McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibilit...McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.展开更多
Background: Tracheal intubation is a common procedure in medical practice, being performed mainly in surgical centers and emergencies in trauma patients. Objective: This systematic literature review aims to understand...Background: Tracheal intubation is a common procedure in medical practice, being performed mainly in surgical centers and emergencies in trauma patients. Objective: This systematic literature review aims to understand the main difficulties and complications related to tracheal intubation. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2016 and 2021, restricted to articles in English and Portuguese with the descriptors: Airway, Difficult intubation, and Complications. After reading the abstracts, 34 articles were found, and, after reading them, 9 articles were selected. Results: This review analyzed 9 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects (author/year of publication, article title, objective, type of study, and database. Discussion: Several factors that influence the success of intubation were identified, such as technical, professional, and patient issues. In addition, measures to minimize the risks involving the procedure were highlighted. Conclusion: Tracheal intubation is a common procedure in surgical centers and emergencies. However, its risks, while low, should not be ignored. Unsuccessful procedures can occur and have consequences for the patient, such as trauma to the upper airway.展开更多
The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for diffi...The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.展开更多
Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as ...Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal cords.VL overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful intubation.Various types of VL blades are available.We devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.展开更多
Objectives:Children with a difficult airway are prone to severe complications in unplanned intubation events.The otolaryngologist is often required to secure the airway using advanced techniques once the traditional m...Objectives:Children with a difficult airway are prone to severe complications in unplanned intubation events.The otolaryngologist is often required to secure the airway using advanced techniques once the traditional methods have failed to establish safe tracheal intubation.The goal of our study was to describe the otolaryngologist''s experience in the management of bedside difficult pediatric airway events.Methods:A case series with chart review of children intubated by the difficult airway response(RaDAR)team in an academic tertiary-care children''s hospital.The electronic medical charts of patients intubated by the RaDAR team between Jan 2020 and Dec 2021 were reviewed.The steps taken to recognize and signal patients with a difficult airway are described.Results:Of the 78 airway code events managed by the RaDAR team,28(37.2%)were intubated by an otolaryngologist.Of these,20(71.4%)were recognized and signaled as a"difficult airway"before emergent intubation.The methods to secure the airway were direct laryngoscopy(n=7),flexible bronchoscopy with/without a laryngeal mask(n=10),rigid bronchoscopy(n=8),and video laryngoscopy(n=1).On average,there were 1.93 attempts to secure the airway following RaDAR activation.The airway was secured by an otolaryngology trainee in 24/28 patients.None of the patients required bedside tracheostomy.Conclusions:Otolaryngologists have unique skills and instruments that may assist with the management of a child with a difficult airway.Close collaboration with anesthesia colleagues,proper training,and proactive recognition and signaling of patients at risk for difficult airway are key factors for safe airway securement.展开更多
BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we de...BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.展开更多
Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement...Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement of other organ systems to varying degrees. Patients with JBS may require surgical intervention to address the underlying phenotypic abnormalities. The many craniofacial abnormalities found in patients with JBS are a concern for the anesthesiologist. We present the case of an adult patient with JBS who is undergoing implantation of a leadless pacemaker. Considering the many cardiac and craniofacial abnormalities in these patients, the anesthesiologist should order diagnostic tests such as echocardiography to assess cardiac function, as well as be prepared to perform advanced airway techniques for difficult airways. The anesthetic provider should be aware of the varied phenotypic expression of JBS and should individualize the anesthetic plan to each patient. Prior medical literature on the anesthetic management of these patients is scarce and limited to pediatric patients. This is the first case report addressing anesthetic concerns in an adult patient with JBS.展开更多
The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various sur...The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various surgeries under general anesthesia. Airway abnormality and various endocrine abnormalities should be considered during general anesthesia for McCune-Albright syndrome patients. A 15-year-old male with McCune-Albright syndrome was admitted with complaint of right nasal obstruction originated from fibrous dysplasia. Endoscopic resection of nasal cavity lesion was scheduled under navigation system guidance. Difficult airway could be anticipated due to protrusion of maxilla and right nostril. Awake fiberoptic intubation was performed by spray-as-you-go technique. When an anesthesiologist expects to take care of the patient with the McCune-Albright syndrome, the most appropriate anesthetic induction and tracheal intubation technique should be selected, and multiple backup instruments such as supraglottic device, video laryngoscope and fiberoptic bronchoscopy should be prepared.展开更多
Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was...Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients. Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5--67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 （including 1375 patients with the atlanto-occipital extension of 〉20° and the Mallampatti＇s grade I or II） and group 2 （containing 308 patients with the atlanto-occipital extension of 〈20° and the Mallampatti＇s grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia （TIVA） or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope （FOSL）. The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients. Results In group 1, the intubation was accomplished during the first attempt in 1279 cases （93%） and the intubation time was 〈3 minutes in 1304 cases （95%）. In group 2, the intubation was completed by the first attempt in 114 patients （37%） and 123 patients had an intubation time of 〈3 minutes （40%）. Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients required four or more attempts which only occurred in group 2. The incidence of traumatic complication was 2.6% and 9.7% with one intubation attempt in groups 1 and 2, respectively, 12.5% and 17.0% with multiple intubation attempts （one vs multiple attempts in both groups, P 〈0.001）. All nontrauamatic complications occurred in group 2 and laryngospasm and hypoxemia were more common in patients using the TIVA compared to those using the sevoflurane inhalational anesthesia （P 〈0.001）. Conclusions This study demonstrated that with a precise airway evaluation, an adequate preoperative preparation and a pre-planned failed intubation strategy, the anesthetist who was experienced in the difficult airway management could safely perform airway control and tracheal intubation under general anesthesia in patients with scar contracture of the neck. We believe that this technique may be very valuable for the management of a known difficult airway because it is comfortable for the patient and saves time for the anesthetist.展开更多
文摘McGrath? MAC video laryngoscope (McG) has been used for orotracheal intubation in both normal patients and patients for whom intubation was expected to be difficult, and has been reported to provide improved visibility of the glottis during tracheal intubation. There are some reports that normal nasotracheal intubation is easier with McG than with macintosh laryngoscope (ML). The usefulness of McG for nasotracheal intubation is beginning to be recognised. We experienced three cases using McG in patients for whom intubation was expected to be difficult due to the limited mouth opening and using McG for those patients enabled smooth nasotracheal intubation. McG provides good visual field during nasotracheal intubation, and is less invasive to the patient.
