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.
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.
D-blade is a relatively new device in the field of videolaryngoscopy, designed for
airway management by enabling indirectoscopic glottic view. In our study, we investigated efficiency
of D-blade in ...comparison with direct Macintosh laryngoscope (gold standard). Fifty-two adult
patients with normal airway scheduled for elective surgery in general anesthesia were randomly assigned
in D-blade video or direct Macintosh group. In the first video group, patients were laryngo-scoped
and intubated by D-blade, and in the second group laryngoscopy and intubation were performed
by Macintosh laryngoscope. Glottic view was evaluated according to Cormack Lehane grading
system (C-L), while duration of intubation and easiness of intubation were evaluated according to
the intubation difficulty score (IDS). Additionally, hemodynamic parameters were recorded before
and after induction. There were no statistically significant between-group differences in time to intubation,
easiness of endotracheal tube insertion, C-L, and IDS. In comparison with direct Macintosh
laryngoscope, D-blade showed similar but still favorable characteristics. In our opinion, D-blade is a
useful device in airway management and should be used in daily anesthesiologist work.
We present the use of recombinant activated factor VIIa (rFVIIa) in a 6-month-old infant that suffered massive bleeding and subsequent coagulation disturbances during elective surgery for choroid ...plexus carcinoma in the lateral ventricle. The administration of rFVIIa resulted in good hemostasis. No intra- or postoperative thromboembolic complications were observed.
Summary
Background: This prospective observational study included a case series of children and adolescents receiving light intravenous propofol anesthesia combined with local anesthesia (LA) for ...arthroscopic knee procedures. The aim was to examine the merits of anesthesia, to discuss the indications for the procedure and to analyze recovery/discharge times from the postanesthesia care unit (PACU).
Methods: A cohort of 147 children and adolescents (ASA 1 and 2) aged 12–18 years admitted for outpatient arthroscopic knee procedures between January 2004 and May 2005 were studied. After IV access in the operating theater, the patients received propofol (10 mg·ml−1). Arthroscopy was performed approximately 15 min after injecting local anesthetic (15 ml 2% lidocaine with epinephrine 1:200 000) partly at the site of insertion of the arthroscope and other instruments (5 ml), and the rest intra‐articular. The following parameters were assessed: airway patency, propofol requirement, vital signs, procedure time, surgical operating conditions, patient satisfaction score, time to discharge, postoperative analgesia and adverse events.
Results: Of 147 patients, 133 patients (90.5%) underwent arthroscopic knee surgery, whereas knee arthroscopy alone was performed in 14 patients (9.5%) without indication for operative treatment. The arthroscopy was well tolerated in 96.6% patients (no pain, movement or discomfort during the procedure) and only five patients required conversion to general anesthesia. Pain experienced during the injection of lidocaine was more severe than pain experienced during the surgical procedure itself (P < 0.001). The surgical evaluation of operative conditions (visualization and access to intra‐articular structures) was generally satisfactory and completely acceptable. Almost 94% (138/147) of patients said they would have the same procedure again under the same type of anesthesia. The mean propfol induction dose was 1.4 mg·kg−1 (range: 0.9–3.8) and mean propofol infusion rate 167 μg·kg−1·min−1 (range: 130–250). Movement was more likely at lower infusion rates (mean: 151 μg·kg−1·min−1). The maximal decrease in respiratory rate was 5.9 ± 5.1 br·min−1 (27.2 ± 21%) and no patient became hypoxic. Patients recovered to preoperative values at 9.8 ± 7.5 min following infusion discontinuation. There were no respiratory or cardiovascular complications. The mean stay in PACU was 47 min (range: 32–150). As many as 71% (105/147) of patients required no analgesics during the first two postoperative hours.
Conclusions: The combination of light intravenous propofol anesthesia combined with local anesthesia for arthroscopic knee procedures provided effective sedation, good preservation of upper airway patency, rapid recovery and pain relief without major side effects and offers a good alternative to the methods already available. The majority of patients did not require postoperative analgesia.
