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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 381] [Impact Index Per Article: 190.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Hanna SF, Mikat-Stevens M, Loo J, Uppal R, Jellish WS, Adams M. Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study. J Clin Anesth 2017; 37:31-37. [DOI: 10.1016/j.jclinane.2016.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
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Shyam R, Chaudhary AK, Sachan P, Singh PK, Singh GP, Bhatia VK, Chandra G, Singh D. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study. J Clin Diagn Res 2017; 11:UC09-UC12. [PMID: 28274023 DOI: 10.7860/jcdr/2017/22001.9284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. MATERIALS AND METHODS After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. RESULTS All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05). CONCLUSION So the FLMA may be a better technique for management of patients with difficult airways.
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Affiliation(s)
- Radhey Shyam
- Assistant Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Chaudhary
- Additional Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Pushplata Sachan
- Assistant Professor, Department of Physiology, Career Institute of Medical Sciences & Hospital , Lucknow, Uttar Pradesh, India
| | - Prithvi Kumar Singh
- Scholar, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Gyan Prakash Singh
- Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Vinod Kumar Bhatia
- Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Girish Chandra
- Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
| | - Dinesh Singh
- Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India
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Kaur H, Kataria AP, Muthuramalingapandian M, Kaur H. Airway Considerations in Case of a Large Multinodular Goiter. Anesth Essays Res 2017; 11:1097-1100. [PMID: 29284884 PMCID: PMC5735459 DOI: 10.4103/aer.aer_86_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with large goiters pose a great challenge to the anesthesiologist regarding securing the airway without compromising the safety of the patient. The technique of intubation depends on the choice and expertise of anesthesiologist. Awake fiberoptic intubation (AFOI) is the preferred technique. We present the case of large multinodular goiter with difficult airway in which AFOI was successfully used to secure the airway. Proper assessment, planning, and preparation for airway management should be done preoperatively to ensure patient safety.
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Affiliation(s)
- Harpreet Kaur
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
| | - Amar Parkash Kataria
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
| | | | - Harjinder Kaur
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
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Miner JR, Rubin J, Clark J, Reardon RF. Retrograde Intubation with an Extraglottic Device in Place. J Emerg Med 2015; 49:864-7. [DOI: 10.1016/j.jemermed.2015.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/23/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
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Solera Ruiz I, Uña Orejón R, Valero I, Laroche F. [Awake craniotomy. Considerations in special situations]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:392-8. [PMID: 23433726 DOI: 10.1016/j.redar.2013.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
Abstract
Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation. The procedure is safe, provides excellent results, and saves money and resources. The anesthesiologist should know the principles underlying neuroanesthesia, the technique of scalp blockade, and the sedation protocols, as well as feeling comfortable with advanced airway management. The main anesthetic aim is to keep patients cooperating when required (analgesia-based anesthesia). This review attempts to summarize the most recent evidence from the clinical literature, a long as the number of patients undergoing craniotomies in the awake state are increasing, specifically in the pediatric population.
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Affiliation(s)
- I Solera Ruiz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital de Torrejón, Torrejón de Ardoz, Madrid, España.
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Ramaiah R, Grabinsky A, Williamson K, Bhanankar SM. Trauma care today, what's new? Int J Crit Illn Inj Sci 2013; 1:22-6. [PMID: 22096770 PMCID: PMC3209986 DOI: 10.4103/2229-5151.79278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Injury is the fourth leading cause of death in the US, and the leading cause of death in younger age. Trauma is primarily a disease of the young and accounts for more years of productive life lost than any other illness. Consequently, almost every health care provider encounters trauma patients from time to time. Many of these patients are critically ill and pose several challenges in the acute phase, including airway and ventilation, fluid management, intracranial pressure control, etc. In the last decade, several strategies and treatment options have been studied in trauma care along with improvement in technologies. In this review, we will discuss a few of the new developments and updates in trauma care.
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Affiliation(s)
- Ramesh Ramaiah
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
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8
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Abstract
Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients.
