Difficult Airway (difficult + airway)

Distribution by Scientific Domains

Terms modified by Difficult Airway

  • difficult airway management

  • Selected Abstracts

    Commentary to "The Difficult Airway" Resident Portfolio

    Debra Perina MD
    No abstract is available for this article. [source]

    Difficult airway , can intubate, 't ventilate

    ANAESTHESIA, Issue 7 2001
    H. Scott
    First page of article [source]

    Difficult airways, difficult intubations and predicted difficult intubations: important differences or mere semantics?

    ANAESTHESIA, Issue 10 2009
    Z. Belagodu
    No abstract is available for this article. [source]

    Difficult airways , difficult decisions: Guidelines for publication?

    ANAESTHESIA, Issue 7 2004
    W. A. Chambers
    No abstract is available for this article. [source]

    Performance of the Airtraq‘ laryngoscope after failed conventional tracheal intubation: a case series

    E. MALIN
    Background: The Airtraq‘, a new disposable indirect laryngoscope, was evaluated in patients with difficult intubation. Methods: The Airtraq‘ was used in 47 patients with predicted or unpredicted difficult intubation after failed orotracheal intubation performed by two senior anaesthesiologists with the Macintosh laryngoscope. Results: Tracheal intubation with Airtraq‘ was successful in 36 patients (80%). The Cormack and Lehane score was IIb,III in 35 patients, and IV in 12 patients, with the Macintosh laryngoscope, while Cormack and Lehane score was I,IIa in 40 patients, IIb,III in three and IV in four with Airtraq‘. A gum elastic bougie was used to facilitate tracheal access in one-third (11/36) of the cases. Orotracheal intubation was not possible with Airtraq‘ in nine cases, five of whom had a pharyngeal, laryngeal or basal lingual tumour. Conclusion: In patients with difficult airway, following failed conventional orotracheal intubation, Airtraq‘ allows securing the airway in 80% of cases mainly by improving glottis view. However, the Airtraq‘ does not guarantee successful intubation in all instances, especially in case of laryngeal and/or pharyngeal obstruction. [source]

    Awake tracheal intubation using the Airtraqģ laryngoscope: a case series

    The Airtraqģ laryngoscope (AL) is a new single use indirect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intubation under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a suspected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available. [source]

    LMA CTrach‘ for placement of a laser microlaryngoscopy tube in an unanticipated difficult airway

    A. Williams
    No abstract is available for this article. [source]

    Tracheal esophageal combitube: a useful airway for morbidly obese patients who cannot intubate or ventilate

    A. Della Puppa
    The tracheal esophageal combitube has been successfully used in many difficult airway circumstances. We report the dramatic case of a morbidly obese patient with a well-known difficult airway who was successfully rescued from a cannot ventilate,cannot intubate situation in our critical care unit by using the tracheal esophageal combitube. Surgical tracheostomy was performed while she was mechanically ventilated through the tracheal esophageal combitube. The tracheal esophageal combitube is a very important device that should be kept available in all cases of morbidly obese airway management. [source]

    Complaints related to respiratory events in anaesthesia and intensive care medicine from 1994 to 1998 in Denmark

    C. Rosenstock
    Background: In Denmark, a National Board of Patients' Complaints (NBPC) was founded in 1988. This study analyses anaesthetic complaints related to adverse respiratory events filed at the NBPC from 1994 to 1998 to point out directions for possible preventive measures. Methods: All decisions made by the NBPC from 1994 to 1998 concerning personnel employed in the Danish health care system were scrutinized. Cases related to anaesthesia and intensive care medicine were reviewed. Adverse respiratory events were identified and classified by mechanism of the incident that had caused the complaint. Detailed information on anaesthetic technique, personnel involved, sequence of events, clinical manifestation of injury, and outcome was recorded. Results: A total of 284 cases was identified. One-fifth (n=60) of the complaints were related to an adverse respiratory event. The overall mortality in these cases was 50% (n=30). In 19 complaints (32%), the treatment was considered substandard. Conclusion: Complaints related to respiratory events reveal that inadequate anaesthetic and intensive care medicine treatment leads to patient damage and death. Preventive strategies should be directed at the development of guidelines for handling the difficult airway, education in the management of the difficult airway, instruction in the correct use of anaesthetic equipment, improvement of interpersonnel communication routines, as well as implementation of simulator training. [source]

