Capnography During Fiberoptic Bronchoscopy to Verify Tracheal Intubation

Wolf, Laura; Gravenstein, Dietrich

doi:10.1213/00000539-199709000-00040

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…551,552 Case reports also observed intubation confirmation with capnography Category B4-B evidence). 354,553 The literature is insufficient to evaluate whether visualization (any technique), flexible bronchoscopy, ultrasonography, or radiography can be effective in confirming appropriate tracheal intubation. Survey Findings.…”

Section: Confirmation Of Tracheal Intubationmentioning

confidence: 99%

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2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

593

547

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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Section: Confirmation Of Tracheal Intubationmentioning

confidence: 99%

“…224–227,300–303 Case reports also observed successful intubation with flexible intubation scopes (Category B4-B evidence ). 304–356…”

Section: Anticipated Difficult Airway Managementmentioning

confidence: 99%

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

593

547

View full text Add to dashboard Cite

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“…However, many head and neck cancer patients with a difficult airway have large tumours that obstruct the airway, so supraglottic carbon dioxide measurements will usually not be displayed as a normal‐shaped capnogram. After the vocal cords are passed, a characteristic E t co 2 waveform is seen, which is also distinct from the irregular, rapidly diminishing capnograms observed with oesophageal intubation and ventilation of the stomach as has been studied by others [8]. The time intervals of the auto calibration function of the capnograph should be checked, to prevent calibration at the crucial moment when carbon dioxide measurements are required.…”

Section: Discussionmentioning

confidence: 89%

Awake fibrecapnic intubation in head and neck cancer patients with difficult airways: new findings and refinements to the technique*

et al. 2007

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SummaryRecently, we described an adaptation of awake fibreoptic intubation that we call awake fibrecapnic intubation. The aim of this study was to evaluate the efficacy and risk of complications with this novel technique in a consecutive case series of head and neck cancer patients known to have difficult airways.We prospectively studied 40 consecutive intubations in head and neck cancer patients prior to a diagnostic or surgical procedure. Following topical anaesthesia, a flexible bronchoscope was introduced into the pharynx; spontaneous respiration was maintained in all patients. A special suction catheter was advanced into the airway through the suction channel of the bronchoscope for carbon dioxide measurements. When four capnograms were obtained, the bronchoscope was railroaded over the catheter and a tracheal tube was placed. All adverse events and complications were recorded.There were no complications associated with the technique. The median (range) time to intubation was 3 min (1.5-15 min). All patients were intubated successfully, 39 (98%) of them using awake fibrecapnic intubation. There was one patient with severe tumour bleeding and acute airway obstruction caused by advancement of the tube over the bronchoscope. This was not considered to be a complication of the fibrecapnic technique. Awake fibrecapnic intubation is a safe and valuable technique in head and neck cancer patients with a difficult airway. We recently described a novel intubation technique 'Awake Fibrecapnic Intubation' (AFcI) [1]. This technique was developed for the intubation of head and neck cancer patients with a difficult airway. It is an adaptation of fibreoptic intubation. A suction catheter is advanced through the working channel of the bronchoscope and repeated carbon dioxide measurements are possible. With this technique, safe intubation is possible when visibility of pharyngeal and laryngeal structures is limited or the anatomy is unrecognisable. In cases of severe airway obstruction, the suction catheter will enter the trachea before the tip of the bronchoscope occludes the airway. We wish to report a further 25 patients and describe some new findings and refinements to the technique.The aim of the current study was to evaluate the efficacy and risk of complications in a consecutive series of 40 intubations. The first 15 intubations that were previously described are included in this consecutive case series [1].

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“…Capnography is considered the most reliable test to confirm correct placement of a tracheal tube [7]. Recently, other authors have used capnography during fibreoptic bronchoscopy to verify tracheal intubation, connecting the capnograph to the working port of the fibrescope [8–10]. However, a special catheter to explore the airway has not been used.…”

Section: Discussionmentioning

confidence: 99%

Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway*

2006

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SummaryAwake fibreoptic intubation is the gold standard for difficult airway management but failures are reported in the literature in up to 13% of cases. In case of failure, a tracheotomy is often indicated. We describe a novel technique for intubation in head and neck cancer patients with a difficult airway that we call awake fibrecapnic intubation. The aim of this study was to investigate the feasibility of this technique. We studied prospectively 15 consecutive intubations in head and neck cancer patients before diagnostic or therapeutic surgical procedures. After topical anaesthesia, a fibrescope was introduced into the pharynx. Spontaneous respiration was maintained in all patients. Through the suction channel of the fibrescope a special suction catheter was advanced into the airway for carbon dioxide measurements. When four capnograms were obtained, the fibrescope was railroaded over the catheter and after identification of tracheal rings, a tracheal tube was placed. Tracheal intubation was successful in all patients without bleeding or complications, with a median (range) time to intubation of 3 (2-15) min. Identification of the vocal cords and glottis was difficult in four patients due to extensive anatomical abnormalities or poor visibility; even in these patients, a capnogram was obtained within 4 s.

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Capnography During Fiberoptic Bronchoscopy to Verify Tracheal Intubation

Cited by 9 publications

References 9 publications

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Awake fibrecapnic intubation in head and neck cancer patients with difficult airways: new findings and refinements to the technique*

Awake fibrecapnic intubation: a novel technique for intubation in head and neck cancer patients with a difficult airway*

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