1
|
Managing and securing the bleeding upper airway: a narrative review. Can J Anaesth 2019; 67:128-140. [DOI: 10.1007/s12630-019-01479-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
|
2
|
Sanguanwit P, Trainarongsakul T, Kaewsawang N, Sawanyawisuth K, Sitthichanbuncha Y. Is retrograde intubation more successful than direct laryngoscopic technique in difficult endotracheal intubation? Am J Emerg Med 2016; 34:2384-2387. [PMID: 27629490 DOI: 10.1016/j.ajem.2016.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/28/2016] [Accepted: 08/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Difficult airway intubation is an emergency condition both at the emergency department (ED) and in out-of-hospital situations. Retrograde intubation (RI) is another option for difficult airway management. There are limited data regarding the successful rate of RI compared with direct laryngoscopy (DL) intubation, the commonly used method in the ED. METHODS This study was a randomized, controlled trial. Participants were randomly assigned to either the RI or the DL technique to attempt intubation on a difficult airway mannequin (Cormack and Lehane grades 3-4). First, all participants received the training on the RI or DL, and then attempted intubation. After the training, the participants had 2 chances to intubate. The outcomes of this study included numbers of participants who successfully intubated and times of successful intubation. RESULTS There were 100 participants in this study, with 50 participants in each group (RI and DL). There was no significant difference between the groups in terms of experience at the ED or DL. The successful rate of intubation was significantly higher in the RI group than in the DL group (74% vs 12%; P = .001), as was the rate of successful intubation on the first attempt (34% vs 8%; P = .026). There were no statistical differences between physicians and medical students in any of the 3 outcomes in either the DL or RI group. CONCLUSIONS The RI technique had a higher success rate in difficult airway intubation than the DL technique, regardless of experience.
Collapse
Affiliation(s)
- Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Thavinee Trainarongsakul
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Noppanan Kaewsawang
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand; Internal Medicine Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yuwares Sitthichanbuncha
- Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, Thailand.
| |
Collapse
|
3
|
Jose A, Nagori SA, Agarwal B, Bhutia O, Roychoudhury A. Management of maxillofacial trauma in emergency: An update of challenges and controversies. J Emerg Trauma Shock 2016; 9:73-80. [PMID: 27162439 PMCID: PMC4843570 DOI: 10.4103/0974-2700.179456] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Trauma management has evolved significantly in the past few decades thereby reducing mortality in the golden hour. However, challenges remain, and one such area is maxillofacial injuries in a polytrauma patient. Severe injuries to the maxillofacial region can complicate the early management of a trauma patient owing to the regions proximity to the brain, cervical spine, and airway. The usual techniques of airway breathing and circulation (ABC) management are often modified or supplemented with other methods in case of maxillofacial injuries. Such modifications have their own challenges and pitfalls in an already difficult situation.
Collapse
Affiliation(s)
- Anson Jose
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shakil Ahmed Nagori
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Agarwal
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Emergent retrograde tracheal intubation in a 3-year-old with stevens-johnsons syndrome. ACTA ACUST UNITED AC 2015; 2:7-8. [PMID: 25612259 DOI: 10.1097/acc.0b013e3182a1af9b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 3-year-old girl suffering from Stevens-Johnsons Syndrome with severe sloughing of the oropharyngeal mucosa was brought to the operating room for an emergent tracheostomy after multiple failed attempts to intubate the trachea in the pediatric intensive care unit. However, a retrograde tracheal intubation was successfully performed in the operating room to secure her airway, after which a tracheostomy was performed. Retrograde intubation can be a quick and effective method for securing the difficult airway.
Collapse
|
5
|
|
6
|
Harris EA, Arheart KL, Fischler KE. Does the site of anterior tracheal puncture affect the success rate of retrograde intubation? A prospective, manikin-based study. Anesthesiol Res Pract 2013; 2013:354317. [PMID: 23878535 PMCID: PMC3710630 DOI: 10.1155/2013/354317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/13/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Retrograde intubation is useful for obtaining endotracheal access when direct laryngoscopy proves difficult. The technique is a practical option in the "cannot intubate / can ventilate" scenario. However, it is equally useful as an elective technique in awake patients with anticipated difficult airways. Many practitioners report difficulty successfully advancing the endotracheal tube due to anatomical obstructions and the acute angle of the anterograde guide. The purpose of this study was to test whether a more caudal tracheal puncture would increase the success rate. Methods. Twenty-four anesthesiology residents were randomly assigned to either a cricothyroid or a cricotracheal puncture group. Each was instructed how to perform the technique and then attempted it on a manikin at their assigned site. Data collection included whether the trachea was intubated, the number of attempts required, and the total time. Results. Both groups displayed a high degree of success. While the group assigned to the cricotracheal site required significantly more time to perform the procedure, they accomplished it in fewer attempts than the cricothyroid group. Conclusion. Retrograde intubation performed via a cricotracheal puncture site, while more time consuming, resulted in fewer attempts to advance the endotracheal tube and may reduce in vivo laryngeal trauma.
