Airtraq® vs. fibreoptic intubation in patients with an unstable cervical spine fracture: A neurophysiological study

Publication date: Available online 25 January 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Patrick Schoettker, Ana Pérez Arias, Etienne Pralong, John Michael Duff, Nicolas Fournier, Istvan BathoryAbstractBackgroundFibreoptic intubation is described as the preferred technique for the non-urgent airway control in patients with an unstable cervical spine injury. Indirect laryngoscopes offer promising advantages, but their safety and impact on cervical spine movement is still discussed.AimWe compared the incidence of significant neurophysiologic modifications associated with tracheal intubation performed randomly by an Airtraq® videolaryngoscope contrasted with asleep fibreoptic intubation in 40 patients with a traumatic unstable cervical spine fracture immobilized by a moulded cervical collar and scheduled for elective surgery.MethodsSomatosensitive evoked potentials (SSEPs) monitoring was performed at four stages: before airway management (baseline), during facemask ventilation, during intubation and after definitive positioning for surgery. Time, ease of intubation, number of attempts and grade view laryngoscopy were also recorded.ResultsSignificant neurophysiological modifications were detected in one patient in each group during intubation. They were also identified during ventilation in 1/40 patients and 13/40 patients after positioning. Intubation times were significantly shorter when performed by an Airtraq® (median [25th;75th] 45 s [41;5...
Source: Trends in Anaesthesia and Critical Care - Category: Anesthesiology Source Type: research

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CONCLUSION: The level of training in airway management especially for non-anesthetists is inhomogeneous. The recently published German S1 guidelines for prehospital airway management recommend education and training as well as the primary use of the video laryngoscope with Macintosh blade. The implementation could lower the incidence of subjective difficult airways. PMID: 32055885 [PubMed - as supplied by publisher]
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
Authors: De Cassai A, Boscolo A, Rose K, Carron M, Navalesi P Abstract BACKGROUND: Airway management is a fundamental goal for the anesthesiologist. The rate of difficult laryngoscopy in patients undergoing thyroid surgery ranges from 6.8% to 9.6%. An accurate and detailed preoperative evaluation of the airway seems to be a promising tool to predict a potentially difficult airway management. We aimed to identify possible risk factors and physical findings that predict difficult intubation in thyroid surgery. METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analysed,...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
ConclusionThere is no anatomical relation between otolaryngologic surgery, the hypoglossal nerve and recurrent laryngeal branch of the vagus nerve. This Tapia’s syndrome case is possibly caused by nerve compression of the two nerves due to anaesthesia cannula. Ginkgo leaf extract, methylcobalamin and mouse nerve growth factor could be used as an alternative treatment plan in case of steroid contraindications.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
CONCLUSION TFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02671877.
Source: European Journal of Anaesthesiology - Category: Anesthesiology Tags: Airway management Source Type: research
ConclusionsWe report the development and evaluation of a CNN that can identify and classify airway anatomy in real time. This neural network demonstrates high performance. The availability of artificial intelligence may improve airway management and bronchoscopy by helping to identify key anatomy real time. Thus, potentially improving performance and outcomes during these procedures. Further, this technology may theoretically be extended to the settings of airway pathology or airway management in the hands of experienced providers. The researchers in this study are exploring the performance of this neural network in clinical trials.
Source: Journal of Medical Systems - Category: Information Technology Source Type: research
AbstractFailure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible  bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. We identified techniques that establish a definitive a...
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
Abstract Infants and children undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anesthesiologist. Optimal perioperative care requires an understanding of these diseases and their impact on airway and anesthetic management. For those children with anomalies affecting airway anatomy, soft tissues of the head and neck, or skeletal mobility, advanced airway management techniques (i.e., modalities other than direct laryngoscopy) may be required to secure the airway. Additionally, some craniofacial surgical procedures have direct implications on...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
This study aimed to assess independent risk factors for perioperative adverse events in individuals with mucopolysaccharidoses/-lipidoses and to analyze the interaction with the primary airway technique implemented. METHODS: This retrospective study included individuals with mucopolysaccharidoses/-lipidoses who underwent anesthesia at two high-volume centers from 2002 to 2016. The data were analyzed in a multivariate hierarchical model, accounting for repeated anesthesia procedures within the same patient and for multiple events within a single anesthesia. RESULTS: Of 141 identified in-patients, 67 (63 mucopolysa...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Rationale: Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. Patient Concerns: A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. Diagnoses: Laryngoscopy-guided endotracheal intubation was expe...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Publication date: Available online 29 November 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Barry McGuire, Kimberley HodgeAbstractTracheal intubation is the act of placing a tube into the trachea. The tube enables oxygen delivery and removal of carbon dioxide, while also allowing for the administration of pharmacological agents. Intubation is the most reliable method of maintaining an airway under anaesthesia, and for protection against aspiration of stomach contents. Traditionally, intubation is achieved by direct visualization of the glottis, but now indirect laryngoscopy (via a videolaryngoscope) is a ...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
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