NOVEL TECHNIQUES FOR DIFFICULT AIRWAY MANAGEMENT IN VARIOUS CLINICAL SCENARIOS: CASE SERIES AND REVIEW OF LITERATURE

Difficult airway management has till date been the most fearsome and challenging part of any anaesthetic management. Meticulous planning is always done prior to anaesthetic induction of such patients with multiple back up plans and rescue strategy. Significant advancements in terms of clinical protocols, techniques, and devices / gadgets in this field have led to decreased incidence of airway related complications. We hereby present a case series of 3 clinical cases with different airway scenarios; 1) Patient with huge goiter, who was intubated with the help of an indigenously developed fish mouth valve device, 2) a temporomandibular joint ankylosis case, managed with awake fibreoptic guided intubation 3) Patient with post burn contracture of face and neck, in which fibreoptic intubation was performed after partial release of scar under tumescent anaesthesia. Extensive preoperative airway evaluation and preparation to handle any emergency by multiple backup plans always helps in smooth sailing through these difficult clinical scenarios

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Temporomandibular joint ankylosis: “A pediatric difficult airway management”

Anesthesia Essays and Researches ◽

10.4103/aer.aer_122_17 ◽

2018 ◽

Vol 12 (1) ◽

pp. 282 ◽

Cited By ~ 1

Author(s):

Deepak Dwivedi ◽

Anoop Sharma ◽

RamMurti Sharma

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Temporomandibular Joint ◽

Difficult Airway Management ◽

Temporomandibular Joint Ankylosis ◽

Joint Ankylosis

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Emergency Surgical Airways Following Activation of a Difficult Airway Management Team in Hospitalized Critically Ill Patients: A Case Series

Journal of Intensive Care Medicine ◽

10.1177/0885066616680594 ◽

2016 ◽

Vol 33 (9) ◽

pp. 517-526 ◽

Cited By ~ 4

Author(s):

Joseph M. Darby ◽

Gregory Halenda ◽

Courtney Chou ◽

Joseph J. Quinlan ◽

Louis H. Alarcon ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Critically Ill ◽

Critically Ill Patients ◽

Case Series ◽

Management Team ◽

Team Approach ◽

High Morbidity ◽

Difficult Airway Management ◽

Surgical Airway

Introduction: An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. Methods: We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT). Results: Of 207 DAMT activations for native airway events, 22 (10.6%) events culminated in an ESA, with 59% of these events occurring in ICUs with the remainder outside the ICU in the context of rapid response team activations. Of patients undergoing ESA, 77% were male, 63% were obese, and 41% had a history of a difficult airway (DA). Failed planned or unplanned extubations preceded 61% of all ESA events in the ICUs, while bleeding from the upper or lower respiratory tract led to ESA in 44% of events occurring outside the ICU. Emergency surgical airway was the primary method of airway control in 3 (14%) patients, with the remainder of ESAs performed following failed attempts to intubate. Complications occurred in 68% of all ESAs and included bleeding (50%), multiple cannulation attempts (36%), and cardiopulmonary arrest (27%). Overall hospital mortality for patients undergoing ESA was 59%, with 38% of deaths occurring at the time of the airway event. Conclusion: An ESA is required in approximately 10% of DA events in critically ill patients and is associated with high morbidity and mortality. Efforts directed at early identification of patients with a difficult or challenging airway combined with a multidisciplinary team approach to management may reduce the overall frequency of ESA and associated complications.

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