The aim of this study was to explore standard anthropometric airway characteristics of patients with obstructive sleep apnea syndrome (OSAS) and determine the incidence and risk factors for difficult ...airway management. Final analysis included 91 patients with polysomnography-verified diagnosis of OSAS who underwent sleep breathing disorder surgery under general anesthesia with direct laryngoscopy oroendotracheal intubation. The incidence of difficult manual mask ventilation during anesthesia induction, difficult intubation and immediate postextubation respiratory complications was 17.6%, 7.7% and 7.7%, respectively. Compared to patients without difficult manual mask ventilation, the group of OSAS patients with difficult manual mask ventilation had a higher rate of body mass index (BMI) ≥25 kgm-2 (p=0.010), Mallampati score ≥3 (p=0.024) and Cormack-Lehane score ≥3 (p=0.002). The OSAS patients with difficult intubation had more Cormack-Lehane score ≥3 (p=0.002) in comparison to those without difficult intubation. Our study demonstrated that manual mask ventilation during anesthesia induction was the most troublesome airway management task in OSAS patients during sleep breathing disorder surgery. Cormack-Lehane score was a relevant determinator of difficult mask ventilation and difficult intubation, while Mallampati score and BMI were relevant determinators only for difficult manual mask ventilation.
Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general anesthesia than in the ...non-obstetric population. The inability to ventilate and oxygenate is one of the most common causes of morbidity and mortality associated with general anesthesia for cesarean section. The aim of this paper is to present and analyze modern guidelines and algorithms for the management of difficult airway in obstetrics as an important segment of anesthesiology practice. Modern difficult airway management guidelines for pregnant women describe the procedure of difficult facemask ventilation, difficult airway management by using supraglottic devices, difficult endotracheal intubation, and emergency cricothyrotomy or tracheotomy in a situation where oxygenation and ventilation are impossible. Algorithms describe the procedures and equipment for each variant of difficult airway and decision-making strategies in situations when neither airway nor adequate oxygenation can be provided. Croatian anesthesiologists in most obstetric departments have appropriate equipment, as well as necessary experience in difficult airway management for pregnant women, and modern algorithms from the most developed countries can be adopted and accommodated to our daily practice, as well as incorporated into the training curricula of residents.
The aim of this study was to assess preoperative airway history data and single anthropometric screening tests of difficult face mask ventilation (FMV) and difficult direct laryngoscopy intubation ...(DLI) in otorhinolaryngological surgery. Final analysis included 62 patients aged ≥14 years undergoing elective surgery with endotracheal intubation at a single center during a one-month period. Data on difficult intubation history, airway symptoms and pathology related to difficult airway were prospectively collected. Han scoring classification of FMV and Intubation Difficulty Score (IDS) were used. There were 14 (22.6%) patients with a history of current airway tumors or abscesses. Only two (3.2%) patients were preoperatively evaluated as anticipated difficult airway. Both were slightly difficult to ventilate and scored IDS 5 and IDS 8. FMV was graded as easy in 50 (80.5%), slightly difficult in 10 (16.1%) and difficult in 2 (3.2%) cases. There were 29 (46.78%) slightly difficult DLIs and one (1.6%) case of difficult DLI. The study confirmed clinically relevant incidence of difficulties with FMV and DLI in otorhinolaryngologic surgery patients. However, there should be stronger evidence to identify a single preoperative variable predicting difficult airway.
Uspostaviti i održati dišni put jedna je od najvažnijih interesnih točaka anesteziologa, no još u dalekoj prošlosti već su i „obični ljudi“ shvatili koliko je važno očuvati dišni put. Tako je krenuo ...dug i fascinantan put tijekom kojega se su se progresivno razvijala pomagala i tehnike namijenjene očuvanju dišnog puta, kao i svijest o važnosti njegovog očuvanja. Od prvih traheotomija tisuću godina prije Krista, preko direktne laringoskopije i ventilacije
bolesnika uz pomoć modernih anestezioloških aparata, došli smo do ere raznih videopomagala: stileta, rigidnih i fleksibilnih bronhoskopa, videolaringoskopa i tako dalje. Veliku ulogu imalo je osvještavanje problema, brojne analize grešaka koje smo kao struka nehotice ostavljali iza sebe tijekom silnih pokušaja i promašaja u nastojanju da učinimo najbolje što možemo za bolesnika. Zahvaljujući tomu i enormnom tehnološkom napretku u zadnjih dvjesto godina, možemo reći da je došlo do revolucije u održavanju dišnog puta. Izazovi u prošlosti naučili su nas mnogo. Međutim, tijekom još uvijek aktualne pandemije COVID-19, opet smo se susreli s novim izazovima dišnog puta, ali iako nitko nije mogao ni približno zamisliti što nas čeka snašli smo se. Za razliku od uobičajenog načina na koji inače radimo u operacijskim dvoranama i jedinicama intenzivne skrbi, vodeći računa o sigurnosti bolesnikova dišnog puta ovaj smo put morali paziti i na to da zaštitimo svoj.
