scholarly journals Anaesthesia for Reconstruction Surgery Post Mandibulectomy in a Patient with a Predicted Difficult Airway: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Omolola Adunni Fagbohun ◽  
Ibifuro Dennar ◽  
Olugbusi Sope ◽  
Oresanwo Theressa
Keyword(s):  
Difficult Airway ◽  
Endotracheal Tube ◽  
Mouth Opening ◽  
Upper Airway ◽  
Index Patient ◽  
Anaesthetic Management ◽  
Neck Mass ◽  
Team Work ◽  
Intubating Laryngeal Mask Airway ◽  
Edentulous Mandible

Introduction: Mandibular surgeries, edentulous mandible, use of dentures, and aging all predispose to residual mandibular ridge resorption and thinning. The edentulous state of the mandible makes the tongue occlude the upper airway. All these, contribute to difficulty in managing the airway. An adequate pre-operative review helped classify this index patient as high risk for difficult airway and adequate steps were taken to facilitate optimal airway management.Case report: We present a 53 years old woman with mandibular deformity, anterior neck mass and inadequate mouth opening who has had a segmental mandibulectomy and a soft tissue closure of reconstruction plate. She was scheduled for mandibular reconstruction.She was successfully intubated using a size 4.5 Intubating Laryngeal Mask Airway (ILMA) through which a size 6.0 ID classic endotracheal tube was introduced for ventilation. A gum elastic bougie was then inserted through the endotracheal tube, both the ILMA and classic endotracheal tube were withdrawn. An armored tube size 6.5 ID was then rail roaded.Conclusion: The successful anaesthetic management of this difficult airway patient was facilitated by a thorough pre-anaesthetic plan, concise and skilled anaesthetic management strategy with a well organized team work.

scholarly journals Difficult Nasal Intubation Using Airway Scope® for a Child With Large Tumor

2018 ◽  
Vol 65 (4) ◽  
pp. 251-254
Author(s):  
Tomoka Matsumura ◽  
Chihiro Suzuki ◽  
Kazumasa Kubota ◽  
Shunsuke Minakuchi ◽  
Haruhisa Fukayama
Keyword(s):  
General Anesthesia ◽  
Difficult Airway ◽  
Endotracheal Tube ◽  
Upper Airway ◽  
Nasal Intubation ◽  
Large Tumor ◽  
Magill Forceps ◽  
Airway Scope ◽  
Glottic View ◽  
Experience Difficulty

We report a case of difficult nasal intubation utilizing a Pentax-Airway scope® AWS-100. A 4-month-old female with a rapidly growing melanotic neuroectodermal tumor was scheduled for resection under general anesthesia. The tumor was a large rubbery mass located in the middle of the mandible. For nasal intubation using the AWS, guidance of the tube toward the glottis was attempted using pediatric Magill forceps. Although we could hold the tube with the Magill forceps, it was difficult to insert the tube into the trachea due to the limited space in her hypopharynx. We then used a standard laryngoscope with a Miller straight blade for direct visual laryngoscopy and successfully intubated the patient with the aid of the pediatric Magill forceps. We often experience difficulty navigating a nasal endotracheal tube toward the glottis even when a clear glottic view is obtained with video laryngoscopes, especially in children with a small oropharyngeal space. However, some reports have been shown that video laryngoscopes are useful for intubation of the difficult airway and causes less stress to the upper airway than direct visual laryngoscopy. Video laryngoscopy can be an excellent way to provide nasal intubation in some but not all children.

scholarly journals Video Laryngoscope Assisted Awake Nasal Intubation with Restricted Mouth Opening in an Operated Radical Neck Dissection Patient

2021 ◽  
Author(s):  
Tejash Hariduttbhai Sharma ◽  
Avani Prafulchandra Vayeda ◽  
Malini K Mehta ◽  
Dinesh K Chauhan
Keyword(s):  
Radical Neck Dissection ◽  
Mouth Opening ◽  
Upper Airway ◽  
Anaesthetic Management ◽  
Video Laryngoscope ◽  
Nasal Intubation ◽  
Forehead Flap ◽  
Flap Surgery ◽  
Neck Extension ◽  
Surgery Patient

Naso-Endotracheal Intubation (NEI) for anaesthesia in oral and maxillofacial surgeries are difficult in case of oral mass, micrognathia, restricted mouth opening, pathological anatomy of upper airway and restricted neck extension. This case report presents the clinical and anaesthetic management for a 46-year-old male patient recently operated for left buccal mucosa squamous cell carcinoma with restricted mouth opening of 1.5 cm, a big rent of 4×5 cm on left cheek and restricted neck extension and flexion scheduled for forehead flap surgery. Patient was intubated with non-channeled Video Laryngoscope (VLS) assisted awake nasal intubation.

