Awake Laryngoscopy in the Emergency Department

Tonna, Joseph E.; DeBlieux, Peter M.C.

doi:10.1016/j.jemermed.2016.11.013

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Alternatively, this study provides the option to use 4% xylocaine gargle with equal efficacy in reduction of bouts of cough. The anesthetic effect given by 4% xylocaine gargle was suitable for performing the VLS [33][34][35]. However, the risk of aerosols generation during the gargle was found to be more.…”

Section: Discussionmentioning

confidence: 99%

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases

Gandhi

Bhatta

Saindani

et al. 2020

Indian J Otolaryngol Head Neck Surg

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To prepare safety protocols for performing videolaryngoscopy (VLS) during COVID-19 pandemic, that would be feasible for patients, hospital and the health care providers. This was a prospective study performed from March 01, 2020 to June 30, 2020. It analyzed the precautions adapted for VLS initially and subsequently describes modifications with the time. The safety protocols are developed considering the safety aspect, the feasibility aspect (due to increase in number of the VLS), and the financial aspect. The VLS was performed with the personal protective equipment (PPE), including the face shield mask and head cover. The PPE was re-used after sterilization with ethylene oxide. For local anesthesia, the oropharynx was sprayed with 15% xylocaine and nose packed with 4% xylocaine soaked pledget. Following the VLS, the scope was wiped three times with 80% alcohol and then immersed in 5.25% sodium hypochlorite and 0.55% orthophthalaldehyde for 10 min each. Each VLS was spaced by at least 15 min gap. The endoscopy suite maintained with laminar air flow. It can be concluded that during the COVID-19 pandemic, the VLS must be performed using PPE with proper sterilization of the scope and the endoscopy suite after the procedure. The use of face shield mask and 15% xylocaine spray into the oropharynx were also highlighted. The financial burden should be minimized by reusing the materials whenever possible.

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Section: Discussionmentioning

confidence: 99%

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases

Gandhi

Bhatta

Saindani

et al. 2020

Indian J Otolaryngol Head Neck Surg

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“…On the other hand, etomidate—which is a nonbenzodiazepine sedative—has been shown to be relatively hemodynamically neutral [ 4 , 5 ], which means there is actually no need for dose reduction in shocked patients [ 11 ]. Ketamine is a particularly suitable agent in this situation due to sympathomimetic properties [ 3 , 5 , 12 , 13 ]. In addition, some neuromuscular blocking agents have indirect cardiovascular effects through histamine release and parasympathetic activity which should also be taken into consideration [ 3 – 5 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ketamine is a particularly suitable agent in this situation due to sympathomimetic properties [ 3 , 5 , 12 , 13 ]. In addition, some neuromuscular blocking agents have indirect cardiovascular effects through histamine release and parasympathetic activity which should also be taken into consideration [ 3 – 5 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…If intubation of a patient with severe metabolic acidosis is necessary, preserving spontaneous respiration is critical both during intubation and with mechanical ventilation. Throughout induction and intubation, it is important to avoid even very brief periods of apnea as any additional CO 2 accumulation can drive a critically low pH even further down and trigger cardiac arrest [ 3 – 5 , 12 , 14 ]. Transnasal humidified rapid-insufflation ventilatory exchange and similar methods that combine the benefits of apneic oxygenation with continuous positive airway pressure and gaseous exchange through flow-dependent dead-space flushing may be particularly useful in this case to increase apnea time [ 4 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Physiologically Difficult Airway in the Patient with Severe Hypotension and Metabolic Acidosis

Capone

Glunčić

Lukić

et al. 2020

Case Reports in Anesthesiology

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The expertise to recognize and manage the difficult airway is essential in anesthesiology. Conventionally, this refers to anatomical concerns causing difficulties with facemask ventilation and/or with tracheal intubation. Severe derangements in patients’ physiology can make induction and intubation likewise difficult, and approximately 30% of critically ill patients had cardiovascular collapse subsequently to intubation. We present the case of a 58-year-old male with a past medical history of type II diabetes and hypertension who presented with altered mental status due to severe metabolic acidosis with a pH of 6.8 on admission to the intensive care unit. The anesthesia team was called to urgently intubate the patient. Upon arrival, the patient was localizing to pain and was hypocapnic, tachycardic, and hypotensive despite ongoing therapy with norepinephrine, vasopressin, and bicarbonate drips. Bedside point-of-care ultrasound showed hyperdynamic left ventricle with no other abnormalities. The patient was induced with IV ketamine, and dissociation occurred with maintenance of spontaneous respirations, which was followed by laryngoscopy and intubation causing only minimal hemodynamic changes. The patient was subsequently dialyzed and treated supportively. He was discharged from the hospital two weeks later—neurologically intact and at his baseline. Combination of hypotension and severe metabolic acidosis is particularly a challenging setting for airway management and a major risk factor for adverse events, including cardiopulmonary arrest. Hemodynamically stable induction agents should be preferred. In addition, sustaining spontaneous ventilation and avoiding periods of apnea in the peri-intubation period is paramount—any buildup of CO2 could push a critically low pH even lower and cause cardiovascular collapse. Sympathomimetic properties of ketamine make this induction agent a particularly appealing choice in this setting. This case report further supports the concept that severe physiologic perturbations—in which conventional induction techniques are not feasible—should be included in the current definition of a difficult airway.

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“…Inexpensive disposable in‐line manometers are available for BVMs and their use is recommended to avoid excessive manual ventilation pressures, which can increase the risk of gastric insufflation and regurgitation . Alternatively, avoiding RSI altogether and performing an awake intubation is sometimes the most prudent course of action in the physiologically compromised patient . It is worth noting that a HNFC system can also be used during awake intubations to prevent desaturation …”

mentioning

confidence: 99%

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

Sakles

2017

Academic Emergency Medicine

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Awake Laryngoscopy in the Emergency Department

Cited by 14 publications

References 19 publications

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases

Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases

Physiologically Difficult Airway in the Patient with Severe Hypotension and Metabolic Acidosis

Maintenance of Oxygenation During Rapid Sequence Intubation in the Emergency Department

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