scholarly journals Retrograde intubation in a case of cancrum oris with sygnathia

2017 ◽  
Vol 6 (3) ◽  
pp. 62-66
Author(s):  
G P Deo ◽  
S K Shrestha ◽  
S Neupane ◽  
H Ojha ◽  
I N Shrestha ◽  
...  
Keyword(s):  
Difficult Airway ◽  
Nasal Intubation ◽  
Intubation Technique ◽  
Open Mouth ◽  
Adequate Ventilation ◽  
Cancrum Oris ◽  
Retrograde Intubation ◽  
Light Sedation ◽  
Local Block ◽  
Selection Of

Difficult intubating conditions, anticipated or unanticipated, are part of every anaesthesist’s life. A large number of aids and various techniques have been described for intubating in such situations. The primary job of the anesthesiologist is to secure the airway and provide adequate ventilation to the anesthetised patient. Failure to manage difficult airway has led to many of the total deaths attributable to anesthesia. Proper airway examination and selection of appropriate method for airway intervention is of utmost importance. The retrograde intubation technique is one of the valuable alternative options in places where fiberoptic bronchoscope is not readily available or affordable in cases with anticipated difficult airway. We report a case of cancrum oris with sygnathia (fusion of jaw) leading to inability to open mouth posted for bilateral coronoidectomy with osteotomy of fused bone and lip repair. An awake retrograde nasal intubation with light sedation and local block was performed. 

scholarly journals Cuffed Oropharyngeal Airway for Difficult Airway Management

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.

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.

Extubation of the Difficult Airway

2019 ◽  
Author(s):  
Alison Dalton
Keyword(s):  
At Risk ◽  
Difficult Airway ◽  
Fiberoptic Bronchoscopy ◽  
Airway Exchange Catheter ◽  
Airway Edema ◽  
Exchange Catheter ◽  
Patients At Risk ◽  
Complicating Factors ◽  
Retrograde Intubation ◽  
Airway Exchange

It is well known that induction and intubation are periods associated with patient risk. Especially in the case of patients with known or suspected difficult airways, extubation may be associated with similar risk. Therefore, attempts at extubation must be well planned, and preparations for urgent or emergent intubation must be in order prior to removal of an endotracheal tube. Preparations should be made on a case-by-case basis with consideration given to that specific patient’s indications for difficult airway management. Patients at risk for airway obstruction from edema require different techniques and preparations compared with those patients at risk for intracranial hypertension. Advanced preparations should include consideration of the best location for extubation (ie, OR, PACU, ICU), required tools (ie, airway exchange catheter, videolaryngoscope, fiberoptic bronchoscope supraglottic device), and personnel. A thorough plan for emergent reintubation should be considered taking into account the patient’s baseline airway anatomy, previous difficulty of intubation, subsequent airway edema, hemodynamics, and other complicating factors (ie, patient now in a Halo device, jaw wiring).  This review contains 5 figures, 6 tables, and 45 references. keywords: airway edema, airway exchange catheter, cricothyrotomy, difficult airway, difficult intubation, extubation, fiberoptic bronchoscopy, retrograde intubation

scholarly journals The retrograde tracheal intubation technique for difficult airway management

2019 ◽  
Vol 3 (2) ◽  
pp. e16 ◽  
Author(s):  
Vincenzo Marchello ◽  
Ruggero M. Corso ◽  
Emanuele Piraccini ◽  
Alfredo Del Gaudio ◽  
Giuseppe Mincolelli ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management ◽  
Intubation Technique

scholarly journals Reducing Nasopharyngeal Trauma: The Urethral Catheter–Assisted Nasotracheal Intubation Technique

2011 ◽  
Vol 58 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Allen Wong ◽  
Paul Subar ◽  
Heidi Witherell ◽  
Konstantin J Ovodov
Keyword(s):  
Soft Tissues ◽  
Nasotracheal Intubation ◽  
Mouth Opening ◽  
Urethral Catheter ◽  
Alternative Methods ◽  
Nasal Intubation ◽  
Intubation Technique ◽  
Invasive Approach ◽  
Dental Procedures ◽  
The Many

Nasal intubation is an advantageous approach for dental procedures performed in the hospital, ambulatory surgery center, or dental office, when possible. Although many who provide anesthesia services are familiar and comfortable with nasal intubation techniques, some are reluctant and uncomfortable because of lack of experience or fear of nasopharyngeal bleeding and trauma. It has been observed from experiences in various settings that many approaches may be adapted to the technique of achieving nasal intubation. The technique that is described in this paper suggests a minimally invasive approach that introduces the nasoendotracheal tube through the nasopharyngeal pathway to the oropharynx in an expedient manner while preserving the nasopharyngeal structures, thus lessening nasal bleeding and trauma to soft tissues. The technique uses a common urethral catheter and can be incorporated along with current intubation armamentaria. As with all techniques, some limitations to the approach have been identified and are described in this paper. Cases with limited mouth opening, neck injury, and difficult airways may necessitate alternative methods. However, the short learning curve along with the many benefits of this technique offers the anesthesia professional additional options for excellent patient care.

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 Experience with Blind Nasotracheal Intubation for Temporomandibular Joint Ankylosis at Mayo Hospital, Lahore

2016 ◽  
Vol 9 (4) ◽  
Author(s):  
Khalid Javed ◽  
Ambrin Amjad ◽  
Muhammad Abdul Aziz
Keyword(s):  
Temporomandibular Joint ◽  
Nasotracheal Intubation ◽  
Fiberoptic Intubation ◽  
Nasal Intubation ◽  
Corrective Surgery ◽  
Tmj Ankylosis ◽  
Airway Control ◽  
Temporomandibular Joint Ankylosis ◽  
Retrograde Intubation ◽  
Joint Ankylosis

Temporomandibular joint ankylosis presents a serious problem for airway management. Alternate or additional technique of airway control are required in this condition. Different options include blind nasotracheal intubation, fiberoptic intubation, retrograde intubation or tracheostomy. Moreover, the patient could be awake or asleep. The purpose of our study was to describe our experience with blind nasotracheal intubation after induction of general anesthesia with spontaneous ventilation in patients of temporomandibular ankylosis presenting for corrective surgery. This experience was gained on all the patients of temporomandibular joint ankylosis presenting to fasciomaxillary department at Mayo Hospital, Lahore over a period of 1 1/2 years. The surgery done was gap arthroplasty with genioplasty. Thirty six patients (male:24, female: 12) with age ranging between 3 years to 25 years with a mean of 12.56 years were studied. All the patients received premedication with atropine 10mg/kg body weight to dry up secretion. Patients were deeply anaesthetized with Halothane, Nitrous oxide with 50% oxygen. Thirty four patients were successfully intubated. Blind nasal intubation failed in 2 patients. The successful blind nasotracheal intubation for surgery for TMJ ankylosis needs adequately and deeply anaesthetized patients, relatively small well lubricated endotracheal tube passed through patent naris with atropine as premedication.

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