    Re: orotracheal to nasotracheal intubation exchange in pediatric patients with a difficult airway

    Rajeev Sharma
    No abstract is available for this article. [source]

    The classic laryngeal mask airway-guided fiberoptic tracheal intubation in children with a difficult airway

    Xu Liao
    No abstract is available for this article. [source]

    The new air-Q‘ intubating laryngeal airway for tracheal intubation in children with anticipated difficult airway: comment

    Matteo Parotto
    No abstract is available for this article. [source]

    Difficult paediatric intubation when fibreoptic laryngoscopy fails

    Agnes Ng
    Summary We report an unusual problem with fibreoptic bronchoscopy in an 8-year-old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher,Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. The patients have malar hypoplasia with down slanting palpebral fissures, high nasal bridge, micrognathia, absence of lower eyelashes, low set posteriorly rotated ears, preauricular tags, atresia of external ear canal, cleft palate, hypoplasia of thumb, with or without radius, and limited elbow extension. Protracted attempts with a fibreoptic bronchoscope failed to visualize the glottis, and this was only possible when the tube was guided to the larynx by blind nasal intubation. Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2,8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation. [source]

    Evaluation of the novel, single-use, flexible aScopeģ for tracheal intubation in the simulated difficult airway and first clinical experiences

    ANAESTHESIA, Issue 8 2010
    T. Piepho
    Summary Flexible fibreoptic intubation is widely accepted as an important modality for the management of patients with difficult airways. We compared the aScopeģ, a novel, single-use, flexible video-endoscope designed to aid tracheal intubation, with a standard flexible intubating fibrescope, by examining the performance of 21 anaesthetists during an easy and difficult intubation simulation in a manikin. Intubation success, time for intubation, and rating of the devices (using a scale from 1, excellent to 6, fail) were documented. Intubation times were similar for both flexible 'scopes in the scenarios (p = 0.59). Successful intubation rates were higher for the standard intubating fibrescope (17/21, 81%) than the aScope (14/21, 67%; p = 0.02) in the difficult intubation scenario. The median (IQR[range]) ratings for the standard fibrescope vs the aScope were respectively: overall, 2 (1.75,2 [1,2.5]) vs 3 (2,3.25 [1,5]) (p < 0.0001); picture quality 2 (1.5,2 [1,3]) vs 3 (2,4 [1,5]) (p < 0.0001). The aScope was also successfully used to facilitate tracheal intubation in five patients with anticipated or unanticipated difficult airways. Picture quality was sufficient to identify the anatomical landmarks. Although the performance of the aScope is acceptable, it does not meet the current quality of standard flexible intubation fibrescopes. [source]

    Manikin study of fibreoptic-guided intubation through the classic laryngeal mask airway with the Aintree intubating catheter vs the intubating laryngeal mask airway in the simulated difficult airway,

    ANAESTHESIA, Issue 8 2010
    A. M. B. Heard
    Summary In this randomised crossover manikin study of simulated difficult intubation, 26 anaesthetists attempted to intubate the trachea using two fibreoptic-guided techniques: via a classic laryngeal mask airway using an Aintree intubating catheter and via an intubating laryngeal mask airway using its tracheal tube. Successful intubation was the primary endpoint, which was completed successfully in all 26 cases using the former technique, and in 5 of 26 cases using the latter (p < 0.0001). The former technique also proved quicker to reach the vocal cords with the fibrescope (median (IQR [range])) time 18 (14,20 [8,44]) s vs 110 (70,114 [30,118]) s, respectively; p = 0.008); and to first ventilation (93 (74,109 [52,135]) s vs 135 (79,158 [70,160]) s, respectively; p = 0.0038)]. We conclude that in simulated difficult intubation, fibreoptic intubation appears easier to achieve using a classic laryngeal mask airway and an Aintree intubating catheter than through an intubating laryngeal mask airway. [source]

    Awake tracheal intubation using the SensaScopeTM in 13 patients with an anticipated difficult airway

    ANAESTHESIA, Issue 8 2010
    P. Biro
    No abstract is available for this article. [source]

