Efficacy of Bronchofiberscope Combined with Pentax-AWS Airwayscope in Patients with Unanticipated Difficult Airway with Lingual Tonsil Hyperplasia

伸泰, 駒澤; 佐和, 真鍋; 隆介, 植木; 基, 井谷; 恒雄, 多田羅; 喜朗, 上農

doi:10.2199/jjsca.31.182

Cited by 1 publication

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“…We retrieved 48 articles: 34 in English, 2,5,9,15 –45 nine in Japanese, 46 –54 two in Spanish, 55,56 one in Korean, 57 one in French, 58 and one in Italian. 59 These articles described a total of 89 patients and 92 cases (see Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Airway management of lingual tonsillar hypertrophy: A narrative review

Wong,

Sleigh

2023

Anaesth Intensive Care

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Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.

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