Extubation and Reintubation of the Difficult Airway

Cooper, Richard M.; Khan, Sofia

doi:10.1016/b978-1-4377-2764-7.00050-6

Cited by 14 publications

(13 citation statements)

References 345 publications

(428 reference statements)

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“… 74 Many of these outcomes can be avoided with proper planning and recognition of risk. 144 - 147 Patients are at particular risk during emergence from anesthesia, relocation to a recovery area, and discontinuation of full monitoring. In the recovery area, recognition and correction of a deteriorating airway can potentially be delayed.…”

Section: Tracheal Extubation In the Patient With A Difficult Airwaymentioning

confidence: 99%

“…This should include identification of patients at risk of failed tracheal extubation, and those with anatomic features that place them at higher risk of difficult re-intubation should this prove necessary. 146 , 147 Examples include but are not limited to patients with a reduced functional residual capacity, increased work of breathing, reduced minute ventilation, increased dead space, swelling in or around the airway, a previously difficult airway, or an airway where accessibility is challenged.…”

Section: Tracheal Extubation In the Patient With A Difficult Airwaymentioning

confidence: 99%

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The difficult airway with recommendations for management – Part 2 – The anticipated difficult airway

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

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260

214

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BackgroundAppropriate planning is crucial to avoid morbidity and mortality when difficulty is anticipated with airway management. Many guidelines developed by national societies have focused on management of difficulty encountered in the unconscious patient; however, little guidance appears in the literature on how best to approach the patient with an anticipated difficult airway.MethodsTo review this and other subjects, the Canadian Airway Focus Group (CAFG) was re-formed. With representation from anesthesiology, emergency medicine, and critical care, CAFG members were assigned topics for review. As literature reviews were completed, results were presented and discussed during teleconferences and two face-to-face meetings. When appropriate, evidence- or consensus-based recommendations were made, and levels of evidence were assigned.Principal findingsPreviously published predictors of difficult direct laryngoscopy are widely known. More recent studies report predictors of difficult face mask ventilation, video laryngoscopy, use of a supraglottic device, and cricothyrotomy. All are important facets of a complete airway evaluation and must be considered when difficulty is anticipated with airway management. Many studies now document the increasing patient morbidity that occurs with multiple attempts at tracheal intubation. Therefore, when difficulty is anticipated, tracheal intubation after induction of general anesthesia should be considered only when success with the chosen device(s) can be predicted in a maximum of three attempts. Concomitant predicted difficulty using oxygenation by face mask or supraglottic device ventilation as a fallback makes an awake approach advisable. Contextual issues, such as patient cooperation, availability of additional skilled help, and the clinician’s experience, must also be considered in deciding the appropriate strategy.ConclusionsWith an appropriate airway evaluation and consideration of relevant contextual issues, a rational decision can be made on whether an awake approach to tracheal intubation will maximize patient safety or if airway management can safely proceed after induction of general anesthesia. With predicted difficulty, close attention should be paid to details of implementing the chosen approach. This should include having a plan in case of the failure of tracheal intubation or patient oxygenation.

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Section: Tracheal Extubation In the Patient With A Difficult Airwaymentioning

confidence: 99%

Section: Tracheal Extubation In the Patient With A Difficult Airwaymentioning

confidence: 99%

The difficult airway with recommendations for management – Part 2 – The anticipated difficult airway

Law

Broemling²,

Cooper³

et al. 2013

Can J Anesth/J Can Anesth

Self Cite

260

214

View full text Add to dashboard Cite

show abstract

“…Thus, the bronchial lumen of DLT may be suitable for the AEC passed during this replacement with a SLT, after thoracic surgery for postoperative ventilator support. AECs can be classified into hollow and solid designs (14). Hollow catheters serve as a conduit to administer oxygen by jet ventilation and to intermittently measure partial pressure of end-tidal carbon dioxide from the trachea.…”

Section: Discussionmentioning

confidence: 99%

Bronchial lumen is the safer route for an airway exchange catheter in double-lumen tube replacement: preventable complication in airway management for thoracic surgery

Wu¹,

Tai²,

Wei³

et al. 2017

J. Thorac. Dis.

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There is no current consensus on which lumen an airway exchange catheter (AEC) should be passed through in double-lumen endotracheal tube (DLT) to exchange for a single-lumen endotracheal tube (SLT) after thoracic surgery. We report an unusual case to provide possible solution on this issue. A 71-year-old man with lung adenocarcinoma had an event of a broken exchange catheter used during a DLT replacement with a SLT, after a video-assisted thoracic surgery. The exchange catheter was impinged at the distal tracheal lumen and snapped during manipulation. All three segments of the catheter were retrieved without further airway compromises. Placement of airway tube exchanger into the tracheal lumen of doublelumen tube is a potential contributing factor of the unusual complication. We suggest an exchange catheter be inserted into the bronchial lumen in optimal depth with the adjunct of video laryngoscope, as the safe method for double-lumen tube exchange.

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“…42 Identification of patients at increased risk and appropriate strategies to increase the need for or safety of reintubation has been discussed. [43][44][45] Airway exchange catheters are commercially available and can be used to maintain airway access following extubation, to serve as a stylet to facilitate reintubation 46 or a conduit for the supplementation of oxygen. Oxygen supplementation by insufflation, positive pressure, or jet ventilation should be done with great caution as serious complications have been reported.…”

Section: Extubationmentioning

confidence: 99%