MedWorm: Airway Management

Awake extracorporeal membrane oxygenation for management of critical distal tracheal obstruction

Otolaryngology - Head and Neck Surgery — Fri, 19 Mar 2010 15:22:39 +0100

Pericarinal obstruction challenges traditional techniques for perioperative airway management. One etiology is spread of recurrent respiratory papillomatosis (RRP) to involve the distal trachea and bronchopulmonary airway. Herein, for carinal RRP, we report the first use of extracorporeal membrane oxygenation (ECMO) in the surgical management of near complete intrinsic airway obstruction. (Source: Otolaryngology - Head and Neck Surgery)

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Prehospital airway management

Emergency Medicine Journal — Fri, 19 Mar 2010 11:45:06 +0100

(Source: Emergency Medicine Journal)

A critical reassessment of ambulance service airway management in prehospital care: Joint Royal Colleges Ambulance Liaison Committee Airway Working Group, June 2008

Emergency Medicine Journal — Fri, 19 Mar 2010 11:45:06 +0100

Paramedic tracheal intubation has been practised in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcomes. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate, and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (eg, laryngeal mask airway), which were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative prehospital airway device for paramedics. (Source: Emergency Medicine Journal)

[Fibrodysplasia ossificans progressiva : Anesthetic management of a 2-year-old child.]

Der Anaesthesist — Fri, 19 Mar 2010 00:00:00 +0100

Authors: Iber T, Klösel S, Schoenes B, Zacharowski K Fibromyalgia ossificans progressiva (FOP) is a severely disabling disorder of connective tissue characterized by congenital malformation of the toes, fingers and vertebrae associated with progressive ossification of striated muscles. Anesthetic management of these patients involves preferably general anesthesia as local or regional anesthesia should be avoided due to possible heterotopic ossification. Airway management is determined by the age of the patient and the progression of the disease. Only a few cases in the literature have reported the anesthetic management of FOP patients and to our knowledge only one case has been published on pediatric patients. In adult, cooperative patients awake fiberoptic intubation is recommend...

Endoscopic Airway Management of Laryngeal Sarcoidosis [Original Article]

Archives of Otolaryngology — Mon, 15 Mar 2010 19:50:56 +0100

Conclusions Minimally invasive endoscopic surgery with intralesional corticosteroid injection and laser reduction is an effective method of controlling laryngeal sarcoid. It improves symptoms immediately with minimal morbidity and, most importantly, reduces the need for systemic steroid administration in most patients. This study supports early recognition and endoscopic intervention in the management of laryngeal sarcoidosis. (Source: Archives of Otolaryngology)

Teaching airway management to novices: a simulator manikin study comparing the 'sniffing position' and 'win with the chin' analogies

British Journal of Anaesthesia — Fri, 12 Mar 2010 16:46:22 +0100

Conclusions The ‘win with the chin’ analogy resulted in adequate airway positioning significantly more often than the ‘sniffing position’ or control. It also maintained atlanto-occipital extension compared with anatomic instructions. Overall, ‘win with the chin’ was a superior teaching analogy and could replace the ‘sniffing position’ analogy. (Source: British Journal of Anaesthesia)

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Emergency airway management using the Bonfils intubation fiberscope

Internal and Emergency Medicine — Thu, 11 Mar 2010 02:49:28 +0100

Content Type Journal ArticleCategory CE - Letter to the EditorDOI 10.1007/s11739-010-0366-9Authors Ruggero M. Corso, Anaesthesia and Intensive Care Unit Emergency Department Ospedale “G.B. Morgagni-Pierantoni” Viale Forlanini, 34 47100 Forlì ItalyGiorgio Gambale, Anaesthesia and Intensive Care Unit Emergency Department Ospedale “G.B. Morgagni-Pierantoni” Viale Forlanini, 34 47100 Forlì ItalyEmanuele Piraccini, Anaesthesia and Intensive Care Unit Emergency Department Ospedale “G.B. Morgagni-Pierantoni” Viale Forlanini, 34 47100 Forlì ItalyFlavia Petrini, Università “G.D’Annunzio” Anaesthesia and Intensive Care Chieti-Pescara Italy Journal Internal and Emergency MedicineOnline ISSN 1970-9366Print ISSN 1828-0447 (Source: Internal and Emergency Medicine)

[Airway management.]

Tidsskrift for den Norske Laegeforening — Thu, 11 Mar 2010 00:00:00 +0100

Authors: Bjerkelund CE, Christensen P, Dragsund S, Aadahl P Background. To secure the airway has the highest priority when handling critically ill and injured patients. The aim of this article is to present simple and new devices and techniques to secure the airway. Material and methods. The paper is based on international algorithms for optimal treatment of patients with acute airway problems, and the authors' experience from clinical work and organizing of courses. Results. Unconscious patients have obstructed airways because the tongue slides back and blocks the airway. This can be prevented by lifting the jaw, possibly supplemented by insertion of an oropharyngeal airway. When these active techniques are not used, patients must be placed in the semi-prone position and air passage c...

