Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

Background Airway injury during general anesthesia is a significant source of morbidity for patients and a source of liability for anesthesiologists. To identify recurrent patterns of injury, the authors analyzed claims for airway injury in the American Society of Anesthesiologists (ASA) Closed Claims Project database. Methods The ASA Closed Claims database is a standardized collection of case summaries derived from professional liability insurance companies closed claims files. All claims for airway injury were reviewed in depth and were compared to other claims during general anesthesia. Results Approximately 6% (266) of 4,460 claims in the database were for airway injury. The most frequent sites of injury were the larynx (33%), pharynx (19%), and esophagus (18%). Injuries to the esophagus and trachea were more frequently associated with difficult intubation. Injuries to temporomandibular joint and the larynx were more frequently associated with nondifficult intubation. Injuries to the esophagus were more severe and resulted in a higher payment to the plaintiff than claims for other sites of airway injury. Difficult intubation (odds ratio = 4.53, 95% confidence interval [CI] = 2.36, 8.71), age older than 60 yr (odds ratio = 2.97, 95% CI = 1.51, 5.87), and female gender (odds ratio = 2.43, 95% CI = 1.09, 5.42) were associated with claims for pharyngoesophageal perforation. Early signs of perforation, e.g., pneumothorax and subcutaneous emphysema, were present in only 51% of perforation claims, whereas late sequelae, e.g., retropharyngeal abscess and mediastinitis, occurred in 65%. Conclusion Patients in whom tracheal intubation has been difficult should be observed for and told to watch for the development of symptoms and signs of retropharyngeal abscess, mediastinitis, or both.

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Anesthetic Management by Laryngeal Mask Airway in a Patient With a History of Difficult Intubation Resulting in Dental Injuries

Anesthesia Progress ◽

10.2344/0003-3006-62.1.20 ◽

2015 ◽

Vol 62 (1) ◽

pp. 20-21 ◽

Cited By ~ 1

Author(s):

Yoshinao Asahi ◽

Ryosuke Fujii ◽

Naoko Usui ◽

Hajime Kagamiuchi ◽

Shiro Omichi ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

General Anesthesia ◽

Difficult Intubation ◽

Dental Treatment ◽

Anesthetic Management ◽

Laryngeal Mask ◽

Respiratory Problems ◽

History Of ◽

Disabled Patients ◽

Dental Injuries

Abstract Disabled patients may face respiratory problems during general anesthesia because of head and neck anomalies. We describe a case of dental treatment under general anesthesia using a laryngeal mask airway in a disabled patient who faced difficulty in endotracheal intubation on several occasions, 5 of which resulted in dental injuries.

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Prevalence and prediction of difficult intubation in Nepalese population

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v2i1.13552 ◽

2015 ◽

Vol 2 (1) ◽

pp. 17-20

Author(s):

Shristi Shah

Keyword(s):

Prospective Study ◽

General Anesthesia ◽

Difficult Intubation ◽

Mouth Opening ◽

Preoperative Assessment ◽

A Prospective Study ◽

Bedside Tests

Background: Prevalence of difficult intubation is estimated as 3 -18% during routine anesthesia. There are various bedside tests to predict the difficult intubation, like Mallampati test, Thyromental distance, Sternomental distance and mouth opening. However, the prevalence and prediction in Nepalese population is still not estimated. So this study is to see the prevalence and to compare the efficacy of airway parameters to predict the difficult intubation in Nepalese population.Methods: A prospective study was done to estimate the prevalence and prediction of difficult intubation in Nepalese population. During six months period, 182 patients who were undergoing routine surgery under General anesthesia were included in the study. Mallampati grading, thyromental distance, mouth opening and sternomental distance were recorded in preoperative assessment. Cormack and Lehane grading were done during intubation and Grade I and II are considered as easy intubation/ laryngoscopy and III and IV are considered as difficult intubation.Results: The prevalence of difficult intubation was 4.9%. Sensitivity of different tests were as follows; Mallampati test – 55%, thyromental distance – 33%, mouth opening – 22% and sternomental distance – 11%. The Specificity of the test as Mallampati test – 98%, thyromental distance – 89%, mouth opening – 96% and sternomental distance – 97%. So the Mallampati test is more sensitive and specific among the tests done.Conclusion: This prospective study shows that the prevalence of difficult intubation is not different in Nepalese population and the bedside predictors also are good tests that could be continued in our population.Journal of Society of Anesthesiologists of Nepal 2015; 2(1): 17-20

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Faculty Opinions recommendation of GlideScope videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718489951.793528517 ◽

2017 ◽

Author(s):

Michael Aziz

Keyword(s):

Obese Patient ◽

Difficult Intubation ◽

Awake Intubation ◽

Morbidly Obese ◽

Fiberoptic Bronchoscope ◽

Morbidly Obese Patient ◽

Glidescope Videolaryngoscope

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Fiberoptic Intubation as a Boon in Limited Mouth Opening Surgeries

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1112 ◽

2011 ◽

Vol 2 (4) ◽

pp. 350-352

Author(s):

