Unmesh Bedekar, Joseph Monteiro, Shwetal Goraksha, Renuka Shilimkar
Thyroid swellings are a known cause of airway obstruction and potentially difficult intubation due to compression and deviation of the trachea. We encountered a unique challenging case of a malignant retrosternal goitre compressing the trachea, with cervical spine metastasis causing paresthesia and weakness in all four limbs, for a two-stage dual procedure, embolisation and excision of thyroid, and embolisation and fixation of the cervical spine.
{"title":"Airway management of thyroid malignancy with cervical spine metastasis for a two-stage dual procedure; Discretion dictates never burn your bridges","authors":"Unmesh Bedekar, Joseph Monteiro, Shwetal Goraksha, Renuka Shilimkar","doi":"10.4103/arwy.arwy_11_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_11_23","url":null,"abstract":"Thyroid swellings are a known cause of airway obstruction and potentially difficult intubation due to compression and deviation of the trachea. We encountered a unique challenging case of a malignant retrosternal goitre compressing the trachea, with cervical spine metastasis causing paresthesia and weakness in all four limbs, for a two-stage dual procedure, embolisation and excision of thyroid, and embolisation and fixation of the cervical spine.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"25 1","pages":"65 - 67"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87028619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endotracheal tube as an airway conduit with simple airway closure manoeuvre for ventilation in an expected difficult airway: A simple technique to avoid difficult bag and mask ventilation","authors":"Tanmay Tiwari, RDinesh Kumar, N. Singh","doi":"10.4103/arwy.arwy_14_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_14_23","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"152 1","pages":"71 - 73"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80830920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tenzin Nyima, Deepika Gupta, S. Mitra, Ramandeep Kaur
Achondroplasia, also known as dwarfism, is a rare autosomal dominant disorder. We, hereby, describe the successful anaesthetic management of a 32-year-old female patient with a height of 90 cm and weighing 35 kg (body mass index of 43.2 kg/m2) posted for an elective caesarean section at 34 weeks 4 days of gestation. We emphasise the need for proper preoperative evaluation of the patient and anticipate difficult regional or general anaesthesia in these patients.
{"title":"Awake fibreoptic intubation: A choice for achondroplastic parturient","authors":"Tenzin Nyima, Deepika Gupta, S. Mitra, Ramandeep Kaur","doi":"10.4103/arwy.arwy_23_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_23_23","url":null,"abstract":"Achondroplasia, also known as dwarfism, is a rare autosomal dominant disorder. We, hereby, describe the successful anaesthetic management of a 32-year-old female patient with a height of 90 cm and weighing 35 kg (body mass index of 43.2 kg/m2) posted for an elective caesarean section at 34 weeks 4 days of gestation. We emphasise the need for proper preoperative evaluation of the patient and anticipate difficult regional or general anaesthesia in these patients.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"15 1","pages":"68 - 70"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78557744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shiksha Singh, Rishikesh Bhatti, A. Tilak, S. Saksena
Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult.
{"title":"Management of a case of tracheal tumour causing near total airway obstruction","authors":"Shiksha Singh, Rishikesh Bhatti, A. Tilak, S. Saksena","doi":"10.4103/arwy.arwy_18_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_18_23","url":null,"abstract":"Tracheal tumours are rare and often present as asthma or chronic obstructive airway disease. These tumours can cause partial or complete airway obstruction, especially after giving anaesthesia. Here, we present a case of tracheal tumour posted for bronchoscopic excision. These tumours present as a real challenge to anaesthesiologists as the airway is shared with the surgeons and maintaining a patent airway can be difficult.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"151 1","pages":"61 - 64"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73634546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Airway management in tracheal resection and anastomosis is very challenging. The technique of securing the airway depends on the degree and location of stenosis. Multidisciplinary planning and good communication are the keys to the successful management of these cases. The technique used to maintain the airway and ventilation may vary and needs to be chosen on a case-to-case basis.
{"title":"Airway management in tracheal resection and anastomosis – Challenges and novel solutions!","authors":"P. Pavithran, B. Sekhar","doi":"10.4103/arwy.arwy_5_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_5_23","url":null,"abstract":"Airway management in tracheal resection and anastomosis is very challenging. The technique of securing the airway depends on the degree and location of stenosis. Multidisciplinary planning and good communication are the keys to the successful management of these cases. The technique used to maintain the airway and ventilation may vary and needs to be chosen on a case-to-case basis.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"40 1","pages":"58 - 60"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78372686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Srivats Ramamoorthy, S. Paneerselvam, Lenin Elakkumanan, P. Rudingwa, K. Govindaraj
Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.