Difficult airway management using the Pentax-AWS (Airway Scope) for a patient with bilateral giant thyroid tumors

Journal of Anesthesia — Wed, 10 Mar 2010 15:45:46 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00540-010-0901-xAuthors Nobuyasu Komasawa, Hyogo College of Medicine Department of Anesthesiology Mukogawa-cho 1-1 Nishinomiya Hyogo 663-8501 JapanRyusuke Ueki, Hyogo College of Medicine Department of Anesthesiology Mukogawa-cho 1-1 Nishinomiya Hyogo 663-8501 JapanTsuneo Tatara, Hyogo College of Medicine Department of Anesthesiology Mukogawa-cho 1-1 Nishinomiya Hyogo 663-8501 JapanYoshiroh Kaminoh, Hyogo College of Medicine Department of Central Surgical Unit Nishinomiya JapanChikara Tashiro, Hyogo College of Medicine Department of Anesthesiology Mukogawa-cho 1-1 Nishinomiya Hyogo 663-8501 Japan Journal Journal of AnesthesiaOnline ISSN 1438-8359Print ISSN 0913-8668 (Source: Journal of Anesthesia)

Paediatric endotracheal tubes: cuff or no cuff?

British Journal of Hospital Medicine — Wed, 10 Mar 2010 00:00:00 +0100

Authors: Jones C Traditional teaching states that when an endotracheal tube is required for airway management of children under the age of about 8 years an uncuffed tube should be used. Cuffed endotracheal tubes were really only used in specific circumstances such as patients requiring ventilation with poorly compliant lungs. PMID: 20220731 [PubMed - as supplied by publisher] (Source: British Journal of Hospital Medicine)

Thoracic Spine Injury after a High-Speed Motor Vehicle Crash

Air Medical Journal — Mon, 01 Mar 2010 00:00:00 +0100

In late October, a hospital-based flight team was activated at 9:30 pm for an approximately 30-year-old man involved in a high-speed motor vehicle crash into a tree. Per emergency medical services (EMS) documentation, flight service was requested for advanced airway management and rapid transport of the patient to a Level 1 trauma center. Ground transport was estimated at 60+ minutes, whereas actual flight time was less than 15 minutes. On the crew's arrival at the designated landing zone, they were escorted to an ambulance where a 100-kg man was immobilized on a stretcher. Because the landing area was at a remote location, the flight team did not witness the scene; however, the ground paramedic reported that the patient was the single-occupant driver of a small sedan. Given the extent...

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Prehospital Management of Pediatric Trauma

Clinical Pediatric Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

This article will review the literature regarding the risks and benefits of various aspects of pediatric trauma care in the prehospital setting. (Source: Clinical Pediatric Emergency Medicine)

Lemon-Aid: Using a mnemonic devices to assess difficult airways

JEMS: Journal of Emergency Medical Services — Mon, 01 Mar 2010 00:00:00 +0100

Airway management is a fundamental aspect of every level of care in the EMS profession. Before the airway can be managed, it must be assessed. Thus, first responders must be taught to properly assess patency and use simple maneuvers to open the airway; EMTs must know how to perform a more in-depth assessment and corrective interventions; and paramedics must be able to carry out all the basic procedures as well as more invasive techniques. All providers need to be able to predict the difficult airway because their management approach will require modifications from standard procedures. (Source: JEMS: Journal of Emergency Medical Services)

Airway management considerations for appendectomy.

Canadian Journal of Anaesthesia — Fri, 26 Feb 2010 00:00:00 +0100

Authors: Fabregat-López J, Cook T PMID: 20186510 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Airway management in acute tetraplegics: a retrospective study

European Spine Journal — Wed, 24 Feb 2010 06:49:40 +0100

The objective of this study was to develop an evidence-based airway management protocol for patients with acute tetraplegia. The method consisted of an analysis of the medical records of patients (September 1997–December 2002) with a spinal cord injury and a neurological deficit less than 8 weeks old. Of the 175 patients, 72 (41, 14%) were tracheotomised. This was influenced by the origin of the paralysis, Frankel score, and number of cervical spine operations, accompanying injuries and accompanying illnesses. Tracheotomy did not affect the duration of treatment, duration of ventilation or length of stay in the intensive care unit. The need for a tracheotomy was able to be predicted in 73.31% with neurological level, Frankel score and severity of accompanying injuries. In pati...

Cervical Support Collar: A Substitute to the Jaw Thrust/Chin Lift Methods of Airway Management During Oral Maxillofacial Surgeries

Journal of Oral and Maxillofacial Surgery — Tue, 23 Feb 2010 14:21:44 +0100

Outpatient single-surgeon–provided intravenous sedation is a safe, cost-effective means of providing anesthesia for numerous oral and maxillofacial surgical procedures. The sedation allows for increased comfort for the patient and can make difficult procedures less stimulating and more routine for patient and surgeon. When sedation is used, it is extremely important that proper airway management techniques are used. Two very basic techniques to maintain airway patency in the sedated patient are the jaw thrust and chin lift methods. The jaw thrust method consists of grasping the angles of the mandible and advancing them forward to increase the opening of the pharynx. The chin lift method consists of advancing the mandible forward by grasping just under the mental protuberance and opening ...

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Emergency Cricothyrotomy

Atlas of the Oral and Maxillofacial Surgery Clinics of North America — Tue, 23 Feb 2010 14:19:33 +0100

This article reviews the indications, contraindications, and techniques of surgical and needle cricothyrotomy. Fortunately, with advances in airway techniques and equipment, emergency cricothyrotomy is not a common procedure. However, in the event that a surgeon has no other means of securing an airway, this procedure may avert a catastrophe. If such a situation does occur, quick and decisive action can best be carried out if there is a thorough understanding of the anatomy and techniques involved. (Source: Atlas of the Oral and Maxillofacial Surgery Clinics of North America)

The incidence of epiglottic cysts in a cohort of adults with acute epiglottitis

Clinical Otolaryngology — Mon, 22 Feb 2010 00:00:00 +0100

Conclusions: The results of this study showed that a pre-existing epiglottic cyst might be associated with a suppurative infection of the supraglottis. Infected epiglottic cysts increased the risk for airway obstruction and recurrence of acute epiglottitis. (Source: Clinical Otolaryngology)

The McKesson prop--an essential tool for the emergency physician?

