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Ozcan E, Ozcan FG. Difficult Airway Management in Oromaxillofacial Tumor Surgery: Two Case Reports and Review of the Literature. Indian J Otolaryngol Head Neck Surg 2025; 77:1088-1094. [PMID: 40070755 PMCID: PMC11890796 DOI: 10.1007/s12070-024-05274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 12/09/2024] [Indexed: 03/14/2025] Open
Abstract
Difficult airway management in oromaxillofacial tumor surgery poses significant challenges for anesthesiologists. We present two case reports of patients with mandibular malignant tumors and maxillary osteosarcoma who underwent surgery under general anesthesia. Preoperative assessment revealed a mass involving the right mandible, completely covering the inside of the mouth and invading the floor of the mouth in the first case, and a mass in the left maxilla extending to the zygomatic arch and orbital floor in the second case. Both patients had limited mouth opening, making direct laryngoscopy impossible. Awake fiberoptic intubation was planned to secure the airway while preserving spontaneous breathing. Sedation was achieved using dexmedetomidine, propofol, and ketamine. The fiberoptic bronchoscope was inserted through the nasal cavity, and the endotracheal tube was advanced once the vocal cords were visualized. Muscle relaxation was induced with rocuronium after confirmation of tracheal placement. Both patients underwent extensive surgical resection and reconstruction procedures. Postoperatively, they were managed in the intensive care unit and subsequently transferred to the ENT service after successful weaning from mechanical ventilation.These cases highlight the importance of thorough preoperative assessment, multidisciplinary planning, and the use of advanced airway management techniques such as awake fiberoptic intubation in patients with oromaxillofacial tumors presenting with anticipated difficult airways.
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Affiliation(s)
- Emine Ozcan
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Istanbul, Turkey
| | - Funda Gümüş Ozcan
- Basaksehir Cam and Sakura City Hospital, Başakşehir, Istanbul, Turkey
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Saracoglu A, Saracoglu KT, Sorbello M, Kurdi R, Greif R. A view on pediatric airway management: a cross sectional survey study. Minerva Anestesiol 2022; 88:982-993. [PMID: 35833855 DOI: 10.23736/s0375-9393.22.16445-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND This survey aimed to investigate routine practices and approaches of clinicians on pediatric airway in anesthesia and intensive care medicine. METHODS A 20-question multiple-choice questionnaire with the possibility to provide open text answers was developed and sent. The survey was sent to the members of European Airway Management Society via a web-based platform. Responses were analyzed thematically. Only the answers from one representative of the pediatric service of each hospital was included into the analysis. RESULTS Among the members, 143 physicians responded the survey, being anesthesiologists (83.2%), intensivists (11.9%), emergency medicine physicians (2.1%), and (2.8%) pain medicine practitioners. A straight blade was preferred by 115 participants (80.4%) in newborns, whereas in infants 86 (60.1%) indicated a curved blade and 55 (38.5%) a straight blade. Uncuffed tracheal tube were preferred by 115 participants (80.4%) in newborns, whereas 24 (16.8%) used cuffed tubes. Approximately 2/3 of the participants (89, 62.2%) reported not to use routinely a cuff manometer in their clinical practice, whereas 54 participants (37.8%) use it routinely in pediatric patients. Direct laryngoscopy for routine pediatric tracheal intubation was reported by 127 participants (88.8%), while 16 (11.2%) reported using videolaryngoscopes routinely. Interestingly, 39 (27.3%) had never performed neither videolaryngoscopy nor flexible bronchoscopy in children. These results were significantly less in hospitals with a dedicated pediatric anesthesiologist. CONCLUSIONS This survey on airway management in pediatric anesthesia revealed that the use of cuffed tubes and the routine monitoring of cuff pressure are rare. In addition, the rate of videolaryngoscopy or flexible optical intubation was low for expected difficult intubation. Our survey highlights the need for properly trained pediatric anesthesiologists working in-line with updated scientific evidence.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul Turkey
| | - Kemal T Saracoglu
- Department of Anesthesiology and Intensive Care, Kartal Dr. Lutfi Kirdar City Hospital, Health Sciences University, Istanbul Turkey -
| | - Massimiliano Sorbello
- Department of Anesthesiology and Intensive Care, AOU Policlinico San Marco, Catania, Italy
| | - Raghad Kurdi
- Department of Anesthesiology and Intensive Care, Marmara University Medical School, Istanbul Turkey
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital Inselspital, Bern, Switzerland
- School of Medicine, Sigmund Freud University, Vienna, Austria
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Tsukamoto M, Kameyama I, Miyajima R, Hitosugi T, Yokoyama T. Alternative Technique for Nasotracheal Intubation Using a Flexible Fiberoptic Scope. Anesth Prog 2022; 69:35-37. [PMID: 35849810 PMCID: PMC9301535 DOI: 10.2344/anpr-69-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
