Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Case Reports
Use of the Aintree intubation catheter in a patient with an unexpected difficult airway.
To present a case where the Aintree intubation catheter (AIC) was used in conjunction with the Laryngeal Mask Airway (LMA) and a fibreoptic bronchoscope (FOB) in a patient with an unexpected difficult airway. ⋯ In this patient, the AIC provided an effective alternative to other methods for intubating through a regular LMA.
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The purpose of this single-centre database review was to establish the incidence of failure to intubate by direct laryngoscopy, to measure morbidity and mortality associated with this event, and to examine the use and efficacy of alternative airway devices. ⋯ The rate of unexpected failure to intubate by direct laryngoscopy is essentially unchanged from earlier studies. While morbidity was low, continued education and early use of alternative difficult airway devices may further limit complications associated with this event.
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Several methods have been described to locate the epidural space, but the loss-of-resistance (LOR) technique is the most commonly used. Expert opinion states that LOR to air is the best medium for neonates and infants. We conducted a Canada-wide postal survey to determine the current state of practice for placement of epidural catheters in pediatric patients. ⋯ LOR to normal saline is the preferred method for identification of the epidural space in children of all age groups. The suggestion by experts that LOR to air should be used in neonates and infants was not supported by the practice of pediatric anesthesiologists across Canada.
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Subdural placement of an epidural catheter is rare and difficult to detect. Electrical stimulation of the epidural space can be useful to detect such an event. The purpose of the present case report is to confirm the efficacy of electrical stimulation to detect a subdural placement of an epidural catheter and to illustrate this unusual positioning by computed tomography (CT) scan images. ⋯ The present case report confirms that electrical stimulation of the epidural space is useful to detect misplacement of epidural catheter such as a subdural placement. CT scan imaging of subdural positioning of an epidural catheter is presented.