Emergency Medicine Journal — Mon, 15 Feb 2010 10:33:10 +0100

We describe two patients who suffered multi-system trauma, with severe maxillofacial injuries that necessitated prompt definitive airway management and mid-face stabilisation in the pre-hospital and emergency department phases of resuscitation. The McKesson prop is a simple yet highly effective tool for use in these injuries. (Source: Emergency Medicine Journal)

Proficient manipulation of fibreoptic bronchoscope to carina by novices on first clinical attempt after specialized bench practice

British Journal of Anaesthesia — Thu, 11 Feb 2010 16:36:44 +0100

Conclusions The endoscopic dexterity required to proficiently drive a bronchoscope in human subjects to an anatomic endpoint relevant to fibreoptic intubation is achievable after 2–4 h of specialized bench training. Training in the local environment may be more conducive to success than in time-limited workshops. Achieving a defined proficiency standard on bench models contributes to the development of basic bronchoscopic competence. This has the potential to protect patients from novice learning curves, optimize clinical education and efficiency, and assist compliance with difficult airway algorithms. (Source: British Journal of Anaesthesia)

Burns: Learning from the past in order to be fit for the future

Critical Care — Wed, 10 Feb 2010 00:00:00 +0100

Many advances have been made in the understanding and treatment of burns. Advances in burn surgery and critical care have decreased mortality and morbidity. Survival from severe burns is not longer the exception, but unfortunately death still occurs. Williams and colleagues have determined in their recent paper the predominant causes of death in order to develop new treatment avenues and future trajectories suitable to increase survival and overall outcome. A lot of burn deaths may be preventable with better airway management and a more precise and adequate volume management, but the leading cause of death in patients suffering from severe burns, that have to be faced, is sepsis. Sepsis due to multi-drug resistant organisms will continue to impede efforts to increase survival and new stra...

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A Comparison of Four Techniques of Emergency Transcricoid Oxygenation in a Manikin.

Anesthesia and Analgesia — Mon, 08 Feb 2010 00:00:00 +0100

Authors: Salah N, Mhuircheartaigh RN, Hayes N, McCaul C Cricothyroidotomy is the final rescue maneuver in difficult airway management. We compared 4 techniques of oxygenation via the cricothyroid membrane in a manikin. The techniques were wire guided, trocar, cannula with jet ventilation, and blade technique (scalpel with endotracheal tube). In the wire-guided group, the time taken to ventilation was slower on all attempts, and there were no successful attempts in <40 seconds. There were no differences between the other groups at any time. Time to ventilation improved with repetition in all groups. Skills were retained at 1 month. PMID: 20142338 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

The Fastrach(TM) Intubating Laryngeal Mask Airway(R): an overview and update.

Canadian Journal of Anaesthesia — Fri, 29 Jan 2010 00:00:00 +0100

CONCLUSIONS: The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. PMID: 20112078 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

[Acute obstructive epiglottitis in intensive care unit: Which airway management strategy?]

Annales Francaises d'Anesthesie et de Reanimation — Wed, 27 Jan 2010 00:00:00 +0100

We report a case of a 52-year-old patient who presented with a prehospital hypoxic respiratory arrest caused by obstructive oedema with a successful resuscitation. Laryngoscopy after a sudden unplanned extubation permits diagnosis of acute obstructive epiglottitis. The growing threat of laryngeal dyspnea prompts emergency tracheal airway protection, by means of the combined preparation of transtracheal oxygenation access and the use of fiber-optic laryngoscopy. This case report emphasises the airway management strategy successfully used in this patient. PMID: 20116197 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Delaying Endotracheal Intubation in Less Severely Injured Trauma Patients Increases Mortality

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:37 +0100

Introduction: Airway management is the number one priority in trauma resuscitation. Patients in cardiopulmonary distress or with airway protection issues clearly need immediate intubation. Despite relatively standard indications for acute post-trauma intubation, there may be a subset of patients who appear clinically stable upon presentation but later deteriorate and require immediate intubation. We sought to determine whether less severely injured patients with delayed intubation have worse outcomes, and to determine any potential risk factors that may predict the need for earlier intubation in this patient population. Our hypothesis was that less severely injured trauma patients with a delay in intubation have higher mortality than those patients intubated earlier with similar injury sev...

A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation

Anaesthesia — Mon, 25 Jan 2010 00:00:00 +0100

This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 [mu]g.kg[minus]1 over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1[ndash]2 [1[ndash]4]) in the dexmedetomidine group and 3 (2[ndash]4 [2[ndash]5]...

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Annals of Emergency Medicine — Fri, 22 Jan 2010 14:15:25 +0100

The author addresses rapid sequence intubation and has created an excellent primer for any provider learning about rapid sequence intubation. The book is easy to understand and generally well written in a conversational style. The material is focused on those providing emergent airway management and is particularly useful for out-of-hospital providers. This is not, nor does it claim to be, a definitive text for airway management. The ideal audiences for this book are providers with some understanding of airway management who are ready to learn about rapid sequence intubation. This includes paramedics, nurses, respiratory therapists, physician trainees and those physicians who practice emergency airway management who may not have had formal training in the technique. (Source: Annals of Emer...