Abstract Osteogenesis Imperfecta is a rare, genetically determined disease with several possible complications in anaesthesia. Anaesthesiologists therefore pay special attention to the treatment of ...patients suffering from Osteogenesis Imperfecta since they commonly suffer from a difficult airway and intraoperative positioning difficulties. We report here the case of unilateral spinal anaesthesia in a patient suffering from Osteogenesis Imperfecta type I. A 28-year-old patient diagnosed with Osteogenesis Imperfecta type I was admitted to the hospital due to lower leg fracture requiring surgical treatment. The patient had blue sclerae, triangular-shaped face, macroglossia, scoliosis of thoracic and lumbar parts of the spine, pectus carinatum and thrombocytopenia. Upon the correction of thrombocytopenia, unilateral spinal anaesthesia with hyperbaric levobupivacain was chosen in order to avoid possible complications typical for general anaesthesia. Consequently, unilateral spinal anaesthesia with a customized local anesthetic could be consdered as a safe anesthetic method for such patients.
Purpose: To investigate whether diclofenac could be used in preemptive and multimodal fashion with local anesthesia (LA) during arthroscopic knee surgery.
Methods: A cohort of 628 patients (age ...range, 14 to 60 years) underwent outpatient arthroscopic knee surgery under LA with 15 mL of 2% lidocaine with epinephrine. Diclofenac 1 mg/kg was administered immediately before the procedure was performed. Pain was intraoperatively assessed with a 10-cm visual analogue scale (VAS). Patients’ and surgeons’ satisfaction with the quality of anesthesia was estimated by a special questionnaire and VAS score.
Results: From the technical point of view, arthroscopic procedures were successfully completed in 98.2% of patients. Pain experienced during injection of lidocaine (VAS score: median, 2.9; mean, 3.4; standard deviation SD, 3.2; range, 0 to 10) was more severe (
P = .0001) than pain experienced during the surgical procedure itself (VAS score: median, 1.8; mean, 2.4; SD, 2.2; range, 0 to 5.2). Arthroscopy was well tolerated by most patients (98.5%), and only 1.4% of procedures had to be terminated prematurely because of patient discomfort. Almost 95.7% of patients reported that they would undergo the same procedure again under the same type of anesthesia. In 4.7% of patients, LA was not considered optimal by the performing surgeon.
Conclusions: Arthroscopic knee surgery with diclofenac and LA with no premedication is an efficient and well-tolerated method used in outpatient practice with no major adverse effects.
Level of Evidence: Level IV, theraputic case series.
The incidence of traumatic spinal cord injury is 11,000 per year, with 55% of the injuries occurring between the age of 16 and 33, 18% of these in women of reproductive age. Diagnostic and early ...spinal decompression along with maintaining the mean arterial pressure to improve spinal cord perfusion and a high progesterone level in pregnancy for its neuroprotective and anti-inflammatory effect have the leading role in neurological recovery and clinical outcome. We present a case of a patient in the 17th week of pregnancy who sustained luxation fracture of the C5 and C6 vertebrae and tetraplegia as passenger in a road accident. The early operative treatment and appropriate anesthetic procedure resulted in good clinical outcome with complete neurological recovery.
Značajke uznapredovale Behterevljeve bolesti (ankilozirajući spondilits) su sve veća osifikacija kralježnice od donjih, lumbalnih dijelova prema višim, cervikalnim što uzrokuje prvo nemogućnost ...izvođenja spinalnog bloka u lumbalnoj regiji, a kasnije, zbog ukočenosti vratnog dijela kralježnice, otežanu intubaciju zbog nemogućnosti ekstenzije i/ili fleksije vrata u tijeku direktne laringoskopije i intubacije. S druge strane, ventilacija na masku je obično izvediva. Ovdje prikazujemo 77-godišnjeg bolesnika koji je bio predviđen za elektivnu operaciju ingvinalne hernije, a čiji je ankilozirajući spondilitis u posljednje vrijeme jako uznapredovao. U skladu s nedavno prihvaćenim “Mainz algoritmom” najprije smo pokušali intubirati fleksibilnim fiberbronhoskopom na budnom bolesniku. Bronhoskop je lako prošao sve do bifurkacije traheje, ali je neočekivano postavljanje endotrahealnog tubusa zapelo na preuskoj nosnici zbog prijeloma nosa koji je bolesnik zadobio u dobi od 8 godina. Zato smo izvukli fiberbronhoskop i nakon indukcije opće anestezije uspjeli intubirati u prvom pokušaju rigidnim fiberskopom po Bonfilsu.
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