Airway trauma during difficult intubation… from the frying pan into the fire?

Kalingarayar, Sriraam; Nandhakumar, Amar; Subramanian, Santhakumar; Namboothiri, Sreedharan

doi:10.4103/ija.ija_140_17

Cited by 7 publications

(6 citation statements)

References 9 publications

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“…It is inserted directly into the trachea, and then the ETT can be guided over it. As the bougie is placed in the trachea, the tip of the bougie is felt clicking as it passes over the tracheal rings [ 9 , 10 ]. When used to exchange out an ETT, the bougie is inserted in the ETT and advanced slowly.…”

Section: Discussionmentioning

confidence: 99%

“…When used to exchange out an ETT, the bougie is inserted in the ETT and advanced slowly. The "hold-up sign" is often used as a guide [ 10 ]. Once this resistance is encountered, one should not apply additional pressure as trauma to the airway can occur.…”

Section: Discussionmentioning

confidence: 99%

“…Complications from the use of a bougie are infrequent but possible. In general, 0.5 to 7% of adverse events associated with difficult intubation are due to trauma [ 10 ]. Those from bougie use are even less and typically involve single-use bougies as they are less flexible and the coating makes sliding the ETT over it more difficult [ 5 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

Bethea

2024

Cureus

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A 45-year-old male with tongue cancer and obstructive sleep apnea presented for glossectomy and right neck dissection. He underwent a difficult nasal intubation assisted by a bougie and Glidescope. After an otherwise uneventful procedure, the patient was extubated and taken to recovery. Several hours later, he developed increased respirations and decreased oxygen (O 2 ) saturation with decreased air movement on the right side of his chest. A chest X-ray confirmed a right pneumothorax. A chest tube was placed with immediate improvement of O 2 saturation and breathing. Pneumothorax was presumably due to trauma from intubation. Although pneumothorax is a potential complication of intubation, it is more likely to occur shortly following intubation instead of hours later. The mechanism is often unknown. Providers must monitor patients throughout the perioperative period for any potential respiratory concerns, especially following a difficult intubation. This will ensure prompt diagnosis and management of any complications and provide an optimal outcome for the patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

Bethea

2024

Cureus

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“…Endotracheal intubation itself is not without complication, ranging from a mild sore throat, 13 minor bleeding 14 and dental damage 15 to laryngotracheal injury 16 and pneumothoraces. 17 Moreover, direct laryngeal stimulation during endotracheal intubation promotes a sympathetic response contributing to haemodynamic instability.…”

Section: Discussionmentioning

confidence: 99%

Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review

et al. 2021

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Objective Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques. Method A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic. Results The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure. Conclusion Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

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“…However, caution needs to be exercised in patients with possible laryngeal or tracheal injury as the endotracheal tube introducer can exacerbate the injury. 96…”

Section: Ti Proceduresmentioning

confidence: 99%

Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies

Karamchandani

Wheelwright

Yang

et al. 2021

Anesthesia &Amp; Analgesia

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Emergency airway management outside the operating room (OR) is often associated with an increased risk of airway related, as well as cardiopulmonary, complications which can impact morbidity and mortality. These emergent airways may take place in the intensive care unit (ICU), where patients are critically ill with minimal physiological reserve, or other areas of the hospital where advanced equipment and personnel are often unavailable. As such, emergency airway management outside the OR requires expertise at manipulation of not only the anatomically difficult airway but also the physiologically and situationally difficult airway. Adequate preparation and appropriate use of airway management techniques are important to prevent complications. Judicious utilization of pre- and apneic oxygenation is important as is the choice of medications to facilitate intubation in this at-risk population. Recent study in critically ill patients has shown that postintubation hemodynamic and respiratory compromise is common, independently associated with poor outcomes and can be impacted by the choice of drugs and techniques used. In addition to adequately preparing for a physiologically difficult airway, enhancing the ability to predict an anatomically difficult airway is essential in reducing complication rates. The use of artificial intelligence in the identification of difficult airways has shown promising results and could be of significant advantage in uncooperative patients as well as those with a questionable airway examination. Incorporating this technology and understanding the physiological, anatomical, and logistical challenges may help providers better prepare for managing such precarious airways and lead to successful outcomes. This review discusses the various challenges associated with airway management outside the OR, provides guidance on appropriate preparation, airway management skills, medication use, and highlights the role of a coordinated multidisciplinary approach to out-of-OR airway management.

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Airway trauma during difficult intubation… from the frying pan into the fire?

Cited by 7 publications

References 9 publications

Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

Delayed Pneumothorax Following Bougie-Assisted Nasal Intubation

Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review

Emergency Airway Management Outside the Operating Room: Current Evidence and Management Strategies

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