Emergency tracheal intubation through intubating laryngeal mask airway in patients with stereotactic frame in situ

Kurnutala, Lakshmi N; Kinthala, Sudhakar; Padmaja, D

doi:10.4103/0019-5049.155007

Cited by 2 publications

(4 citation statements)

References 5 publications

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“…To ensure safety for patients awaiting stereotactic biopsy with a frame already in position, proactive identification of acquired difficulty in the airway management; [5] strategy to select the most appropriate 'airway' devices (supra/infra-glottic airway); [2] and combination 'approach' (conventional, guided) should be ensured. The use of various intubation 'aids' (FOB, tracheal tube introducers) should be judicially exercised…”

Section: Resultsmentioning

confidence: 99%

“…Stereotactic neurosurgery has its own share of anaesthetic implications, including those related to upper airway management. [1,2] Primarily, the application of the stereotactic frame results in a difficult-to-access airway situation due to induced neck movement limitation and difficulty with the conduct of direct laryngoscopy. [3] We present an anticipated non-difficult airway whose management became problematic due to the presence of an in-position stereotactic frame.…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic neck mobility restriction due to stereotactic fixed-frame application: Implications of a ‘non-laryngoscopic’ airway management approach

Bhutani

Dutta

Ganguly

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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Stereotactic biopsy is a common minimal access neurosurgical procedure. It requires a stereotactic frame to be secured on the head, and thereafter, based on computerised tomography scan markings on the frame, precise biopsy is retrieved. For anaesthesiologists, the application of frame poses difficulty in accessing the upper airway with the conventional laryngoscopy-intubation methodology. The various airway-access limitations imposed by an ‘in-place’ frame can be problematic and should be addressed. This report elucidates the problems caused by the presence of stereotactic frame in the management of upper airway. The approach to upper airway can be variable on a case-to-case basis, depending on attending anaesthesiologists’ decision-making and availability of equipments/devices. Here, the, recommendations on the problematic points and the suggested way thereof are presented.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iatrogenic neck mobility restriction due to stereotactic fixed-frame application: Implications of a ‘non-laryngoscopic’ airway management approach

Bhutani

Dutta

Ganguly

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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“…However, previous case reports have reported potential problems associated with airway management including failed insertion of intubating laryngeal mask airway (iLMA) and esophageal perforation following multiple intubation attempts. 2,3 Therefore, it has always been suggested to keep an Allen wrench with the patient to remove the frame in emergency situations where intubation or LMA insertion is not successful. 3 Recently, newer procedures such as SEEG and magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) may require special configurations of the standard stereotactic frame (Leksell G series frame, Elekta, Stolkhom, Sweden).…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Therefore, it has always been suggested to keep an Allen wrench with the patient to remove the frame in emergency situations where intubation or LMA insertion is not successful. 3 Recently, newer procedures such as SEEG and magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) may require special configurations of the standard stereotactic frame (Leksell G series frame, Elekta, Stolkhom, Sweden). In such applications, a straight front bar may be required, which further restricts the access to the airway and makes airway management even more difficult (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

Dalby

Iorio-Morin

Kalia

et al. 2021

Can. J. Neurol. Sci.

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Background: The use of stereotactic headframes for neurosurgical procedures requiring targeted localization continues to grow with new advancements in technology and treatment modalities. A configuration of the Leksell stereotactic G frame with a straight front bar, useful in epilepsy and laser cases, almost completely obscures oral access and presents a significant airway challenge for the anesthetist. Although previous papers have suggested that the entire headframe should be removed during an airway emergency, we describe a novel method to remove only the front bar. Methods: We performed an observational mannequin study. Anesthesia personnel from a single center were asked to intubate a mannequin with the Leksell frame fully in situ and again with the front bar removed. In addition, the time to remove the entire frame versus only the front bar was investigated. Results: Eighteen anesthesia personnel participated in the study as well as four neurosurgeons. The average time to intubate the mannequin in the frame was 23.5 (11.4) seconds and with the front bar removed, 10.9 (2.5) seconds (p < 0.001). The average time taken to remove just the front bar by the neurosurgeons was 35.4 (7.3) seconds compared to an average of 83.3 (18.6) seconds to remove the headframe entirely (p < 0.001). Conclusion: Our study demonstrates that intubating with the Leksell front bar in situ is possible with videolaryngoscopy under an ideal situation. More importantly, the removal of just the front bar is a simpler more streamlined approach requiring statistically less time to secure an airway.

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Emergency tracheal intubation through intubating laryngeal mask airway in patients with stereotactic frame in situ

Cited by 2 publications

References 5 publications

Iatrogenic neck mobility restriction due to stereotactic fixed-frame application: Implications of a ‘non-laryngoscopic’ airway management approach

Iatrogenic neck mobility restriction due to stereotactic fixed-frame application: Implications of a ‘non-laryngoscopic’ airway management approach

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

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