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.
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