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Affiliation(s)
- Kelvin Williamson
- Department of Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, #359724, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Ramaiah Ramesh
- Department of Anesthesiology and Pain Medicine, University of Washington/Harborview Medical Center, #359724, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Andreas Grabinsky
- Department of Emergency and Trauma Anesthesia, University of Washington/Harborview Medical Center, #359724, 325 Ninth Avenue, Seattle, WA 98104, USA
- Department of King County Medic One, University of Washington/Harborview Medical Center, #359724, 325 Ninth Avenue, Seattle, WA 98104, USA
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Hamard F, Ferrandiere M, Sauvagnac X, Mangin JC, Fusciardi J, Mercier C, Laffon M. [Propofol sedation allows awake intubation of the difficult airway with the Fastrach LMA]. Can J Anaesth 2005; 52:421-7. [PMID: 15814760 DOI: 10.1007/bf03016288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate target controlled infusion anesthesia (TCI) with propofol for conscious intubation [(Ramsay score equal to 3 (RS 3)] through the Fastrach laryngeal mask airway (LMA). METHODS 17 consenting and unpremedicated patients, who showed criteria for difficult intubation (score developed by Arne et al. > or = 11), were monitored and received supplemental oxygen. Propofol was administered by TCI, with successive targets of 0.6 and 1 microg x mL(-1), while the RS was evaluated: if = 3, LMA intubation was attempted, if < 3 the TCI was increased by steps of 0.2 microg x mL(-1) until an RS of 3 was reached. Local anesthesia (lidocaine 5%) of the oropharynx was carried out at 0.6 and 1 microg x mL(-1), together with local anesthesia of the nasopharynx at 1 microg x mL(-1). A standardized questionnaire evaluated memory of and satisfaction with the technique (score/10) on postoperative day 1. RESULTS The LMA was inserted in 100% of cases and intubation was successful in 16 out of 17 cases (one failure). The propofol target concentration to obtain a RS of 3 was 1.25 +/- 0.07 microg x mL(-1). Amnesia occurred as soon as the target concentration of propofol exceeded 1 microg x mL(-1). The patients found the technique very satisfactory (median satisfaction score = 9.4/10). Incidents of coughing or nausea were observed in 47% and 5% of cases respectively. There was no oesophageal intubation and no desaturation (SpO2 < 95%). CONCLUSION Propofol administered by TCI to achieve a RS of 3 allows conscious intubation to be performed through a LMA under satisfactory conditions. A LMA could be a possible alternative to a "conscious" fibroscopy.
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Affiliation(s)
- Franck Hamard
- Du Groupement d'Anesthésie et de Réanimation Chirurgical, Service d'anesthésie réanimation chirurgicale, Centre hospitalier universitaire de Tours, 2 boulevard Tonnelé, 37000 Tours, France.
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Degler SM, Dowling RD, Sucherman DR, Leighton BL. Awake intubation using an intubating laryngeal mask airway in a parturient with spina bifida. Int J Obstet Anesth 2005; 14:77-8. [PMID: 15627548 DOI: 10.1016/j.ijoa.2004.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 07/01/2004] [Accepted: 07/01/2004] [Indexed: 11/16/2022]
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Asai T, Shingu K. Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope: incidence, causes and solutions. Br J Anaesth 2004; 92:870-81. [PMID: 15121723 DOI: 10.1093/bja/aeh136] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- T Asai
- Department of Anaesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka 570-8507, Japan.
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12
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Young B. The intubating laryngeal-mask airway may be an ideal device for airway control in the rural trauma patient. Am J Emerg Med 2003; 21:80-5. [PMID: 12563589 DOI: 10.1053/ajem.2003.50012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A review of the literature on advanced airway management indicates that the intubating laryngeal-mask airway (ILMA) may be an ideal device for airway control in the rural trauma patient. The ILMA is an advanced laryngeal-mask airway designed to allow oxygenation of the unconscious patient as well as blind tracheal intubation with an endotracheal tube. The ILMA is an easy-to-use airway with a high success rate of insertion, and requires little training. For the rural physician managing a difficult airway in a trauma patient, the ILMA has been found to be reliable and successful when other techniques fail, such as fiberoptic intubation and direct laryngoscopy. The ILMA has also been reported to cause less hemodynamic change and less injury to the teeth and lips than direct laryngoscopy. Further, the ILMA was found to be easier and faster to use with a higher success rate than either the combitube or endotracheal tube for unskilled healthcare providers. Limitations and complications of the ILMA may include aspiration, esophageal intubation, damage to the larynx or other tissues during blind passage of a tracheal tube, and edema of the epiglottis.
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Affiliation(s)
- Barb Young
- Department of Anesthesiology, Regions Hospital, St. Paul, MN, USA
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13
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Abstract
The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.
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Affiliation(s)
- G Caponas
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom
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14
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Abstract
Adverse pulmonary outcomes that follow anesthesia and surgery are often attributed to anesthesia care. PPCs are a significant concern for anesthesia caregivers because they use drugs and techniques that temporarily decrease lung volume, impair airway reflexes, limit immune function, and depress secretion mobilization. A significant component of perioperative risk derives from the surgical site, postoperative pain, and effects of pharmacologic pain management. Rapidly evolving surgical and anesthesia techniques and the introduction of newer pharmaceutical agents make it difficult to identify best practice from retrospective experience reported in the perioperative literature. Prospective studies that deal with specific patient populations, incomparable patient groups or techniques, and unique practice bias have limited validity of claims regarding several promising approaches to perioperative risk reduction. In the absence of clear scientific principles, a perioperative pulmonary risk management strategy for the early part of this century is based on the consensus practice of informed clinicians (Box 4).
