Awake insertion of the air-Q™ intubating laryngeal airway device that facilitates safer tracheal intubation in morbidly obese patients

Shiraishi, Toshio

doi:10.1093/bja/aet389

Cited by 11 publications

(8 citation statements)

References 4 publications

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“…A combined approach to ATI using both VL and FB has been described and could be considered in complex clinical scenarios (Grade D). In a well‐topicalised patient, insertion of an SAD as a conduit for ATI:FB has also been described , and may provide the benefit of maintaining airway patency. Single‐use flexible bronchoscopes are associated with a similar safety profile to re‐usable ones .…”

Section: Procedural Setupmentioning

confidence: 99%

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

et al. 2019

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Summary Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high‐quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post‐tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.

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Section: Procedural Setupmentioning

confidence: 99%

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

et al. 2019

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“…Arslan et al has reported that supraglottic airway device was inserted after the induction of general anesthesia with 1 μg/kg fentanyl, 3 mg/kg propofol and 0.6 mg/kg rocuronium, and then facilitate tracheal intubation in morbidly obese patients [ 12 ]. Shiraishi reported an observational study to show a safer method of airway management in obese patients by performing awake insertion (intravenous injection of 20-40 μg/kg midazolam and 1-2 μg/kg fentanyl) of the supraglottic airway device allowing spontaneous ventilation to facilitate subsequent tracheal intubation [ 13 ]. However, the optimum anesthetics for supraglottic airway device insertion with spontaneous breathing in obese patients have not been standardized.…”

Section: Introductionmentioning

confidence: 99%

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

et al. 2017

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BackgroundAirway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia.MethodsThirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon’s up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient’s response to supraglottic airway device insertion was classified as either ‘movement’ or ‘no-movement’. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from ‘movement’ or ‘no-movement’ response.ResultsThe ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28–3.42) % and 4.03 (3.16–17.83) % for supraglottic airway device Blockbuster™ insertion, respectively.ConclusionWe conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16009071, Registered on 24 August 2016.

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“…Isono admonishes that: “Awake intubation should be considered when any element of the triple airway maneuver, including mandible advancement, neck extension and mouth opening, is disturbed in obese patients with severe OSA [31]. ” Though they lack protection against aspiration of gastric contents, supraglottic airway devices — including the laryngeal mask airway (LMA) — can also be used as a rescue technique for ventilation and intubation [32,33]. No specific device can restore oxygenation, but sound planning, clear communication and skillful use of available resources can facilitate navigation through a difficult airway scenario.…”

Section: Oxygenation Before Intubation: Airway Management In the Obesementioning

confidence: 99%

Strategies for managing oxygenation in obese patients undergoing laparoscopic surgery

Ortiz

Vidal-Melo

Walsh

2015

Surgery for Obesity and Related Diseases

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The worldwide trend toward increasing body mass index (BMI) has caused the anesthetic management of overweight, obese, and severely obese patients to become common. The increase in oxygen demand coupled with the anatomic and physiologic changes associated with excess adipose tissue make maintenance of oxygenation a major challenge during induction, maintenance and recovery from general anesthesia. It is crucial for anesthesiologists, surgeons and perioperative healthcare providers alike to have a thorough understanding of the impact of airway management and mechanical ventilation on the respiratory care of the obese in the immediate perioperative setting. In this manuscript we aim to discuss the consequences of obesity, particularly abdominal obesity, on respiratory physiology and provide suggestions on intraoperative ventilatory strategies to maintain oxygenation in the severely obese patient undergoing pneumoperitoneum.

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Awake insertion of the air-Q™ intubating laryngeal airway device that facilitates safer tracheal intubation in morbidly obese patients

Cited by 11 publications

References 4 publications

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

Strategies for managing oxygenation in obese patients undergoing laparoscopic surgery

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