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Difficult Intubation (difficult + intubation)
Selected AbstractsDifficult intubation in obstetric general anaesthesiaANAESTHESIA, Issue 5 2010M. J. Milsom No abstract is available for this article. [source] Difficult intubation of a child through laryngeal mask airway with two tracheal tubesACTA PAEDIATRICA, Issue 12 2006TANIL KENDIIRLI 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] Performance of the AirtraqÔ laryngoscope after failed conventional tracheal intubation: a case seriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009E. MALIN Background: The AirtraqÔ, a new disposable indirect laryngoscope, was evaluated in patients with difficult intubation. Methods: The AirtraqÔ 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 AirtraqÔ 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 AirtraqÔ. A gum elastic bougie was used to facilitate tracheal access in one-third (11/36) of the cases. Orotracheal intubation was not possible with AirtraqÔ 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, AirtraqÔ allows securing the airway in 80% of cases mainly by improving glottis view. However, the AirtraqÔ does not guarantee successful intubation in all instances, especially in case of laryngeal and/or pharyngeal obstruction. [source] Combining the EndoFlex® tube with fiberoptic bronchoscopy in difficult intubationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009K. SUGIYAMA We applied a combination technique using the EndoFlex® tube with fiberoptic bronchoscopy for a 69-year-old man presenting with limited mouth opening and neck movement. Awake nasotracheal intubation was performed under conscious sedation with propofol and fentanyl. After positioning the tip of the EndoFlex® tube in the oropharynx, the fiberoptic bronchoscope was inserted into the tube until the tip reached the bevel of the tube. Anterior flexion of the distal tip of the EndoFlex® tube facilitated uncomplicated insertion of the tube into the trachea without impingement on the arytenoids. Fiberoptic visualization confirmed that the distal-tip flexing mechanism of the EndoFlex® tube corrected the direction of the tube tip anteriorly, allowing entry into the trachea. We present a case where this technique proved valuable for tracheal intubation in a patient with limitations of mouth opening and neck movement. [source] Airway management behaviour, experience and knowledge among Danish anaesthesiologists , room for improvementACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2001M. S. Kristensen Background: Problems with managing the airways in relation to anaesthesia causes severe morbidity and mortality. A large proportion of these adverse respiratory events is preventable. Still patients continue to die from airway disasters related to anaesthesia, also in Scandinavia. The goal of this study is to identify which efforts are likely to improve this situation. Methods: A questionnaire asking about experience, behaviour and availability of various items of equipment was mailed to all members of the Danish Society of Anaesthesiologists and were returned anonymously. Results: More than 65% of respondents have sufficient access to a flexible fibrescope, but still 17% of specialists have no access and the vast majority (>67%) has little (1,10 times) or no experience in its use for awake intubation. A total of 52,70% knew the basic principles of the ASA difficult airway algorithm, but despite this only 25,50% would perform awake intubation if a difficult intubation was expected. More than 20% of respondents had experienced preventable airway management mishaps. In all, 18,46% did not know how to oxygenate via the cricothyroid membrane. Conclusion: There is room for improvement regarding airway management skills among Danish anaesthesiologists. It is likely that airway management can be improved by: A) Better knowledge of an appropriate plan, algorithm, for airway management. B) Awake intubation used more often. C) More experience in fibreoptic intubation. D) All anaesthesiologists accepting that previous difficult intubation is an indicator of future difficulties. E) All anaesthesiologists knowing, and practising on manikins, how to oxygenate via the cricothyroid membrane. F) Always having a laryngeal mask airway immediately available when inducing anaesthesia. [source] Review article: Perioperative care of patients with epidermolysis bullosa: proceedings of the 5th international symposium on epidermolysis bullosa, Santiago Chile, December 4,6, 2008PEDIATRIC ANESTHESIA, Issue 9 2010FAAP, KENNETH GOLDSCHNEIDER MD Summary Epidermolysis bullosa (EB) has become recognized as a multisystem disorder that poses a number of pre-, intra-, and postoperative challenges. While anesthesiologists have long appreciated the potential difficult intubation in patients with EB, other systems can be affected by this disorder. Hematologic, cardiac, skeletal, gastrointestinal, nutritional, and metabolic deficiencies are foci of preoperative medical care, in addition to the airway concerns. Therefore, multidisciplinary planning for operative