Collapse
Affiliation(s)
- Eric A. Harris
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami/Miller School of Medicine, Miami, FL 33136, USA
| | - Kristopher L. Arheart
- Division of Biostatistics, Department of Epidemiology and Public Health, University of Miami/Miller School of Medicine, Miami, FL 33136, USA
| | | |
Collapse
|
7
|
Jain G, Singh DK, Yadav G, Gupta SK, Tharwani S. A modification in the tube guide to facilitate retrograde intubation: A prospective, randomised trial. Indian J Anaesth 2012; 55:499-503. [PMID: 22174468 PMCID: PMC3237151 DOI: 10.4103/0019-5049.89883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The technique of anterograde over a retrograde guide is considered to be more reliable and preferable in comparison to only retrograde one, for improving the success rate of retrograde intubation. As the prior technique requires a lengthy guidewire to negotiate the whole channel of a tube guide, we designed a side eye at one end of tube guide, which obviated the above requirement while maintaining the integrity of the whole channel assembly. The efficacy of this modified technique was compared with the conventional one for retrograde intubation procedure. Methods: In a prospective, randomised fashion, 98 cases posted for surgery of carcinoma buccal mucosa were included in this trial. These cases were randomised to the conventional (Group I) or the modified technique (Group II) for retrograde intubation. Intubation time (first attempt), total number of successful intubations, cause of failures and any associated side effects were recorded and compared between the groups. Results: The total number of successful intubations were significantly higher in group II (95.83%, 46/48 cases) as compared to group I (66.66%, 31/48 cases) (P<0.001). Mean intubation time was 118±22 second in group I versus 124±26 second in group II (P=0.39). The side effects did not differ significantly between the groups. Conclusions: Improvising the tube guide resulted in a significant rise in the number of successful intubations through a modified retrograde intubation technique, with no side effects. This should encourage the use of retrograde intubation technique as a first option for difficult airway management.
Collapse
Affiliation(s)
- Gaurav Jain
- Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, India
| | | | | | | | | |
Collapse
|
8
|
Varshney PG, Kachru N. Fibreoptic-aided retrograde intubation: Is it useful to combine two techniques? Indian J Anaesth 2012; 55:546-7. [PMID: 22174484 PMCID: PMC3237167 DOI: 10.4103/0019-5049.89908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Preeti Goyal Varshney
- Department of Anesthesiology and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | | |
Collapse
|
9
|
Kellman RM, Losquadro WD. Comprehensive airway management of patients with maxillofacial trauma. Craniomaxillofac Trauma Reconstr 2011; 1:39-47. [PMID: 22110788 DOI: 10.1055/s-0028-1098962] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Airway management in patients with maxillofacial trauma is complicated by injuries to routes of intubation, and the surgeon is frequently asked to secure the airway. Airway obstruction from hemorrhage, tissue prolapse, or edema may require emergent intervention for which multiple intubation techniques exist. Competing needs for both airway and surgical access create intraoperative conflicts during repair of maxillofacial fractures. Postoperatively, edema and maxillomandibular fixation place the patient at risk for further airway compromise.
Collapse
Affiliation(s)
- Robert M Kellman
- Department of Otolaryngology and Communication Sciences, State University of New York, Upstate Medical University, Syracuse, New York
| | | |
Collapse
|
10
|
Abstract
Summary Successful management of difficult tracheal intubation by retrograde intubation has been reported for almost 50 years and can be used whether or not it is anticipated. There are numerous reports of variations to the basic technique to enhance reproducibility of this guided blind procedure. A review and analysis of the equipment and techniques provides a better understanding of this effective technique.