{"title":"Comparison of C-MACTM videolaryngoscope with Macintosh Laryngoscope in anticipated difficult airway: A randomised controlled trial","authors":"Srivats Ramamoorthy, S. Paneerselvam, Lenin Elakkumanan, P. Rudingwa, K. Govindaraj","doi":"10.4103/arwy.arwy_19_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_19_22","url":null,"abstract":"Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"158 1","pages":"51 - 57"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73490700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maintaining airway patency during anaesthesia is the primary responsibility of the anaesthesiologist. Apart from anaesthetic agents, there are many factors which influence the pharyngeal patency. Understanding the pharyngeal collapsibility and behaviour of the upper airway during sleep would help in increasing the safety of patients under anaesthesia. The mechanism of pharyngeal collapse, the role of pharyngeal dilators, negative intra-thoracic pressure and multiple other factors involved to maintain pharyngeal patency are described in the article. Clinical and radiological tools to predict upper airway collapsibility have also been explained with supportive evidence. This article should be considered a resource for concepts of pharyngeal dynamics and mechanics to improve airway patency and to predict pharyngeal collapsibility and thereby safety during anaesthesia.
{"title":"Mechanics and dynamics of the pharynx: An insight into pharyngeal collapse","authors":"Apeksh Patwa, A. Shah, Apeksh Patwa","doi":"10.4103/arwy.arwy_8_23","DOIUrl":"https://doi.org/10.4103/arwy.arwy_8_23","url":null,"abstract":"Maintaining airway patency during anaesthesia is the primary responsibility of the anaesthesiologist. Apart from anaesthetic agents, there are many factors which influence the pharyngeal patency. Understanding the pharyngeal collapsibility and behaviour of the upper airway during sleep would help in increasing the safety of patients under anaesthesia. The mechanism of pharyngeal collapse, the role of pharyngeal dilators, negative intra-thoracic pressure and multiple other factors involved to maintain pharyngeal patency are described in the article. Clinical and radiological tools to predict upper airway collapsibility have also been explained with supportive evidence. This article should be considered a resource for concepts of pharyngeal dynamics and mechanics to improve airway patency and to predict pharyngeal collapsibility and thereby safety during anaesthesia.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"25 1","pages":"43 - 50"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77695283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fishing for a needle in a haystack! retained swivel knife in the adenoids of patient posted for endoscopic septoplasty with inferior turbinate reduction","authors":"A. Elayat, V. Chandran","doi":"10.4103/arwy.arwy_42_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_42_22","url":null,"abstract":"","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"8 1","pages":"38 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76558572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Aims: Awake fibreoptic intubation (AFOI) is the standard method of airway management in the anticipated difficult airway. While many drugs have been employed for sedation, there is no single drug that can be recommended as the drug of choice. Dexmedetomidine is characterised by effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, we hypothesised that dexmedetomidine should be suitable for AFOI and compared it to the control drug fentanyl. This study assesses the level of sedation and intubating conditions using dexmedetomidine or fentanyl during awake fibreoptic orotracheal intubation. Methods: Sixty adult patients, American Society of Anaesthesiology class I and II, who required orotracheal intubation during general anaesthesia with the normal airway were randomised to receive dexmedetomidine 0.6 μg/kg (Group A) or fentanyl 1.0 μg/kg (Group B) intravenous infusion for 10 min, after topical anaesthesia to the airway. A total of 60 patients were allocated, 30 patients in each group. The primary objective was to assess the intubating conditions with dexmedetomidine compared to fentanyl. Results: The intubation score for vocal cord movement (1.57 ± 0.68 in Group A vs 1.93 ± 0.75 in Group B) and cough (1.50 ± 0.78 in Group A vs 1.90 ± 0.72 in Group B), endoscopy score (2.17 ± 0.59 in Group A vs 2.47 ± 0.69 in Group B), sedation score (4.73 ± 0.5 in Group A vs 4.47 ± 0.57 in Group B) and patient satisfaction score (1.20 ± 0.41 in Group A vs 1.47 ± 0.68 in Group B) were statistically significant in patients receiving dexmedetomidine. During the procedure, there was a statistically and clinically significant increase in heart rate of 1.5% in Group A versus 22% in Group B, and an increase in mean arterial pressure of 1.95% in Group A versus and 10.27% in the Group B. Conclusion: Dexmedetomidine provided better intubation conditions than fentanyl, with greater haemodynamic stability, better sedation and greater patient satisfaction score compared to fentanyl during awake fibreoptic oral intubation.