care is imperative. A multinational, interdisciplinary panel of experts assembled in Santiagio, Chile to review the best practices for perioperative care of patients with EB. This paper presents guidelines that represent a synthesis of evidence-based approaches and the expert consensus of this panel and are intended to aid physicians new to caring for patients with EB when operative management is indicated. With proper medical optimization and attention to detail in the operating room, patients with EB can have an uneventful perioperative course. [source] The Management of difficult intubation in childrenPEDIATRIC ANESTHESIA, Issue 2009ROBERT W.M. WALKER FRCA Summary This article looks at the current techniques and equipment recommended for the management of the difficult intubation scenario in pediatric practice. We discuss the general considerations including preoperative preparation, the preferred anesthetic technique and the use of both rigid laryngoscopic and fiberoptic techniques for intubation. The unanticipated scenario is also discussed. [source] Use of the Ambu® aScopeÔ in 10 patients with predicted difficult intubationANAESTHESIA, Issue 10 2010E. Pujol Summary Fibreoptic intubation is the gold standard for patients with predicted difficult intubation. The Ambu® aScopeÔ is a single-use device for fibreoptic tracheal intubation. We assessed its performance in 10 patients with predicted difficult tracheal intubation. The procedure was easy and successful in nine patients. However, the limited time of use did not permit intubation in one patient who required three attempts with different size tracheal tubes. The limited image resolution that can be expected of a single-use fibreoptic system and the absence of a suction channel are other potential limitations. On the other hand, being single-use this device has the advantage of avoiding the risk of infectious disease transmission and is always ready to use. [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 2010A. 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] Tracheal intubation using the Airtraq®: a comparison with the lightwandANAESTHESIA, Issue 7 2010E. Y. Park Summary The Airtraq® laryngoscope is a new tracheal intubation device that has been developed for the management of normal and difficult airways. As with the lightwand, the Airtraq can be used without placing the patient in the ,sniffing position' for direct laryngoscopy. The purpose of this study was to compare the efficacy and usability of the Airtraq with that of the lightwand during routine airway management. One hundred ASA 1-2 patients scheduled for elective surgery under general anaesthesia were randomly assigned to either the Airtraq (n = 50) or lightwand (n = 50). Intubation was performed by one of two anaesthetists experienced in the use of both devices. There was no difference in success rate, intubation time, and haemodynamic response between the two groups. In conclusion, the Airtraq® and lightwand have similar efficacy in patients without risk factors for difficult intubation. [source] The use of capnography and the availability of airway equipment on Intensive Care Units in the UK and the Republic of Ireland,ANAESTHESIA, Issue 5 2010A. P. Georgiou Summary At least 20% of reported major adverse airway events occur on the intensive care unit. This study surveyed 315 (96%) of all general, satellite, hepatobiliary, cardiac and neuro-intensive care units in the UK and the Republic of Ireland, finding that only 100 (32%) units always use capnography for tracheal intubation while only 80 (25%) always use capnography for continuous monitoring of patients requiring controlled ventilation. Three hundred and ten (98%) units utilise a checklist of airway equipment, 311 (99%) check its functionality on a daily basis and 296 (94%) units have access to a bronchoscope. Whilst 297 (94%) ICUs have an airway trolley, sufficient equipment for unanticipated difficult intubation was only seen on 33 (10%) of units. Guidelines addressing minimum standards for monitoring and airway safety on ICU are not being met and remain below the standard expected. [source] Awake tracheal intubation using the SensascopeÔ in 13 patients with an anticipated difficult airwayANAESTHESIA, Issue 5 2010R. Greif Summary We present the use of the SensaScopeÔ, 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] Human immunodeficiency virus (HIV)-associated lipodystrophy and difficult intubationANAESTHESIA, Issue 11 2009G. J. Mar No abstract is available for this article. [source] A documented previous difficult tracheal intubation as a prognostic test for a subsequent difficult tracheal intubation in adultsANAESTHESIA, Issue 10 2009L. H. Lundstrøm Summary We investigated the diagnostic accuracy of a documented previous difficult tracheal intubation as a stand-alone test for predicting a subsequent difficult intubation. Our assessment included patients from the Danish Anaesthesia Database who were scheduled for tracheal intubation by direct laryngoscopy. We used a four-point scale to grade the tracheal intubation. A previous difficult intubation was