文摘Background: Tracheal intubation is a common procedure in medical practice, being performed mainly in surgical centers and emergencies in trauma patients. Objective: This systematic literature review aims to understand the main difficulties and complications related to tracheal intubation. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2016 and 2021, restricted to articles in English and Portuguese with the descriptors: Airway, Difficult intubation, and Complications. After reading the abstracts, 34 articles were found, and, after reading them, 9 articles were selected. Results: This review analyzed 9 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects (author/year of publication, article title, objective, type of study, and database. Discussion: Several factors that influence the success of intubation were identified, such as technical, professional, and patient issues. In addition, measures to minimize the risks involving the procedure were highlighted. Conclusion: Tracheal intubation is a common procedure in surgical centers and emergencies. However, its risks, while low, should not be ignored. Unsuccessful procedures can occur and have consequences for the patient, such as trauma to the upper airway.
文摘The aim of the study is to assess the possibility of intubation in each patient, the lyche to be difficult intubation, to fred all the causes of the difficult intubation, to fred and apply appropriate scales for difficult intubation, to estimate the frequency of difficult intubation. Endotmcheal intubation is the basic reanimation procedure performed both in hospital and out-of-hospital settings. It is carded out whenever chest movements and spontaneous respiration are compromised. Respiratory arrest may occur for a variety of reasons （such as cardac arrest, coma of any origin, poisining） or direct damage to the airways, e.g. in various traumas （damages to the face, oropharynx, larynx, trachea, chest）. The basic endotracheal intubation kit contains： laryngoscope, endotracheal tubes, connectors （tube and Ambu bag connectors）, complete Ambu kit （face mask and bag）, 20 mL syringe for cuff inflating, suction apparatus, stylete, and Magill forceps. In order to assess the successfulness of endotracheal intubation, it is necessary first to identify patients who need to be intubated. With the aim of identifying such patients, numerous screening tests and scales have been created to predict difficult intubation. The best known and most commonly used are the Mallampati and Wilson classifications as well as the LEMON airway assessment method. Nevertheless, difficult intubation accounts for 1% of cases. It usually occurs when manipulation of the laryngoscope blade is not possible in obese patients and patients with short neck, in congenital restricted mouth opening, limited neck movement as well as limited temporomandibular joint mobility; in cases of edema, fibrosis and lesions of the tongue, pharynx and larynx; when there are anatomical variations and congenital malformations of the oral cavity, pharynx, larynx, head, neck and chest.
文摘Airway management plays a crucial role in providing adequate oxygenation and ventilation to patients during various medical procedures and emergencies.When patients have a limited mouth opening due to factors such as trauma,inflammation,or anatomical abnormalities airway management becomes challenging.A commonly utilized method to overcome this challenge is the use of video laryngoscopy(VL),which employs a specialized device equipped with a camera and a light source to allow a clear view of the larynx and vocal cords.VL overcomes the limitations of direct laryngoscopy in patients with limited mouth opening,enabling better visualization and successful intubation.Various types of VL blades are available.We devised a novel flangeless video laryngoscope for use in patients with a limited mouth opening and then tested it on a manikin.