Airway management in obese patients

Current Anaesthesia and Critical Care — Fri, 15 Jan 2010 13:41:36 +0100

This article aims to improve understanding of the term ‘difficult airway’ in the obese population and focuses primarily on evidence related to pre-operative airway assessment and intra-operative airway management in the obese patient. (Source: Current Anaesthesia and Critical Care)

Airway management in an infant with double aortic arch

Journal of Anesthesia — Tue, 05 Jan 2010 17:06:02 +0100

Abstract A 2-month old male was admitted due to repeated cyanotic attacks. He had suffered from stridor and retractive breathing since birth. Double aortic arch was diagnosed and the vascular ring formed by the double aortic arch was compressing the trachea. Multirow detector computed tomography showed that he had a right-dominant double aortic arch with left ductus arteriosus and an aberrant left subclavian artery, and that the narrowest part of the trachea, where the diameter was 2.0 mm, was located 9.0 mm above the carina. Airway management in patients with extreme narrowing of the trachea is challenging for anesthesiologists. He was scheduled for ligation and division of the left aortic arch and ductus arteriosus. In the operating theater, anesthesia was slow...

Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training

Emergency Medicine Journal — Tue, 22 Dec 2009 21:18:11 +0100

Conclusion: The FFC is a more realistic and preferred model for direct laryngoscopic orotracheal intubation training. Trucorp and Laerdal manikin can be used as alternative models. (Source: Emergency Medicine Journal)

Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Resuscitation — Mon, 21 Dec 2009 00:00:00 +0100

Conclusion: The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation. (Source: Resuscitation)

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Out-of-hospital airway management by paramedics and emergency physicians using laryngeal tubes

Resuscitation — Mon, 14 Dec 2009 00:00:00 +0100

Conclusion: The LT-D/LTS-D represents a reliable tool for prehospital airway management in the hands of both paramedics and emergency physicians. It can be used as an initial tool to secure the airway until ETI is prepared, as a definitive airway by rescuers less experienced with ETI or as a rescue device when ETI has failed. (Source: Resuscitation)

Effect of cricoid force on airway calibre in children: a bronchoscopic assessment

British Journal of Anaesthesia — Thu, 10 Dec 2009 16:21:41 +0100

Conclusions Forces well below the recommended value of 30 N will cause significant compression/distortion of the airway in a child. (Source: British Journal of Anaesthesia)

The emergency airway.

British Journal of Hospital Medicine — Mon, 07 Dec 2009 00:00:00 +0100

Authors: Goon SS, Stephens RC, Smith H The 'can't intubate, can't ventilate' scenario is a nightmare for all clinicians who manage airways. Cricothyroidotomy is one of several emergency airway management techniques. Cricothyroidotomy is a short-term solution which provides oxygenation, not ventilation, and is not a definitive airway. PMID: 20081629 [PubMed - as supplied by publisher] (Source: British Journal of Hospital Medicine)

Prehospital treatment guidelines in severe traumatic brain injury: What really happens outside the hospital?

Resuscitation — Mon, 07 Dec 2009 00:00:00 +0100

The international Brain Trauma Foundation guidelines recommend prehospital endotracheal intubation in all patients with traumatic brain injury (TBI) and a Glasgow Coma Scale (GCS)≤8. Adherence to these guidelines during prehospital management of severely injured TBI patients has been shown to be associated with reduced morbidity and mortality. In contrast, we reported that 44% of patients with severe TBI were not endotracheally intubated during prehospital trauma care in our urban trauma region. This may be explained by the absence of a physician-based mobile medical team at the trauma scene that is equipped and trained for airway management. From our results we concluded that there is a discrepancy between guidelines and reality in prehospital treatment strategies of severe TBI patients...

[Tracheostoma : Handling and complications.]

Der Anaesthesist — Thu, 03 Dec 2009 00:00:00 +0100

Authors: Richter T, Sutarski S Tracheostomy has gained importance due to recent developments in critical care medicine. This procedure is the most frequent surgical intervention on intensive care wards. Indications for tracheostomy (conventional versus dilatational) should consider the duration of the need for a tracheal cannula. The decision for one of the types of tracheostomy may have a relevant impact on the airway management and the rehabilitation of swallowing, because these are dependent on state of the tracheostoma and its subsequent maintenance. Selection of the appropriate cannula helps to avoid complications and improve patient comfort. To minimize the risks during tracheostomy, skills and expertise on the management of life- threatening complications are necessary. Early an...

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Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy.

Anesthesia and Analgesia — Wed, 02 Dec 2009 00:00:00 +0100

Conclusions: Multiple techniques resulted in successful airway control both before and after the induction of general anesthesia. Tracheal intubation was accomplished with both fiberoptic visualization and DL. In instances of poor direct visualization of the glottis, decompression of the airway by opening of the surgical incision may facilitate intubation of the trachea. PMID: 19955509 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

The High-Risk Airway

Emergency Medicine Clinics of North America — Tue, 01 Dec 2009 14:43:34 +0100

There are few conditions in emergency medicine as potentially challenging and high-risk as the difficult or failed airway. The emergency physician must be able to anticipate the difficult or failed airway, recognize associated physiologic deficits, and plan accordingly. Preparation, pretreatment strategies, and selection of alternative airway devices may mitigate the potential morbidity and management failure associated with the high-risk airway. There are a myriad of airway devices new to emergency medicine, which can increase the chance of successful airway management and rescue. Understanding why the airway is potentially difficult and assessing whether oxygenation can be maintained can guide the clinician's strategy and technique for successful management of the high-risk airway. (Sour...

