Rigid fiberscope intubation of a patient awake with remifentanil sedation
Abstract
Introduction. When choosing the appropriate management for a difficult airway patient, either established or suspected, several intervention options should be considered. Some management algorithms recommend awake intubation under direct laryngoscopy or optical instruments. Rigid and semi-rigid stylets are optical devices developed for managing the difficult airway that have proven to be fast, non-traumatic and reliable.
Objectives. To describe the use of different strategies to approach the difficult airway in an emergency surgery, using the Airway RIFL (rigid intubation fiberoptic laryngoscope) as one of the options.
Methodology and results. This is a case of a 69-yr old patient admitted to the ER for hemostasis and surgery of a chest neoplasia. The patient was considered a difficult airway patient because of a history of multiple tumor resections and radiotherapy in the airway, resulting in a notorious facial deformity. Intubation on a full stomach. Topical anesthesia was considered the first choice for airway management, remifentanil sedation and direct laryngoscopy but this is not possible due to a limited oral opening: three nasal intubation attempts were made but failed. Then it was decided to use the Airway RIFL device and the procedure was successful.
Conclusions. When dealing with a difficult airway patient, having several management strategies at hand, local anesthesia and sedation, allow for excellent patient collaboration and a fast orotracheal intubation using a rigid fiberscope, even under emergency situations.
References
2. Magill IW. Endotracheal anaesthesia. Proc R Soc Med. 1928;22(2):83-8.
3. Macintosh RR. A new laryngoscope. Lancet. 1943;1:205.
4. Davis L, Cook-Sather S, Schreiner M. Lighted stylet tracheal intubation: a review. Anesth Analg. 2000;90(3):745-56.
5. Marco CA, Marco AP. Airway adjuncts. Emerg Med Clin N Am. 2008;26(4):1015-27.
6. Levitan RM, Kush S, Hollander JE. Devices for difficult airway management in academic emergency departments: results of a national survey. Ann Emerg Med. 1999;33(6):694-8.
7. Reeder TJ, Brown CK, Norris DL. Managing the difficult airway: a survey of residency directors and a call for change. J Emerg Med. 2005;28(4):473-8.
8. Ezri T, Szmuk P, Warters RD, Katz J, Hagberg CA. Difficult airway management practice patterns among anesthesiologists practicing in the United States: have we made any progress? J Clin Anesth. 2003;15(6):418-22.
9. Liem EB, Bjoraker DG, Gravenstein D. New options for airway management: intubating fibreoptic stylets. Br J Anaesth. 2003;91(3):408-18.
10. Pfitzner L, Cooper MG, Ho D. The Shikani Seeing Stylet for difficult intubation in children: initial experience. Anaesth Intensive Care. 2002;30(4):462-6.
11. Gempeler F, Devis A, Pedraza P. Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedetomidina. Reporte de casos. Rev Col Anest. 2009;37:49-56.
12. Kovacs G, Law A, Petrie D. Awake fiberoptic intubation using an optical stylet in ananticipated dificult airway. Ann Emerg Med. 2007;49(1):81-3.
13. Brimacombe J, Keller C, Künzel KH, Gaber O, Boehler M, Pühringer F. Cervical spine motion during airway management:a cinefluoroscopic study of the posteriorly destabilized third vertebrae in human cadavers. Anesth Analg. 2000;91(5):1274-8.
14. Rudolph C, Schlender M. Clinical experiences with fiber optic intubation with the Bonfils intubation fiberscope. Anaesthesiol Reanim. 1996;21(5):127-30.
15. Hagberg CA. Special devices and techniques. Anesthesiology Clin N Am. 2002;20(4):907-32.
16. Hung O, Murphy M. Management of the difficult and failed airway. New York: McGraw Hill; 2007.
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