Sunil Dutt ◽

Salman Basha

Keyword(s):

Case Report ◽

General Anesthesia ◽

Difficult Intubation ◽

Mouth Opening ◽

Orotracheal Intubation ◽

Fiberoptic Intubation ◽

Present Case Report ◽

Limited Mouth Opening ◽

Temporomandibular Joint Ankylosis ◽

Joint Ankylosis

ABSTRACT Surgery of temporomandibular joint ankylosis under general anesthesia poses a great challenge to anesthesiologists. This surgery falls in the category of difficult intubation as direct vocal cord visualization is difficult due to an inability to open the mouth. The present case report suggests that the fiberoptic intubation has become an essential skill for anesthetists dealing with patients in whom orotracheal intubation is anatomically difficult.

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The Effect of Screening Tests for Predicting Difficult Intubation and the Duration of Anesthesia Resident Training for Dental Trauma Associated with General Anesthesia

Korean Journal of Anesthesiology ◽

10.4097/kjae.2008.54.3.289 ◽

2008 ◽

Vol 54 (3) ◽

pp. 289

Author(s):

Cheol Lee ◽

Seri O

Keyword(s):

General Anesthesia ◽

Difficult Intubation ◽

Dental Trauma ◽

Resident Training ◽

Screening Tests ◽

Anesthesia Resident

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A Case of General Anesthesia for a Young Infant in Whom Intubation Was Suspected to Be Difficult Because of a Thyrolingual Cyst

Anesthesia Progress ◽

10.2344/anpr-65-02-04 ◽

2018 ◽

Vol 65 (2) ◽

pp. 127-128

Author(s):

Tomoyasu Noguchi ◽

Noriko Miyazawa ◽

Nami Ooyama ◽

Tatsuya Ichinohe

Keyword(s):

Case Report ◽

General Anesthesia ◽

Difficult Intubation ◽

Young Infant ◽

The Other ◽

Fiberoptic Intubation ◽

Nasal Intubation ◽

Nasopharyngeal Airway

This is a case report of an infant who underwent thyrolingual cystectomy under general anesthesia. Two tracheal tubes were used: 1 for nasopharyngeal airway and the other for fiberoptic intubation. With this method, nasal intubation was successfully performed without hypoxia and hypercapnia even in a 3-month-old infant. We concluded this is a useful intubation method for infants who are predicted to be a difficult intubation.

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Correlation between Ultrasound Measured Distance from Skin to Epiglottis and Epiglottis to Mid-vocal Cord with Cormack-Lehane Classification for predicting Difficult Intubation

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v6i1.2045 ◽

2019 ◽

Author(s):

Sussan Soltani Mohammadi ◽

Abdolhossein Baradaran Tavakkoli ◽

Mojtaba Marashi

Keyword(s):

Tracheal Intubation ◽

General Anesthesia ◽

Vocal Cord ◽

Difficult Intubation ◽

Invasive Procedure ◽

Difficult Tracheal Intubation ◽

Cross Sectional ◽

Cutoff Value ◽

Lehane Grade ◽

Measured Distance

Background: Difficult tracheal intubation is an important challenge for anesthesiologists. Many anatomical parameters are available for evaluating the ease of tracheal intubation. Cormack-Lehane (CL) grade is one that can reliably predict a difficult intubation but it is an invasive procedure and can be performed in an anesthetised patient so it is not useful during pre-anesthetic airway evaluation. Prediction of the CL grading before operation can help in better airway management during induction of anesthesia. The aim of this study was to find a correlation between ultrasound measured distance from skin to epiglottis and from epiglottis to mid-vocal cord with Cormack-Lehane grading in patients undergoing general anesthesia for predicting difficult intubation. Methods: In a cross-sectional study, 60 ASA class I - III patients aged 18 - 70 years who were scheduled for tracheal intubation under general anesthesia were included. Before anesthesia, an ultrasound view of the airway was obtained and the distance from skin to the epiglottis and from the epiglottis to the mid-point between the ends of vocal cords were all recorded. The ultrasound measurements were then compared with the CL grade during direct laryngoscopy under general anesthesia. Results: Thirty-six patients had CL grade I, twenty-one had CL grade II and three had CL grade III. It was observed that the correlation between CL grade and distance from skin to epiglottis (DSE) with cutoff value 21mm(with an accuracy of 99%, a sensitivity of 100%, and a specificity of 82% ; P=0.0001) and from epiglottis to mid vocal cord distance (EMVD) with cutoff value 13.38(with an accuracy of 99%, a sensitivity of 100%, and a specificity of 85% ; P=0.01) and the ratio of DSE/EMVD with cutoff value 1.64(with an accuracy of 95%, a sensitivity of 100%, and a specificity of 91%; P=0.004) was significant for predicting of difficult intubation in patients with BMI>25. Conclusion: Our study revealed good correlation between DES/EMVC ratio and Cormack-Lehane grade, therefore sonographic measurement criteria may be helpful in airway evaluations before anesthesia for predicting difficult intubation.

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