Use of nasotracheal intubation in patients receiving oral cavity free flap reconstruction

Head and Neck — Tue, 01 Dec 2009 00:00:00 +0100

Conclusions.NTI is a safe alternative to tracheotomy for select patients receiving oral cavity free flap reconstruction and may reduce hospital stay and feeding tube dependence at discharge. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 (Source: Head and Neck)

Airway management for victims of penetrating trauma: analysis of 50,000 cases

American Journal of Surgery — Tue, 01 Dec 2009 00:00:00 +0100

Conclusions: Victims of penetrating trauma who require any airway management have a high mortality rate. The cause of this difference awaits further prospective investigation. (Source: American Journal of Surgery)

Airway management in a bleeding adult following tonsillectomy: a case report.

AANA Journal — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Brar MS A 37-year-old morbidly obese man with a history of obstructive sleep apnea underwent elective tonsillectomy. The patient was successfully intubated with an 8.0-mm regular cuffed endotracheal tube. A large video laryngoscope (GlideScope, Verathon Inc, Bothell, Washington) was used for intubation, as airway assessment indicated a potentially difficult airway. The surgery was uneventful, but active bleeding was noticed in the oropharynx after extubation. The patient was reintubated, again with the use of a GlideScope. The bleeding site was cauterized, and the patient was extubated after meeting the criteria for an awake extubation. He was discharged home the following day. Eight days postoperatively, the patient returned to the emergency center with spontaneous bleeding f...

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GlideScope® use in the obstetric patient

International Journal of Obstetric Anesthesia — Mon, 30 Nov 2009 00:00:00 +0100

Parturients present well described, specific problems with airway management. Moreover, it is not uncommon for obstetric suites to be sited away from the main operating rooms (ORs), as in our institution, necessitating a separate difficult airway cart. Because of the potential for airway problems in this remote location, we decided to obtain a GlideScope® videolaryngoscope for use in the obstetric suite. This decision proved to be fortunate, as we recently made urgent use of the GlideScope® in two patients in one day. (Source: International Journal of Obstetric Anesthesia)

Airway management for out-of-hospital cardiac arrest—More data required

Resuscitation — Fri, 27 Nov 2009 14:09:28 +0100

Establishing an airway and oxygenating vital organs is a fundamental component of cardiopulmonary resuscitation (CPR). Ideally, the method used to establish an airway should be reliable, effective, easy, safe and rapid. Above all, interruptions to chest compressions must be minimal during the procedure. Unfortunately, no airway management technique meets this ideal, particularly in the pre-hospital environment. (Source: Resuscitation)

Anaesthesia in prehospital emergencies and in the emergency room

Resuscitation — Fri, 27 Nov 2009 00:00:00 +0100

Conclusions: For pre-oxygenation, high-flow oxygen should be delivered with a tight-fitting face-mask provided with a reservoir. In haemodynamically unstable patients, ketamine may be the induction agent of choice. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. An experienced health-care provider may consider prehospital anaesthesia induction. A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a patient in extremis. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. A lesser experienced health-care provider should completely refrain from intubatio...

Annals of Emergency Medicine — Thu, 26 Nov 2009 14:14:48 +0100

Emergency medicine is a critical specialty with an emphasis on the acutely ill and injured. It requires prioritization, and rapid, safe decisionmaking. Generally speaking, no aspect is of greater importance than appropriate airway assessment and management. This has rightly drawn emergency medicine into the forefront of airway management. (Source: Annals of Emergency Medicine)

Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?

Emergency Medicine Journal — Tue, 24 Nov 2009 18:04:19 +0100

Conclusion: Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews is likely to be inadequate with such infrequent exposure to the skill. (Source: Emergency Medicine Journal)

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Manual of emergency airway management

Emergency Medicine Journal — Tue, 24 Nov 2009 18:04:19 +0100

(Source: Emergency Medicine Journal)

Dynamic upper airway changes during sleep in patients with obstructive sleep apnea syndrome.

Acta Oto-Laryngologica — Sat, 21 Nov 2009 00:08:03 +0100

Conclusion: The narrowing pattern of the upper airway in obstructive sleep apnea patients may be different in sleep as compared with awake. Three different types of obstruction were observed in these subjects during drug-induced sleep. The different obstruction pattern during drug-induced sleep suggests that different strategies should be selected in upper airway management. Objectives: To identify the sites of narrowing and evaluate dynamic upper airway movement in patients with obstructive sleep apnea syndrome (OSAS) while awake and asleep. Patients and methods: This study included 10 patients treated for OSAS between August 2003 and June 2004. Overnight polysomnography was performed on all patients. Parameters including gender, age, neck circumference, and body mass index were recorded....

Difficult Mask Ventilation.

Anesthesia and Analgesia — Fri, 20 Nov 2009 17:27:37 +0100

Authors: El-Orbany M, Woehlck HJ Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. The lack of a precise standard definition creates a problem for studies on DMV and causes confusion in data communication and comparisons. DMV develops because of multiple factors that are technique related and/or airway related. Frequently, the pathogenesis involves a combination of these factors interacting to cause the final clinical picture. The reported incidence of DMV varies widely (from 0.08% to 15%) depending on the criteria used for its definition. Obesity, age older than 55 yr, history of snoring, lack of teeth, t...

