Awake Fibreoptic Intubation in a Pregnant Patient with a Laryngeal Cyst

Prabhu, Archana; ManNally, Laura; Pradhan, P.; Amin, Hazem H

doi:10.5005/jp-journals-10027-1014

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

“…Specific pathology‐related airway or respiratory investigations included two‐dimensional airway reconstruction from CT images and intrathoracic anatomy . In 15 women, awake laryngoscopy/nasendoscopy was carried out to assess laryngoscopy view before making a decision on anaesthetic technique , although most of these were before non‐obstetric surgery.…”

Section: Resultsmentioning

confidence: 99%

“…We identified 52 women having awake flexible bronchoscopic intubation, all but eight of whom were at caesarean section [7,11,24,25,29,31,38,42]; five women also had thyroidectomy performed under the same anaesthetic (see also Supporting Information, Appendix S1). Three women underwent flexible bronchoscopic intubation after an initial direct laryngoscopy showed a poor view [9,20,38]. In five women, bronchoscopic intubation followed failed regional anaesthesia [10,14,16,27,35].…”

Section: Awake Tracheal Intubation Using the Flexible Bronchoscopementioning

confidence: 99%

“…In 15 women, awake laryngoscopy/nasendoscopy was carried out to assess laryngoscopy view before making a decision on anaesthetic technique [20,23,38,39,51,53,59,60,80,96,112,130,133,137,142], although most of these were before non-obstetric surgery.…”

Section: Airway Assessmentmentioning

confidence: 99%

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Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Awake Tracheal Intubation Using the Flexible Bronchoscopementioning

confidence: 99%

Section: Airway Assessmentmentioning

confidence: 99%

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Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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“…We found only two case reports of symptomatic glottic lesions during pregnancy. One case was managed with an awake fibreoptic intubation in a patient with a large glottic lesion [5] and the other was managed with a rapid sequence induction followed by sub-glottic jet ventilation [6]. We describe the first awake videolaryngoscopic intubation supplemented with THRIVE in a pregnant patient with a laryngeal lesion.…”

Section: Introductionmentioning

confidence: 99%

Awake videolaryngoscopic intubation in a pregnant patient with a large vocal cord lesion

2016

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We describe the case of a 39-year-old female, 29 weeks pregnant who required urgent excision of a large laryngeal lesion. This was symptomatic, almost completely obstructing her glottis and creating a ball-valve effect. Rapid progression of the lesion made the patient increasingly dyspnoeic and stridulous over the course of 2 weeks from presentation until surgery. Due to pregnancy-related challenges and additional risks of complete airway obstruction, we conducted an awake videolaryngoscopic intubation supplemented with Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) for oxygenation.We discuss the anaesthetic challenges and management of this case, in particular this patient's airway pathology in the context of pregnancy. An overview of laryngeal pathology under the influence of pregnancy hormones is also presented.

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Tongue depressor as an intubation aid in a patient with vallecular cyst: A case report

Monem¹,

Khan²,

Awan³

2018

jaccr

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Introduction: Vallecular cyst is a rare occurring often encountered incidentally, which may compromise the airway during induction of anesthesia. There is a high risk for cyst rupture and soiling of the airway during manipulation of the airway. Case Report: We report a case of a young 23-year-old female with a history of difficulty in breathing and swallowing for the past 1½ years. She underwent emergency tracheostomy and excision of some oral swelling 10years back. She was electively booked for excision of the cyst. Various techniques and instruments have been described in the past. We used a tongue depressor to gently push the cyst aside and successfully rail loaded a reinforced endotracheal tube over a gum elastic bougie. Conclusion: Intubation in a patient with oropharyngeal cyst poses a significant risk in view of complete airway obstruction or aspiration of the contents in case rupture of the cyst. Various techniques for intubation have been reported, either awake or under general anesthesia. We successfully used a tongue depressor to shift the cyst away as an aid for intubation. This technique has so far not been reported in the literature. Keywords: Vallecular cyst, induction, tongue depressor.

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Awake Fibreoptic Intubation in a Pregnant Patient with a Laryngeal Cyst

Cited by 3 publications

References 11 publications

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Awake videolaryngoscopic intubation in a pregnant patient with a large vocal cord lesion

Tongue depressor as an intubation aid in a patient with vallecular cyst: A case report

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