scholarly journals A Cohort and Database Study of Airway Management in Patients Undergoing Thyroidectomy for Retrosternal Goitre

2014 ◽  
Vol 42 (6) ◽  
pp. 700-708 ◽  
Author(s):  
N. Gilfillan ◽  
C. M. Ball ◽  
P. S. Myles ◽  
J. Serpell ◽  
W. R. Johnson ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Thyroid Surgery ◽  
Good Evidence ◽  
Anaesthetic Induction ◽  
Tracheal Compression ◽  
Induction Technique ◽  
Failed Airway ◽  
Symptoms And Signs

Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning.

scholarly journals (P1-62) The Risk Factors for Difficult or Failed Airway: A Prosepctive Cohor Study

2011 ◽  
Vol 26 (S1) ◽  
pp. s118-s118
Author(s):  
C. Hsu
Keyword(s):  
Risk Factors ◽  
Airway Management ◽  
Difficult Airway ◽  
Healthcare Providers ◽  
Positive Association ◽  
Daily Practice ◽  
Trauma Patients ◽  
Airway Trauma ◽  
Failed Airway ◽  
Airway Devices

The risk factors for difficult airway or failed airway: a prospective cohort study Airway management is always the first priority and time-treasures in critical ill-patients. Improper managementof difficult airway or resultant fail airway would bring poor prognosis to patients. We investigated the risk factors of difficult or fail airway from the multiple dimension of factors including patients, healthcare and airway devices. We enrolled 252 intubated patients, including 37 trauma patients, 55 patients (22%) with difficult airway, and 22 patients (8.7%) with fail airway. In analysis of risk factors of difficult airway, factors including obesity, short neck or thickness of soft tissue, facial deformities and oral-nasal bleeding have positive association with fail airway, but the seniority of healthcare providers had no effect. However, experienced healthcare providers have more success rate after the occurrence of fail airway. The most complications of fail airway include airway trauma and hypoxia. As compared with non-trauma patients, trauma patients have more episodes of fail airway, difficult airway, and use of RSI, rescue airway for fail airway, airway trauma and vomiting. Therefore, it is necessary to establish an easy and safe standard guideline in daily practice of difficult and urgent airway management for healthcare providers.

scholarly journals Complication of Laparoscopy under General Anaesthesia

1977 ◽  
Vol 5 (2) ◽  
pp. 169-171 ◽  
Author(s):  
H. H. Chiu ◽  
K. H. Ng
Keyword(s):  
General Anaesthesia ◽  
Aetiological Factor ◽  
Anaesthetic Induction ◽  
Induction Technique ◽  
The Common ◽  
Precautionary Measures

Two cases are presented in which injury to the stomach occurred in association with laparoscopy under general anaesthesia. The common aetiological factor was gastric inflation resulting from I.P.P.V. via mask. Precautionary measures in the anaesthetic induction technique are described.

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.

Difficult Airway: Special Considerations in Pregnancy

2017 ◽  
Author(s):  
Rania Elkhateb ◽  
Jill M. Mhyre
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Surgical Procedures ◽  
Labor And Delivery ◽  
Difficult Airway Management ◽  
Increased Risk ◽  
Airway Equipment ◽  
Failed Airway ◽  
Management Algorithms ◽  
In Pregnancy

Pregnant patients are at increased risk of difficult airway management due to both anatomic and physiologic changes that occur with pregnancy and during the process of labor. While the majority of surgical procedures on labor and delivery are performed with neuraxial anesthesia, general anesthesia may be required at any time. As such, all anesthesia professionals must be prepared at all times for unplanned and emergent obstetric airway management, including management of the difficult airway in the parturient. Strategies include assessment of patient risk early in labor, maintaining difficult airway equipment in the labor and delivery suites, conducting simulation scenarios of difficult and failed airway management, and following difficult airway management algorithms.

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