Retrograde nasal intubation via the cleft in Pierre-Robin Sequence neonates: A case series

International Journal of Pediatric Otorhinolaryngology — Fri, 20 Nov 2009 14:12:50 +0100

Abstract: Pierre-Robin Sequence, the triad of glossoptosis, micrognathia and cleft palate, provides a challenge in airway management both in and out of the operating room. Transnasal intubation is greatly preferred during its surgical intervention for maximum oral exposure in these very small patients without the added encumbrance of an oral endotracheal tube. From 2001 to 2009, three neonates with Pierre-Robin Sequence who underwent surgery to improve their airway had a novel method of securing a transnasal airway performed in the operating theater. After successful placement of a laryngeal mask airway (LMA) and subsequent endotracheal intubation via the LMA, this technique was used to convert from an oral to a nasal intubation. After the LMA is removed, a smaller endotracheal tube is pla...

A consensus-based template for uniform reporting of data from pre-hospital advanced airway management

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Fri, 20 Nov 2009 00:00:00 +0100

Conclusion: We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

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Utility of the Pentax-AWS® without interruption of chest compression: Comparison of the Macintosh laryngoscope with the Pentax-AWS® in manikin model

Resuscitation — Wed, 18 Nov 2009 00:00:00 +0100

Abstract: Background: Emergency airway management in suboptimal conditions can result in difficulties in tracheal intubation. The video laryngoscope (Pentax-AWS®) has potential advantages during difficult tracheal intubations. According to the 2005 guidelines for cardiopulmonary resuscitation (CPR), all rescuers should minimize interruption of chest compressions. Our hypothesis is that tracheal intubation using the Pentax-AWS® is possible without interruption of chest compressions. We tested this using tracheal intubation performed by less experienced medical personnel in a manikin model.Methods: Thirty-two less experienced ( (Source: Resuscitation)

Successful airway management with use of a laryngeal mask airway in a patient with CHARGE syndrome

Journal of Anesthesia — Tue, 17 Nov 2009 23:58:53 +0100

This report describes a case of CHARGE syndrome observed in a 6-year-old male patient with a difficult airway, in whom anesthesia was managed successfully using a laryngeal mask airway. Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s00540-009-0791-yAuthors Yusuke Hara, Kyoto University Hospital Department of Anesthesia 54 Shogoin-Kawaracho, Sakyo-ku Kyoto 6060-8507 JapanKiichi Hirota, Kyoto University Hospital Department of Anesthesia 54 Shogoin-Kawaracho, Sakyo-ku Kyoto 6060-8507 JapanKazuhiko Fukuda, Kyoto University Hospital Department of Anesthesia 54 Shogoin-Kawaracho, Sakyo-ku Kyoto 6060-8507 Japan Journal Journal of AnesthesiaOnline ISSN 1438-8359Print ISSN 0913-8668 Journal Volume Volume 23 Journal Issue Volume 23, Number 4 / November, 200...

Traction over inflation-tube of endotracheal tube to facilitate emergency intubation in a patient with anteriorly placed larynx

Resuscitation — Mon, 16 Nov 2009 00:00:00 +0100

We describe a simple and useful technique to overcome the difficulty we encountered during emergency airway management of such a patient in the absence of such sophisticated equipment. (Source: Resuscitation)

Vocal Cord Dysfunction in Amyotrophic Lateral Sclerosis: Four Cases and a Review of the Literature [Neurological Review]

Archives of Neurology — Mon, 09 Nov 2009 20:51:42 +0100

We describe 4 patients with amyotrophic lateral sclerosis (ALS) and glottic narrowing due to vocal cord dysfunction, and review the literature found using the following search terms: amyotrophic lateral sclerosis, motor neuron disease, stridor, laryngospasm, vocal cord abductor paresis, and hoarseness. Neurological literature rarely reports vocal cord dysfunction in ALS, in contrast to otolaryngology literature (4%-30% of patients with ALS). Both infranuclear and supranuclear mechanisms may play a role. Vocal cord dysfunction can occur at any stage of disease and may account for sudden death in ALS. Treatment of severe cases includes acute airway management and tracheotomy. (Source: Archives of Neurology)

Supraglottic swelling may not correlate with tongue swelling in angiotensin converting enzyme inhibitor-induced angioedema

The Laryngoscope — Thu, 05 Nov 2009 00:00:00 +0100

We present a representative case. This observation suggests that all patients with ACEI-induced angioedema should undergo laryngeal fiberoptic examination and appropriate airway management. Laryngoscope, 2009 (Source: The Laryngoscope)

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Rapid Sequence Intubation & Rapid Sequence Airway: An Airway 911 Guide

JEMS: Journal of Emergency Medical Services — Sun, 01 Nov 2009 00:00:00 +0100

By the author's own admission, this isn't a comprehensive airway management text but is instead designed as an adjunct to a rapid sequence intubation (RSI) course. The text is written in a very relaxed, conversational tone and presents the fundamental elements of RSI and rapid sequence airway (RSA) management. RSA differs from RSI in that it deals with the placement of non-visualized airways, such as the Combitube and King airway, instead of the endotracheal tube. (Source: JEMS: Journal of Emergency Medical Services)

[Difficult airway management in paediatric patients]

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Sun, 01 Nov 2009 00:00:00 +0100

