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Kumar A, Singh K. Use of laryngoscope blade as a rescue intubating airway during fiberoptic orotracheal intubation. Saudi J Anaesth 2023; 17:126-127. [PMID: 37032671 PMCID: PMC10077767 DOI: 10.4103/sja.sja_475_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kunal Singh
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Causer E, Alfawaz M, BinBraik Y, Lombardi J, Al Lawati K, Sharif S, Ligori T, Oczkowski S. Comparing the efficacy of oral intubating airways to facilitate successful fiberoptic intubation: A systematic review. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.101207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kuwana K, Obara S, Tanaka S, Sato Y, Yoshida K, Hanayama C, Hakozaki T. The use of the Sanuki airway™ in three patients with suspected difficult airway. SAGE Open Med Case Rep 2021; 9:2050313X211031311. [PMID: 34290870 PMCID: PMC8273519 DOI: 10.1177/2050313x211031311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
The Sanuki airway is a single-use intubation oral airway designed for fiberoptic bronchoscope intubation. Sanuki airway has a bite block function and a wide lumen for the tracheal tube to pass through. Here, three cases are reported in which Sanuki airway was used for oral fiberoptic bronchoscope intubation. Case 1 is a patient who presented with reduced mouth opening and intraoral edema due to facial bone fracture. Case 2 is a patient who suffered from severe neck stiffness and had reduced mouth opening due to systemic psoriatic arthritis. Case 3 is a patient who suffered from multiple facial traumas and was in a full-stomach state. In all patients, advancing the tip of the bronchofiber into the larynx using Sanuki airway was possible under dexmedetomidine sedation, which contributed to the successful tracheal intubation. Using Sanuki airway may be considered an option for oral fiberoptic bronchoscope intubation in patients anticipated with difficult airways.
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Affiliation(s)
- Keisuke Kuwana
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Shinju Obara
- Surgical Operation Department, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Shiori Tanaka
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Yuki Sato
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Keisuke Yoshida
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Chie Hanayama
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Takahiro Hakozaki
- Department of Anesthesiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
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Yang J, Kim S, Lee B, Lee K, Kim D, Lee J, Jun HJ, Yoon JS, Cho SS. A fiberoptic orotracheal intubation successfully performed using a modified Guedel airway in a sedated emergency patient - A case report. Anesth Pain Med (Seoul) 2020; 15:378-382. [PMID: 33329839 PMCID: PMC7713837 DOI: 10.17085/apm.20030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Fiberoptic intubation is a powerful and safe technique to deal with airway difficulty, but it requires a lot of training to be able to perform correctly. There are various specialized oral airways for fiberoptic intubation, but none of them have perfect functionality. Case A 75-year-old male (body weight 71.6 kg, height 159.3 cm, body mass index 28.22 kg/m2) was diagnosed with acute appendicitis, and it was decided to do a laparoscopic appendectomy. After the induction of general anesthesia, it was impossible to insert the direct laryngoscope deep enough for vocal cord visualization without damaging the teeth because of limited mouth opening. We successfully performed fiberoptic intubation with a newly modified Guedel airway via a longitudinal channel on the convex side and a distal opened lingual end. Conclusions Our modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.
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Affiliation(s)
- Jaeyoung Yang
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Seonjin Kim
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Bousung Lee
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Kwanghaeng Lee
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Dongseok Kim
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Jaedo Lee
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Hee Jung Jun
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Jin Sun Yoon
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
| | - Sam Soon Cho
- Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea
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Lim WY, Teo CEH, Wong P. Awake Intubation via an Ambu AuraGain in a Patient With Extreme Obesity: A Case Report. A A Pract 2019; 13:48-50. [PMID: 30829682 DOI: 10.1213/xaa.0000000000000986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe obesity is associated with increased morbidity and mortality. Airway management is challenging due to difficulties in positioning and airway management and altered pulmonary physiology. We report a case of awake flexible bronchoscopic intubation via an Ambu AuraGain in a patient with a body mass index of 54 kg/m scheduled for elective thyroidectomy. The procedure was well tolerated and easily performed in the full sitting position for optimal airway and ventilation and cardiovascular stability during intubation. To our knowledge, this is the first published report of awake flexible bronchoscopic intubation via an AuraGain, and we discuss our rationale for using this technique.
