difficult airways.

scholarly journals Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kjartan E. Hannig ◽  
Rasmus W. Hauritz ◽  
Christian Jessen ◽  
Jan Herzog ◽  
Anders M. Grejs ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Physiological Changes ◽  
Difficult Airway Management ◽  
Successful Intubation ◽  
Flexible Bronchoscope ◽  
Difficult Airways ◽  
Invasive Techniques ◽  
Nose And Throat

Pregnancy is associated with anatomical and physiological changes leading to potential difficult airway management. Some pregnant women have known difficult airways and cannot be intubated even with a hyperangulated videolaryngoscope. If neuraxial techniques are also impossible, awake tracheal intubation with a flexible bronchoscope may be one of the few available options to avoid more invasive techniques. The Infrared Red Intubation System (IRRIS) may help nonexpert anesthesiologists in such situations and may enhance the chance of successful intubation increasing safety for the mother and the fetus, especially in hospitals without the ear, nose, and throat surgical backup.

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