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Affiliation(s)
- Charles B Watson
- Department of Anesthesia, Bridgeport Hospital, Perry 3, Box 5000, 267 Grant Street, Bridgeport, CT 06610, USA.
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Sener EB, Sarihasan B, Ustun E, Kocamanoglu S, Kelsaka E, Tur A. Awake tracheal intubation through the intubating laryngeal mask airway in a patient with halo traction. Can J Anaesth 2002; 49:610-3. [PMID: 12067875 DOI: 10.1007/bf03017390] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report a case of awake tracheal intubation through the intubating laryngeal mask airway (ILMA) in a patient with halo traction. CLINICAL FEATURES A 16-yr-old, 40 kg, boy with atlanto-occipital instability and halo traction was scheduled for surgery under general anesthesia. The head of the patient was fixed in a position of flexion and extension was impossible. Cranial magnetic resonance imaging revealed that pharyngeal and laryngeal axes were aligned, but that the oral axis was in an extreme divergent plane. The tongue and oropharynx were anesthetized with 10% lidocaine spray and bilateral superior laryngeal nerve blockade was performed. Under sedation, awake orotracheal intubation via ILMA was successful. Fibreoptic bronchoscopy has been recommended for awake tracheal intubation in such patients. Other techniques, such as use of the Bullard laryngoscope have been described also but awake tracheal intubation through the ILMA in patients with a halo device in situ has seldom been reported in the medical literature. CONCLUSION Airway management of patients with cervical spine instability includes adequate preoperative evaluation of the airway and choosing the appropriate intubation technique. We suggest that the ILMA may be an adequate alternative for awake tracheal intubation in patients with an unstable cervical spine and cervical immobilization with a halo device.
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Affiliation(s)
- Elif Bengi Sener
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey.
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Reardon RF, Martel M. The intubating laryngeal mask airway: suggestions for use in the emergency department. Acad Emerg Med 2001; 8:833-8. [PMID: 11483462 DOI: 10.1111/j.1553-2712.2001.tb00217.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With the increased use of rapid-sequence induction and its potential complications, emergency physicians need a rescue device for unexpected difficult intubations. The intubating laryngeal mask airway (ILMA) is an ideal rescue airway since it can be placed quickly and can provide adequate ventilation in nearly all patients. It can then be used as conduit for endotracheal intubation, while ventilation is ongoing. The authors review the current literature on the ILMA. In conjunction with their experience using the ILMA in the emergency department (ED), a modification of the American Society of Anesthesiologists difficult airway algorithm was derived for use in the ED. The ILMA appears to be valuable for managing difficult airways.
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Affiliation(s)
- R F Reardon
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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Dhar P, Osborn I, Brimacombe J, Meenan M, Linton P. Blind orotracheal intubation with the intubating laryngeal mask versus fibreoptic guided orotracheal intubation with the Ovassapian airway. A pilot study of awake patients. Anaesth Intensive Care 2001; 29:252-4. [PMID: 11439795 DOI: 10.1177/0310057x0102900305] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a randomized, prospective pilot study, we compared awake blind orotracheal intubation using the intubating laryngeal mask airway (blind-ILM) with awake fibreoptic-guided orotracheal intubation using an Ovassapian airway (FOS-OA). Fifty-four patients (ASA 1 to 3, aged 18 to 85 years) requiring awake intubation for elective surgery were randomly allocated by coin toss into two groups: 31 patients were intubated blindly through the ILM (blind-ILM) and 23 were intubated using fibreoptic guidance through the Ovassapian airway (FOS-OA). Sedation to a target clinical end-point (spontaneous eye-closing, but responsive to verbal command) was obtained with fentanyl/midazolam and a cricothyroid puncture was performed with 3 ml lignocaine 4%. The oropharynx was then topicalized until tolerance of a Guedel airway was achieved. The number of failed attempts (maximum of three allowed), overall success rates, the time from insertion of the airway to capnographic (blind-ILM) or fibreoptic (FOS-OA) confirmation of intubation or until three failed attempts, and cardiovascular responses before and during intubation, were recorded. The first time (blind-ILM, 25/31 [81%]; FOS-OA, 20/23 [87%], P = 0.6) and overall (blind-ILM, 26/31 [84%]; FOS-OA, 22/23 [96%], P = 0.2) intubation success rates were similar. The mean +/- SD time to intubation was shorter for the blind-ILM group (104 +/- 65 vs 158 +/- 115 sec, P = 0.05). There were no clinically significant differences in blood pressure or heart rate between groups. Compared with baseline values, there was no cardiovascular response to intubation in either group. We conclude that the blind-ILM and FOS-OA techniques have similar success rates and cardiovascular responses, but intubation is slightly quicker with the blind-ILM technique.