    Awake tracheal intubation using the Sensascope‘ in 13 patients with an anticipated difficult airway

    ANAESTHESIA, Issue 5 2010
    R. Greif
    Summary We present the use of the SensaScope‘, an S-shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans-cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. In all cases, tracheal intubation was achieved using the SensaScope. The median (IQR [range]) insertion time (measured from the time the facemask was taken away from the face until an end-expiratory CO2 reading was visible on the monitor) was 58 s (38,111 [28,300]s). In nine of the 13 cases, advancement of the SensaScope into the trachea was easy. Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway. [source]

    A comparison between the GlideScopeģ Video Laryngoscope and direct laryngoscope in paediatric patients with difficult airways , a pilot study

    ANAESTHESIA, Issue 4 2010
    C. Karsli
    Summary The GlideScopeģ Video Laryngoscope may improve the view seen at laryngoscopy in adults who have a difficult airway. Manikin studies and case reports suggest it may also be useful in children, although prospective studies are limited in number. We hypothesised that the paediatric GlideScope will result in an improved view seen at laryngoscopy in children with a known difficult airway, compared to direct laryngoscopy. Eighteen children with a history of difficult or failed intubation were prospectively recruited. After inhalational induction, each patient had laryngoscopy performed using a standard blade followed by GlideScope videolaryngoscopy. The GlideScope yielded a significantly improved laryngoscopic view, both with (p = 0.003) and without (p = 0.004) laryngeal pressure. The mean (SD) time taken to achieve the optimal view was 20 (8)s using conventional laryngoscopy and 26 (22)s using the GlideScopeģ (p = 0.5). The GlideScopeģ significantly improves the laryngoscopic view obtained in children with a difficult airway. [source]

    Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin,

    ANAESTHESIA, Issue 1 2010
    L. De Lloyd
    Summary We compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. Each anaesthetist performed two intubations with each method via each device. The mean (SD) time for the first intubation using the tracheal tube over the fibrescope was 43 (24) s with the classic laryngeal mask airway and 22 (9) s with the i-gel (95% CI for the difference 12,30 s, p < 0.0001). The mean (SD) times for the first intubation when using the Aintree Intubation Catheter was 46 (24) s with the classic laryngeal mask airway and 37 (9) s with the i-gel (95% CI for the difference 5,12 s, p < 0.0001). We recorded five (5/64, 8%) oesophageal intubations when using the classic laryngeal mask airway and none when using the i-gel. The participants rated the ease of railroading of the tracheal tube and railroading the Aintree Intubation Catheter over the fibrescope to be significantly easier (p < 0.0001 and p = 0.002 respectively) when using the i-gel than when using the classic laryngeal mask airway. Furthermore, 30/32 (94%) of anaesthetists reported preference for the i-gel over the classic laryngeal mask airway for fibrescope guided tracheal intubation when managing a difficult airway. We conclude that the i-gel is likely to be a more appropriate conduit than the classic laryngeal mask airway for fibrescope guided intubation irrespective of the intubation method used. [source]

    A paramedic study comparing the use of Airtraq, Airway Scope and Macintosh laryngoscopes in a simulated difficult airway

    ANAESTHESIA, Issue 7 2009
    A. Lewis
    No abstract is available for this article. [source]

    Airtraq laryngoscope for bronchial blocker placement in a difficult airway

    ANAESTHESIA, Issue 6 2009
    G. DeGregoris
    No abstract is available for this article. [source]

    Ankylosing spondylitis: recent developments and anaesthetic implications

    ANAESTHESIA, Issue 5 2009
    L. J. Woodward
    Summary Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri-operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti-tumour necrosis factor-, agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken. [source]

    The management of severe emergence agitation using droperidol

    ANAESTHESIA, Issue 11 2006
    R. Hatzakorzian
    Summary Emergence agitation can occur following recovery from general anaesthesia. The patient may exhibit aggressive behaviour, disorientation, agitation and restlessness. Untreated, this complication may result in significant morbidity. We report two cases where droperidol was successfully used in the management of severe emergence agitation. In the first case, droperidol was administered to prevent the occurrence of postoperative agitation in a patient known to suffer from this condition following previous general anaesthetics. In the second case, droperidol was used to treat emergence agitation in a morbidly obese patient with a difficult airway who was aggressive and difficult to restrain. Both of these patients remained calm and co-operative, with stable cardio-respiratory parameters, following the administration of droperidol and showed no further signs of agitation. We suggest that droperidol is an effective medication that may be used to prevent and treat severe emergence agitation due to its rapid sedative effect and minimal cardio-respiratory depression. [source]

    Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway,

    ANAESTHESIA, Issue 5 2006
    J. M. Huitink
    Summary Awake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2,15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s. [source]

    Retrolaryngeal extension of goitre in a morbidly obese patient leading to a difficult airway

    ANAESTHESIA, Issue 12 2000
    S. Podder
    No abstract is available for this article. [source]

    Difficult airway equipment in English emergency departments

    ANAESTHESIA, Issue 5 2000
    T. Morton
    The need for tracheal intubation in the emergency department is often unpredictable and precipitous in nature. When compared with the operating room, a higher incidence of difficult intubation is observed. There are currently no accepted guidelines with respect to the stocking of difficult airway equipment in the emergency department. We have conducted a telephone survey to determine the availability of equipment for the management of the difficult airway in English emergency departments. Overall, the majority of units held a curved laryngoscope blade (100%), gum elastic bougie (99%) and surgical airway device (98%). Of alternative devices for ventilation, a laryngeal mask airway was kept by 65% of departments, a needle cricothyroidostomy kit by 63% and an oesophageal-tracheal twin-lumen airway (Combitube) by 18%. Of alternative devices for intubation, fewer than 10% held a retrograde intubating kit, intubating laryngeal mask, bronchoscope or lighted stylet. Seventy-four per cent of departments held an end-tidal carbon dioxide detector. [source]

    Difficult intubation of a child through laryngeal mask airway with two tracheal tubes

    ACTA PAEDIATRICA, Issue 12 2006
    Abstract Difficult tracheal intubation occurs infrequently. It is estimated that difficult laryngoscopy occurs in 1,2% of patients. Tracheal intubation of especially small infants can be challenging. When faced with a difficult airway, intubation through a laryngeal mask airway is one method of obtaining a secure airway. Here, we report a 23-mo-old girl with chronic lung disease and severe pneumonia, who was admitted to our paediatric intensive care unit. Since the patient could not be intubated by the standard method, because her larynx was up and forward, she was intubated successfully with a laryngeal mask airway through which two consecutive tracheal tubes were inserted. Conclusion: Laryngeal mask airway has an important role as a back-up device in case direct visualization of the larynx is not possible. [source]

    Video-laryngoscopes in the adult airway management: a topical review of the literature

    The aim of the present paper is to review the literature regarding video-laryngoscopes (Storz V-Mac and C-Mac, Glidescope, McGrath, Pentax-Airway Scope, Airtraq and Bullard) and discuss their clinical role in airway management. Video-laryngoscopes are new intubation devices, which provide an indirect view of the upper airway. In difficult airway management, they improve Cormack,Lehane grade and achieve the same or a higher intubation success rate in less time, compared with direct laryngoscopes. Despite the very good visualization of the glottis, the insertion and advancement of the endotracheal tube with video-laryngoscopes may occasionally fail. Each particular device's features may offer advantages or disadvantages, depending on the situation the anaesthesiologist has to deal with. So far, there is inconclusive evidence indicating that video-laryngoscopy should replace direct laryngoscopy in patients with normal or difficult airways. [source]

    Awake nasal intubation using a combination of the EndoFlexģ tube and fibreoptic bronchoscopy in patients with difficult airways

    J. H. Liu
    No abstract is available for this article. [source]

    Paediatric airway management: basic aspects

    Paediatric airway management is a great challenge, especially for anaesthesiologists working in departments with a low number of paediatric surgical procedures. The paediatric airway is substantially different from the adult airway and obstruction leads to rapid desaturation in infants and small children. This paper aims at providing the non-paediatric anaesthesiologist with a set of safe and simple principles for basic paediatric airway management. In contrast to adults, most children with difficult airways are recognised before induction of anaesthesia but problems may arise in all children. Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described. [source]