Authors: Laschat M, Kaufmann J, Wappler F A difficult airway in childhood is very uncommon. Therefore, it will always be an unfamiliar and menacing situation for most anaesthetists. Knowledge of the individual pathology, associated anaesthesiological problems and possible solutions provide the basis for successful airway management. Endoscopical techniques are essential for the process. The following article shows how a difficult airway in childhood can be recognized and which anaesthesiological options exist to handle such a situation. PMID: 19918704 [PubMed - in process] (Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS)

Pierre Robin sequence: appearances and 25 years of experience with an innovative treatment protocol

Journal of Pediatric Surgery — Sun, 01 Nov 2009 00:00:00 +0100

Conclusion: The Pierre Robin sequence, as seen as a heterogeneous group, presents with variation of the cleft palate defects with glossoptosis and concomitant micrognathic mandible. The surgical management and certain prepalatal intervention as nonsurgical management with an innovative treatment strategy were evaluated. (Source: Journal of Pediatric Surgery)

Mortality in anesthesia: a systematic review

Clinics — Fri, 30 Oct 2009 14:28:46 +0100

This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s), study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 de...

Is obesity a cause of surgical cancellation in outpatient surgery center?

Journal of Clinical Anesthesia — Mon, 26 Oct 2009 00:00:00 +0100

Obesity continues to dramatically increase in the United States. Obese and morbidly obese patients are at high-risk for difficult airway management, cardiopulmonary dysfunction, aspiration, and markedly increased perioperative morbidity and mortality . Because of this increased risk, body mass index (BMI) over 45 kg.m−2 is considered a contraindication for outpatient surgery . (Source: Journal of Clinical Anesthesia)

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Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management.

Canadian Journal of Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

CONCLUSIONS: Anesthesia training programs must provide residents with the skill sets necessary for safe independent practice in airway management. The changes in the scope and reality of residency training have exposed limitations in the traditional mentoring model of residency training; consequently, many programs have responded by offering sub-specialty rotations. In particular, advanced airway management rotations are being offered increasingly to residents in the Canadian training programs. Considerations and strategies to develop and implement a structured airway management program during anesthesia residency are discussed. PMID: 19847588 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Management of a Difficult Airway With Direct Ventilation Through Nasal Airway Without Facemask

Journal of Oral and Maxillofacial Surgery — Tue, 20 Oct 2009 13:14:09 +0100

Mask ventilation is a key component of airway management for oral surgeons and anesthesia care providers. Clinicians often encounter a difficult airway in which adequate mask ventilation may be difficult or impossible. Difficult mask ventilation has been described as the inability for an experienced anesthesiologist to provide adequate face mask ventilation because of one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas. Although the exact pathogenesis of the difficult airway is not clearly defined, the presence of upper airway obstruction has been demonstrated to be the key contributor. Risk factors for difficult mask ventilation and upper airway obstruction correlate well and include increased age, obesit...

Airway management of an elective surgical patient.

British Journal of Nursing — Sun, 11 Oct 2009 00:00:00 +0100

This article explores not only the anatomy of the respiratory system but the different techniques and methods employed to manage a patient's airway. Airway management can be divided into three distinct phases. The first phase deals with the management of the airway while the patient undergoes an operation; this is managed by the anaesthetist. While the second phase deals with the patient's airway in the immediate recovery period, it usually occurs in a recover room and is managed by a recovery nurse. The third phase is when the patient returns to the ward, and for the first 24-48 hours after a general anaesthetic. It is only by recognizing the signs and symptoms of respiratory distress and initiating effective treatment that serious consequences can be avoided. PMID: 19966739 [PubMed -...

Management of a massive thoracoabdominal impalement: a case report

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Tue, 06 Oct 2009 23:00:00 +0100

A 26 year old male was impaled through his chest and upper abdomen with an iron angle, one and half meter long and five centimeters thick. The iron angle entered the chest, through the epigastrium and exited posteriorly just inferior to the angle of left scapula. The patient was transported to hospital with the iron angle in situ. Positioning the patient for intubation proved a major challenge. An unconventional position for intubation allowed a successful airway management. Paucity of time prevented us from gauging the nature and extent of injury. The challenges posed by massive impalement could be successfully managed due to rapid pre-hospital transfer and co-ordinated team effort. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

Intracranial pressure pulse amplitude during changes in head elevation: a new parameter for determining optimum cerebral perfusion pressure?

Acta Neurochirurgica — Tue, 06 Oct 2009 12:53:28 +0100

Conclusions Head elevation is an important part of the ICP and CPP therapy in neurointensive care. When searching for the patient-specific optimum upper body position, ICPPA may provide additional information. Providing that the cerebral autoregulation is intact, the lowest ICPPA of a patient corresponds to the individual upper body position with the highest CPP. Content Type Journal ArticleCategory Clinical ArticleDOI 10.1007/s00701-009-0520-1Authors Felix Mahfoud, Johann Wolfgang Goethe University Department of Neurosurgery, Neurocenter Frankfurt am Main GermanyJürgen Beck, Johann Wolfgang Goethe University Department of Neurosurgery, Neurocenter Frankfurt am Main GermanyAndreas Raabe, Johann Wolfgang Goethe University Department of Neurosurgery, Neurocenter Frankf...

