[Acute obstructive epiglottitis in intensive care unit: Which airway management strategy?]
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)...
POSTED 01/26/2010 at 06:00 PM --
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Delaying Endotracheal Intubation in Less Severely Injured Trauma Patients Increases Mortality
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......
POSTED 01/25/2010 at 10:42 AM --
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A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation
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]......
POSTED 01/24/2010 at 06:00 PM --
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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......
POSTED 01/22/2010 at 08:15 AM --
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Airway management in an infant with double aortic arch
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......
POSTED 01/05/2010 at 11:06 AM --
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Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training
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)...
POSTED 12/22/2009 at 03:18 PM --
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Effect of cricoid force on airway calibre in children: a bronchoscopic assessment
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)...
POSTED 12/10/2009 at 10:21 AM --
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The emergency airway.
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)...
POSTED 12/06/2009 at 06:00 PM --
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[Tracheostoma : Handling and complications.]
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......
POSTED 12/02/2009 at 06:00 PM --
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Airway Management in Patients Who Develop Neck Hematomas After Carotid Endarterectomy.
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)...
POSTED 12/01/2009 at 06:00 PM --
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The High-Risk Airway
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......
POSTED 12/01/2009 at 08:43 AM --
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Use of nasotracheal intubation in patients receiving oral cavity free flap reconstruction
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)...
POSTED 11/30/2009 at 06:00 PM --
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Airway management in a bleeding adult following tonsillectomy: a case report.
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......
POSTED 11/30/2009 at 06:00 PM --
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GlideScope® use in the obstetric patient
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)...
POSTED 11/29/2009 at 06:00 PM --
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Airway management for out-of-hospital cardiac arrest—More data required
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)...
POSTED 11/27/2009 at 08:09 AM --
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Anaesthesia in prehospital emergencies and in the emergency room
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......
POSTED 11/26/2009 at 06:00 PM --
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Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills?
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)...
POSTED 11/24/2009 at 12:04 PM --
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Manual of emergency airway management
(Source: Emergency Medicine Journal)...
POSTED 11/24/2009 at 12:04 PM --
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Dynamic upper airway changes during sleep in patients with obstructive sleep apnea syndrome.
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.......
POSTED 11/20/2009 at 06:08 PM --
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Difficult Mask Ventilation.
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......
POSTED 11/20/2009 at 11:27 AM --
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