Conventional laryngoscopy as a rescue for fiber-optic-assisted tracheal intubation in a patient with perilaryngeal edema after rigid bronchoscopy: A case report

Garg, Rakesh; Nandi, Rudranil; Hadda, Vijay

doi:10.4103/lungindia.lungindia_251_17

Cited by 1 publication

(2 citation statements)

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“…[ 24 , 25 ] Also, there are case reports of using DL and ELM together, to assist FOB-guided intubation and to overcome airway obstruction from perilaryngeal edema. [ 26 ] In our patient, a McGrath video laryngoscope was inserted, and the jaw and the tongue were lifted with the blade to expand the space for the rotating NIM tube to pass through the airway. To improve larynx angulation, the ELM procedure that was previously used was also implemented.…”

Section: Discussionmentioning

confidence: 99%

“…There are a few case reports discussing the management of difficult airways, such as cervical spine ankylosis due to rheumatoid arthritis or large vallecular hemangiomas, by using DL- or VL-assisted FOB-guided intubation [24,25] . Also, there are case reports of using DL and ELM together, to assist FOB-guided intubation and to overcome airway obstruction from perilaryngeal edema [26] . In our patient, a McGrath video laryngoscope was inserted, and the jaw and the tongue were lifted with the blade to expand the space for the rotating NIM tube to pass through the airway.…”

Section: Discussionmentioning

confidence: 99%

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Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement

et al. 2022

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Rationale: Goiter, an abnormal enlargement of the thyroid gland, can induce airway distortion or tracheal compression. Airway management can be challenging for anesthesiologists, depending on the location and size of the mass as well as the patient's airway conditions, although it is reported that most cases can easily be managed by oral intubation.Patient concerns: A 61-year-old female patient who had planned for a total thyroidectomy due to a huge goiter was intubated with nerve integrity monitoring (NIM) tubes, using video laryngoscopy (VL) and oral fiberoptic bronchoscopy (FOB) alone. The respective attempts initially failed.Diagnosis: The patient's thyroid mass extended from the C3 cervical spine level to the T1 thoracic spine level with retropharyngeal involvement, causing an upper airway anatomical alteration that made intubation difficult. FOB manipulation was challenging due to the acute angulation of the laryngeal inlet and the tongue and the consequent interruption by the epiglottis. There was resistance to tube introduction, despite counterclockwise rotation of the NIM tube, due to acute angulation of the larynx and circumferential narrowing of the oropharyngeal and supraglottic space.Interventions: In the first step of FOB-guided intubation, external laryngeal manipulation (ELM) was performed to improve the angle of the glottic opening and to elevate epiglottis tip. This allowed for FOB introduction into the trachea. VL was then performed transorally to elevate the tongue base and increase space, using the blade. ELM was applied simultaneously to move the glottis lower, thereby reducing the angle of the tube passage.Outcomes: The NIM tube was successfully introduced into the trachea with counterclockwise rotation in FOB-guided intubation.Lessons: The combination of techniques using basic and popular devices and maneuvers, such as ELM and VL, may be useful for the successful management of difficult airways related to retropharyngeal goiter, without the need for surgical airway.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%