Difficult tracheostomy tube placement in an obese patient with a short neck -A case report-

Hwang, Sung Mi; Jang, Ji Su; Yoo, Jae In; Kwon, Hyung Ki; Lee, Soo Kyung; Lee, Jae Jun; Lim, So Young

doi:10.4097/kjae.2011.60.6.434

Cited by 15 publications

(10 citation statements)

References 6 publications

(4 reference statements)

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“…Airway exchange catheters have been used for the performance of difficult tracheostomies in orotracheally intubated patients in the ICU setting. 8 A solid ETT exchanger has been used as a guidewire for difficult tracheostomy tube placement in an intubated obese patient with a short neck as reported by Hwang et al 9 However, use of hollow airway exchange catheter as described by us in previously unintubated patients has not been reported yet.…”

Section: Discussionmentioning

confidence: 99%

Innovative Use of Cook\'s Pediatric Airway Exchange Catheter in Difficult Tracheostomies

Nerurkar¹,

Jain²,

Tendolkar³

et al. 2018

Journal of Research &Amp; Innovation in Anesthesia

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Tracheostomy is a routine airway procedure performed by surgeons and anesthesiologists. However, it is a life-saving procedure in cases of severe tracheal stenosis secondary to traumatic airway injuries, or prior tracheal surgeries. Tracheostomy is challenging in these situations even in experienced hands, especially in an emergency setting, and there can be a fatal loss of airway. Cook's pediatric airway exchange catheter can be successfully used in such cases to safely achieve an appropriatesized tracheostomy even in adults. Initial transtracheal airway access is achieved with a smaller (internal diameter 3.5-4.5 mm) uncuffed endotracheal tube (ETT) to relieve obstruction and improve oxygenation. Railroading of bigger tubes over a Cook's pediatric airway exchange catheter inserted into the smaller ETT is then sequentially done to achieve a desired size of tracheostomy without loss of airway or compromised oxygenation. We describe five cases of difficult tracheostomy with the use of this technique.

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Section: Discussionmentioning

confidence: 99%

Innovative Use of Cook\'s Pediatric Airway Exchange Catheter in Difficult Tracheostomies

Nerurkar¹,

Jain²,

Tendolkar³

et al. 2018

Journal of Research &Amp; Innovation in Anesthesia

View full text Add to dashboard Cite

show abstract

“…Suction catheters, nasogastric tubes, endotracheal tube exchangers, guidewires, and Eschmann tracheal tube introducers have all been variously used in Fig. 2 Corynebacterium diphtheria the management of difficult tracheostomy tube insertion [13]. In morbidly obese patients, cervical lipectomy or ''defatting'' tracheostomy have been successfully employed to access the trachea prior to tracheostomy [14].…”

Section: Discussionmentioning

confidence: 99%

“…In the morbidly obese population, the incidence of complications from tracheostomy has been reported to be approximately 25% with an estimated mortality of 2%, attributed mainly to the loss of airway accessibility [ 12 ]. Suction catheters, nasogastric tubes, endotracheal tube exchangers, guidewires, and Eschmann tracheal tube introducers have all been variously used in the management of difficult tracheostomy tube insertion [ 13 ]. In morbidly obese patients, cervical lipectomy or “defatting” tracheostomy have been successfully employed to access the trachea prior to tracheostomy [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress

Soni

Chacko

Poorey

2020

Indian J Otolaryngol Head Neck Surg

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Difficult airway is a commonly encountered problem in the anesthesia practice, might needing otolaryngologist expert in creation of surgical airway. Supraglottic airways, surgical or needle cricothyrotomy, high frequency jet ventilation, cardiopulmonary bypass (Tunstall in Can J Anaesth 36:611-613, 1989) are initial rescue measures in such scenario. But in otolaryngology practice, patient presenting with stridor having difficult airway and difficult tracheostomy concurrently will definitely pose problems resulting in life-threatening consequences. We report cases in which difficult airway and difficult tracheostomy coexisted. (1) upper tracheal stenosis following strangulation and intubation (2) short neck with obesity (3) blunt trauma to neck with surgical emphysema (4) deep neck space infection (5) Paediatric tracheostomy in faucial diphtheria. Though difficult surgical tracheostomy in difficult airway is challenging, the anticipation of complications and planning can minimise the difficulty in the technique.

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“…Until tract maturation is complete, the layer of surrounding tissues is still loose, and hence, it could enter the pseudo tract. In particular, the risk of loss of airway is much greater if the length of the stoma track is long because of edema, bleeding, or excessive fat tissues [ 8 ]. To confirm tract maturation and remove the granulation tissue, the first tracheostomy tube exchange is usually performed by ENT surgeons 48 h after the tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening tension pneumothorax after unsuccessful tracheostomy tube exchange in a trauma patient - A case report -

2020

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Background Tracheostomy tube exchange is a common and safe procedure. However, when the tracheocutaneous tract is not completely mature, cannula exchange or endotracheal tube insertion via the tracheostomy site can rarely induce life-threatening complications, including subcutaneous emphysema, loss of airway, tension pneumothorax, and pneumoperitoneum. Case We report a case of life-threatening tension pneumothorax developed during tracheostomy tube exchange with a reinforced endotracheal tube for a planned facial surgery after recent tracheostomy in a trauma patient. Conclusions Understanding of the pathogenesis and the use of preventive strategies based on it are expected to provide safer and more effective anesthetic management to patients with tracheostomy.

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Difficult tracheostomy tube placement in an obese patient with a short neck -A case report-

Cited by 15 publications

References 6 publications

Innovative Use of Cook\'s Pediatric Airway Exchange Catheter in Difficult Tracheostomies

Innovative Use of Cook\'s Pediatric Airway Exchange Catheter in Difficult Tracheostomies

Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress

Life-threatening tension pneumothorax after unsuccessful tracheostomy tube exchange in a trauma patient - A case report -

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