Wire-guided (Seldinger technique) intubation through a face mask in urgent, difficult and grossly distorted airways

Abstract

We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

Successful wire-guided fiberoptic nasotracheal intubation in a patient with hemifacial microsomia - A case report -

“…This set is intended for intubation with the LMA conduit using a FOB, bronchoscopic port, J-tip guidewire, and exchange catheter. According to Heier et al [ 3 ], once the guidewire and exchange catheter are positioned in the trachea, a tracheal tube of 5.0-mm or greater ID can be inserted. If a tracheal tube with a smaller ID is desired, intubation can be performed by threading the ETT over the guidewire alone [ 3 ].…”

“…According to Heier et al [ 3 ], once the guidewire and exchange catheter are positioned in the trachea, a tracheal tube of 5.0-mm or greater ID can be inserted. If a tracheal tube with a smaller ID is desired, intubation can be performed by threading the ETT over the guidewire alone [ 3 ]. However, because the Arndt ® Airway Exchange catheter with J-tip guide wire has not yet been introduced in Korea, it may not be easy to use routinely in the same manner as previously reported cases.…”

“…FOB-guided intubation is the most versatile and commonly used method for difficult airway management. Moreover, successful FOB intubation, using a commercially available guide wire (Arndt ® Airway Exchange catheter with J-tip guide wire, Cook Critical Care, USA) has been reported earlier [ 3 – 8 ]. However, most of these cases were intubated through the laryngeal mask airway (LMA) or face mask, while wire-guided FOB nasotracheal intubation has been rarely reported.…”

Airway Management in a Child with Goldenhar Syndrome

“…[ 3 ] This may be the safest and most effective method for difficult airway in pediatric patients with Goldenhar syndrome. Successful cases for these difficult intubations with other techniques were reported, such as pediatric GlideScope, Airtraq, wire-guided intubation, LMA,[ 4 5 ] and intubating LMA was also a good option. According to the anesthesia recommendations for patients suffering from Goldenhar syndrome, surgical airway equipment and experts should be ready.…”