Endotracheal Intubation with Flexible Fiberoptic Bronchoscopy in Patients with Abnormal Anatomic Conditions of the Head and Neck

Abstract

We perfo rmed a retrospective char t review to evaluate the indications for endotracheal intubatio n via flexi ble jiberoptic bronchoscopy in patients who were scheduled for surgery or who were hospitalized in the intensive care unit of our I,IOO-bed, tertiary care university hospital. We reviewed 9,201 clinical records of anesthetic pro cedures durin g which endotracheal intubation had been perform ed fro m Januar y to Decemb er 2002. We identified 66 patients who had been intubated withflexible jib eroptic bronchoscopy. On preanesthetic examinatio n, 61 ofthese patients fwd been fo und to be poor candidates f or conventional laryn goscopic intubat ion-51 because of abnorma l head and neck anatomy and 10 because of reduced visual access to the airway (Ma llampati class IV). The remainin g 5 patients were intubated via flexible jib eroptic bronchoscopy after conventional intubation had failed during eme rgency surgery. Our study emphasizes (1) the importan ce of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to havejib eroptic bronchoscopes and an anesthes iologist or bronchoscopist skilled in their use available in operating suites and intensive care units.

Breves consideraciones sobre el síndrome de dolor-disfunción de la ATM en el paciente con deformidad dentofacial

“…En cuanto a las ventajas destaca que no necesita de la apertura oral, que es más confortable para el paciente ya que evita el reflejo nauseoso y que es más sencilla porque evita el colapso de la vía aérea. Las desventajas de la técnica serían que emplea un tubo de menor diámetro y los posibles riesgos de traumatismo, epistaxis y tunelización submucosa 4 .…”