Approach to Difficult Airway Management

2021 ◽  
Author(s):  
Laura Matrka ◽  
Liuba Soldatova
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Management Strategies ◽  
Management Plan ◽  
Supraglottic Airway ◽  
Patient Specific ◽  
Prior History ◽  
Patient Cooperation ◽  
American Society ◽  
Lemon Score

According to the 2013 American Society of Anesthesiology Practice Guidelines for Management of the Difficult Airway, a term “difficult airway” refers to clinical situations in which a likelihood of 1) difficulty with patient cooperation or consent, 2) difficult mask ventilation, 3) difficult supraglottic airway placement, 4) difficult laryngoscopy, 5) difficult intubation, and/or 6) difficult surgical airway is high. Several considerations are important when approaching each individual clinical scenario. An airway management plan should include patient-specific and situation-specific factors that take into account findings of bedside airway evaluation, prior history of intubations, the acuity of the situation requiring intubation, and the level of airway obstruction. The following module provides an overview of these factors along with a brief introduction to specific clinical situations in which some airway management strategies are more suitable.1,2 This review contains 10 figures, 7 tables and 32 references Key words: Difficult airway, intubation, LEMON score, High-Flow Nasal Cannula Oxygenation, THRIVE

scholarly journals Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure Airway Management for Reconstructive Surgery in a Pediatric Patient with Burn Contracture of the Neck

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Tolga Totoz ◽  
Kerem Erkalp ◽  
Sirin Taskin ◽  
Ummahan Dalkilinc ◽  
Aysin Selcan
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Pediatric Patient ◽  
Reconstructive Surgery ◽  
Management Technique ◽  
Anesthesia Induction ◽  
Nasal Intubation ◽  
Stepwise Approach ◽  
Patient Cooperation ◽  
Trial Phase

Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.

Unanticipated Difficult Airway in Anesthetized Patients

2004 ◽  
Vol 100 (5) ◽  
pp. 1146-1150 ◽  
Author(s):  
Xavier Combes ◽  
Bertrand Le Roux ◽  
Powen Suen ◽  
Marc Dumerat ◽  
Cyrus Motamed ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Improve Patient Safety ◽  
Management Strategies ◽  
Adherence Rate ◽  
Difficult Airway Management ◽  
Intubation Technique ◽  
Management Processes ◽  
Intubating Laryngeal Mask Airway ◽  
Difficult Ventilation

Background Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management. Methods After a 2-month period of training in airway management, 41 anesthesiologists were asked to follow a predefined algorithm for management in the case of an unanticipated difficult airway. Two different scenarios were distinguished: "cannot intubate" and "cannot ventilate." The gum elastic bougie and the Intubating Laryngeal Mask Airway (ILMA) were proposed as the first and second steps in the case of impossible laryngoscope-assisted tracheal intubation, respectively. In the case of impossible ventilation or difficult ventilation, the IMLA was recommended, followed by percutaneous transtracheal jet ventilation. The patient's details, adherence rate to the algorithm, efficacy, and complications of airway management processes were recorded. Results Impossible ventilation never occurred during the 18-month study. One hundred cases of unexpected difficult airway were recorded (0.9%) among 11,257 intubations. Deviation from the algorithm was recorded in three cases, and two patients were wakened before any alternative intubation technique attempt. All remaining patients were successfully ventilated with either the facemask (89 of 95) or the ILMA (6 of 95). Six difficult-ventilation patients required the ILMA before completion of the first intubation step. Eighty patients were intubated with the gum elastic bougie, and 13 required a blind intubation through the ILMA. Two patients ventilated with the ILMA were never intubated. Conclusion When applied in accordance with a predefined algorithm, the gum elastic bougie and the ILMA are effective to solve most problems occurring during unexpected difficult airway management.

scholarly journals Branchio-otic syndrome: An opportunity to reassess the paediatric anaesthetists’ approach to the difficult syndromic airway

2019 ◽  
pp. 27-30
Author(s):  
L Indiveri ◽  
AN Mohamed ◽  
A Milner
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Case Reports ◽  
Management Plan ◽  
Branchial Arch ◽  
Flexible Bronchoscope ◽  
Branchial Cleft ◽  
Spectrum Disorders ◽  
Indispensable Tool ◽  
Bag Mask Ventilation

Branchio-oto-renal spectrum disorders are rare genetic entities with variable penetrance and concurrently display a wide phenotypic variation. A common issue to syndromic children is a propensity for difficult bag-mask ventilation, intubation or both. Unfortunately, there is no uniformity of this challenge, assessment strategy or management plan. This case with features of branchio-otic syndrome provided the opportunity to examine several aspects of paediatric anaesthetic airway management. The child was booked for branchial cyst removal but appeared to have other features of abnormal branchial cleft development. An outline of the executed anaesthetic plan is presented and discussed. Three different techniques were sequentially tried in this patient before the airway was secured. Various case reports in the literature inconsistently describe easy to very difficult airway management in children with branchio-oto-renal spectrum disorders. Branchial arch dysgenesis is almost always associated with difficult direct laryngoscopy. There is undoubtedly no singular way to ideally manage a child with a difficult airway. Many tools for difficult airways are available. However, despite the improvement of difficult paediatric airway equipment, it would appear that for the anaesthetist the flexible bronchoscope remains an indispensable tool.