Collapse
Affiliation(s)
- S S Dhara
- Department of Anaesthesia, Royal Hobart Hospital, Hobart, Tasmania, Australia.
| |
Collapse
|
11
|
Abstract
Airway management in the emergency department is a critical skill that must be mastered by emergency physicians. When rapid-sequence induction with oral-tracheal intubation performed by way of direct laryngoscopy is difficult or impossible due to a variety of circumstances, an alternative method or device must be used for a rescue airway. Retrograde intubation requires little equipment and has few contraindications. This technique is easy to learn and has a high level of skill retention. Familiarity with this technique is a valuable addition to the airway-management armamentarium of emergency physicians caring for ill or injured patients. Variations of the technique have been described, and their use depends on the individual circumstances.
Collapse
Affiliation(s)
- David Burbulys
- David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90504, USA.
| | | |
Collapse
|
12
|
Perry M, Morris C. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Int J Oral Maxillofac Surg 2008; 37:309-20. [DOI: 10.1016/j.ijom.2007.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/29/2007] [Accepted: 11/06/2007] [Indexed: 10/22/2022]
|
13
|
Management of the difficult and failed airway in obstetric anesthesia. J Anesth 2008; 22:38-48. [DOI: 10.1007/s00540-007-0577-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Accepted: 09/03/2007] [Indexed: 10/22/2022]
|
14
|
Matériels d’intubation et de ventilation utilisables en cas de contrôle difficile des voies aériennes. Législation et maintenance. ACTA ACUST UNITED AC 2008; 27:33-40. [DOI: 10.1016/j.annfar.2007.10.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
|
16
|
|
17
|
Goldmann K, Braun U. Airway management practices at German university and university-affiliated teaching hospitals--equipment, techniques and training: results of a nationwide survey. Acta Anaesthesiol Scand 2006; 50:298-305. [PMID: 16480462 DOI: 10.1111/j.1399-6576.2006.00853.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Until recently, Germany did not have national airway management guidelines. This survey collected comprehensive data on departmental airway management practices from German teaching institutions to identify weaknesses, and the results are presented here. German national airway guidelines were formulated by an expert group on the basis of these data and the current evidence in the literature. METHODS Questionnaires were mailed to the directors of 452 university and university-affiliated anaesthesia departments. They were asked to respond to 39 questions on the use of particular equipment and techniques, management of the difficult airway and training in airway management. RESULTS Two hundred and twelve questionnaires were returned. Many alternative devices for endotracheal intubation, such as the Bullard laryngoscope, the Bonfils laryngoscope and the Trachlight, are not used in the majority (80%) of departments. Thirty-six per cent of departments do not have difficult airway carts. No departmental difficult airway management plan is used in 22% of departments. Patients are not provided with written information on their personal airway management difficulties in 14% of departments. Structured training in the form of block rotation is offered in only 29-40% of departments. Although trainees perform fibreoptic intubation (FOI) in most departments, appropriate training in FOI is not available in some departments (8%). CONCLUSION There are deficits in various areas of airway management, in particular training and the use of algorithms. International guidelines and recommendations are not followed by a large number of German teaching institutions. The provision of German national airway guidelines should improve this situation.
Collapse
Affiliation(s)
- K Goldmann
- Department of Anaesthesia and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany.
| | | |
Collapse
|
18
|
Abstract
Airway management involves far more than just proficiency with tracheal intubation techniques. There are several infraglottic techniques available and the method chosen will depend on the accessibility of equipment, the level of training and expertise, and the patient's specific injury or disease. Endotracheal intubation is most commonly performed by direct laryngoscopy. Several modifications of laryngoscope blades and a variety of adjuncts such as bougies may help to accomplish even a difficult airway. Rigid intubation fibrescopes do improve the view of the larynx, especially in patients with difficult anatomy. They also permit tracheal intubation with less head and cervical spine movement than is often generated by direct laryngoscopy. Successful intubation, however, requires considerable experience, as in intubation techniques using flexible fibrescopes. Both the EasyTube and the Combitube serve as an infraglottic or a supraglottic airway. The tip of the EasyTube resembles the one of an endotracheal tube, whereas the Combitube is much more bulky.