Management of difficult airway in a pregnant patient with severely reduced mouth opening

2020 ◽  
pp. 1-8
Author(s):  
Faisal Shamim ◽  
Aly Bahadur ◽  
Dinaz Gandhi ◽  
Anum Aijaz
Keyword(s):  
Difficult Airway ◽  
Third Molar ◽  
Mouth Opening ◽  
Upper Airway ◽  
Neck Region ◽  
Pregnant Patient ◽  
Odontogenic Infections ◽  
Dental Abscess ◽  
Life Threatening ◽  
Risk Of Aspiration

Abstract Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to odontogenic infections. If left untreated, severe dental abscess can progress to Ludwig’s angina, which is a potentially lethal cellulitis that rapidly extends to the neck region and may lead to life-threatening upper airway obstruction. We report the case of a pregnant woman who presented with intense throbbing pain, trismus and severely reduced mouth opening due to dental abscess for the last one week. She required incision and drainage of abscess with extraction of third molar under general anaesthesia. There are some significant challenges to anaesthesiologist like the risk of aspiration and failed intubation in patients with pregnancy and anticipated difficult airway. With counselling and proper preparation, we were able to manage this case with awake intubation.  Continuous...

scholarly journals Newer Airway Gadgets: Rescuers in Difficult Airway Scenarios

2021 ◽  
Author(s):  
Jyoti Deshpande ◽  
Namrata Sadafule ◽  
Merlin Elizabeth Jacob
Keyword(s):  
Laryngeal Mask Airway ◽  
Difficult Airway ◽  
Mouth Opening ◽  
Patient Characteristics ◽  
Laryngeal Mask ◽  
Tmj Ankylosis ◽  
Obese Female ◽  
Intubating Laryngeal Mask Airway ◽  
Skilled Personnel ◽  
The Right

Background: As anaesthetists, we may constantly be in the learning curve of the management of difficult airway scenario. It can have a disastrous outcome if one is not adequately prepared with the right equipment. Over time there has been multiple ways to tackle difficult airway scenarios. Needless to say, appropriate airway gadgets are carefully chosen according to the surgery and patient characteristics. But what if these certain techniques fail? Then, what next? The inability to efficiently manage a difficult airway is the major cause of morbidity and mortality in anaesthetic practice. Here, we discuss 4 different case scenarios of difficult airway management. case reports:Case 1 was a pediatric patient with TMJ ankylosis, with mouth opening 4mm, in whom we used the fibreoptic technique. Case 2- A failed fibreoptic attempt in a case of recurrent Ca oral cavity where we secured the airway using Airtraq videolaryngoscope. Case 3- A patient with post burn contracture over front of neck and anterior shoulder where we decided to use intubating laryngeal mask airway for securing airway and Case 4- An obese female patient posted for hysterolaparoscopy where we used the Laryngeal Mask Airway Supreme. Conclusion: Effective usage of newer drugs, equipment and airway gadgets by technically skilled personnel, with sound clinical judgement are essential factors in reducing airway related adverse scenario and it is of utmost importance to keep these alternate gadgets handy and to be proficient with its usage.

scholarly journals Developmental features and predicting airway failure risk in critically ill children with mandibular hypoplasia using 3D computational tomographic analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Doo-Hwan Kim ◽  
Eunseo Gwon ◽  
Junheok Ock ◽  
Jong-Woo Choi ◽  
Jee Ho Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Difficult Airway ◽  
Hyoid Bone ◽  
Three Dimensional ◽  
Upper Airway ◽  
Critically Ill Children ◽  
Healthy Controls ◽  
Mandibular Hypoplasia ◽  
Tongue Position ◽  
Developmental Features

AbstractIn children with mandibular hypoplasia, airway management is challenging. However, detailed cephalometric assessment data for this population are sparse. The aim of this study was to find risk factors for predicting difficult airways in children with mandibular hypoplasia, and compare upper airway anatomical differences using three-dimensional computed tomography (3D CT) between children with mandibular hypoplasia and demographically matched healthy controls. There were significant discrepancies in relative tongue position (P < 0.01) and anterior distance of the hyoid bone (P < 0.01) between patients with mandibular hypoplasia and healthy controls. All mandibular measures were significantly different between the two groups, except for the height of the ramus of the mandible. After adjusting for age and sex, the anterior distance of hyoid bone and inferior pogonial angle were significantly associated with a difficult airway (P = 0.01 and P = 0.02). Quantitative analysis of upper airway structures revealed significant discrepancies, including relative tongue position, hyoid distance, and mandible measures between patients with mandibular hypoplasia and healthy controls. The anterior distance of the hyoid bone and inferior pogonial angle may be risk factors for a difficult airway in patients with mandibular hypoplasia.

Comparison of the Intubating Laryngeal Mask Airway with the Fiberoptic Intubation in Anticipated Difficult Airway Management

2001 ◽  
Vol 94 (6) ◽  
pp. 968-972 ◽  
Author(s):  
Olivier Langeron ◽  
François Semjen ◽  
Jean-Louis Bourgain ◽  
Alain Marsac ◽  
Anne-Marie Cros
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Adverse Events ◽  
Oxygen Saturation ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Laryngeal Mask ◽  
Fiberoptic Intubation ◽  
Alternative Technique ◽  
Intubating Laryngeal Mask Airway

Background The intubating laryngeal mask airway (ILMA; Fastrach; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation. Methods One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance &lt; 65 mm, interincisor distance &lt; 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation &lt; 90%, bleeding) were recorded. Results The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation &lt; 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P &lt; 0.05). Conclusion The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.

scholarly journals Anaesthesia management of a difficult airway patient with severe aortic stenosis for major oncosurgery

2021 ◽  
Vol 8 (4) ◽  
pp. 597-599
Author(s):  
Ninad Chodankar ◽  
Disha Kapadia ◽  
Hemant Mehta
Keyword(s):  
Aortic Stenosis ◽  
Difficult Airway ◽  
Severe Aortic Stenosis ◽  
Mouth Opening ◽  
Perioperative Period ◽  
Fiberoptic Intubation ◽  
Team Approach ◽  
Free Fibula Flap ◽  
Early Recovery ◽  
Perioperative Morbidity

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge.We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2.Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.

Sign in / Sign up

Export Citation Format

Share Document