A comfortable and unconscious intubation by the combination of intermittent sevoflurane inhalation and the modified spray-as-you-go technique for a patient with severe postburn mentosternal contracture

Mapping Intimacies ◽

10.22541/au.162891512.28811240/v1 ◽

2021 ◽

Author(s):

Zhi Wang ◽

Yong Yang ◽

Yang Chen ◽

Bin Yi ◽

Kai Lu ◽

...

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Spontaneous Breathing ◽

Difficult Airways

Airway management of patients with difficult airways is a challenge to the anesthesiologists and awake tracheal intubation is the recommended strategy. A safe, comfortable, unconscious, and satisfied intubation with spontaneous breathing keeping was achieved by intermittent sevoflurane inhalation and the modified spray-as-you-go technique for airway topicalization and intubation.

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Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup

Case Reports in Anesthesiology ◽

10.1155/2021/6778805 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Kjartan E. Hannig ◽

Rasmus W. Hauritz ◽

Christian Jessen ◽

Jan Herzog ◽

Anders M. Grejs ◽

...

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Physiological Changes ◽

Difficult Airway Management ◽

Successful Intubation ◽

Flexible Bronchoscope ◽

Difficult Airways ◽

Invasive Techniques ◽

Nose And Throat

Pregnancy is associated with anatomical and physiological changes leading to potential difficult airway management. Some pregnant women have known difficult airways and cannot be intubated even with a hyperangulated videolaryngoscope. If neuraxial techniques are also impossible, awake tracheal intubation with a flexible bronchoscope may be one of the few available options to avoid more invasive techniques. The Infrared Red Intubation System (IRRIS) may help nonexpert anesthesiologists in such situations and may enhance the chance of successful intubation increasing safety for the mother and the fetus, especially in hospitals without the ear, nose, and throat surgical backup.

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Faculty Opinions recommendation of Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management: a randomized clinical trial.

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

10.3410/f.724506025.793511810 ◽

2015 ◽

Author(s):

Michael Aziz

Keyword(s):

Clinical Trial ◽

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Randomized Clinical Trial ◽

Difficult Airway Management

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Secrets to a successful awake fibreoptic intubation (AFOI) on a patient with odentogenous abscess

BMJ Case Reports ◽

10.1136/bcr-2020-238600 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238600

Author(s):

Ming Kai Teah ◽

Esther Huey Ring Liew ◽

Melvin Teck Fui Wong ◽

Tat Boon Yeap

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Patient Outcomes ◽

Fibreoptic Intubation

Awake fibreoptic intubation (AFOI) is an established modality in patients with anticipated difficulty with tracheal intubation. This case demonstrates that with careful and meticulous preparations, AFOI can lead to improved airway management and excellent patient outcomes. A 38-year-old woman presented with severe trismus secondary to odentogenous abscess was identified preoperatively as having a potential difficult airway. AFOI was performed successfully using combined Spray-As-You-Go and dexmedetomidine technique.

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Analysis of tracheal intubation in out-of-hospital helicopter emergency medicine recorded by video laryngoscopy

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00863-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jürgen Knapp ◽

Bettina Eberle ◽

Michael Bernhard ◽

Lorenz Theiler ◽

Urs Pietsch ◽

...

Keyword(s):

Emergency Medicine ◽

Quality Control ◽

Tracheal Intubation ◽

Airway Management ◽

Success Rate ◽

Video Laryngoscope ◽

Solar Irradiation ◽

Video Laryngoscopy ◽

Trauma Patients ◽

Intubation Success

Abstract Background Tracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative. Methods We conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider’s level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy. Results FPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers’ expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified. Conclusion Airway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.

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Comparison of Airtraq® Laryngoscope, Bonfils Endoscope and Fiberoptic Bronchoscope for Awake Tracheal Intubation: A Randomized, Controlled Trial

Austin Journal of Anesthesia and Analgesia ◽

10.26420/austinjanesthesiaandanalgesia.2021.1100 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

Köhne W ◽

◽

Elfers-Wassenhofen A ◽

Nosch M ◽

Groeben H ◽

...

Keyword(s):

Tracheal Intubation ◽

Success Rate ◽

Local Anesthesia ◽

Difficult Intubation ◽

Spontaneous Breathing ◽

Case Reports ◽

Controlled Trial ◽

Fiberoptic Intubation ◽

Randomized Controlled ◽

Glottic View

Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.

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Airway Management in Children

10.2310/anes.18002 ◽

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

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Airway assessment and management

10.1093/med/9780198853053.003.0015 ◽

2021 ◽

pp. 361-404

Author(s):

Jules Cranshaw ◽

Emira Kursumovic ◽

Tim Cook

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Intubation ◽

Rapid Sequence Induction ◽

Respiratory Viruses ◽

Airway Assessment ◽

Rapid Sequence ◽

Sequence Induction ◽

Practical Information ◽

Apnoeic Oxygenation

This chapter provides detailed, practical and up-to-date information on management of the airway. It demystifies airway terminology, outlines airway assessment, and describes the management of the unanticipated difficult airway in adults. It includes a new section on intubating critically ill patients using the vortex approach, and outlines the equipment and techniques used to aid airway management. It gives practical information on the emergency front of neck airway and strategies to approach the obstructed airway. It explains rapid sequence induction, inhalational induction, awake tracheal intubation, and extubation after difficult intubation. It contains new sections on apnoeic oxygenation and how to manage patients with airborne respiratory viruses.

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