Collapse
Affiliation(s)
- Andreas R Thierbach
- Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
| | | |
Collapse
|
19
|
Perry M, Dancey A, Mireskandari K, Oakley P, Davies S, Cameron M. Emergency care in facial trauma--a maxillofacial and ophthalmic perspective. Injury 2005; 36:875-96. [PMID: 16023907 DOI: 10.1016/j.injury.2004.09.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Revised: 09/10/2004] [Accepted: 09/10/2004] [Indexed: 02/02/2023]
Abstract
Facial trauma, with or without life- and sight-threatening complications, may arise following isolated injury, or it may be associated with significant injuries elsewhere. Assessment needs to be both systematic and repeated, with the establishment of clearly stated priorities in overall care. Although the American College of Surgeons Advanced Trauma Life Support (ATLS) system of care is generally accepted as the gold standard in trauma care, it has potential pitfalls when managing maxillofacial injuries, which are discussed. Management of facial trauma can arguably be regarded as "facial orthopaedics", as both specialities share common management principles. This review outlines a working approach to the identification and management of life- and sight-threatening conditions following significant facial trauma.
Collapse
Affiliation(s)
- Michael Perry
- Maxillofacial Unit, The Royal Group of Hospitals, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
| | | | | | | | | | | |
Collapse
|
20
|
Ho CM, Yin IW, Tsou KF, Chow LH, Tsai SK. Gastric rupture after awake fibreoptic intubation in a patient with laryngeal carcinoma. Br J Anaesth 2005; 94:856-8. [PMID: 15764626 DOI: 10.1093/bja/aei124] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
An 86-yr-old man with recurrent laryngeal carcinoma developed gastric rupture after awake fibreoptic intubation before induction of general anaesthesia. Early clinical signs included a distended, tense and tympanic abdomen with pain and massive pneumoperitoneum (chest radiograph). Laparotomy revealed a 4-cm longitudinal perforation along the lesser curvature of the stomach. This case represents a rare but severe complication that may occur during fibreoptic intubation in the awake patient.
Collapse
Affiliation(s)
- C-M Ho
- Department of Anaesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
| | | | | | | | | |
Collapse
|
21
|
Ezri T, Szmuk P. Recent trends in tracheal intubation: emphasis on the difficult airway. Curr Opin Anaesthesiol 2004; 17:487-90. [PMID: 17031081 DOI: 10.1097/00001503-200412000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW Difficult airways can lead to critical incidents during anaesthesia, and death. Although many cases can be anticipated, some still go undiscovered before induction, thereby exposing the patient to unexpected risks and the anaesthesiologist to unexpected challenges. In addition to improving prediction of difficult airways, education for skill acquisition and management planning, and a quest for superior management techniques and airway tools are of the utmost importance in preventing airway catastrophes. RECENT FINDINGS We review recent advances in predicting difficult airways in special population groups that are known to have a higher incidence of difficult airway. Education, exercising airway skills, management planning with both predicted and unpredicted difficult airways, and the need for adherence to algorithms for management of difficult airway are emphasized as key to successful management. Finally, recent developments in airway management techniques and new airway devices are summarized. SUMMARY Improving reproducibility and reliability in predicting a difficult airway may limit the number of unpredicted difficult intubations. A safer approach to management of the difficult airway can be achieved by improving airway management skills and adhering to universally accepted and proven airway algorithms, including developing approaches to management of predicted and unpredicted difficult airways. Improving on existing airway techniques and tools (of which there are many), rather than creating new devices, is a desirable trend that may contribute to safer airway management in the future.
Collapse
Affiliation(s)
- Tiberiu Ezri
- Department of Anesthesia, the Edith Wolfson Medical Center, Holon, Israel.
| | | |
Collapse
|
22
|
Keul W, Bernhard M, Völkl A, Gust R, Gries A. Methoden des Atemwegsmanagements in der pr�klinischen Notfallmedizin. Anaesthesist 2004; 53:978-92. [PMID: 15502884 DOI: 10.1007/s00101-004-0734-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the majority of emergency situations definite airway control can be achieved by endotracheal intubation with or without preceding bag valve mask ventilation. However, both techniques can fail because of many different reasons. Therefore, alternative techniques for routine anaesthesia and emergency situations are required. In the present article difficulties that may arise using bag valve mask ventilation and endotracheal intubation are discussed and an overview of available alternatives is given.
Collapse
Affiliation(s)
- W Keul
- Klinik für Anaesthesiologie, Bereich Notfallmedizin, Ruprecht-Karls-Universität, Heidelberg.
| | | | | | | | | |
Collapse
|