In oral maxillofacial surgery, the endotracheal tube (ETT) is often inserted nasotracheally to provide surgeons a better view and easier access to the oral cavity. Use of a flexible fiberoptic scope is an effective technique for difficult intubation. While the airway anatomy can be observed as the scope is advanced, the ETT tip cannot be observed with the traditional method. It is occasionally difficult to advance the ETT beyond the glottis as impingement of the ETT tip may occur. We devised a new nasotracheal intubation technique using a fiberoptic scope. In this novel technique, the ETT and fiberoptic scope are inserted into the pharyngeal space separately through the right and left nasal cavities. This permits continuous observation of the glottis as the ETT is advanced into the trachea. The main advantage of this technique is that the ETT tip is visualized as it is advanced, which helps avoid impingement of the ETT. If resistance is noted, the ETT can easily be rotated or withdrawn without causing laryngeal damage, leading to safe and smooth intubation. This novel technique allows advancement of the ETT under continuous indirect vision, thus minimizing contact of the ETT with the laryngeal structures and aiding in unhindered passage into the glottis.
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Affiliation(s)
- Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Izumi Kameyama
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Riho Miyajima
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Takashi Hitosugi
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Peyton J, Fiadjoe J, Stein ML, Park R, Staffa S, Zurakowski D, Kovatsis P. Comparing standard and non-standard videolaryngoscopes in children: methodological issues. Response to Br J Anaesth 2021; 127: e52-e4. Br J Anaesth 2021; 127:e172-e173. [PMID: 34511260 DOI: 10.1016/j.bja.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- James Peyton
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
| | - John Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Mary L Stein
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Raymond Park
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Steven Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
| | - Pete Kovatsis
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA
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Vowles BJ, Rodda B, Ringrose D. Evaluation of intubating adjuncts to videolaryngoscopy in a simulated difficult airway: A manikin cross-over study. Anaesth Intensive Care 2021; 49:327-329. [PMID: 34348485 DOI: 10.1177/0310057x211012275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Bruce Rodda
- Department of Anaesthesia, Broomfield Hospital, Chelmsford, UK
| | - David Ringrose
- Department of Anaesthesia, Southend University Hospital, Southend, UK
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Mahli N, Md Zain J, Mahdi SNM, Chih Nie Y, Chian Yong L, Shokri AFA, Maaya M. The Performance of Flexible Tip Bougie™ in Intubating Simulated Difficult Airway Model. Front Med (Lausanne) 2021; 8:677626. [PMID: 34026801 PMCID: PMC8137891 DOI: 10.3389/fmed.2021.677626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
This prospective, randomized, cross-over study compared the performance of the novel Flexible Tip Bougie™ (FTB) with a conventional bougie as an intubation aid in a simulated difficult airway manikin model among anaesthesiology trainees with regards of first pass success rate, time to intubation, number of attempts and ease of use. Sixty-two anesthesiology trainees, novice to the usage of FTB, participated in this study. Following a video demonstration, each participant performed endotracheal intubation on a manikin standardized to a difficult airway view. Each participant performed direct laryngoscopy and intubated the manikin using a conventional bougie and FTB, at least 1 day in between devices, in a randomized order. The first pass success rate was significantly higher with FTB (98.4%) compared to conventional bougie (85.5%), p = 0.008. The median time to intubation was significantly faster when using FTB, median = 32.0 s [Interquartile range (IQR): 23.8–41.3 s] compared to when using conventional bougie, median = 41.5 s (IQR: 31.8–69.5 s), p < 0.001. The FTB required significantly less intubation attempts compared to conventional bougie, p = 0.024. The overall ease of use, scored on a Likert scale from 1 to 5, was significantly higher in the FTB (4.26 ± 0.53) compared to the conventional bougie (3.19 ± 0.83), p < 0.001. This simulated difficult airway manikin study finding suggested that FTB is a useful adjunct for difficult airway intubation. The FTB offered a higher first pass success rate with a faster time to intubation and less required attempts.
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Affiliation(s)
- Nurfadilah Mahli
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Jaafar Md Zain
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Siti Nidzwani Mohamad Mahdi
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Yeoh Chih Nie
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Liu Chian Yong
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Fairuz Abdul Shokri
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Maaya
- Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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