Anesthetic management of thoracoscopic pulmonary wedge resection with a giant tracheal diverticulum in the carina: a case report and review of the literature

A tracheal diverticulum (TD) is a rare disease that is usually diagnosed as an incidental finding on thoracic computed tomography or bronchoscopy. TDs can be classified as congenital or acquired. In patients undergoing surgery, TDs can result in difficult intubation, difficult ventilation, pneumothorax, and other complications. We herein report a case of anesthetic management of thoracoscopic pulmonary wedge resection in a patient with a giant TD in the carina. Intraoperative double-lumen intubation and single-lung ventilation were challenging to perform. Fiberoptic-guided intubation was helpful, and intraoperative management was tailored to avoid diverticulum rupture. In this report, we also review complications related to TD in surgical patients undergoing mechanical ventilation. Ventilation is one of the most prominent anesthetic challenges. The close collaboration of the entire medical team was a key factor in the successful management of this rare case.

Obesity - COVID-19 and mechanical ventilation of intubated patient

Obesity as a disease causes a restrictive lung disease and is a sufficient predisposing factor for difficult ventilation of the patient in the ventilator. In addition to covid-19, the phenomenon of hard lung is observed as the ventilation of intubated patients is very difficult and recruitment is quite difficult to achieve. The combination is quite difficult as these patients oppose the ventilator. This paper aims to explore the link between obesity and mechanical ventilation in COVID-19 patients.

Second Generation Supraglottic Airway (SGA) Devices

Supraglottic Airways (SGAs) are an integral part of anaesthetic care. Since their introduction, several modifications, additions, and variations have been developed and are currently in clinical practice since the last 25 years. Not only are they useful for difficult ventilation during both in-hospital and out-of-hospital difficult airway management, they also act as a conduit for tracheal intubation. The newer or second-generation SGAs have been designed to provide a better seal of the airway and are relatively safer since they allow gastric aspiration. Thus, the SGAs may be the most versatile component in the airway management cart. Existing literature on SGAs tends to focus on first generation SGAs and their use in OT only. However, the scope and use of these devices is vast. Knowledge regarding specific devices and supporting data for their use is of utmost importance to patient’s safety. This chapter addresses various types of commercially available novel SGAs and their use in and out of hospital settings.

Nuevo sistema de predicción de dificultad en la ventilación a través de dispositivos supraglóticos

El objetivo de este estudio fue proponer y validar un nuevo sistema de puntuación clínica para predecir la dificultad de ventilación a través de un dispositivo supraglótico (DSG). Los autores desarrollaron un score que se validó prospectivamente en 5532 pacientes. Se asignaron valores numéricos a cada uno de los 4 factores de riesgo que se identificaron: varón, mayor de 45 años, distancia tiromentoniana (DTM) corta y movilidad cervical limitada, y su suma compuso el score. El rango de dicho score va de 0 a 7 puntos. Un score de 4 o mayor se asocia a un riesgo incrementado de dificultad de ventilación a través de DSG. Nuestra conclusión es que el nuevo score para predicción de dificultad de ventilación a través de dispositivos supraglóticos es fácil de usar y podría ayudar en el plan de manejo de la VAD por los anestesiólogos. ABSTRACT New prediction system for difficult ventilation through a supraglottic airway device. The aim of this study was to propose and validate a new clinical score to predict difficult ventilation through a supraglottic airway device. The authors developed a scoring system that was prospectively validated in 5532 patients. They assigned point values to each of the identified four risk factors: male, age >45 yr., short thyromental distance, and limited neck movement, their sum composing the score. The score ranged between 0 and 7 points. A score 4 or greater is associated with an increased risk of difficult ventilation through a supraglottic airway device. Our conclusion is that the new score for prediction of difficult ventilation through a supraglottic airway device is easy to use and could help anesthetists plan for difficult airway management.

Goldenhar Syndrome

Goldenhar syndrome (also known as oculo-auriculo-vertebral spectrum, facio-auriculo-vertebral syndrome, and Goldenhar-Gorlin syndrome) is caused by fetal growth disturbances of the first two brachial clefts. Diagnostic criteria include eye, ear, mandibular, and/or vertebral anomalies. These patients may also have cardiac and renal malformations with varying degrees of severity. Airway management for Goldenhar patients may include difficult ventilation and intubation, which may become increasingly difficult with age. Vertebral anomalies including fused cervical vertebrae and/or cervical instability further complicate airway management. Pulmonary complications occur due to congenital malformations and scoliosis, which can lead to thoracic insufficiency syndrome. This chapter discusses genetics, presentation, and management of Goldenhar syndrome.

AirWay Scope™ for Difficult Ventilation in a Patient With Epiglottic Cyst

Epiglottic cysts often cause difficulty in airway management, with potential serious life-threatening complications.1 This case report describes a patient with an epiglottic cyst in whom mask ventilation became difficult after induction of anesthesia. Immediately, an AirWay Scope™ (TMAWS-S100; Pentax, Japan) was inserted orally, and the location of the epiglottis was clarified to assess the reason for difficulty with ventilation. This case demonstrates usefulness of the AirWay Scope in patients with epiglottic cyst.