Managing and securing the bleeding upper airway: a narrative review

Kristensen, Michael Seltz; McGuire, Barry

doi:10.1007/s12630-019-01479-5

Cited by 35 publications

(29 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, because the stomach may be filled with blood, the use of an SGA is only suitable as a temporary measure, or as a guide to intubation. 213 , 214 …”

Section: Special Situationsmentioning

confidence: 99%

“…Otherwise, preparations should be made for an ATI with alternative techniques that can be used even if visibility of the airway is obscured by blood. 213 Such techniques include awake FONA, awake FB-guided intubation via an SGA as well as awake DL or Mac-VL, awake retrograde-, blind nasal-, oral digital-, lighted stylet-, and ultrasound-guided intubation. 213 Awake intubation with a FB or VL can still be attempted in this situation, but might fail, so the airway manager should be prepared to use one of the alternatives mentioned above.…”

Section: Special Situationsmentioning

confidence: 99%

“… 213 Such techniques include awake FONA, awake FB-guided intubation via an SGA as well as awake DL or Mac-VL, awake retrograde-, blind nasal-, oral digital-, lighted stylet-, and ultrasound-guided intubation. 213 Awake intubation with a FB or VL can still be attempted in this situation, but might fail, so the airway manager should be prepared to use one of the alternatives mentioned above. In addition, a “double set-up” to allow for eFONA should be prepared (Table 8 ) in case the airway is lost during attempted management.…”

Section: Special Situationsmentioning

confidence: 99%

See 2 more Smart Citations

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

View full text Add to dashboard Cite

Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

show abstract

“…In addition, because the stomach may be filled with blood, the use of an SGA is only suitable as a temporary measure, or as a guide to intubation. 213 , 214 …”

Section: Special Situationsmentioning

confidence: 99%

Section: Special Situationsmentioning

confidence: 99%

Section: Special Situationsmentioning

confidence: 99%

See 1 more Smart Citation

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

101

View full text Add to dashboard Cite

show abstract

“…Airway management in those patients is extremely challenging. Some of techniques used to secure airway such as video laryngoscope or fiberoptic laryngoscopes might be ineffective because of the soiled hypopharynx and equipment with blood, effective preoxygenation might be difficult in an anxious not tolerated patient, THRIVE and HFNO should be used with extreme caution because blood may force in lower airway, use of SAD has limited effectiveness because of the high risk of aspiration, patient swallow the blood and should be considered as a full stomach case and patient cannot lie supine feeling suffocated and difficult to deal with, are the main problems associated with airway management in these patients [57].…”

Section: Upper Airway Bleedingmentioning

confidence: 99%

“…Airway management started with airway examination and localizing cricothyroid membrane as an emergency solution of cannot intubate scenario. Out of all the airway management ways, only the placement cuffed ETT using RSII might fulfill the desired goals which are; securing a conduit for patient ventilation, protect the patient from blood aspiration in the lungs, and provide good space for the surgeon to address the source of bleeding and controlling it [57].…”

Section: Upper Airway Bleedingmentioning

confidence: 99%

Airway Management in Full Stomach Conditions

Bassam¹,

Zaghw²,

Khan³

et al. 2021

Special Considerations in Human Airway Management

View full text Add to dashboard Cite

Pulmonary aspiration in the perioperative period is one of the well-known complications under anesthesia and procedural sedation. A full stomach condition either due to non-adherence to fasting guidelines or due to various other factors that delay gastric emptying are the most common causes. Following aspiration, a patient may develop a wide spectrum of clinical sequelae. The key factors in preventing aspiration include proper pre-operative assessment, appropriate premedication and operating room preparations. Rapid sequence induction and intubation is the recommended technique for securing the airway in cases of full stomach. Management of aspiration depends on the nature of the aspirate. Pre-operative fasting guidelines have been established by various medical societies which may be modified in special circumstances of high risk of aspiration. Prediction of difficult airway in certain cases of full stomach necessitates clinical expertise in airway management.

show abstract

Epiglottic injury and airway management – a challenging and unexpected diagnosis

Gutierres,

Guedes,

Rosa

et al. 2024

Anaesthesia Reports

View full text Add to dashboard Cite

SummaryPatients with facial trauma are complex; difficult airway management is often anticipated and challenging for the anaesthetist. Awake tracheal intubation is the gold standard in the management of predicted difficult airway because of its high success rate and safety profile. We present the case of a patient with facial trauma who underwent orotracheal intubation with combined videolaryngoscopy and flexible bronchoscopy, under conscious sedation with intermittent boluses of ketamine and dexmedetomidine. Videolaryngoscopy showed significant oedema and epiglottic laceration, not diagnosed by the computed tomography scan, with visualisation of a false passage that could have led to a failed intubation and further trauma. Airway management in patients with facial trauma is challenging and should be planned and discussed by a multidisciplinary team. A technique combining videolaryngoscopy and flexible bronchoscopy during awake intubation has previously been described and, when used in this case, was successful.

show abstract

Managing and securing the bleeding upper airway: a narrative review

Cited by 35 publications

References 80 publications

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Airway Management in Full Stomach Conditions

Epiglottic injury and airway management – a challenging and unexpected diagnosis

Contact Info

Product

Resources

About