Airway management and enhanced recovery after surgery pathways in a patient with Madelung's disease

Tang, Yaxing; Wang, Shanqiu; Ping, Li; Tatang, Xiaoning

doi:10.23736/s0375-9393.19.13445-1

Cited by 10 publications

(16 citation statements)

References 2 publications

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“…1 The incidence of anesthesia-induced pulmonary aspiration is very low (0.03%) in elective surgery 2 when preoperative fasting rules have been complied and in the absence of risk factors for regurgitation of gastric contents such as pregnancy or morbid obesity. 3,4 However, in emergency conditions, noncompliance with preoperative fasting rules and delayed gastric emptying markedly increase the risk of pulmonary aspiration. 5 In this context, a rapid sequence induction (RSI) of anesthesia is recommended to minimize the risk of aspiration, combining the use of a shortacting hypnotic and a muscle relaxant, mainly succinylcholine, associated with the application of a manual pressure to the cricoid cartilage (known as Sellick maneuver).…”

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confidence: 99%

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

et al. 2019

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The use of cricoid pressure (Sellick maneuver) during rapid sequence induction (RSI) of anesthesia remains controversial in the absence of a large randomized trial.OBJECTIVE To test the hypothesis that the incidence of pulmonary aspiration is not increased when cricoid pressure is not performed.DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, noninferiority trial conducted in 10 academic centers. Patients undergoing anesthesia with RSI were enrolled from February 2014 until February 2017 and followed up for 28 days or until hospital discharge (last follow-up, February 8, 2017). INTERVENTIONSPatients were assigned to a cricoid pressure (Sellick group) or a sham procedure group.MAIN OUTCOMES AND MEASURES Primary end point was the incidence of pulmonary aspiration (at the glottis level during laryngoscopy or by tracheal aspiration after intubation). It was hypothesized that the sham procedure would not be inferior to the cricoid pressure. The secondary end points were related to pulmonary aspiration, difficult tracheal intubation, and traumatic complications owing to the tracheal intubation or cricoid pressure. RESULTSOf 3472 patients randomized, mean (SD) age was 51 (19) years and 1777 (51%) were men. The primary end point, pulmonary aspiration, occurred in 10 patients (0.6%) in the Sellick group and in 9 patients (0.5%) in the sham group. The upper limit of the 1-sided 95% CI of relative risk was 2.00, exceeding 1.50, failing to demonstrate noninferiority (P = .14). The risk difference was −0.06% (2-sided 95% CI, −0.57 to 0.42) in the intent-to-treat population and −0.06% (2-sided 95% CI, −0.56 to 0.43) in the per protocol population. Secondary end points were not significantly different among the 2 groups (pneumonia, length of stay, and mortality), although the comparison of the Cormack and Lehane grade (Grades 3 and 4, 10% vs 5%; P <.001) and the longer intubation time (Intubation time >30 seconds, 47% vs 40%; P <.001) suggest an increased difficulty of tracheal intubation in the Sellick group.CONCLUSIONS AND RELEVANCE This large randomized clinical trial performed in patients undergoing anesthesia with RSI failed to demonstrate the noninferiority of the sham procedure in preventing pulmonary aspiration. Further studies are required in pregnant women and outside the operating room.

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confidence: 99%

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

et al. 2019

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“…This, along with the decreased chest wall compliance and increased intra-abdominal pressure, significantly reduces the functional residual capacity (FRC) and the closing capacity to the extent that many a times the closing capacity is higher than the FRC thereby closing the smaller airways even during normal tidal volume breathing. Oxygen desaturation often occurs early after induction, secondary to the FRC and atelectasis worsened by the supine position [26]. Obese patients may have obstructive sleep apnea causing intermittent and repeated upper airway collapse, leading to partial or total airway occlusion for short periods during sleep.…”

Section: Obese Patientsmentioning

confidence: 99%

“…The use of videolaryngoscopy and apneic oxygenation has been recommended during tracheal intubation in this high-risk group. After tracheal intubation, application of positive end expiratory pressure is recommended [26].…”

Section: Obese Patientsmentioning

confidence: 99%

“…The odds ratio of severe complications related to intubation occurred 20 times more often in the ICU [25]. Obese patients are at higher risk for anatomical factors associated with increased difficulty in tracheal intubation [25,26]. In addition, these patients have a physiologically difficult airway due to the higher resting metabolic demand, higher oxygen consumption, and a higher cardiac output.…”

Section: Types Of Physiologically Diffcult Airwaymentioning

confidence: 99%

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The physiologically difficult airway: an emerging concept

Myatra

Divatia

Brewster

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed.Recent findingsPhysiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ventilation. These derangements are especially recognized in critically ill patients, but can also occur in otherwise healthy patients including obese, pregnant and pediatric patients who have certain physiological alterations. Critically ill patients may have a physiologically difficult airway due to the presence of acute respiratory failure, hypoxemia, hypotension, severe metabolic acidosis, right ventricular failure, intracranial hypertension, and risk of aspiration of gastric contents during tracheal intubation.SummaryUnderstanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.

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“…Most anesthesiologists administer a high fraction of inspired oxygen (FiO 2 ) during induction and emergence of anesthesia to prevent desaturation, in preparation for unpredictable difficult intubation, [1][2][3] ventilation failure, and loss of airway patency, [4] especially in obese patients. [5] Unfortunately, administration of a high intraoperative inspired oxygen concentration can lead to postoperative pulmonary complications. [6] One of the most common and serious postoperative respiratory complications on the first day after surgery is atelectasis [7,8] which arouses ventilation/perfusion mismatch, [9] consequently interrupting oxygenation of blood.…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound score-based assessment of postoperative atelectasis in obese patients according to inspired oxygen concentration: A prospective, randomized-controlled study

et al. 2023

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Background: According to a recent meta-analysis, in patients with a body mass index (BMI) ≥ 30, a high fraction of inhaled oxygen (FiO2) did not increase postoperative atelectasis. However, a high FiO2 generally increases the risk of postoperative atelectasis. Therefore, this study aimed to evaluate the effect of FiO2 on the development of atelectasis in obese patients using the modified lung ultrasound score (LUSS). Methods: Patients were assigned to 4 groups: BMI ≥ 30: group A (n = 21) and group B (n = 20) and normal BMI: group C (n = 22) and group D (n = 21). Groups A and C were administered 100% O2 during preinduction and emergence and 50% O2 during anesthesia. Groups B and D received 40% O2 for anesthesia. The modified LUSS was assessed before and 20 min after arrival to the postanesthesia care unit (PACU). Results: The difference between the modified LUSS preinduction and PACU was significantly higher in group A with a BMI ≥ 30 (P = .006); however, there was an insignificant difference between groups C and D in the normal BMI group (P = .076). Conclusion: High FiO2 had a greater effect on the development of atelectasis in obese patients than did low FiO2; however, in normal-weight individuals, FiO2 did not have a significant effect on postoperative atelectasis.

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Airway management and enhanced recovery after surgery pathways in a patient with Madelung's disease

Cited by 10 publications

References 2 publications

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia

The physiologically difficult airway: an emerging concept

Lung ultrasound score-based assessment of postoperative atelectasis in obese patients according to inspired oxygen concentration: A prospective, randomized-controlled study

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