Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T04:06:50.632Z Has data issue: false hasContentIssue false

Surgeon-performed intubation in awake patients utilising an anterior commissure laryngoscope with bougie: a retrospective case series

Published online by Cambridge University Press:  31 October 2019

N R Vasan*
Affiliation:
Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, USA
E Kosik
Affiliation:
Department of Anesthesiology, University of Oklahoma Health Sciences Center, USA
B Collins
Affiliation:
Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, USA
M Clampitt
Affiliation:
Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, USA
*
Author for correspondence: Dr Nilesh R Vasan, College of Medicine Building, 800 Stanton L Young Blvd, Suite 1400, Oklahoma City, Oklahoma 73104, USA E-mail: [email protected]

Abstract

Objective

This retrospective case series examined the outcomes of surgeon-performed intubation using the anterior commissure rigid laryngoscope and bougie in adults with a difficult airway, including awake patients.

Methods

This study comprised a series of adult patients who underwent surgeon-performed intubation over a 10-year period. They were identified by a records search for the Current Procedural Terminology (‘CPT’) code 31500 – ‘intubation by surgeon’.

Results

Forty-nine intubations performed in the operating theatre were reviewed. Intubation performed by the surgeon using the rigid anterior commissure laryngoscope was successful in 47 of the cases (96 per cent). Over half of the patients had experienced failed intubation attempts with other methods by other providers prior to the surgeon performing direct laryngoscopy. Twenty intubations were performed without paralytics and with the patient awake.

Conclusion

In properly selected adults who need an urgent, secure airway in the operating theatre, surgeon-performed anterior commissure laryngoscopic intubation using a bougie should be considered a safe, reliable procedure. In most cases, this procedure can be performed in selected patients whilst awake, with sedation.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr N R Vasan takes responsibility for the integrity of the content of the paper

References

1Brown, CA 3rd, Bair, AE, Pallin, DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med 2015;65:363–70Google Scholar
2Cattano, D, Panicucci, E, Paolicchi, A, Forfori, F, Giunta, F, Hagberg, C. Risk factors assessment of the difficult airway: an Italian survey of 1956 patients. Anesthes Analg 2004;99:1774–9Google Scholar
3Rose, DK, Cohen, MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994;41(5 pt 1):372–83Google Scholar
4Moon, HY, Baek, CW, Kim, JS, Koo, GH, Kim, JY, Woo, YC et al. The causes of difficult tracheal intubation and preoperative assessments in different age groups. Korean J Anesthesiol 2013;64:308–14Google Scholar
5Siyam, MA, Benhamou, D. Difficult endotracheal intubation in patients with sleep apnea syndrome. Anesth Analg 2002;95:1098–102Google Scholar
6Hiremath, AS, Hillman, DR, James, AL, Noffsinger, WJ, Platt, PR, Singer, SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anesth 1998;80:606–11Google Scholar
7Langeron, O, Masso, E, Huraux, C, Guggiari, M, Bianchi, A, Coriat, P et al. Prediction of difficult mask ventilation. Anesthesiology 2000;92:1229–36Google Scholar
8Shiga, T, Wajima, Z, Inoue, T, Sakamoto, A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005;103:429–37Google Scholar
9Beydon, L, Lorino, AM, Verra, F. Topical upper airway anaesthesia with lidocaine increases airway resistance by impairing glottis function. Intensive Care Med 1995;21:920–6Google Scholar
10Ho, A, Chung, DC, To, E, Karmakar, MK. Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway. Can J Anaesth 2004;51:838–41Google Scholar
11Sofferman, RA, Johnson, DL, Spencer, RF. Lost airway during anesthesia induction: alternatives for management. Laryngoscope 1997;107:1476–82Google Scholar
12Mace, SE. Challenges and advances in intubation: airway evaluation and controversies with intubation. Emerg Med Clin North Am 2008;26:9771000Google Scholar
13Davies, R, Balachandran, S. Anterior commissure laryngoscope. Anesthesia 2003;58:721–2Google Scholar