Emergent Awake tracheostomy—The five‐year experience at an urban tertiary care center

Fang, Christina H.; Friedman, Remy; White, Priscilla E.; Mady, Leila J.; Kalyoussef, Evelyne

doi:10.1002/lary.25348

Cited by 42 publications

(44 citation statements)

References 19 publications

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“…Awake tracheotomy should be performed on the impending airway obstruction and in a timely manner before complete obstruction occurs 19 . Because awake tracheotomy is life-saving, efficacious and safe method to secure an airway in these patients with a low incidence of complications 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Difficult Airway caused by a Subglottic Tumor: A Case Report

Jiang

Lan

et al. 2019

Preprint

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Background: Securing the airway is a core skill for an anesthesiologist, the gold standard of which is tracheal intubation. Patient with subglottic tumor is a situation of difficult airways and could be a challenge for anesthesiologists. The “cannot ventilate, cannot intubate” during anesthesia induction can be lethal. So we always prepared awake approach for diagnosed difficult airway, but awake fiberoptic intubation may be also failed. Case presentation: In this case report we present a 55 years old female patient was scheduled for laryngeal tumor resection, and was planned awake intubation guided by fiber bronchoscope. After awake intubation attempt failed, emergency tracheostomy was successfully completed by ENT surgeon. After securing airway, general anesthesia was performed and the operation proceeded with laryngeal tumor resection. Conclusions: It is important that ENT surgeon must be asked to remain standby for possible need of emergency tracheostomy to prevent awake fiberoptic intubation failure. Ultrasound or computed tomography scan examination of the trachea may be useful to provide guidance for anesthesiologists to choose the appropriate endotracheal tube IDs or tracheostomy directly by measuringthe degree of airway stenosis. Keywords: Subglottic Tumor; difficult airway; ENT; anesthesia

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Section: Discussionmentioning

confidence: 99%

Difficult Airway caused by a Subglottic Tumor: A Case Report

Jiang

Lan

et al. 2019

Preprint

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“…For many patients, however, an entirely awake procedure is difficult to tolerate due to multiple factors including anxiety, claustrophobia exacerbated by surgical drapes, worsening of dyspnoea due to semi-recumbent positioning and discomfort from peri-procedural manipulation of the neck. Accordingly, some sedation is administered to the majority of patients undergoing tracheostomies under LA [2]. Adequate sedation may also play a critical role in ensuring safe progress of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Further benefits of high-flow humidified transnasal oxygenation include the application of continuous positive airway pressure (CPAP) of approximately 7cmH 2 O, splinting open collapsible airways and reducing shunt [1]. This may also serve to improve efficiency of spontaneous ventilation [4], an effect which likely explains the low EtCO 2 noted upon commencement of ventilation through the tracheostomy, despite the preceding period of apnoea.…”

Section: Discussionmentioning

confidence: 99%

The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) to facilitate Tracheostomy under sedation

et al. 2016

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Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is an apnoeic oxygenation technique which has also been observed to allow a degree of carbon dioxide clearance [1]. We present the case of a 61-year-old patient with impending complete upper airway obstruction secondary to an advanced supraglottic neoplasm, precluding orotracheal intubation. The patient became agitated during tracheostomy under local anaesthesia and required sedation to the point of apnoea in order to complete the procedure safely. The use of THRIVE throughout this case was invaluable in bridging periods of ensuing hypoventilation and apnoea, preventing oxygen desaturation and hypercarbia.

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“…Unlike the present case, if bleeding occurs inside the mouth or the neck from trauma or other emergencies, a clear field of vision in the oropharynx area cannot be secured, and therefore, the airway may be secured via emergency tracheostomy under local anesthesia with the patient in the sitting position [ 15 ]. However, the present case is that of a patient with infection, where tracheostomy was difficult due to deviation of the anatomic structures and swelling caused by the neck infection.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of bilateral pneumothorax during tracheostomy in a patient with deep neck infection

Kang

Won

Chang

2016

J Dent Anesth Pain Med

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Infection that progresses to deep areas of the neck requires appropriate assessment of the airway, and securing of the airway is critical in patients with deep neck infection. In the patient in our case report, bilateral pneumothorax occurred while performing tracheostomy to the airways of a patient with deep neck infection, and therefore, this paper details the method used to secure the airway of patients with deep neck infection.

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Emergent Awake tracheostomy—The five‐year experience at an urban tertiary care center

Abstract: 4.

Cited by 42 publications

References 19 publications

Difficult Airway caused by a Subglottic Tumor: A Case Report

Difficult Airway caused by a Subglottic Tumor: A Case Report

The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) to facilitate Tracheostomy under sedation

Occurrence of bilateral pneumothorax during tracheostomy in a patient with deep neck infection

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