Managing Known Difficult Airways in Obstetric Patients Using a Flexible Bronchoscope and IRRIS: A Case-Illustrated Guide for Nonexpert Anesthesiologists, without Surgical Backup

Abstract

Pregnancy is associated with anatomical and physiological changes leading to potential difficult airway management. Some pregnant women have known difficult airways and cannot be intubated even with a hyperangulated videolaryngoscope. If neuraxial techniques are also impossible, awake tracheal intubation with a flexible bronchoscope may be one of the few available options to avoid more invasive techniques. The Infrared Red Intubation System (IRRIS) may help nonexpert anesthesiologists in such situations and may enhance the chance of successful intubation increasing safety for the mother and the fetus, especially in hospitals without the ear, nose, and throat surgical backup.

Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit

“… 2 , 15 The patient should be positioned upright sitting and face‐to‐face with the anesthesiologist, providing both maximal luminal patency and maximal patient comfort and, hence, a reduced need for sedation. 3 , 4 , 6 …”

“…If invasive techniques are to be avoided, acute Awake Tracheal Intubation with a Flexible Bronchoscope (ATI ‐ FB) may be the best option. 1 , 3 , 4 …”

Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the Intensive Care Unit

“…2,15 The patient should be positioned upright sitting and face-to-face with the anaesthesiologist, providing both maximal luminal patency and maximal patient comfort and, hence, a reduced need for sedation. 3,4,6 The most common problems with acute ATI-FB in critically ill patients may be categorized as follows:…”

“…Some patients cannot be intubated with a hyperangulated videolaryngoscope (HA-VL). [1][2][3][4] This case-report describes a patient in respiratory failure requiring acute intubation, with previous impossible HA-VL intubation. If invasive techniques are to be avoided, acute Awake Tracheal Intubation with a Flexible Bronchoscope (ATI-FB) may be the best option.…”

“…If invasive techniques are to be avoided, acute Awake Tracheal Intubation with a Flexible Bronchoscope (ATI-FB) may be the best option. 1,3,4 The Infrared Red Intubation System (IRRIS -Guide In Medical, Nazareth, Israel) 5 may enhance the chances of success, especially, if the ATI-FB has to be performed by non-expert anaesthesiologists, who only infrequently perform FB.…”