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Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians

Resuscitation — Mon, 05 Oct 2009 00:00:00 +0100

Abstract: Aim: To collect data regarding prehospital paediatric tracheal intubation by emergency physicians skilled in advanced airway management.Methods: A prospective 8-year observational study of a single emergency physician-staffed emergency medical service. Self-reporting by emergency physicians of all children aged 0–14 years who had prehospital tracheal intubation and were attended by either anaesthesia-trained emergency physicians (group 1) or by a mixture of anaesthesia and non-anaesthesia-trained emergency physicians (group 2).Results: Eighty-two out of 2040 children (4.0%) had prehospital tracheal intubation (58 in group 1). The most common diagnoses were trauma (50%; in school children, 73.0%), convulsions (13.4%) and SIDS (12.2%; in infants, 58.8%). The overall tracheal intu...

Ventilation strategies in gastrointestinal endoscopy

Techniques in Gastrointestinal Endoscopy — Thu, 01 Oct 2009 00:00:00 +0100

Spontaneous breathing is the default mode of ventilation for procedures in gastrointestinal (GI) endoscopy. Sedative–hypnotic medications profoundly impair respiratory control and airway patency. Fundamental physiology of hypoventilation is reviewed in the context of the patient presenting for interventional endoscopy. The endoscopy setting presents unique challenges for airway management and ventilation. These include a shared airway, patient-positioning, and out-of-Operating Room location. Strategies to support airway patency, oxygenation, and ventilation that are commonly employed in the controlled setting of the operating room can be effectively adapted to the GI endoscopy suite. Techniques discussed include nasal airway devices/CPAP, pressure-support ventilation, jet ventilation, an...

Equipment for airway management

Anaesthesia and intensive care medicine — Wed, 30 Sep 2009 23:00:00 +0100

We describe the ‘RAW’ approach (Ready, Able, Willing) and list five phases of airway management in which equipment is used. These are: facemask ventilation with adjuncts, airway clearance with suction or foreign body removal, use of supraglottic airway devices, tracheal intubation with a variety of laryngoscopes including the flexible fibre-optic bronchoscope and subglottic management using cricothyroidotomy or tracheostomy. Tracheal tubes and aids for placement are described. (Source: Anaesthesia and intensive care medicine)

A Practical Approach to Airway Management

NLH - ENT and Audiology - Events — Tue, 29 Sep 2009 16:39:20 +0100

(Source: NLH - ENT and Audiology - Events)

Airway Management and Smoke Inhalation Injury in the Burn Patient

Clinics in Plastic Surgery — Tue, 29 Sep 2009 16:24:25 +0100

Smoke inhalation injury, a unique form of acute lung injury, greatly increases the occurrence of postburn morbidity and mortality. In addition to early intubation for upper-airway protection, subsequent critical care of patients who have this injury should be directed at maintaining distal airway patency. High-frequency ventilation, inhaled heparin, and aggressive pulmonary toilet are among the therapies available. Even so, immunosuppression, intubation, and airway damage predispose these patients to pneumonia and other complications. (Source: Clinics in Plastic Surgery)

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Severe angioedema in myxedema coma: a difficult airway in a rare endocrine emergency

The American Journal of Emergency Medicine — Thu, 24 Sep 2009 16:29:47 +0100

We describe a case of an unidentified woman who presented to the ED with myxedema coma requiring urgent endotracheal intubation and was found to have extensive posterior pharyngeal angioedema inconsistent with her relatively benign external examination. This case highlights the typical features of myxedema coma and discusses our necessity for a rescue device in definitive endotracheal tube placement. Emergency physicians should anticipate a potentially difficult airway in all myxedema coma patients regardless of the degree of external facial edema present. (Source: The American Journal of Emergency Medicine)

Determination of difficult intubation in the ED

The American Journal of Emergency Medicine — Thu, 24 Sep 2009 16:29:40 +0100

Conclusions: The thyroid-to-hyoid distance less than 2 fingers is the only independent variable in predicting difficult intubation. Mallampati classification is not a useful tool in classifying the difficult intubation in the ED that the “LEMON” acrostic can be modified to “LEON”. (Source: The American Journal of Emergency Medicine)

Anesthesia: Emergency Airway Management in Sudden Compromise

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics — Wed, 23 Sep 2009 16:31:52 +0100

The difficult airway falls into two major “life-threatening” categories: inability to ventilate and inability to intubate. Difficult airway situations may be predictable in 5% of the general population, based on reliable studies. However, there are certain body morphology characteristics which are good predictors of the difficult airway: abnormal neck circumference, thyromental distance, and Mallampati scoring that can “narrow the search” for the anticipated difficult airway. Several studies and several difficult cases were presented with treatment recommendations for the unexpected urgent or emergent situation discussed. (Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics)

The effectiveness of supraglottic airway devices in pre hospital basic life support airway management [What's New in Emergency Pre-hospital Care Research? 2008 Conference organised by 999 EMS Research Forum in collaboration with University of Sheffield and the National Ambulance Research Steering Group]

Emergency Medicine Journal — Tue, 22 Sep 2009 17:01:56 +0100

(Source: Emergency Medicine Journal)

[What's New in Emergency Pre-hospital Care Research? 2008 Conference organised by 999 EMS Research Forum in collaboration with University of Sheffield and the National Ambulance Research Steering Group] The effectiveness of supraglottic airway devices in pre hospital basic life support airway management

Emergency Medicine Journal — Mon, 21 Sep 2009 23:00:00 +0100

(Source: Emergency Medicine Journal)

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Smiths Medical - Protex¿ Tracheal Tube - Class 1 Recall