3.Fiberoptic bronchoscope and C-MAC video laryngoscope assisted nasal-oral tube exchange: two case reports.
Sungmi JI ; Jaegyok SONG ; Seok Kon KIM ; Moon Young KIM ; Sangyun KIM
Journal of Dental Anesthesia and Pain Medicine 2017;17(3):219-223
In cases of multiple facial trauma and other specific cases, the anesthesiologist may be asked to convert an oral endotracheal tube to a nasal endotracheal tube or vice versa. Conventionally, the patient is simply extubated and the endotracheal tube is re-inserted along either the oral or nasal route. However, the task of airway management can become difficult due to surgical trauma or worsening of the airway condition. Fiberoptic bronchoscopy was considered a novel method of airway conversion but this method is not useful when there are secretions and bleeding in the airway, or if the anesthesiologist is inexperienced in using this device. We report a successful airway conversion under the aid of both, a fiberoptic bronchoscope and a C-MAC video laryngoscope.
Airway Management
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Bronchoscopes*
;
Bronchoscopy
;
Hemorrhage
;
Humans
;
Intubation, Intratracheal
;
Laryngoscopes*
;
Methods
4.Perioperative airway management for patients with morbid obesity.
Ya-hong GONG ; Xue-rong YU ; Yu-guang HUANG
Acta Academiae Medicinae Sinicae 2011;33(3):224-227
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
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Anesthesia
;
methods
;
Humans
;
Obesity
;
surgery
;
Perioperative Care
5.Difficult Airway for Patients Undergoing Spine Surgeries.
Lu-Lu MA ; Xue-Rong YU ; Bo ZHU ; Yu-Guang HUANG ; Jian-Xiong SHEN ; Jian-Guo ZHANG
Chinese Medical Journal 2016;129(6):749-750
6.Anaesthetic management of acute airway obstruction.
Patrick WONG ; Jolin WONG ; May Un Sam MOK
Singapore medical journal 2016;57(3):110-117
The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.
Acute Disease
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Airway Management
;
methods
;
Airway Obstruction
;
therapy
;
Anesthesia
;
methods
;
Anesthetics
;
therapeutic use
;
Humans
7.Blind nasal intubation as an alternative to difficult intubation approaches.
Hwanhee YOO ; Jae Moon CHOI ; Jun Young JO ; Sukyung LEE ; Sung Moon JEONG
Journal of Dental Anesthesia and Pain Medicine 2015;15(3):181-184
Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.
Aged
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Airway Management
;
Bronchoscopy
;
Cartilage
;
Emergencies
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Humans
;
Intubation*
;
Methods
;
Neck
;
Pathology
;
Patient Compliance
;
Soil
8.Blind nasal intubation as an alternative to difficult intubation approaches.
Hwanhee YOO ; Jae Moon CHOI ; Jun Young JO ; Sukyung LEE ; Sung Moon JEONG
Journal of Dental Anesthesia and Pain Medicine 2015;15(3):181-184
Airway difficulties are a major concern for anesthesiologists. Even though fiberoptic intubation is the generally accepted method for management of difficult airways, it is not without disadvantages-requires patient cooperation, and cannot be performed on soiled airway or upper airways with pre-existing narrowing pathology. Additionally, fiberoptic bronchoscopy is not available at every medical institution. In this case, we encountered difficult airway management in a 71-year-old man with a high Mallampati grade and a thick neck who had undergone urologic surgery. Several attempts, including a bronchoscope-guided intubation, were unsuccessful. Finally, blind nasal intubation was successful while the patient's neck was flexed and the tracheal cartilage was gently pressed down. We suggest that blind nasal intubation is a helpful alternative in difficult airway management and it can be a lifesaving technique in emergencies. Additionally, its simplicity makes it a less expensive option when advanced airway technology (fiberoptic bronchoscopy) is unavailable.
Aged
;
Airway Management
;
Bronchoscopy
;
Cartilage
;
Emergencies
;
Humans
;
Intubation*
;
Methods
;
Neck
;
Pathology
;
Patient Compliance
;
Soil
9.Laryngeal Mask Airway Insertion in Adults: Comparison between Fully Deflated and Partially Inflated Technique.
Jiwon AN ; Seo Kyung SHIN ; Ki Jun KIM
Yonsei Medical Journal 2013;54(3):747-751
PURPOSE: The laryngeal mask airway (LMA) is a supraglottic airway device designed to seal around the laryngeal inlet. A controlled study was designed to compare the effectiveness and complications in inserting the LMA when the cuff is fully deflated and partially inflated. MATERIALS AND METHODS: American Society of Anesthesiologists physical status I or II 172 female patients scheduled for gynecologic procedures were included in this study. Patients were randomly allocated into one of the two groups; fully deflated (n=86) and partially inflated group (n=86). A size #4 LMA was inserted. The number of attempts, time taken for successful insertion, grade of leak, grade of fiberoptic view, and complications were evaluated. RESULTS: All 172 patients completed the study protocol. The number of attempts, time taken for successful insertion, and grade of leak were not significantly different between the two groups. The grade of fiberoptic view and complications were lower in the fully deflated group. CONCLUSION: The fully deflated method is more accurate and safe because of better fiberoptic view and lesser complications than the partially inflated group.
Adult
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Airway Management/adverse effects/instrumentation/*methods
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Female
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Humans
;
Laryngeal Masks/*adverse effects
;
Middle Aged
10.Comparison of Formulae for Orotracheal Intubation Depth in the Paediatric Population.
Jen Heng PEK ; Elizabeth Mj TAN ; Ying HAO ; Gene Yk ONG
Annals of the Academy of Medicine, Singapore 2018;47(4):138-142
INTRODUCTIONMultiple formulae have been proposed for calculating orotracheal depth for paediatric intubation. However, literature on the validation of these formulae in the emergency department setting is limited. Three methods described in the local Advanced Paediatric Life Support curriculum include the Broselow tape, endotracheal tube (ETT) size x 3, and the age-based formula of age divided by 2, add 12. We aimed to determine their accuracy.
MATERIALS AND METHODSPatients with intubation performed in the Children's Emergency from 1 January 2009 to 31 December 2013 were included in this retrospective observational study. The depths of ETT placement based on the formulae were calculated from the actual depth of ETT. ETT position between T2 to T4 vertebral bodies of the chest radiograph was taken as the reference position for radiological accuracy.
RESULTSETT size x 3 has the highest accuracy of 76.5%, as compared to 67.9% for age-based formula and 63.5% for Broselow tape. When the formulae were inaccurate, Broselow tape often predicted a depth that was too shallow as compared to ETT size x 3 ( = 0.006) and age-based formula ( = 0.011). The accuracy of Broselow tape was not uniform across the age groups, with highest accuracy in patients 1 to 8 years old. ETT size x 3 had the highest accuracy in patients weighing more than 25 kg.
CONCLUSIONETT size x 3 was superior for determining orotracheal intubation depth but cannot preclude the confirmation of appropriate placement of ETT by auscultation and chest radiograph.
Airway Management ; standards ; Algorithms ; Child ; Female ; Humans ; Intubation, Intratracheal ; methods ; standards ; Retrospective Studies