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.

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.

scholarly journals A national survey of videolaryngoscopy in Hungary

2019 ◽  
Author(s):  
Balint Nagy
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Intensive Therapy ◽  
Management Technique ◽  
Clinical Settings ◽  
Difficult Airway Management ◽  
Management Scenarios ◽  
Electronic Survey ◽  
The Public ◽  
Patterns Of Use

Abstract Background Videolaryngoscopy (VL) as a new airway management technique has evolved in recent decades, and a large number of videolaryngoscopes are now available on the market. Most recent major guidelines already recommend the immediate availability and use of VL in difficult airway management scenarios. However, national data on the availability of VL, introduction into practice and patterns of use are rarely published. Therefore, the current study aimed to provide data on VL in Hungary. Methods An electronic survey was designed and popularized with the help of the Hungarian Society of Anaesthesiology and Intensive Therapy to explore the availability, use, and practice of and attitudes toward VL among Hungarian anesthesiologists. The survey was conducted in 2018 and ended on 31.12.2018. Results In total, 324 forms were returned and analyzed. Responders were mainly males (58%), specialists (80%) and those involved in anesthesia (68%) in the public sector. Two hundred and ten (65%) responders had access to various videolaryngoscopes and were mainly from surgery, intensive care and traumatology units. No responders reported the availability of eight videolaryngoscopes out of the eighteen listed devices, and 32% of the responders had never used any videolaryngoscope in clinical settings. The most commonly available devices were KingVision, MacGrath Mac and Airtraq. Most of the responders reported using videolaryngoscopes mainly for difficult airway management and reported using a fiberscope as the first alternative device. Popular methods for selecting videolaryngoscopes included the following: short clinical trial (n=67/324), decision of the departmental lead (n=65/324) and price (n=54/324). The majority of responders had some training prior to clinical application, but training was mainly voluntary. Overall, 98% of the responders considered videolaryngoscopes beneficial. Conclusions Approximately two-thirds of Hungarian anesthesiologists have immediate access to videolaryngoscopes, which are used mainly for difficult airway management. The overall attitude towards VL is positive, and many videolaryngoscopes are known and have been used by Hungarian anesthesiologists. However, only a few devices on the market are used commonly. Based on the results, further improvement might be recommended regarding VL training and availability.

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 24 (4) ◽  
pp. 349-354
Author(s):  
Valerie Au ◽  
Benjamin Marsh ◽  
Claudia Benkwitz
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Airway Management ◽  
Difficult Airway ◽  
Mediastinal Mass ◽  
Management Technique ◽  
Difficult Airway Management ◽  
Posterior Mediastinal Mass ◽  
Membrane Oxygenation ◽  
Mediastinal Masses ◽  
Posterior Mediastinal

Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior mediastinal masses. Studies on posterior mediastinal masses are even more limited in the pediatric population. We present a case of a large posterior mediastinal mass in a 4-year-old child who presented with extremely difficult airway management during endobronchial intubation due to severe external compression that led to use of an adapted airway management technique with a rigid airway exchanger for lung isolation. Due to the pathology of the mass, a tracheal tear was encountered during surgical dissection and the patient required emergent venovenous extracorporeal membrane oxygenation to allow for successful airway repair and complete resection of the mass.

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.

Pediatrics: Foreign Body Aspiration

2018 ◽  
pp. 109-114
Author(s):  
Aimee Kakascik
Keyword(s):  
Foreign Body ◽  
Airway Management ◽  
Pediatric Patient ◽  
Vascular Access ◽  
Foreign Body Aspiration ◽  
Main Topic ◽  
Anesthesia Induction ◽  
Preoperative Management ◽  
Inhalational Anesthesia ◽  
Respiratory Status

In this chapter the essential aspects of anesthesia for foreign body aspiration in the pediatric patient are reviewed. Subtopics include airway management in a patient with a foreign body aspiration, interventions to avoid, and drugs indicated for securing the airway in a patient with this condition. The chapter is divided into preoperative, intraoperative, and postoperative sections with important subtopics related to the main topic in each section. Issues related to preoperative management include assessment of respiratory status, vascular access, and airway management. Intraoperative topics discussed include, inhalational anesthesia, induction, and the patient’s emergence from anesthesia. Postoperative concerns addressed are postoperative stridor and nausea.

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 Anaesthesia for Maxillo Facial Surgery

2021 ◽  
pp. 95-117
Author(s):  
Rebecca Jacob ◽  
Subramanyam S. Mahankali ◽  
Renita Maria ◽  
Suman Ananathanarayana ◽  
Garima Sharma ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Maxillofacial Surgery ◽  
Management Technique ◽  
Team Members ◽  
Good Communication ◽  
Surgical Access ◽  
Facial Surgery ◽  
Tissue Oedema

AbstractMaxillofacial surgery presents unique challenges to the anaesthesiologist. The main challenges include working with multiple professionals; managing a shared airway; ensuring good surgical access; identifying difficult airway and choosing an appropriate airway management technique perioperatively; using measures to reduce bleeding and tissue oedema. To achieve this effectively and safely, there is a great need for good communication among anaesthesiologists, surgeons and other team members.

Approach to Difficult Airway Management

2021 ◽  
Author(s):  
Laura Matrka ◽  
Liuba Soldatova
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Management Strategies ◽  
Management Plan ◽  
Supraglottic Airway ◽  
Patient Specific ◽  
Prior History ◽  
Patient Cooperation ◽  
American Society ◽  
Lemon Score

According to the 2013 American Society of Anesthesiology Practice Guidelines for Management of the Difficult Airway, a term “difficult airway” refers to clinical situations in which a likelihood of 1) difficulty with patient cooperation or consent, 2) difficult mask ventilation, 3) difficult supraglottic airway placement, 4) difficult laryngoscopy, 5) difficult intubation, and/or 6) difficult surgical airway is high. Several considerations are important when approaching each individual clinical scenario. An airway management plan should include patient-specific and situation-specific factors that take into account findings of bedside airway evaluation, prior history of intubations, the acuity of the situation requiring intubation, and the level of airway obstruction. The following module provides an overview of these factors along with a brief introduction to specific clinical situations in which some airway management strategies are more suitable.1,2 This review contains 10 figures, 7 tables and 32 references Key words: Difficult airway, intubation, LEMON score, High-Flow Nasal Cannula Oxygenation, THRIVE

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