文摘Objectives:Children with a difficult airway are prone to severe complications in unplanned intubation events.The otolaryngologist is often required to secure the airway using advanced techniques once the traditional methods have failed to establish safe tracheal intubation.The goal of our study was to describe the otolaryngologist''s experience in the management of bedside difficult pediatric airway events.Methods:A case series with chart review of children intubated by the difficult airway response(RaDAR)team in an academic tertiary-care children''s hospital.The electronic medical charts of patients intubated by the RaDAR team between Jan 2020 and Dec 2021 were reviewed.The steps taken to recognize and signal patients with a difficult airway are described.Results:Of the 78 airway code events managed by the RaDAR team,28(37.2%)were intubated by an otolaryngologist.Of these,20(71.4%)were recognized and signaled as a"difficult airway"before emergent intubation.The methods to secure the airway were direct laryngoscopy(n=7),flexible bronchoscopy with/without a laryngeal mask(n=10),rigid bronchoscopy(n=8),and video laryngoscopy(n=1).On average,there were 1.93 attempts to secure the airway following RaDAR activation.The airway was secured by an otolaryngology trainee in 24/28 patients.None of the patients required bedside tracheostomy.Conclusions:Otolaryngologists have unique skills and instruments that may assist with the management of a child with a difficult airway.Close collaboration with anesthesia colleagues,proper training,and proactive recognition and signaling of patients at risk for difficult airway are key factors for safe airway securement.
文摘BACKGROUND A“cannot intubate,cannot oxygenate(CICO)”situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation.In this paper,we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx(TTIP)technique.CASE SUMMARY A 43-year-old man was diagnosed with parotid tumor for>10 years.Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx.Tumor excision was arranged.However,we encountered CICO during anesthesia induction.An endotracheal tube was used as an emergency supraglottic airway device(TTIP)to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway.The patient did not experience desaturation despite sudden loss of definite airway.During tracheostomy,the pulse oximetry remained 100%with our technique of ventilating the patient.The arterial blood gas analysis revealed PaCO_(2)35.7 mmHg and PaO2242.5 mmHg upon 50%oxygenation afterward.CONCLUSION Using an endotracheal tube as a supraglottic airway device,patients may have increased survival without experiencing life-threatening desaturation.
文摘Johanson-Blizzard syndrome (JBS) is a rare genetic disorder characterized by multiple craniofacial abnormalities, intellectual disability, sensorineural hearing loss, pancreatic exocrine insufficiency, and involvement of other organ systems to varying degrees. Patients with JBS may require surgical intervention to address the underlying phenotypic abnormalities. The many craniofacial abnormalities found in patients with JBS are a concern for the anesthesiologist. We present the case of an adult patient with JBS who is undergoing implantation of a leadless pacemaker. Considering the many cardiac and craniofacial abnormalities in these patients, the anesthesiologist should order diagnostic tests such as echocardiography to assess cardiac function, as well as be prepared to perform advanced airway techniques for difficult airways. The anesthetic provider should be aware of the varied phenotypic expression of JBS and should individualize the anesthetic plan to each patient. Prior medical literature on the anesthetic management of these patients is scarce and limited to pediatric patients. This is the first case report addressing anesthetic concerns in an adult patient with JBS.
文摘The McCune-Albright syndrome is rare disease diagnosed by the clinical triad, fibrous dysplasia, café-au lait skin pigmentations and endocrine hyperfunction. Those patients with bone issues could have various surgeries under general anesthesia. Airway abnormality and various endocrine abnormalities should be considered during general anesthesia for McCune-Albright syndrome patients. A 15-year-old male with McCune-Albright syndrome was admitted with complaint of right nasal obstruction originated from fibrous dysplasia. Endoscopic resection of nasal cavity lesion was scheduled under navigation system guidance. Difficult airway could be anticipated due to protrusion of maxilla and right nostril. Awake fiberoptic intubation was performed by spray-as-you-go technique. When an anesthesiologist expects to take care of the patient with the McCune-Albright syndrome, the most appropriate anesthetic induction and tracheal intubation technique should be selected, and multiple backup instruments such as supraglottic device, video laryngoscope and fiberoptic bronchoscopy should be prepared.
文摘Background Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients. Methods This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5--67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 （including 1375 patients with the atlanto-occipital extension of 〉20° and the Mallampatti＇s grade I or II） and group 2 （containing 308 patients with the atlanto-occipital extension of 〈20° and the Mallampatti＇s grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia （TIVA） or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope （FOSL）. The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients. Results In group 1, the intubation was accomplished during the first attempt in 1279 cases （93%） and the intubation time was 〈3 minutes in 1304 cases （95%）. In group 2, the intubation was completed by the first attempt in 114 patients （37%） and 123 patients had an intubation time of 〈3 minutes （40%）. Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients required four or more attempts which only occurred in group 2. The incidence of traumatic complication was 2.6% and 9.7% with one intubation attempt in groups 1 and 2, respectively, 12.5% and 17.0% with multiple intubation attempts （one vs multiple attempts in both groups, P 〈0.001）. All nontrauamatic complications occurred in group 2 and laryngospasm and hypoxemia were more common in patients using the TIVA compared to those using the sevoflurane inhalational anesthesia （P 〈0.001）. Conclusions This study demonstrated that with a precise airway evaluation, an adequate preoperative preparation and a pre-planned failed intubation strategy, the anesthetist who was experienced in the difficult airway management could safely perform airway control and tracheal intubation under general anesthesia in patients with scar contracture of the neck. We believe that this technique may be very valuable for the management of a known difficult airway because it is comfortable for the patient and saves time for the anesthetist.
