Acta clinica Croatica
-
Acta clinica Croatica · Sep 2012
Case ReportsDifficult airway management in a polytraumatized patient with osteogenesis imperfecta and multiple congenital spinal and thoracic deformities and severe kyphoscoliosis: case report.
Airway management in a polytraumatized patient with severe spinal and thoracic deformities demands detailed investigation of anatomical characteristics of the head, neck and airways, as well as thoracic configuration, before attempting endotracheal intubation. This enables the physician to predict a difficult airway and prepare for difficult airway management. We present a case of a 50-year-old polytraumatized patient with multiple congenital bone deformities associated with the syndrome of osteogenesis imperfecta and severe kyphoscoliosis, unable of lying on his back due to gibbus, who was successfully intubated in first attempt using video laryngoscope and only mild sedation. In patients with such severe multiple deformities, the use of video laryngoscope or Bonfils rigid endoscope should be mandatory in order to ensure success of intubation in first attempt and to avoid the possible aspiration of gastric contents.
-
Airway management relates to the period of tracheal intubation, maintenance of endotracheal tube in situ, and finally extubation. Problems related to difficult extubation still pose significant challenge for both anesthesiologists and intensivists. This article reviews current approach to extubation strategy following difficult intubation. Guidelines and algorithm may be helpful in order to ensure safe management of the patient during this delicate period of airway management.
-
The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. ⋯ Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine.
-
Acta clinica Croatica · Sep 2012
Subglottic high frequency jet ventilation in surgical management of bilateral vocal fold paralysis after thyroidectomy.
Lesion of the recurrent laryngeal nerves as a consequence of thyroid surgery results in bilateral vocal fold paralysis and respiratory obstruction. The initial treatment involves ensuring an adequate airway and it ranges from tracheostomy to endo-extralaryngeal laterofixating operations in general anesthesia. Subglottic high frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery. ⋯ No complications secondary to the ventilation technique were observed. No perioperative tracheotomy was necessary. It is concluded that subglottic HFJV is an easy and safe way to ventilate patients with bilateral vocal fold paralysis when endoscopic intervention is performed.
-
Airway management in the intensive care unit (ICU) is a challenging procedure and is frequently associated with life threatening complications. The incidence of difficult intubations ranges from 10% to 22%, depending on the setting and the patients in need of endotracheal intubation. Multiple attempts are often needed to secure the airway. ⋯ Parts of this protocol are appropriate staffing, pre-oxygenation and strategies to avoid cardiovascular complications. In conclusion, high practical skill of airway management is needed in critically ill patients. Monitoring such as capnography and alternative equipment for securing the airway is not just mandatory in the operating room but also in the ICU.