Videolaryngoscope‐assisted flexible intubation tracheal tube exchange in a patient with a difficult airway

Abstract

An 88-year-old woman presented with acute airway obstruction caused by a large retrothyroid bleed following anterior neck trauma. Her airway was secured in the operating theatre with an awake nasal flexible optical bronchoscope tracheal intubation using an Intubating Laryngeal Mask Airway tracheal tube. Haemostasis was achieved following surgical ligation and the patient was transferred to the critical care unit. Postoperatively, a large leak around the tracheal tube was noted and a decision was made to change to an orotracheal tube with a subglottic drainage port. Our exchange technique required two experienced operators. The first operator used videolaryngoscopy with a hyperangulated blade to establish an optimal view of the larynx. The second operator placed an airway exchange catheter through the existing nasal tracheal tube to ensure airway control. The trachea was then intubated orally using a flexible optical bronchoscope observed under direct vision using the videolaryngoscope. The technique combined several simple and well-documented approaches, but importantly, the airway remained secure and visible throughout the procedure.

Combined use of the GlideScope and flexible fiberoptic bronchoscope after several failed intubation attempts for a retrosternal thyroid mass: a case report

“…Saunders et al described videolaryngoscopy-assisted flexible intubation in the context of exchanging ETT, highlighting the significance of combining techniques to maintain a visible airway throughout the procedure. 11 Greib et al successfully performed tracheal intubation on 16 patients using a VLS and a flexible bronchoscope. 12 Young et al reported a case of successful airway management using a McGrath MAC VLS and a flexible bronchoscope in a morbidly obese patient with large goiter.…”

Airway management equipment and practice: time to optimise institutional, team, and personal preparedness

“…Videolaryngoscopy is used universally and after 5 yr we believe that we are still learning new skills and benefitting our patients. 27 We removed all first-generation SGAs from use 3 yr ago (except for flexible laryngeal masks for head and neck surgery) and have only two types of second-generation SGA available for routine (and rescue) use. Point-of-care eFONA kits (a scalpel, a bougie, and a tracheal tube) are boxed and available in every location where anaesthesia takes place.…”

Reports in anaesthesia come of age!

“…Saunders et al. are the first to describe a novel approach to videolaryngoscope‐assisted flexible intubation tracheal tube exchange, which, using a combination of several simple techniques, ensures the airway remains secure and visible throughout . They provide an excellent recipe to navigate this challenging scenario which will be of use to all clinicians.…”