A complication of transtracheal jet ventilation and use of the Aintree intubation catheter^® during airway resuscitation

Abstract

Summary We report the management of a patient requiring surgical laryngoscopy with a view to laser resection of an epiglottic recurrence of laryngeal cancer. Previous attempts at tracheal intubation and awake nasal fibreoptic intubation had failed. During a previous anaesthetic the patient had been both ‘impossible to intubate and to ventilate’. Neck scarring potentially complicated access for transtracheal jet ventilation. Nevertheless, a cricothyroid catheter was placed and surgery performed during low frequency ‘volume’ jet ventilation. Upper airway obstruction developed during the procedure, preventing exhalation, which led to raised intrathoracic pressure, cardiovascular collapse and barotrauma. The airway was re‐established by insertion of an LMA Proseal™. Fibreoptic placement of an Aintree intubation catheter® through this allowed re‐oxygenation and exchange for a cuffed tracheal tube. Some hours after the procedure, re‐intubation was necessary. This was achieved using the Aintree intubation catheter as an aid to nasal fibreoptic intubation and as a tube exchanger. Novel roles of the Aintree intubation catheter and LMA Proseal in this case are discussed. Complications of transtracheal jet ventilation as well as possible methods for avoiding them are also reviewed.

Cricothyroidotomy catheters: an investigation of mechanisms of failure and the effect of a novel intracatheter stylet

“…Cricothyroidotomy catheter complications described in case reports include subcutaneous emphysema from the catheter pulling out of the trachea, barotrauma with pneumothorax from a blocked upper airway and blockage from kinking [7,[10][11][12][13]. We Figure 4 On the left a 50 mm 14 G Optiva catheter showing the resting position after insertion into an opened trachea with contact between the tip and the mucosa.…”

Non‐conventional uses of the Aintree Intubating Catheter in management of the difficult airway

“…This may be overcome by using gum elastic bougie guided insertion, in which case the insertion success may actually exceed that of the LMA Classic [12]. Also, the PLMA has a slightly smaller internal diameter than the LMA Classic, though an AIC will readily pass through all adult size PLMAs (sizes [3][4][5]. The PLMA may not be as widely available as the LMA Classic and anaesthetists may be less familiar with it.…”

A reply

“…We read with interest the recent article on the determination of site of tracheal tube impingement during nasotracheal fibreoptic intubation [1]. The conclusion of the study was that the most common site of impingement is the right arytenoid cartilage, as shown for orotracheal fibreoptic intubation [2].…”

“…With reference to their last comment, the authors may be interested in some work we have recently presented that indicates a significantly greater incidence of impingement of a flexometallic tube as compared with the intubating laryngeal mask airway tube [1]. …”

“…Cook et al report airway rescue using a Proseal TM laryngeal mask airway paired with fibrescope-guided placement of an Aintree intubation catheter Ò [1]. They recognised that their patient had the 'full house' for airway problems, with recognised difficulties in facemask ventilation, tracheal intubation and subglottic cannulation.…”