Emergency Cricothyroidotomy for Difficult Airway Management After Asynchronous Bilateral Neck Dissections: A Case Report and Literature Review

Uehara, Masataka; Kokuryo, Shinya; Sasaguri, Masaaki; Tominaga, Kazuhiro

doi:10.1016/j.joms.2015.06.152

Cited by 7 publications

(7 citation statements)

References 45 publications

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“…Postoperative complications may prohibit healing, extend the length of hospital stays, and be life-threatening [1][2][3][4][5]. Notably, the causes of airway obstruction include postoperative hematoma, pharyngolaryngeal edema, and morphological changes of the airway; thus, appropriate airway management is required [6,7]. There are three methods of postoperative airway management: 1) extubation, 2) endotracheal intubation under sedation, and 3) tracheostomy.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Abe

Kurita

Ito

et al. 2020

Preprint

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Background: In oral cancer surgery, the decision to tracheotomize is often determined based on the experience of the surgeon. Sometimes, tracheotomy may be performed for cases that may not necessarily require tracheotomy. For such cases, safety is achieved by airway management, but the patients are exposed to tracheotomy-related complications. Several evaluation methods have been reported to predict the need for selective tracheotomy in patients with oral cancer. In this study, we investigated the competency of clinical scoring systems in identifying patients who require tracheotomy among the oral malignancy cases treated with surgery in our department, and examined the degree of agreement between the surgeon’s decision and the scores of various scoring systems. Methods: This study was conducted on 110 patients with oral cancer who were treated with surgery under general anesthesia in the Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, between January 2007 and April 2018. Among them, 67 patients (44 male and 23 female), who were managed by resection and reconstruction, were retrospectively analyzed. To derive the score, we evaluated the endpoint of these indices from clinical records and images. We divided the patients, based on the Cameron and Gupta scores, into two groups: tracheotomy and no tracheotomy groups, and evaluated the degree of agreement by calculating the κ coefficient. Results: After the assessment, the κ coefficients of the Gupta and Cameron scores were 0.61 (95% CI, 0.4-0.82) and 0.6 (95% CI, 0.38-0.82), respectively. The clinical evaluation of the κ coefficient indicated that the Gupta and Cameron scores agreed substantially. Discussion: These score matched the decision of the surgeon and confirmed that it was able to be applied to the decision of the airway management. However, these values are affected by prevalence. When unilateral total neck dissection and resection of the primary lesion were performed, though it was high-risk, the score was low, and an evaluation contradicted it. Conclusions: In this study, the Cameron and Gupta scores agreed with the decision of the experienced surgeon to some extent, and were confirmed to adapt to the clinical judgment.

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Section: Introductionmentioning

confidence: 99%

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Abe

Kurita

Ito

et al. 2020

Preprint

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“…A possible explanation for the acute respiratory obstruction was tissue swelling due to oedema after tube placement in combination with altered lymphatic drainage patterns because of the neck dissection and diminishes flexibility of tissues after radiation therapy. Another case report stated the same mechanism as the cause of an upper airway obstruction in which also an emergency cricothyroidotomy was required to handle the difficult airway 4. Our patient also had radiation therapy and neck dissection in her medical history, so this combination could be an explanation for the postoperative airway obstruction as well.…”

Section: Differential Diagnosismentioning

confidence: 59%

Emergency percutaneous transtracheal jet ventilation in a hypoxic cardiopulmonary resuscitation setting: a life-saving rescue technique

Dong¹,

Horst

Krage

2018

BMJ Case Reports

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(Un)anticipated difficult airway remains a challenge in anaesthesia. Percutaneous transtracheal jet ventilation has been shown to be an adequate technique for temporary oxygenation and ventilation and has been described as an acknowledged method in emergency settings of an unanticipated difficult airway. These emergency settings can be considered as low incidence high-risk situations. Both technical and non-technical skills should be trained regularly as education and simulation continues to play an important factor in patient safety. Furthermore, postoperative laryngeal oedema due to altered lymphatic drainage patterns must be considered as a possible mechanism of an upper airway obstruction in combination with a history of neck dissection and radiotherapy.

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“…A transverse or vertical incision is made through the skin and cricothyroid membrane [51,61]. The main long-term morbidity associated with cricothyroidotomy is the development of subglottic stenosis, so a change to standard tracheostomy within 24-48 hours is advisable [58,62]. Several techniques have been described for emergency cricothyroidotomy, including the rapid four-step technique, bougie-assisted cricothyroidotomy, and the use of cricothyroidotomy scissors [63]; however, evidence of the superiority of one technique over the others is lacking [47,64].…”

Section: B2 How Is Emergency Tracheostomy Performed? Recommendationmentioning

confidence: 99%

Guidelines for Tracheostomy From the Korean Bronchoesophagological Society

Nam

Shin

Jeong

et al. 2020

Clin Exp Otorhinolaryngol

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The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.

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Emergency Cricothyroidotomy for Difficult Airway Management After Asynchronous Bilateral Neck Dissections: A Case Report and Literature Review

Cited by 7 publications

References 45 publications

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Assessment of the degree of agreement between the judgment of tracheotomy score and the clinician: a retrospective analysis

Emergency percutaneous transtracheal jet ventilation in a hypoxic cardiopulmonary resuscitation setting: a life-saving rescue technique

Guidelines for Tracheostomy From the Korean Bronchoesophagological Society

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