Case Report

Newer Airway Gadgets: Rescuers in Difficult Airway Scenarios

Abstract

Background: As anaesthetists, we may constantly be in the learning curve of the management of difficult airway scenario. It can have a disastrous outcome if one is not adequately prepared with the right equipment. Over time there has been multiple ways to tackle difficult airway scenarios. Needless to say, appropriate airway gadgets are carefully chosen according to the surgery and patient characteristics. But what if these certain techniques fail? Then, what next? The inability to efficiently manage a difficult airway is the major cause of morbidity and mortality in anaesthetic practice. Here, we discuss 4 different case scenarios of difficult airway management.
Case reports: Case 1 was a pediatric patient with TMJ ankylosis, with mouth opening 4mm, in whom we used the fibreoptic technique. Case 2- A failed fibreoptic attempt in a case of recurrent Ca oral cavity where we secured the airway using Airtraq videolaryngoscope. Case 3- A patient with post burn contracture over front of neck and anterior shoulder where we decided to use intubating laryngeal mask airway for securing airway and Case 4- An obese female patient posted for hysterolaparoscopy where we used the Laryngeal Mask Airway Supreme.
Conclusion: Effective usage of newer drugs, equipment and airway gadgets by technically skilled personnel, with sound clinical judgement are essential factors in reducing airway related adverse scenario and it is of utmost importance to keep these alternate gadgets handy and to be proficient with its usage.

[1] Ovassapian A. Fiberoptic endoscopy and the difficult airway. 2nd ed. Philadelphia: Lippincott-Raven Press; 1996. PMid:8695139
[2] Vasudevan A, Venkat R, Badhe AS. Optimal external laryngeal manipulation versus McCoy blade in active position in patients with poor view of glottis on direct laryngoscopy. Indian J Anaesth 2010; 54(1):45-8.
[3] Fuchs G, Schwarz G, Baumgartner A, Kaltenbock F, Voit-Augustin H, Planinz W. Fiberoptic intubation in 327 neurosurgical patients with lesions of the cervical spine. J Neurosurg Anesthesiol. 1999; 11(1):11-6.
[4] Aoyama K, Takenaka I, Sata T, Shigematsu A. Use of the fiberscope-video camera system for difficult tracheal intubation. Br J Anaesth. 1996; 77(5):662-4
[5] Takenaka I, Aoyama K, Nakamura M, Fukuyama H, Urakami Y, Takenaka Y, Kadoya T. Oral styletted intubation under video control in a patient with a large mobile glottic tumour and a difficult airway. Can J Anaesth. 2002; 49(2):203-6.
[6] Morray JP, Geiduschek JM, Caplan RA, Posner KL, Gild WM, Cheney FW, et al. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993; 78:461–7.
[7] Kulkarni J, Shah K, Khan AA, Khaire S. Anaesthetc management of temporomandibular joint ankylosis without fibreoptic bronchoscope – A review of 31 cases. IOSR J Dent Med Sci. 2013; 8:50–4.
[8] Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015; 115(2):171-82.
[9] Nasim S, Maharaj CH, Butt I, Malik MA, O' Donnell J, Higgins BD, et al. Comparison of the Airtraq and Truview laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins. BMC Emerg Med. 2009; 9:2.
[10] Brain AI, Verghese C, Addy EV, Kapila A. The intubating laryngeal mask. I: Development of a new device for intubation of the trachea. Br J Anaesth. 1997; 79(6):699-703.
[11] Langeron O, Semjen F, Bourgain JL, Marsac A, Cros AM. Comparison of the intubating laryngeal mask airway with the fibreoptic intubation in anticipated difficult airway management. Anaesthesiology. 2001; 94:968-72
[12.] Gupta P, Bamba Ch. Airway management of a patient with severe post burn mento-sternal contracture: A novel approach, Egyptian Journal of Anaesthesia, 2017; 33(3):295-297.
[13] Brooks P, Ree R, Rosen D, Ansermino M. Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways. Can J Anaesth. 2005; 52(3):285-90.
[14] Kulkarni A, Pathak S. Failed fibre optic intubation in a difficult airway- an anaesthetic nightmare. Sri Lankan Journal of Anaesthesiology. 2018; 26(2):150–152.
Files
IssueVol 7 No 3 (2021): Summer QRcode
SectionCase Report(s)
Published2021-07-31
DOI https://doi.org/10.18502/aacc.v7i3.6913
Keywords
Difficult airway Fibreoptic intubation Videolaryngoscopy LMA supreme Intubating laryngeal mask airway (LMA)

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Deshpande J, Sadafule N, Jacob M. Newer Airway Gadgets: Rescuers in Difficult Airway Scenarios. Arch Anesth & Crit Care. 2021;7(3):195-198.