背景和目的:清醒纤维插管(AFOI)是预期困难气道管理的标准方法。虽然有许多药物被用于镇静，但没有一种药物可以作为推荐的首选药物。右美托咪定具有镇静、镇痛、健忘症和无呼吸抑制作用。因此，我们假设右美托咪定应该适用于AFOI，并将其与对照药物芬太尼进行比较。本研究评估清醒时使用右美托咪定或芬太尼气管插管的镇静水平和插管条件。方法:选取60例美国麻醉学会I级和II级成人患者，在气道正常情况下全麻时需经气管插管，随机分为两组，分别在气道局部麻醉后给予右美托咪定0.6 μg/kg (A组)或芬太尼1.0 μg/kg (B组)静脉输注10 min。共分配60例患者，每组30例。主要目的是评估右美托咪定与芬太尼的插管条件。结果:插管得分为声带运动组(1.57±0.68 vs 1.93±0.75在B组)和咳嗽在A组(1.50±0.78 vs 1.90±0.72在B组),内窥镜检查得分在A组(2.17±0.59 vs 2.47±0.69在B组),镇静评分在A组(4.73±0.5 vs 4.47±0.57在B组)和病人满意度得分在A组(1.20±0.41 vs 1.47±0.68在B组)在病人接受dexmedetomidine统计学意义。在手术过程中，a组患者心率升高1.5%，B组升高22%，a组平均动脉压升高1.95%，B组升高10.27%。结论:与芬太尼相比，右美托咪定提供了更好的插管条件，在清醒的纤维纤维口服插管过程中，右美托咪定具有更好的血流动力学稳定性，更好的镇静作用和更高的患者满意度评分。
{"title":"Comparison between dexmedetomidine and fentanyl on intubating condition to facilitate awake oral fibreoptic intubation under topical anaesthesia – A randomised controlled trial","authors":"V. Panwar, S. Krishnan, Anil Sharma","doi":"10.4103/arwy.arwy_26_22","DOIUrl":"https://doi.org/10.4103/arwy.arwy_26_22","url":null,"abstract":"Background and Aims: Awake fibreoptic intubation (AFOI) is the standard method of airway management in the anticipated difficult airway. While many drugs have been employed for sedation, there is no single drug that can be recommended as the drug of choice. Dexmedetomidine is characterised by effects of sedation, analgesia, amnesia and lack of respiratory depression. Hence, we hypothesised that dexmedetomidine should be suitable for AFOI and compared it to the control drug fentanyl. This study assesses the level of sedation and intubating conditions using dexmedetomidine or fentanyl during awake fibreoptic orotracheal intubation. Methods: Sixty adult patients, American Society of Anaesthesiology class I and II, who required orotracheal intubation during general anaesthesia with the normal airway were randomised to receive dexmedetomidine 0.6 μg/kg (Group A) or fentanyl 1.0 μg/kg (Group B) intravenous infusion for 10 min, after topical anaesthesia to the airway. A total of 60 patients were allocated, 30 patients in each group. The primary objective was to assess the intubating conditions with dexmedetomidine compared to fentanyl. Results: The intubation score for vocal cord movement (1.57 ± 0.68 in Group A vs 1.93 ± 0.75 in Group B) and cough (1.50 ± 0.78 in Group A vs 1.90 ± 0.72 in Group B), endoscopy score (2.17 ± 0.59 in Group A vs 2.47 ± 0.69 in Group B), sedation score (4.73 ± 0.5 in Group A vs 4.47 ± 0.57 in Group B) and patient satisfaction score (1.20 ± 0.41 in Group A vs 1.47 ± 0.68 in Group B) were statistically significant in patients receiving dexmedetomidine. During the procedure, there was a statistically and clinically significant increase in heart rate of 1.5% in Group A versus 22% in Group B, and an increase in mean arterial pressure of 1.95% in Group A versus and 10.27% in the Group B. Conclusion: Dexmedetomidine provided better intubation conditions than fentanyl, with greater haemodynamic stability, better sedation and greater patient satisfaction score compared to fentanyl during awake fibreoptic oral intubation.","PeriodicalId":7848,"journal":{"name":"Airway Pharmacology and Treatment","volume":"110 1","pages":"10 - 16"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87079555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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