defined according to the presence of a record documenting a difficult penultimate tracheal intubation-score for the 15 499 patients anaesthetised more than once. Our assessment demonstrates that a documented history of previous difficult or failed intubation using direct laryngoscopy are strong predictors of a subsequent difficult or failed intubation and may identify 30% of these patients. Although previous investigators have reported predictive values that exceed our findings markedly, a documented previous difficult or failed tracheal intubation appears in everyday anaesthetic practice to be a strong predictor of a subsequent difficult tracheal intubation. [source] Thyromental distance measurement , fingers don't ruleANAESTHESIA, Issue 8 2009P. A. Baker Summary Thyromental distance (TMD) measurement is commonly used to predict difficult intubation. We surveyed anaesthetists to determine how this test was being performed. Comparative accuracy of ruler measurement and other forms of measurement were also assessed in a meta-analysis of published literature. Of respondents, 72% used fingers for TMD measurement and also considered three finger widths the minimum acceptable TMD. In terms of distance, the minimum acceptable TMD was felt to be 6.5 cm by 55% of respondents. However, the actual width of three fingers was (range) 4.6,7.0 cm (mean 5.9 cm), with significant differences between genders and between proximal and distal interphalangeal joints. The meta-analysis showed ruler measurement increased test sensitivity (48% (95% CI 43,53) vs 16% (95% CI 14,19) without a ruler), when predicting difficult intubation. [source] The formulation and introduction of a ,can't intubate, can't ventilate' algorithm into clinical practiceANAESTHESIA, Issue 6 2009A. M. B. Heard Summary Both the American Society of Anesthesiologists and the Difficult Airway Society of the United Kingdom have published guidelines for the management of unanticipated difficult intubation. Both algorithms end with the ,can't intubate, can't ventilate' scenario. This eventuality is rare within elective anaesthetic practice with an estimated incidence of 0.01,2 in 10 000 cases, making the maintenance of skills and knowledge difficult. Over the last four years, the Department of Anaesthetics at the Royal Perth Hospital have developed a didactic airway training programme to ensure staff are appropriately trained to manage difficult and emergency airways. This article discusses our training programme, the evaluation of emergency airway techniques and subsequent development of a ,can't intubate, can't ventilate' algorithm. [source] Mortality related to anaesthesia in France: analysis of deaths related to airway complications,ANAESTHESIA, Issue 4 2009Y. Auroy Summary Death certificates from the French national mortality database for the calendar year 1999 were reviewed to analyse cases in which airway complications had contributed to peri-operative death. Respiratory deaths (and comas) found in a previous national 1978,82 French survey (1 : 7960; 95% CI 1 : 12 700 to 1 : 5400) were compared with the death rate found in the present one: 1 : 48 200 (95% CI 1 : 140 000 to 1 : 27 500). In 1999, deaths associated with failure of the breathing circuit and equipment were no longer encountered and no death was found to be related to undetected hypoxia in the recovery unit. Deaths related to difficult intubation also occurred at a lower rate than in the previous report (1 : 46 000; 95% CI 1 : 386 000 to 1 : 13 000) in 1978,82 vs 1 : 176 000 (95% CI 1 : 714 000 to 1 : 46 000) in 1999, a fourfold reduction. In most cases, there were both inadequate practice and systems failure (inappropriate communication between staff, inadequate supervision, poor organisation). This large French survey shows that deaths associated with respiratory complications during anaesthesia have been strikingly reduced during this 15-year period. [source] A simple fibreoptic assisted laryngoscope for paediatric difficult intubation: a manikin study,ANAESTHESIA, Issue 4 2009K. Komiya Summary The fibreoptic assisted laryngoscope is a new airway device. We compared the fibreoptic assisted laryngoscope with the Bullard laryngoscope, Macintosh laryngoscope and fibreoptic bronchoscope in a manikin with a simulated Cormack and Lehane Grade 4 laryngoscopic view. Eighteen anaesthetists intubated the manikin's trachea using these devices and the success rate of intubation was measured. They were then asked to rate the subjective difficulty of intubation. The success rate (95% confidence interval) was 100% (94.6,100) with the fibreoptic assisted laryngoscope, 88.9% (80.5,97.3) using the Bullard laryngoscope, 37.0% (24.1,49.9) with the Macintosh laryngoscope, and 22.2% (11.1,33.3) using the fibreoptic bronchoscope. Tracheal intubation using the fibreoptic assisted laryngoscope or Bullard laryngoscope is easier than that using the Macintosh laryngoscope or fibreoptic bronchoscope by subjective difficulty score. All of the intubations were successful with the fibreoptic assisted laryngoscope without practice. These results suggest that fibreoptic