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Affiliation(s)
- Wan Yen Lim
- From the Departments of Anaesthesiology and Intensive Care
| | | | - Patrick Wong
- From the Departments of Anaesthesiology and Intensive Care
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Lim WY, Wong P. Awake supraglottic airway guided flexible bronchoscopic intubation in patients with anticipated difficult airways: a case series and narrative review. Korean J Anesthesiol 2019; 72:548-557. [PMID: 31475506 PMCID: PMC6900415 DOI: 10.4097/kja.19318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022] Open
Abstract
Awake intubation is indicated in difficult airways if attempts at securing the airway after induction of general anesthesia may lead to harm due to potential difficulties or failure in those attempts. Conventional awake flexible bronchoscopic intubation is performed via the nasal, or less commonly, oral route. Awake oral flexible bronchoscopic intubation (FBI) via a supraglottic airway device (SAD) is a less common technique; we refer to this as ‘supraglottic airway guided’ FBI (SAGFBI). We describe ten cases with anticipated difficult airways in which awake SAGFBI was performed. After sedation and adequate airway topicalization, an Ambu AuragainTM SAD was inserted. A flexible bronchoscope, preloaded with a tracheal tube, was then inserted through the SAD. Finally, the tracheal tube was railroaded over the bronchoscope, through the SAD and into the trachea. The bronchoscope and the SAD were carefully removed, whilst keeping the tracheal tube in-situ. The technique was successful and well tolerated by all patients, and associated complications were rare. It also offered the advantages of performing an ‘awake test insertion’ of the SAD, an ‘awake look’ at the periglottic region, and an ‘awake test ventilation.’ In certain patients, awake SAGFBI offers advantages over conventional awake FBI or awake videolaryngoscopy. More research is required to evaluate its success and failure rates, and identify associated complications. Its place in difficult airway algorithms may then be further established.
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Affiliation(s)
- Wan Yen Lim
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Patrick Wong
- Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore
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Khattab SA, Mahmoud SR, Youssef MMI, Fawzy M. Comparison of three airway conduits for fiberoptic-guided intubation: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1080/11101849.2019.1589719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | | | - Maher Fawzy
- Faculty of Medicine, Cairo University, Giza, Egypt
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An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Modern" Era, 1960 to Present. Anesthesiology 2019; 130:686-711. [PMID: 30829659 DOI: 10.1097/aln.0000000000002646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This fourth and last installment of my history of basic airway management discusses the current (i.e., "modern") era of anesthesia and resuscitation, from 1960 to the present. These years were notable for the implementation of intermittent positive pressure ventilation inside and outside the operating room. Basic airway management in cardiopulmonary resuscitation (i.e., expired air ventilation) was de-emphasized, as the "A-B-C" (airway-breathing-circulation) protocol was replaced with the "C-A-B" (circulation-airway-breathing) intervention sequence. Basic airway management in the operating room (i.e., face-mask ventilation) lost its predominant position to advanced airway management, as balanced anesthesia replaced inhalation anesthesia. The one-hand, generic face-mask ventilation technique was inherited from the progressive era. In the new context of providing intermittent positive pressure ventilation, the generic technique generated an underpowered grip with a less effective seal and an unspecified airway maneuver. The significant advancement that had been made in understanding the pathophysiology of upper airway obstruction was thus poorly translated into practice. In contrast to consistent progress in advanced airway management, progress in basic airway techniques and devices stagnated.
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Xue FS, Cui XL, Wang SY. Lingual traction to aid fibreoptic orotracheal intubation. Can J Anaesth 2014; 62:94-5. [PMID: 25280876 DOI: 10.1007/s12630-014-0245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/18/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Fu S Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
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Castañeda Pascual M, Batllori Gastón M, Unzué Rico P, Murillo Jaso E, Dorronsoro Auzmendi M, Martín Vizcaíno MP. [Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:134-141. [PMID: 23159021 DOI: 10.1016/j.redar.2012.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 09/12/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.
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Affiliation(s)
- M Castañeda Pascual
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Complejo Hospitalario de Navarra, Pamplona, España.
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ARENKIEL B, SMITT M, OLSEN KS. The duration of fibre-optic intubation is increased by cricoid pressure. A randomised double-blind study. Acta Anaesthesiol Scand 2013; 57:358-63. [PMID: 23075453 DOI: 10.1111/j.1399-6576.2012.02789.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND In some categories of patients, a rapid sequence induction using a fibre-optic method may be indicated. The aim of the present study was to examine the effect of cricoid pressure (CP) on the duration of fibre-optic intubation. The hypothesis was that CP would prolong the intubation time. METHODS The study was a randomised, double-blind, cross-over study. The patients were intubated twice, in a randomised way, using a flexible fibrescope once with and once without CP. The intubation time and the visualisation of the glottis were registered. If the intubation was not completed within 180 s, it was registered as failed. CP was standardised to a pressure of 30 N. The data are given as the mean (standard deviation) or median [interquartile] (range). RESULTS Fifty patients were included, with a mean age of 53 years (14.6) and mean body mass index of 26.4 (4.3). Three intubations without and 13 intubations with CP failed. The durations of intubation without and with CP were 59 s [53-79 s] (34-144 s) and 75 s [67-104 s] (43-179 s), respectively (P < 0.001). CONCLUSION The study showed that CP prolongs the duration of fibre-optic intubation in patients with Mallampati grades 1-2.
