The difficult airway and BURP — a truly Canadian perspective

Lam, Arthur M.

doi:10.1007/bf03012617

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…The first attempt at direct laryngoscopy should always be performed in optimal conditions after ensuring adequate muscle relaxation and appropriate position of the head and neck (normally the 'sniffing' position of head extension and neck flexion) [27]. Use of optimum external laryngeal manipulation (OELM) [28][29][30][31][32] or BURP (backward, upward, and rightward pressure on the thyroid cartilage) [33][34][35], if required, applied with the anaesthetist's right hand, should be an integral part of this first attempt [27]. If, despite these measures, there is still a grade 3 or 4 [25] view, then alternative techniques will be needed.…”

Section: Plan A: Initial Tracheal Intubation Planmentioning

confidence: 99%

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Henderson¹,

Popat²,

Latto³

et al. 2012

Anaesthesia

186

254

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Section: Plan A: Initial Tracheal Intubation Planmentioning

confidence: 99%

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Henderson¹,

Popat²,

Latto³

et al. 2012

Anaesthesia

186

254

View full text Add to dashboard Cite

“…The first attempt at direct laryngoscopy should always be performed in optimal conditions after ensuring adequate muscle relaxation and appropriate position of the head and neck (normally the ‘sniffing’ position of head extension and neck flexion) [27]. Use of optimum external laryngeal manipulation (OELM) [28–32] or BURP (backward, upward, and rightward pressure on the thyroid cartilage) [33–35], if required, applied with the anaesthetist's right hand, should be an integral part of this first attempt [27]. If, despite these measures, there is still a grade 3 or 4 [25] view, then alternative techniques will be needed.…”

Section: Plan A: Initial Tracheal Intubation Planmentioning

confidence: 99%

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Henderson¹,

Popat²,

Latto³

et al. 2004

Anaesthesia

884

327

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SummaryProblems with tracheal intubation are infrequent but are the most common cause of anaesthetic death or brain damage. The clinical situation is not always managed well. The Difficult Airway Society (DAS) has developed guidelines for management of the unanticipated difficult tracheal intubation in the non-obstetric adult patient without upper airway obstruction. These guidelines have been developed by consensus and are based on evidence and experience. We have produced flow-charts for three scenarios: routine induction; rapid sequence induction; and failed intubation, increasing hypoxaemia and difficult ventilation in the paralysed, anaesthetised patient. The flowcharts are simple, clear and definitive. They can be fully implemented only when the necessary equipment and training are available. The guidelines received overwhelming support from the membership of the DAS. Disclaimer: It is not intended that these guidelines should constitute a minimum standard of practice, nor are they to be regarded as a substitute for good clinical judgement.

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“…The patient's head was then positioned in a sniffing 18 position and DL was performed using a size 4 MacIntosh laryngoscope . The best Cormack and Lehane (CL) grade visualized, with or without backwards upwards rightward pressure, 19 was noted. The investigators then placed the patient's head back into a neutral position and any oropharyngeal secretions were systematically suctioned.…”

Section: Methodsmentioning

confidence: 94%

Patient factors associated with difficult flexible bronchoscopic intubation under general anesthesia: a prospective observational study

Touré

Williams

Kerouch

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Patient characteristics associated with difficult tracheal intubation using a flexible bronchoscope (FB) under general anesthesia have not been prospectively evaluated. This observational study aimed to identify demographic and morphologic factors associated with difficult FB intubation. Methods We recruited 420 adult elective surgery patients undergoing tracheal intubation during general anesthesia. Patients characteristics were recorded including age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status, history of snoring, obstructive sleep apnea, Mallampati score, upper lip bite test score, neck circumference and skinfold thickness, maximal neck flexion and extension angles, absence of teeth, Cormack and Lehane grade, presence of blood or secretions during intubation, as well as the inter-incisor, thyromental, sternothyroid, and manubriomental distances. The time (duration) needed to complete intubation (primary endpoint) and the number of attempts needed were correlated with these patient characteristics in a multivariable analysis. Results Intubation was successful on the first attempt in 409/420 patients (97%). Seven patients (1.7%) needed more than one attempt. Failure to intubate with the FB occurred in four patients (1%). A correlation was found between intubation duration and visibility impaired by secretions or blood (P \ 0.001), higher neck skinfold thickness (P \ 0.001), and larger endotracheal tube diameter (relative to a constant 5.5 mm FB; P \ 0.001). Conclusions The presence of secretions or blood that impair FB glottic visualization, a larger diameter endotracheal tube on the same size FB, as well as higher neck skinfold thickness may prolong the duration of FB intubation under general anesthesia. Trial registration www.clinicaltrials.gov (NCT02769819); registered 5 May, 2016.

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The difficult airway and BURP — a truly Canadian perspective

Cited by 4 publications

References 4 publications

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

Patient factors associated with difficult flexible bronchoscopic intubation under general anesthesia: a prospective observational study

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