Fiberoptic-guided intubation (FOI) has been an indispensable component of difficult airway management especially in instances where anatomical limitations precluded use of conventional direct laryngoscopy. Its use, however, is not without risks.

This paper presents a 4-year-old female with a limited mouth opening scheduled for an elective oral commissurotomy who developed signs and symptoms of tension pneumothorax immediately following a successful fiberoptic nasotracheal intubation. Passive insufflation of high-flow oxygen through a flexible fiberoptic bronchoscope preloaded with a tight-fitting endotracheal tube led to accumulation of air. This caused lung hyperinflation and subsequently, pneumothorax.

BACKGROUND: Resilience engineering is a paradigm for safety management that focuses on coping with complexity to achieve success, even considering several conflicting goals. Modern sociotechnical systems have to be resilient to comply with the variability of everyday activities, the tight-coupled and underspecified nature of work, and the nonlinear interactions among agents. At organizational level, resilience can be described as a combination of four cornerstones: monitoring, responding, learning, and anticipating. METHODS: Starting from these four categories, this article aims at defining a semiquantitative analytic framework to measure organizational resilience in complex sociotechnical systems, combining the resilience analysis gridand the analytic hierarchy process. RESULTS: This article presents an approach for defining resilience abilities of an organization, creating a structured domain-dependent framework to define a resilience profile at different levels of abstraction, and identifying weaknesses and strengths of the systemand potential actions to increase system's adaptive capacity. An illustrative example in an anesthesia department clarifies the outcomes of the approach. CONCLUSION: The outcome of the resilience analysis grid, i.e., a weighed set of probing questions, can be used in different domains, as a support tool in a wider Safety-II oriented managerial action to bring safety management into the core business of the organization.
Anesthesia Department, Hospital ; Commerce ; Learning ; Safety Management

Klippel-Feil Syndrome (KFS) continues to pose significant challenges for anesthesiologists. Beyond the expected complexities of managing difficult airways in these patients, they often present with systemic anomalies that can elevate the risk of morbidity during surgeries conducted under anesthesia. Furthermore, laparoscopic procedures bring about additional physiologic changes that must be taken into consideration when planning the anesthetic care for these individuals. This report details the anesthetic management of a 29-year-old female diagnosed with Klippel-Feil Syndrome (KFS) and concomitant Müllerian duct aplasia-Renal agenesis-Cervicothoracic Somite dysplasia (MURCS) as well as Chiari Type 1 Malformation, who underwent a successful pelvic laparoscopic surgery. The airway was secured through awake fiberoptic-guided intubation while general anesthesia was maintained with a combination of sevoflurane inhalation and remifentanil infusion. Intraoperatively, the team prioritized neuroprotection, lung-protective ventilation strategies, and renal preservation measures. The anesthetic management of patients with KFS necessitates a comprehensive assessment of their anomalies. Incorporating these considerations into the anesthetic management will help mitigate the procedure's adverse effects and lead to favorable patient outcomes.
Anesthesia ; Airway Management ; Klippel-Feil Syndrome ; Laparoscopy

No abstract available.
Anesthesia ; Arthroplasty, Replacement, Knee ; Pain Management

This is a case of conjoined emphalopagus twins, VC and VD, who undergo operation of separation.
Human ; CONJOINED TWINS ; ANESTHESIOLOGIST, SEPARATION ; TWINS ; ANESTHESIA MANAGEMENT ; KETAMINE ; AIRWAY MANAGEMENT

Supraglottic airway devices (SADs) have become prevalent in children because they avoid many of the adverse effects associated with endotracheal intubation. The laryngeal mask airway (LMA) Classic and the LMA Proseal have proven safe and efficacious for routine cases in pediatric patients. The LMA Proseal provides a better airway seal and protection against aspiration than the LMA Classic in children. Most SADs are designed for airway maintenance during routine anesthesia, but other roles include rescue airway after failed intubation, conduit to facilitate difficult intubation and as an adjunct device for special situations in or outside the hospital (e.g., neonatal resuscitation). Recently developed second-generation SADs, the i-gel and the LMA Supreme may be a suitable alternative for airway management when a single-use device with gastric access is needed in children. The Air-Q intubating laryngeal airway may be feasible as a conduit for tracheal intubation for pediatric patients with a difficult airway. This review article discusses the safety and efficacy of SADs in children.
Airway Management ; Anesthesia ; Child* ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks

To minimize morbidity arising from airway management related to anesthesia, the anesthesiologist performs a through history and physical examination and approaches all patients with well-through-out plans for various eventualities. Numerous anatomic and pathologic abnormalities may lead to difficult tracheal intubation. Failed tracheal intubation is frustrating, increase the risk of pulmonary aspiration, and may contribute to organ ischemia and then it imminently endangers the patients life and necessitates invasive approaches to ventilation. Use of the flexible fiberoptic bronchoscope has become an essential skill for anesthesiologists confronted with anatomic or physiologic abnormalities of the upper airway. The widespread availability of flexible fiberoptic bronchoscope has allowed anesthesiologists to use fiberoptic techniques eariler in airway instrumentation and, thereby, avoid failed intubation and trauma to the airway. This review will focus on practical information that will aid in successful utilization of fiberoptic bronchoscope.
Airway Management ; Anesthesia ; Bronchoscopes ; Humans ; Intubation ; Ischemia ; Physical Examination ; Ventilation

Intubating patients with a huge, fixed supraglottic mass causing an obstruction of the glottis is difficult to most anesthesiologists. We attempted awake fiberoptic orotracheal intubation assisted by Glidescope(R) Videolaryngoscope (GVL) following topical anesthesia with 4% lidocaine spray and remifentanil infusion. The glottis could not be identified by the GVL view. However, by entering toward the right side of the mass with bronchoscope, the glottis was found. Due to stiffness of the mass, we were unable to further enter the area using the bronchoscope. Alternatively, we attempted to expose the glottis by GVL blade and then successfully intubated the patient by manually pressing the cricoids cartilage. GVL is nonetheless an excellent instrument in airway management compared to fiberoptic bronchoscope for patients with a huge and fixed supraglottic mass.
Airway Management ; Anesthesia ; Bronchoscopes ; Cartilage ; Glottis ; Humans ; Intubation ; Lidocaine ; Piperidines

Opioids are the cornerstone for treating moderate to severe pain and are commonly used for anesthesia and pain management. However, large inter-individual variability exists in the analgesic and adverse effects. It would be very helpful to predict the opioid response of each patient, considering the serious outcomes related to insufficient pain control and fatal side effects. Pharmacogenetic data on opioids have accumulated; thus, the aim of this article is to review the pharmacogenetic studies related to opioids frequently used for anesthesia and pain management.
Analgesia ; Analgesics, Opioid ; Anesthesia* ; Humans ; Pain Management* ; Pharmacogenetics*

The excess fatty tissues on the head, neck, thorax, and abdomen of morbid obese patients can impede the patency of the upper airway and impair lung functions. Meanwhile, these patients often have comorbidities such as obstructive sleep apnea, hypoventilation syndrome, chronic obstructive pulmonary disease, and asthma, which may result in difficult airway, intraoperative hypoventilation, and postoperative respiratory depression. Therefore, perioperative airway management for morbid obese patients may pose a big challenge to anesthesiologists. Anesthesiologists should know well about the pathophysiological features of respiratory system and grasp rational management principles, so as to improve the safety and effectiveness of perioperative airway management and optimize the clinical prognosis.
Airway Management ; Anesthesia ; methods ; Humans ; Obesity ; surgery ; Perioperative Care