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Affiliation(s)
- B. ARENKIEL
- University of Copenhagen; Glostrup Hospital; Glostrup; Denmark
| | - M. SMITT
- University of Copenhagen; Glostrup Hospital; Glostrup; Denmark
| | - K. S. OLSEN
- University of Copenhagen; Glostrup Hospital; Glostrup; Denmark
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Houde BJ, Williams SR, Cadrin-Chênevert A, Guilbert F, Drolet P. A Comparison of Cervical Spine Motion During Orotracheal Intubation with the Trachlight® or the Flexible Fiberoptic Bronchoscope. Anesth Analg 2009; 108:1638-43. [DOI: 10.1213/ane.0b013e31819c60a1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rewari V, Ramachandran R, Trikha A. Lingual traction: a useful manoeuvre to lift the epiglottis in a difficult oral fibreoptic intubation. Acta Anaesthesiol Scand 2009; 53:695-6. [PMID: 19419380 DOI: 10.1111/j.1399-6576.2009.01934.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Botana M, Fernández-Villar A, Leiro V, Represas C, Méndez A, Piñeiro L. [Tracheal intubation guided by fibrobronchoscopy in patients with difficult airway. Predictive factors of the outcome]. Med Intensiva 2009; 33:68-73. [PMID: 19401106 DOI: 10.1016/s0210-5691(09)70684-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVE Tracheal intubation (TI) guided by fibrobronchoscopy (FB) is one of the essential techniques in the approach to the difficult airway (DAW). Few works have been published on the possible causes of TI failure with this procedure. This study aims to discover which factors could predict TI failure with FB. MATERIAL AND METHODS An observational and retrospective study in which the last 122 consecutive TIs guided by FB (between January 2000 and April 2008) performed by our group were included. A multivariate analysis of the factors that could influence in the outcome was conducted: cause of the DAW, TI pathway, type of endotracheal tube, elective or urgent indication of the procedure, sedation level and experience of the bronchoscopist. RESULTS Tracheal intubation in individuals who are going to undergo surgical interventions accounts for 92.6% of the total. The most frequent indications of TI by FB were: limitation of neck movement (60 cases), airway stenosis (24), increase of soft tissues (13), narrow oral aperture (9), airway compression (6), and vocal cord paralysis (6). In 10 (8.2%) cases, TI by FB was not possible. The variables that best predicted IT failure in the multivariate analysis were profound sedation/ general anesthesia (OR = 12.2; 95% CI, 1.8-84; p = 0.01) and limited experience of the bronchoscopist (OR = 25.3; 95% CI, 3.5-181.8; p = 0.001). CONCLUSIONS TI guided by FB performed by bronchoscopist is successful in more than 90% of the cases with DAW. The skill and experience of the bronchoscopist is one of the primary determining factors of success of the procedure. Profound sedation may condition TI guided by FB failure.
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Affiliation(s)
- M Botana
- Unidad de Técnicas Broncopleurales, Servicio de Neumología, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España.
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Hodzovic I, Petterson J, Wilkes AR, Latto IP. Fibreoptic intubation using three airway conduits in a manikin: the effect of operator experience. Anaesthesia 2007; 62:591-7. [PMID: 17506738 DOI: 10.1111/j.1365-2044.2007.05054.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a randomised cross-over study, 72 anaesthetists (24 Senior House Officers, 24 Specialist Registrars and 24 Consultants) attempted to place a fibreoptic scope in the trachea of a manikin using three airway conduits: the Berman airway, the LMA Classic(trade mark) and the intubating laryngeal mask airway. The time for insertion of the airway conduit, delivery of two breaths and fibreoptic scope placement in the trachea was the primary endpoint. These overall times were significantly shorter (median [interquartile range]) using the LMA Classic (36 [28-45]) than via the intubating laryngeal mask (54 [42-79]) and the Berman airway (45 [33-80]), p < 0.0001. Senior House Officers were significantly slower than both Specialist Registrars and Consultants (p < 0.0001). The LMA Classic was considered to be the easiest conduit to use for fibreoptic scope placement by all grades of anaesthetists. We conclude that the LMA Classic is the most effective conduit for fibreoptic scope placement especially for anaesthetists with limited experience in its use.
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Affiliation(s)
- I Hodzovic
- Department of Anaesthetics and Intensive Care Medicine, Cardiff University, Heath Park, Cardiff, UK.
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Greenland KB. Comparison of the jaw lift with the Berman airway for fibreoptic intubation. Anaesthesia 2007; 62:193-4; author reply 194. [PMID: 17223818 DOI: 10.1111/j.1365-2044.2007.04959_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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