Recognition and Management of the Difficult Airway with Special Emphasis on the Intubating Lma-Fastrach/Whistle Technique: A Brief Review with Case Reports

Rich, James M.

doi:10.1080/08998280.2005.11928072

Cited by 11 publications

(12 citation statements)

References 27 publications

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“…Such a situation also makes it difficult to impossible to do a subsequent FFB assisted intubation or use of any such device [3]. However in our study an attempt at blind intubation was always made by a senior experience anesthetist before the FFB was brought into the picture.…”

Section: Discussionmentioning

confidence: 95%

“…Difficult tracheal intubation has been reported in cases from all specialties with varying rates of incidence [3]. There are many methods suggested for the identification and anticipation of such cases.…”

Section: Discussionmentioning

confidence: 99%

“…intra oral disproportion [5]. Various other methods have been suggested like the multivariate airway risk index with logical regression proposed by el Ganzouri and the 6 D method of James Rich [3,6]. Even though methods which take into consideration multiple factors are in general more reliable than those which don't [2], none of the methods are infallible, each having its own drawbacks.…”

Section: Discussionmentioning

confidence: 99%

“…Since then many devices and techniques have been developed for easing the task of intubation. These include the laryngeal mask airway, retrograde intubation, indirect rigid fiberoptic laryngoscopy, FFB, the lightwand, videolaryngoscopic devices and the malleable fiberoptic stylet [3]. Devices like various kinds of fiberoptic compatible oral airways have also been made which facilitate the process of FFB aided intubation while keeping the airway patent [13].…”

Section: Discussionmentioning

confidence: 99%

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A Study of Flexible Fiberoptic Bronchoscopy Aided Tracheal Intubation for Patients Undergoing Elective Surgery Under General Anesthesia

Ajay

Singhania

Akkara

et al. 2012

Indian J Otolaryngol Head Neck Surg

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A difficult airway complicates up to one tenths of cases of elective general anesthesia. Such situations can be anticipated and tackled by fiberoptic flexible bronchoscopy (FFB) assisted tracheal intubation. To study the indications and outcomes of FFB assisted tracheal intubation in patients with anticipated difficult airway, who are undergoing surgery under general anesthesia. Cases who were intubated using FFB assistance were included in the study. Detailed examination was done pre operatively to be able to predict the difficult airway. Intubation was done with the help of a FFB after induction of general anesthesia. There were total 52 cases. Majority were male and in the fourth decade of life. Oral submucous fibrosis was the commonest indication for the procedure. There were two cases of failure, but no significant mortality or morbidity. A difficult airway can be encountered across specialties. It can be anticipated by simple or multi factorial methods. Awake FFB aided intubation is the gold standard in cases of anticipated difficult airway. Failure rates of 4-66 % have been reported. In the present study the failure rate was less than 4 % with no morbidity or mortality. FFB assisted intubation is safe and effective in paediatric patients too. FFB assisted intubation done in an organised and skilled manner is a very important skill to have to tackle cases of difficult intubation. Hence it should be included in training programmes of anesthesia.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Study of Flexible Fiberoptic Bronchoscopy Aided Tracheal Intubation for Patients Undergoing Elective Surgery Under General Anesthesia

Ajay

Singhania

Akkara

et al. 2012

Indian J Otolaryngol Head Neck Surg

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“…33 In 2005, a case series was published describing the use of the airway whistle with the FT-LMA in four patients with known difficult airways (the status of two patients was post neck radiation for neck cancers, and two patients were morbidly obese [body mass indexes (BMI) of 49.1 kgÁm -2 and 72.8 kgÁm -2 ]). 34 The FT-LMA was inserted awake in each case, and placement was optimized using the Chandy maneuvers based on the loudest whistling that was produced during inspiration and exhalation. In three of the four patients (in the fourth patient no whistle was used for ETT placement), the clinicians proceeded with intubation that too was guided by use of the airway whistle.…”

Section: Miscellaneous Techniquesmentioning

confidence: 99%

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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Purpose To provide an evidence-based overview and update on the use of the Fastrach TM Intubating Laryngeal Mask AirwayÒ (FT-LMA) when used within operative and non-operative settings. Principal findings The FT-LMA is available in three sizes to provide ventilation and the ability to pass an endotracheal tube (ETT) into the trachea blindly, semi-blindly, or with indirect visualization for patients over 30 kg. The Chandy maneuver is recommended routinely; the first maneuver optimizes ventilation, and the second maneuver increases success at endotracheal intubation (ETI). The manufacturer's reinforced tube or a pre-warmed or reversed standard ETT may be utilized. Insertion and ventilation are successful in almost all patients. Blind ETI is highly successful; adjuncts are generally not necessary. The FT-LMA has a proven role in the airway management of anticipated difficult operating room (OR) intubations, unanticipated OR intubations, cervical spine injuries, and limited airway access situations. Literature in the pre-hospital and emergency department settings is limited but favourable. The FT-LMA has compared favourably with fibreoptic intubation, the LMA-Classic TM , the laryngeal tube, and the CobraPLA TM . Initially, the more expensive LMA CTrach TM appeared to be more successful, but overall it is not. The FT-LMA airway seal pressures are excellent; serious complications are uncommon, and the FT-LMA figures prominently in most difficult airway guidelines. Conclusions The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. Constatations principales Le FT-LMA est disponible en trois tailles pour permettre la ventilation et le passage d'une sonde endotrache´ale (SET) dans la trache´e de façon aveugle, semi-aveugle ou avec visualisation directe chez les patients pesant plus de 30 kg. La manoeuvre de Chandy est recommande´e de façon routinie`re; la premie`re manoeuvre optimise la ventilation, et la seconde augmente le succe`s lors d'une intubation endotrache´ale (IET). La sonde arme´e du fabricant ou une SET standard pre´chauffe´e ou inverse´e peut eˆtre utilise´e. L'insertion et la ventilation re´ussissent chez presque tous les patients. L'IET en aveugle a un taux de re´ussite e´leve´; en re`gle ge´ne´rale, les accessoires ne sont pas ne´cessaires. Le FT-LMA joue un rôle e´prouve´dans la prise en charge des voies ae´riennes lors d'intubations anticipe´es comme difficiles dans la salle d'ope´ration (SOP), d'intubations impre´vues en SOP, de le´sions de la colonne cervicale et dans les situations oul 'acce`s aux voies ae´riennes est limite´. La litte´rature portant sur son utilisation dans des contextes pre´-hospitaliers et dans le de´partement des urgences est restreinte mais favorable. Le FT-LMA a e´te´favorablement compare´al 'intubation par fibroscopie, au LMA...

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Airway Management

Schälte¹

Evidenzbasierte Medizin in Anästhesie Und Intensivmedizin

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Recognition and Management of the Difficult Airway with Special Emphasis on the Intubating Lma-Fastrach/Whistle Technique: A Brief Review with Case Reports

Cited by 11 publications

References 27 publications

A Study of Flexible Fiberoptic Bronchoscopy Aided Tracheal Intubation for Patients Undergoing Elective Surgery Under General Anesthesia

A Study of Flexible Fiberoptic Bronchoscopy Aided Tracheal Intubation for Patients Undergoing Elective Surgery Under General Anesthesia

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Airway Management

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