Efrain Cubillo IV, MD
Narjeet Khurmi, MD, Use of Glidescope in Trial Extubation of the Difficult Airway(2016)SDRP Journal Of Anesthesia & Surgery 1(1)
Commonly patients arrive to the operating suites with potential airway issues. They include pregnant woman, patients with cervical spine arthritis, the morbidly obese and patients who have had multiple and prolonged intubations. An estimated 40% of the adult population is deemed to be obese based on Body Mass Index.12 Many intubated patients experience a degree of laryngeal edema or swelling (see figure 1 and 2). However, symptoms typically remain subclinical. Frequent laryngoscopy can lead to laryngeal edema and trauma. The duration of endotracheal intubation is directly correlated to degree of edema. Intraoperative fluid management and fluid shifts can also aggravate laryngeal edema.5 Early re-intubation (0-72 hours post-extubation) occurs about 12% of the time.5 Safely managing a difficult airway (expected or unexpected) is critical to the overall well-being of the patient. Many evaluations and precautions are taken at the onset of an anesthetic. One should be just as vigilant at the conclusion of an anesthetic involving a challenging airway to avoid post-extubation complications. While guidelines to safely plan and perform extubation exist, the use of modern technology seems to be less prevalent. Using a video laryngoscope to evaluate the airway prior to extubation can be a valuable adjunct in the overall assessment of readiness to extubate a patient. In this report we describe a case of failed extubation and the ultimate use of video laryngoscopy to assist in the decision making process to extubate or perform a tracheostomy.
Cavallone L, Vannucci A. Extubation of the Difficult Airway and Extubation Failure. Anesthesia & Analgesia 2013; 116:368-383. PMid:23302983View Article PubMed/NCBI
Karmarkar S, Varshney S. Tracheal Extubation. Contin EducAnaesthCrit Care Pain 2008;8:7.View Article
Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the Difficult Airway: A closed claims analysis. Anesthesiology 2005;103:33-9. PMid:15983454View Article PubMed/NCBI
Asai T, Koga K, Vaughan S. Respiratory complications associated with tracheal intubation and extubation. British Journal Anesthesia 1998;80:767-75.View Article
Faris K, Zayaruzny M, Spanakis S. Extubation of the Difficult Airway. Journal of Intensive Care Medicine;26(4) 261-266.
King C, Moores L, Epstein S. Should Patients be able to Follow Commands Prior to Extubation? Respiratory Care; Jan 2010 (55) 56-65. PMid:20040124View Article PubMed/NCBI
Keenan MA, Stiles CM, Kaufman RL. Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis. Use of the fiberoptic bronchoscope in rheumatoid disease. Anesthesiology 1983;58;441-9. http://www.ncbi.nlm.nih.gov/pubmed/19293691 http://www.ncbi.nlm.nih.gov/pubmed/21447488 http://www.jcafulltextonline.com/article/S0952-8180(03)00132-6/abstract http://www.ncbi.nlm.nih.gov/pubmed/11979168 http://www.ncbi.nlm.nih.gov/pubmed/24108263 https://doi.org/10.1097/00000542-198305000-00009 PMid:6837996View Article PubMed/NCBI
Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Anesthesiology 2009; 110:891-7. PMid:19293691View Article PubMed/NCBI
Cook TM, Woodall N, Frerk C. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British Journal of Anaesthesia 2011; 106: 617-310. PMid:21447488View Article PubMed/NCBI
Kuczkowksi KM, Reisner LS, Benumof JL. Airway problems and new solutions for the obstetric patient. Journal Clinical Anesthesia 2003; 15:552-563.View Article
Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine 2002; 27:949-953. PMid:11979168View Article PubMed/NCBI
Joshi G, Ahmad S, Riad W, Eckert S, Chung F. Selection of Obese Patients undergoing ambulatory surgery: A systematic review of the literature. Anesthesia & Analgesia Nov 2013; 117: 1082-1091. PMid:24108263View Article PubMed/NCBI
Fandino L, Tarazona N., Diaz J. Reflux laryngitis: an Otolaryngologist's perspective. Rev Col Gastroenterol [online]. 2011, vol.26, n.3, pp. 198-206.
Barash P, Cullen B, Stoelting R. Clinical Anesthesia - 4th edition. Page 614.
Newmark J, Ahn Y, Adams M, Bittner E, Wilcox S. Use of Video Laryngoscopy and Camera Phones to Communicate Progression of Laryngeal Edema in Assessing for Extubation: A Case Series. Journal of Intensive Care Medicine 2013; 28(1): 67-71. PMid:22337710View Article PubMed/NCBI
Ochoa ME, Marin C, Frutos-Vivar F. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systemic review and meta-analysis. Intensive Care Medicine 2009; 35(7): 1171-1179. PMid:19399474View Article PubMed/NCBI
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 2001; 120: 1262-1270. PMid:11591570View Article PubMed/NCBI
Wittekamp B, van Mook W, Tjan D, Zwaveling J. Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. Critical Care 2009; 13:233-242. PMid:20017891 PMCid:PMC2811912View Article PubMed/NCBI
Wattenmaker I, Concepcion M, Hibberd P, Lipson S. Upper airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surgery Am 1994; 76: 360-365.View Article
Burke CM, Walsh MT, Pryor SG, Kasperbauer JL. Severe postextubation laryngeal obstruction: the role of prior neck dissection and radiation. Anesthesia and Analgesia 2006; 102: 322-325. PMid:16368851View Article PubMed/NCBI
Wegmuller B, Hug K, Meier Buenzli C, Yuen B, Maggiorini M, Rudiger A. Life-threatening laryngeal edema and hyponatremia during hysteroscopy. Crit Care Res Pract 2011; 2011: 140381.View Article
Chassot PG, Marucci C, Delabays A, Spahn DR. Perioperative antiplatelet therapy. AmFam Physician 2010; 82:1484-1489. PMid:21166368PubMed/NCBI
Erdos G, Tzanova I. Perioperative anesthetic management of mediastinal masses in adults. Eur J Anesthesthesiology 2009; 26:627-632. PMid:19384235View Article PubMed/NCBI
Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence and adverse physiologic effects of residual neuromuscular block. AnesthAnalg 2010; 111: 120-128.View Article