assisted laryngoscope may be a useful tool for paediatric difficult intubation. [source] Evaluation of tracheal tube introducers in simulated difficult intubation,ANAESTHESIA, Issue 3 2009C. Janakiraman Summary In a randomised cross-over study, 72 anaesthetists attempted to place Pro-Breathe, new Portex, and Frova single-use tracheal tube introducers and an Eschmann multiple-use introducer in the trachea of a manikin set to simulate a grade 3 laryngeal view. Successful placement (proportion, 95% confidence interval) of either the Frova (78%, 67,86%) or the Eschmann introducer (64%, 52,74%) was significantly more likely (p < 0.0001) than with the Pro-Breathe (4%, 1,12%) or the new Portex introducer (13%, 7,22%). The difference between the success rates for the Frova and the Eschmann introducers (p = 0.08) was not significant. A separate experiment revealed that the peak force that could be exerted by the Pro-Breathe, new Portex and Frova single-use introducers were three to six times greater than that which could be exerted by the Eschmann introducer (p < 0.0001). The single-use introducers are more likely to cause tissue trauma during placement, particularly if held close to the tip. [source] Review of a systematic approach for suspected difficult intubation under general anaesthesiaANAESTHESIA, Issue 12 2008W. Dow No abstract is available for this article. [source] Prehospital airway management in Ambulance Services in the United Kingdom,ANAESTHESIA, Issue 11 2004S. Ridgway Summary A postal survey of the 38 Ambulance Services in the United Kingdom was undertaken to find out what equipment is provided for paramedic crews to aid tracheal intubation and to confirm tracheal placement. The response rate to our survey was 100%. Fourteen (37%) ambulance services provided neither stylet nor bougie to facilitate difficult intubation. The laryngeal mask airway was available to 15 (40%) ambulance services. Seventeen (45%) ambulance services had use of a needle cricothyroidotomy set. Twenty-nine (76%) ambulance services had no type of device other than a stethoscope to confirm tracheal tube placement. This survey showed wide variations in the equipment for airway management available to paramedic crews in the United Kingdom. We recommend provision of a standard set of airway management equipment to all paramedic crews in the United Kingdom together with introduction of appropriate training programmes. [source] The rigid nasendoscope as a tool for difficult tracheal intubation: A manikin study,ANAESTHESIA, Issue 7 2003N. Goodwin Summary We examined the use of the 30° rigid nasendoscope in aiding difficult tracheal intubations. A Cormack and Lehane grade 4 difficult intubation (no view of glottis or epiglottis) was set up on a manikin. After 10 s of tuition, 40 anaesthetists attempted to pass a standard gum elastic bougie between the cords, with and without the nasendoscope, in randomised order. A bougie curved to an ,optimal curve' was also tested. Using the standard bougie 13/40 (33%) passed the bougie between the cords without the nasendoscope, compared with 31/40 (78%) when using the nasendoscope (p < 0.001). The ,optimal curve' bougie resulted in 29/40 (73%) and 39/40 (98%) success rates without and with the nasendoscope, respectively (p = 0.004). The nasendoscope is a simple and easy to use tool in grade 4 intubation, and results are improved further by the use of an ,optimal curve' bougie. [source] Predicting difficult intubation 2ANAESTHESIA, Issue 6 2002M. Kristensen No abstract is available for this article. [source] Predicting difficult intubation , worthwhile exercise or pointless ritual?ANAESTHESIA, Issue 2 2002Article first published online: 23 JAN 200 First page of article [source] Another case of ,awkward teeth' producing a difficult intubationANAESTHESIA, Issue 9 2000C. Wasson [source] Difficult airway equipment in English emergency departmentsANAESTHESIA, Issue 5 2000T. 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 and failed intubation in 3430 obstetric general anaesthetics*ANAESTHESIA, Issue 11 2009E. A. Djabatey Summary A retrospective audit was performed of all obstetric general anaesthetics in our hospital over an 8 year period to determine the incidence of difficult and failed intubation. Data was collected from a number of sources to ensure accuracy. A total of 3430 rapid sequence anaesthetics were given. None of the patients had a failed or oesophageal intubation (95% CI, 0,1:1143). There were 23 difficult intubations (95% CI, 1:238,1:100). This was anticipated in nine cases, requiring awake fibreoptic intubation in three cases. Consultants or specialist registrars were involved in the management of all cases. We attribute the low incidence of airway complications to the above average rate of general anaesthesia in our hospital, senior cover and specialised anaesthetic operating department assistants. [source] Difficult airways, difficult intubations and predicted difficult intubations: important differences or mere semantics?ANAESTHESIA, Issue 10 2009Z. Belagodu No abstract is available for this article. [source] | ||||||||||