scholarly journals Airway Management and Anesthesia for Tracheal Resection in a 68-Year-Old: 3 Airways for the Price of 1

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Klint J. Smart ◽  
Iwan P. Sofjan
Keyword(s):  
Airway Management ◽  
Balloon Dilation ◽  
Airway Device ◽  
Rigid Bronchoscopy ◽  
Supraglottic Airway ◽  
Tracheal Resection ◽  
Intravenous Anesthesia ◽  
Prolonged Intubation ◽  
Persistent Symptoms ◽  
Evaluation Phase

Subglottic tracheal stenosis can occur after prolonged intubation or tracheostomy. This stenosis can become severe and causes symptoms refractory to endoscopic interventions that require tracheal resection. This surgery presents unique anesthetic issues due to the airway anatomy, physiology, and shared airway management with the surgical team. We present the case of a 68-year-old patient who underwent cervical tracheal resection and reconstruction due to persistent symptoms despite balloon dilation and medical management with oxygen and heliox. Our anesthesia management involved several techniques that allowed the safe completion of this procedure. Firstly, we started the airway management with a combined size 4 Ambu® AuraStraight™ (Denmark) supraglottic airway device and flexible bronchoscopy to allow localization of the stenosis and dilation before endotracheal tube (ETT) placement. The conventional approach for this endoscopic evaluation phase is to use rigid bronchoscopy. Secondly, we used prior CT images to help guide our ETT tube size selection. Thirdly, we used total intravenous anesthesia during most of the procedure because of the intermittent apnea necessary to complete the tracheal resection. Lastly, extubation had to be done very carefully to minimize excessive patient neck movement and avoid any reintubation. Both could lead to a catastrophe with the newly reconstructed trachea.

Airway Management in Children

2019 ◽  
Author(s):  
James Peyton ◽  
Raymond Park
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Fiberoptic Bronchoscopy ◽  
Difficult Tracheal Intubation ◽  
Airway Device ◽  
Successful Outcome ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Factors Associated ◽  
Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references.  Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

Anesthetic Management of a Patient With Tracheal Dehiscence Post–Tracheal Resection Surgery

2017 ◽  
Vol 21 (4) ◽  
pp. 360-363 ◽  
Author(s):  
Sang Kim ◽  
Maryna Khromava ◽  
Jeron Zerillo ◽  
George Silvay ◽  
Adam I. Levine
Keyword(s):  
Airway Management ◽  
Anesthetic Management ◽  
Fiberoptic Intubation ◽  
Tracheal Resection ◽  
Distal Stump ◽  
Intravenous Anesthesia ◽  
Tracheal Rupture ◽  
Alternative Techniques ◽  
Awake Fiberoptic Intubation ◽  
Resection And Anastomosis

We present a case of a patient with complete tracheal dehiscence and multiple false passages after recent tracheal resection and anastomosis. Loss of tracheal continuity after disruption of anastomosis with distal stump retraction presents a unique anesthetic challenge given lack of access to the trachea and the need for adequate anesthesia and analgesia for surgical neck dissection. Traditional airway management, including awake fiberoptic intubation, intubation via direct laryngoscopy, needle cricothyrotomy, and awake tracheostomy are not viable options. Using total intravenous anesthesia with spontaneous ventilation, surgeons dissected the neck, retrieved the distal tracheal stump, repaired the trachea, and formalized the tracheostomy. We highlight the importance of recognizing the symptoms of a tracheal rupture, understanding the extreme limitation of securing the airway with traditional techniques, and discuss the alternative techniques including use of extracorporeal membrane oxygenation to avoid airway management. Awareness of increased mortality risk with tracheal reoperation and the significance of close communication between the anesthesiologists, the surgeons, and the patient is necessary for successful management.

scholarly journals The Difficult Airway Trolley: A Narrative Review and Practical Guide

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Martin F. Bjurström ◽  
Mikael Bodelsson ◽  
Louise W. Sturesson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Future Research ◽  
Clinical Settings ◽  
Airway Equipment ◽  
National Expert ◽  
Airway Devices ◽  
Facemask Ventilation

Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

Unrecognized failed airway management using a supraglottic airway device

Resuscitation ◽  
2017 ◽  
Vol 119 ◽  
pp. 1-4 ◽  
Author(s):  
Veer D. Vithalani ◽  
Sabrina Vlk ◽  
Steven Q. Davis ◽  
Neal J. Richmond
Keyword(s):  
Airway Management ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Failed Airway

scholarly journals Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy

2021 ◽  
Vol 9 ◽  
Author(s):  
Teiji Sawa ◽  
Atsushi Kainuma ◽  
Koichi Akiyama ◽  
Mao Kinoshita ◽  
Masayuki Shibasaki
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Outer Diameter ◽  
Difficult Airway Management ◽  
Supraglottic Airway Device ◽  
Endotracheal Tubes ◽  
Inner Diameter ◽  
Neonates And Infants

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS). Some VLSs are equipped with small blades for infants. Advanced SADs have small sizes for infants, and some effectively function as conduits for endotracheal intubation. The smallest FOS has an outer diameter of 2.2 mm and enables intubation with endotracheal tubes with an inner diameter of 3.0 mm. DAM in neonates and infants can be improved by effectively selecting the appropriate device combination and ensuring that available providers have the necessary skills.

Ambu® Auragain™, an alternative supraglottic airway device for airway management in prone position

Airway ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. 39
Author(s):  
Deepak Dwivedi ◽  
Vidhu Bhatnagar ◽  
Saurabh Sud ◽  
Bhavna Hooda
Keyword(s):  
Airway Management ◽  
Prone Position ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device

scholarly journals A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maja Pålsdatter Lønvik ◽  
Odd Eirik Elden ◽  
Mats Joakimsen Lunde ◽  
Trond Nordseth ◽  
Karin Elvenes Bakkelund ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Success Rate ◽  
Clinical Performance ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Ambulance Personnel ◽  
Increased Risk ◽  
Supraglottic Airway Devices ◽  
Hospital Cardiac Arrest

Abstract Background Airway management in patients with out of hospital cardiac arrest (OHCA) is important and several methods are used. The establishment of a supraglottic airway device (SAD) is a common technique used during OHCA. Two types of SAD are routinely used in Norway; the Kings LTS-D™ and the I-gel®. The aim of this study was to compare the clinical performance of these two devices in terms of difficulty, number of attempts before successful insertion and overall success rate of insertion. Methods All adult patients with OHCA, in whom ambulance personnel used a SAD over a one-year period in the ambulance services of Central Norway, were included. After the event, a questionnaire was completed and the personnel responsible for the airway management were interviewed. Primary outcomes were number of attempts until successful insertion, by either same or different ambulance personnel, and the difficulty of insertion graded by easy, medium or hard. Secondary outcomes were reported complications with inserting the SAD’s. Results Two hundred and fifty patients were included, of whom 191 received I-gel and 59 received LTS-D. Overall success rate was significantly higher in I-gel (86%) compared to LTS-D (75%, p = 0.043). The rates of successful placements were higher when using I-gel compared to LTS-D, and there was a significant increased risk that the insertion of the LTS-D was unsuccessful compared to the I-gel (risk ratio 1.8, p = 0.04). I-gel was assessed to be easy to insert in 80% of the patients, as opposed to LTS-D which was easy to insert in 51% of the patients. Conclusions Overall success rate was significantly higher and the difficulty in insertion was significantly lower in the I-gel group compared to the LTS-D in patients with OHCA.

scholarly journals Cervical tracheal resection without intubation

2021 ◽  
Vol 102 (3) ◽  
pp. 381-388
Author(s):  
A A Akopov ◽  
M G Kovalev
Keyword(s):  
Endotracheal Tube ◽  
Tracheal Stenosis ◽  
Airway Device ◽  
Early Postoperative Period ◽  
Supraglottic Airway ◽  
Tracheal Resection ◽  
Supraglottic Airway Device ◽  
Airway Patency ◽  
Surgical Interventions ◽  
Tube Removal

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis tracheal resection without using an endotracheal tube. Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis. Results. The resection length ranged from 15 to 45 mm (on average, 273 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 1099 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 122 days). No restenosis was detected at long term follow-up. Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.

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