Tracheal extubation with a laryngeal mask airway and exchange catheter in a patient with a difficult airway

Raveendran, Raviraj; Sastry, Sunita G.; Wong, David T.

doi:10.1007/s12630-013-0041-5

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…The airway exchange catheter (AEC) has been a suggested as part of an extubation strategy when managing difficult airways that may require re‐intubation . The AEC is a long hollow tube inserted through a tracheal tube before extubation.…”

Section: Resultsmentioning

confidence: 99%

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

et al. 2016

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Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment. The findings in the section on Intensive Care and Emergency Medicine reinforce the importance of good airway management in the critical care environment and, in particular, the need for appropriate guidelines to improve patient safety. This narrative review focuses on strategies for safe extubation of the trachea for patients with potentially difficult upper airway problems in the intensive care unit.

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Section: Resultsmentioning

confidence: 99%

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

et al. 2016

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“…Recent data show a relevant incidence of between 11% and 64% of patients who need to receive a change of out-of-hospital airway management during emergency care due to insufficient ventilation [ 2 , 4 ]. Numerous case reports and several studies have been published concerning complications or successfully applied techniques in such situations [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Limited visualisation because of the established TT, secretions, oedema in patients with sepsis, limited spine mobility due to cervical spine injury, and restricted positioning resources may complicate laryngoscopy, especially conventional direct laryngoscopy (DL) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are many methods that can be used for TT or SGA exchange to reduce severe adverse events during the procedure. All safe methods should include optimal glottis visualisation, clearing the pathway for TT exchange, and ensuring airway continuity with airway exchange catheters (AECs) [ 11 , 12 , 14 ]. Recently, the use of video laryngoscopy (VL) has increased glottis visualisation and intubation success in difficult airway situations [ 14 , 15 , 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study

Kriege,

Demare,

Ruemmler

et al. 2023

JCM

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Background: The swapping of a supraglottic airway device or a tracheal tube in anaesthetised adult patients is a challenging procedure because potential complications through hypoxemia and loss of airway may occur, with life-threatening implications. This study aims to evaluate which airway technique offers the highest success rate concerning a secure airway in established supraglottic airway and tracheal tube airway exchange scenarios. Methods: After ethical approval, anaesthesiologists were randomised 1:1 into simulated scenarios: an LTS group (malpositioned laryngeal tube) and a Cuff group (relevant cuff leakage of a placed tracheal tube). After that, both groups completed a common scenario consisting of a partially obstructed tracheal tube lumen in a fixed prone position with a Mayfield clamp. The primary endpoint was a successful tracheal airway exchange within ten minutes after the start of the scenario and before severe hypoxemia (SpO2 < 80%) arose. Secondary endpoints were the evaluation of factors influencing success after 10 min. Results: In total, 60 anaesthesiologists (LTS group n = 30; Cuff group n = 30) with a median experience of 7 years (IQR 4-11) were observed. Within 10 min, a malpositioned laryngeal tube was successfully exchanged by 27/30 (90%) participants, compared to the exchange of a tracheal tube with a relevant cuff leakage by 29/30 (97%; p > 0.05). An airway exchange in an obstructed tube scenario occurred in 22/59 (37%). Loss of airway maintenance showed an obvious association with failure in the common scenario (p = 0.02). Conclusion: The results of this simulation-based study reflect that the exchange of an existing but insufficient airway device in clinical practice is a high-risk procedure. Especially in a fixed prone position, the deliberate evaluation of the existing airway patency and well-conceived airway management in the case of the accidental loss of the airway or obstructed airway access are crucial.

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“…The laryngeal mask airway (LMA) is frequently used as an effective and safe airway adjunct in general anesthesia [1,2]. In clinical practice, a situation arises occasionally where internal jugular vein (IJV) catheterization after LMA insertion is required [3,4].…”

Section: Introductionmentioning

confidence: 99%

Effect of Positive End-Expiratory Pressure on Overlap Between Internal Jugular Vein and Carotid Artery in Mechanically Ventilated Patients with Laryngeal Mask Airway (LMA) Insertion – A Prospective Randomized Trial

Chen

et al. 2019

Med Sci Monit

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Background In the present study, we aimed to determine the effect of different positive end-expiratory pressure (PEEP) levels on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) and the overlap index between the RIJV and the right common carotid artery (RCCA) in mechanically ventilated patients with laryngeal mask airway (LMA) insertion. Material/Methods A total of 60 patients who were scheduled for elective surgery under general anesthesia with LMA insertion were enrolled. After LMA insertion, the image of RIJV and RCCA were taken after applying 4 different PEEPs in a random order: 0 (P0), 5 (P5), 10 (P10), and 15 (P15) cm H 2 O. The CSA, transverse and anteroposterior (AP) diameters of the RIJV, and the overlap index were measured. Results Compared to group P0, the overlap indexes of P10 ( P =0.0032) and P15 ( P <0.001) were significantly increased, but without a significant trend toward further increases in group P15. PEEP at 10 and 15 cm H 2 O increased CSA, transverse and AP diameter of the RIJV in comparison to group P0 (all P <0.001). There was a statistically significant increase in CSA of the RIJV in P15 compared with P10 by 12.2% ( P <0.001), but did not reach the relevant cut-off value (ΔCSA ≥15%). Conclusions The application of PEEP at 10 cm and 15 cm H 2 O in patients receiving mechanical ventilation with LMA insertion significantly increases the size of the RIJV. However, the overlap index between the RIJV and the RCCA increased as well.

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Tracheal extubation with a laryngeal mask airway and exchange catheter in a patient with a difficult airway

Cited by 6 publications

References 5 publications

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

Exchange of a Tracheal Tube and Supraglottic Airway Device: Evaluation of Different Techniques in Three Simulated Airway Scenarios (TUBE Study)—A Prospective, Randomised Controlled Study

Effect of Positive End-Expiratory Pressure on Overlap Between Internal Jugular Vein and Carotid Artery in Mechanically Ventilated Patients with Laryngeal Mask Airway (LMA) Insertion – A Prospective Randomized Trial

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