Current treatment of difficult airway: a practical review of advanced techniques for airway management

The airway by definition is a conduit through which the air passes; or it is the route by which the air travels from the nose or mouth to the lungs. An exhaustive review was performed with the available literature using the PubMed, ScienceDirect, Scopus and Cochrane databases from 2009 to 2021. The search criteria were formulated to identify reports related to difficult airway management. To allow controlled ventilation, the airway must meet two characteristics in priority order, be permeable and airtight. In assessing risk, in addition to looking for predictors of difficult airway, it was important to understand the global clinical circumstances. Faced with a patient with a difficult airway, decision-making must be agile and correct since any decision can modify the clinical outcome.

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Cuffed Oropharyngeal Airway for Difficult Airway Management

Anesthesia Progress ◽

10.2344/0003-3006-61.3.107 ◽

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.

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

Revista Electrónica AnestesiaR ◽

10.30445/rear.v12i7.821 ◽

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.

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