A technique for maintenance of airway access in infants with a difficult airway following tracheal extubation

Tracheal extubation of patients with a difficult airway represents a challenge to anaesthesiologists and intensive care physicians. While a variety of techniques designed to maintain access to the airway in case of the need for tracheal reintubation have been described in adults, no reports have been published in infants and young children. We describe an approach to this issue in a young child with severe micrognathia.     

Use of a tracheoscopic ventilation tube for endotracheal intubation in the difficult airway

Difficult endotracheal intubation is a clinical challenge for anesthesiologists and other practitioners of airway management. The use of a tracheoscopic ventilation tube, a novel airway device, for endotracheal intubation during general anesthesia in two patients with difficult airways after unsuccessful direct laryngoscopy is presented.     

Use of GlideScope for double lumen endotracheal tube insertion in an awake patient with difficult airway

There is scientific evidence that an anticipated difficult airway must be managed with the patient being awake. The GlideScope has been proven to be a useful device to intubate the trachea in some instances when difficult airway is present, and particularly in the awake patient. It has also been used for double lumen tube (DLT) in the anaesthetized patient, but its use with DLT in both circumstances, awake patients with difficult airway has not been described.GlideScope enabled us to achieve accurate local anesthetic spraying and a successful endotracheal intubation with a double lumen tube (DLT) in an awake patient with predicted difficult airway and bronchoaspiration risk. Different ways to resolve cases like this can be found in the anesthetic literature, but we think this could be another option to bear in mind. We also describe a new variation in the maneuver of introducing a DLT into the trachea under GlideScope view as DLT presents with some difficulties when introduced under normal circumstances.This option could add some risk for the patients when used in inexperienced hands and there is not sufficient scientific evidence in the literature to recommend it for all cases.     

Airway management with dexmedetomidine for difficult airway

BACKGROUND : Dexmedetomidine has the advantage of producing sedation accompanying patient's cooperation without respiratory depression. We managed the airways of 10 cases with suspected difficult tracheal intubation under sedation with dexmedetomidine. METHODS : A dexmedetomidine loading dose of lmcg x kg(-1) IV was administered over 10 minutes and with supplementation until satisfactory sedation was obtained, followed by infusion of 0.2-0.7mcg x kg(-1) x hr(-1). During loading dose administration, the upper airway was anesthetized topically. RESULTS : Five cases were intubated fiberscopically, and 3 obstructive sleep apnea syndrome (OSAS) cases received direct laryngoscopy to exclude "cannot intubate, cannot ventilate (CICV)". One case with a large laryngeal tumor had tracheostomy, and another case with recurred pharyngeal cancer was intubated through the permanent tracheotomy site. All the cases were well sedated (Ramsay sedation scale 2-4) and cooperative during the procedure. No respiratory depression nor airway obstruction occurred even in the OSAS cases. In one case hypertension and elevated heart rate were noted transiently during loading dose administration. Another case had postinduction hypotension treated with a small dose of vasopressor. All cases had no uncomfortable recall. CONCLUSIONS : Dexmedetomidine is a safe and effective sedative for awake difficult airway management, for example, fiberscopic intubation, tracheostomy and direct laryngoscopy, though some attention must be paid to circulatory changes.     

困难气道患者的拔管策略

背景 困难气道患者拔管失败率相对较高,易出现严重的并发症.目的 对于困难气道患者,拔管前进行充分的气道评估,制定安全、可控的拔管策略非常重要.内容 重点介绍了困难气道或可疑困难气道患者拔管前的气道评估,以及针对不同的困难气道患者所应该采取的拔管处理策略.趋向 困难气道患者拔管前应该进行全面的气道评估,熟悉困难气道插管、拔管的操作流程、掌握气管导管交换器等困难拔管工具的操作技术以及插管失败后其他的可能选择,以提高困难气道患者围拔管期的安全.