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Affiliation(s)
- P Dhar
- New York University Medical Center, New York, USA
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Joo HS, Kapoor S, Rose DK, Naik VN. The intubating laryngeal mask airway after induction of general anesthesia versus awake fiberoptic intubation in patients with difficult airways. Anesth Analg 2001; 92:1342-6. [PMID: 11323374 DOI: 10.1097/00000539-200105000-00050] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We performed the current study to compare tracheal intubation (TI) using awake fiberoptic intubation (AFOI) and TI using the intubating laryngeal mask airway (ILMA) in patients with difficult airway. Our hypothesis was that patients with difficult airways could be safely intubated after induction of anesthesia using the ILMA. After ethics approval and informed consent, 38 patients who were identified to have difficult airways were randomly assigned to AFOI or TI using the ILMA. Patients in the AFOI group had the usual sedation and airway topicalization. Patients in the ILMA group were induced with propofol for ILMA insertion and succinylcholine for TI. The first TI attempt was done blindly via the ILMA and all subsequent attempts were performed with fiberoptic guidance. All patients in the ILMA group were successfully ventilated. Successful TI was achieved in all patients in both groups. However, in 10% of the patients in the ILMA group, TI was achieved by a second anesthesiologist who was more experienced with the use of the ILMA. In a postoperative questionnaire, patients in the ILMA group were more satisfied with their method of TI (P < 0.01). The ILMA is a useful device in the management of patients with difficult airways and may be a valuable alternative to AFOI when AFOI is contraindicated or in the patient with the unanticipated difficult airway. IMPLICATIONS The intubating laryngeal mask airway is a useful device in the management of patients with difficult airways and may be a valuable alternative to awake fiberoptic intubation (AFOI) when AFOI is contraindicated or in the patient with the unanticipated difficult airway.
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Affiliation(s)
- H S Joo
- Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.
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Faraj JH, Darwish AA, Salinis P, AI Kaabi M. Bullard laryngoscope: Management of difficult airway in maxillofacial surgery. Qatar Med J 2000. [DOI: 10.5339/qmj.2000.2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Difficult intubation has an incidence of 1.5-8.5%. Failed intubation occurs in 0.13-0.3% of general anaesthetics and it has been found that 30% of the mortality attributed to anaesthesia is related to difficulties in the management of the airway(1). Many techniques and instruments have been advocated in the management of difficult airways; one of these being the Bullard laryngoscope (BL). We report the management of two cases of difficult airway due to limited mouth opening using the Bullard laryngoscope.
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Affiliation(s)
- J. H. Faraj
- **Department of Maxillofacial Surgery, Hamad Medical Corporation Doha, Qatar
| | - A. A. Darwish
- *Department of Anesthesia, Hamad Medical Corporation Doha, Qatar
| | - P. Salinis
- *Department of Anesthesia, Hamad Medical Corporation Doha, Qatar
| | - M. AI Kaabi
- *Department of Anesthesia, Hamad Medical Corporation Doha, Qatar
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Asai T, Eguchi Y, Murao K, Niitsu T, Shingu K. Intubating laryngeal mask for fibreoptic intubation--particularly useful during neck stabilization. Can J Anaesth 2000; 47:843-8. [PMID: 10989852 DOI: 10.1007/bf03019662] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions. METHODS In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0-2.5 mgxkg(-1) propofol, 50-100 microg fentanyl and 1.0 mgxkg(-1) vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted. RESULTS In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions. CONCLUSIONS Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.
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Affiliation(s)
- T Asai
- Department of Anesthesiology, Kansai Medical University, Moriguchi City, Osaka, Japan.
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21
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Abstract
Patients who are difficult to intubate are randomly encountered. Patients who are in the postoperative period or who have suffered trauma have a greater chance of being difficult to intubate. The ability to quickly mobilize trained personnel and advanced equipment provides the best chance for a good outcome for these patients. Practice in placement of and intubation with LMAs is an important step toward providing an extensive safety net for patients needing intubation.
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Affiliation(s)
- R A Barnett
- Department of Anesthesia, University of Pennsylvania School of Medicine, Philadelphia, USA
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22
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Abstract
The last decade of the millennium has witnessed the introduction of new extratracheal airway devices for use in fasted patients undergoing ambulatory anaesthesia. A growing awareness of the potential of such devices in the difficult airway has contributed to their increasing use.
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Affiliation(s)
- C Verghese
- Department of Anaesthesia, Royal Berkshire & Battle Hospitals NHS Trust, Reading, UK
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