scholarly journals The Difficult Airway Trolley: A Narrative Review and Practical Guide

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Martin F. Bjurström ◽  
Mikael Bodelsson ◽  
Louise W. Sturesson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Future Research ◽  
Clinical Settings ◽  
Airway Equipment ◽  
National Expert ◽  
Airway Devices ◽  
Facemask Ventilation

Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

Management of the Difficult Airway

2005 ◽  
Vol 103 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Gene N. Peterson ◽  
Karen B. Domino ◽  
Robert A. Caplan ◽  
Karen L. Posner ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Airway Management ◽  
Difficult Airway ◽  
Odds Ratio ◽  
Improve Patient Safety ◽  
Multiple Logistic Regression Analysis ◽  
Management Strategies ◽  
Difficult Airway Management ◽  
Malpractice Claims ◽  
Time Periods

Background The purpose of this study was to identify the patterns of liability associated with malpractice claims arising from management of the difficult airway. Methods Using the American Society of Anesthesiologists Closed Claims database, the authors examined 179 claims for difficult airway management between 1985 and 1999 where a supplemental data collection tool was used and focused on airway management, outcomes, and the role of the 1993 Difficult Airway Guidelines in litigation. Chi-square tests and multiple logistic regression analysis compared risk factors for death or brain damage (death/BD) from two time periods: 1985-1992 and 1993-1999. Results Difficult airway claims arose throughout the perioperative period: 67% upon induction, 15% during surgery, 12% at extubation, and 5% during recovery. Death/BD with induction of anesthesia decreased in 1993-1999 (35%) compared with 1985-1992 (62%; P < 0.05; odds ratio, 0.26; 95% confidence interval, 0.11-0.63; P = 0.003). In contrast, death/BD associated with other phases of anesthesia did not significantly change over the time periods. The odds of death/BD were increased by the development of an airway emergency (odds ratio, 14.98; 95% confidence interval, 6.37-35.27; P < 0.001). During airway emergencies, persistent intubation attempts were associated with death/BD (P < 0.05). Since 1993, the Airway Guidelines were used to defend care (8%) and criticize care (3%). Conclusions Death/BD in claims from difficult airway management associated with induction of anesthesia but not other phases of anesthesia decreased in 1993-1999 compared with 1985-1992. Development of additional management strategies for difficult airways encountered during maintenance, emergence, or recovery from anesthesia may improve patient safety.

scholarly journals LEMON SCORE: A TOOL TO PREDICT DIFFICULT AIRWAY IN ED IN INDIAN SETTING.

2019 ◽  
Vol 3 (12) ◽  
Author(s):  
Sumalya Tripathi ◽  
Dr V.S Shinde ◽  
Zahid Parvez Shaikh
Keyword(s):  
Emergency Medicine ◽  
Airway Management ◽  
Difficult Airway ◽  
Invasive Mechanical Ventilation ◽  
Common Finding ◽  
Successful Resuscitation ◽  
Emergency Airway ◽  
Indian Setting ◽  
Lemon Score ◽  
Neck Mobility

Background: Airway management is a critical need in many acutely ill and injured patients. Inadequate delivery of oxygen to brain and other vital structures is the quickest killer. Emergency airway management is the major key for successful resuscitation in ED. Emergency medicine is an emerging branch in India at present and no research study has been conducted to evaluate difficult airway prediction score. Hence this study aimed to find the use of LEMON score as a tool to predict difficult airway in our ED. Methods: All the patients requiring invasive mechanical ventilation with age >12 years, not admitted outside and admitted to the emergency medicine department from July 2017 to September 2019 were included in our study.  A total of 67 patients required invasive ventilation and were assessed by LEMON score for difficult intubation. This score is related to number of attempts required and Cormack lehane class of laryngoscopic view while intubation. Results: In the “LOOK EXTERNALLY” the most common finding was edentulous mouth with occurrence of 26.87%. In ‘EVALUATE’ component the most common difficulty was 2-3-2. In MALLAMPATI CLASS 56.71% were class I, 39.39% were class II. In OBSTRUCTION component of LEMON, 98.51% had no obstruction. In NECK MOBILITY component we found that 85.1% subjects had mobile neck and only 15.15% subjects had restricted neck mobility. We observed that the LEMON score is 60% sensitive and 96.15% specific to predict difficult airway. The positive predictive value was 83.33%. Conclusion: This tool can reduce the chance of unexpectedly encountering difficult airway.

scholarly journals Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy

2021 ◽  
Vol 9 ◽  
Author(s):  
Teiji Sawa ◽  
Atsushi Kainuma ◽  
Koichi Akiyama ◽  
Mao Kinoshita ◽  
Masayuki Shibasaki
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Outer Diameter ◽  
Difficult Airway Management ◽  
Supraglottic Airway Device ◽  
Endotracheal Tubes ◽  
Inner Diameter ◽  
Neonates And Infants

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS). Some VLSs are equipped with small blades for infants. Advanced SADs have small sizes for infants, and some effectively function as conduits for endotracheal intubation. The smallest FOS has an outer diameter of 2.2 mm and enables intubation with endotracheal tubes with an inner diameter of 3.0 mm. DAM in neonates and infants can be improved by effectively selecting the appropriate device combination and ensuring that available providers have the necessary skills.

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