Pandemija COVID-19 započela je u Wuhanu, Kina, u prosincu 2019. godine, brzo se šireći izvan Kine. U ožujku 2020. godine Svjetska zdravstvena organizacija (SZO) službeno je proglasila pandemiju. ...Pandemija je imala ozbiljne zdravstvene, socijalne i ekonomske posljedice, a zdravstveni sustav u Hrvatskoj, kao i u većini zemalja svijeta, suočavao se s brojnim izazovima i opterećenjima. Nedostatak bolničkih kreveta, posebno u jedinicama intenzivne medicine (JIM), te manjak medicinskog osoblja s kompetencijama potrebnim za skrb o najtežim bolesnicima
predstavljali su ozbiljne izazove i stvarali značajne poteškoće u skrbi oboljelih od bolesti COVID-19. Europsko društvo za intenzivnu medicinu (engl. European Society of Intensive Care Medicine, ESICM) jedno je od prvih društava koje je naglasilo važnost dodatne edukacije liječnika i sestara/tehničara te organiziralo edukaciju za medicinsko osoblje kako bi im pružili osnovna znanja i vještine za rad s bolesnicima zaraženima bolešću COVID- 19. U razdoblju od 10. listopada 2020. do 9. svibnja 2021. provedena je izobrazba prvenstveno neintenzivnog
medicinskog osoblja kako bi se povećao broj zdravstvenog osoblja koje bi se moglo rasporediti u vrijeme kada postoji potreba za brzim, privremenim i značajnim povećanjem kapaciteta u JIM-u te unaprijedila kvaliteta zbrinjavanja oboljelih od bolesti COVID-19.
CHALLENGES IN THE USE OF VIDEO LARYNGOSCOPES Maldini, Branka; Hodžović, Iljaz; Goranović, Tatjana ...
Acta clinica Croatica (Tisak),
03/2016, Letnik:
55 Suppl 1, Številka:
Supplement 1
Journal Article
Recenzirano
Odprti dostop
Despite the lack of uniformity and the need of further investigation, video laryngoscopy continues to gain popularity both inside and outside the operating room. It has quickly become a first line ...strategy for potential and/or encountered difficult intubation. It is well established that video laryngoscope improves laryngeal view as compared with direct laryngoscopy in patients with suspected difficult intubation and simulated difficult airway scenarios. For novices and experienced anesthesiologists alike, video laryngoscopy is easy to use and the skills involved are easy to master. However, it is important to say that video laryngoscopes may be used in a variety of clinical scenarios and settings because of the video laryngoscope design offering an alternative intubation technique in both anaesthetized and awake patients. The aim of this article is to show and highlight clinical situations in which the use of video laryngoscope is a challenge for an experienced anesthesiologist in solving the airway. Challenges in the use of video laryngoscope with which we deal and encounter in everyday clinical practice that are discussed in this paper are intubation in the prehospital setting and emergency departments, intubation in Intensive Care Unit, intubation in a patient with cervical spine immobilization, and awake video laryngoscopy-assisted tracheal intubation in the obese. We also point out the important role of video laryngoscope as a tool for teaching and training in airway education. Training and education in difficult airway management is essential to improve patient safety at endotracheal intubation in emergency situation.
ALTERNATIVE DEVICES IN AIRWAY VISUALIZATION Maldini, Branka; Hodžović, Iljaz; Goranović, Tatjana
Acta clinica Croatica (Tisak),
03/2016, Letnik:
55 Suppl 1, Številka:
Supplement 1
Journal Article
Recenzirano
Odprti dostop
The Macintosh laryngoscope has been the most widely used device for intubation since its invention by Foregger in the 1940s. Recently, video and optic laryngoscopy assisted tracheal intubation has ...been used widely in patients with difficult airways. Their routine use, however, is not widely practiced. This review will summarize some of the newly available devices to assist tracheal intubation, with their advantages and disadvantages when compared with conventional laryngoscopes. It also presents the reasons to support their use in both elective and emergency airway management.
Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is ...needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.
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.
Face mask ventilation is a life saving technique. This article will review aetiology and patophysiological consequences of inadequate mask ventilation. The main focus will be on circulatory changes ...during induction of anesthesia, before and in a short period after intubation that could be attributed to inadequate mask ventilation in humans.
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