Difficult intubation?

Question

After my emergency appendectomy, my anesthesiologist said I was very difficult to intubate because of my arthritic cervical spine and slightly recessed mandible. My uvula and posterior pharyngeal wall were quite sore for a day or two. If I need further surgery, how can this be handled?

Answer 1

most importantly, tell your anesthesiologist about the history of difficult intubation. sometimes we can avoid a general anesthetic altogether- for instance, an appendectomy could be done under a spinal anesthetic.

if general anesthesia is unavoidable, then sometimes we can use an LMA (laryngeal mask airway) to maintain the airway. that would obviate the need for endotracheal intubation. however, an LMA can only be used in certain surgeries (for example, in laparoscopic surgeries we can't use LMAs) and shouldn't be used if there is an aspiration risk (IE: full stomach, GERD, obesity).

if endotracheal intubation is necessary, then the most conservative approach would be to do an awake fiberoptic intubation. however, many times it's quite feasible to do an "asleep look"- where the patient is induced normally and the anesthesiologist performs a direct laryngoscopy, and if they have a good view they can just intubate. if not, they use alternate methods such as light wand, eschmann stylet, intubating LMA, or fiberoptic intubation. the "asleep look" method is only viable if there is confidence that mask ventiation is feasible, so that there is no danger of having an asleep patient who you cannot intubate nor ventilate.

unfortunately, nothing will guarantee that you won't have a sore throat again, but being prepared for a difficult airway will certainly help your anesthesiologist provide a safer anesthetic for you.

Answer 2

If your surgery is elective, call the anesthesia department and see if you can drop by for a quick exam and consult. If we know about you ahead of time, things are easier for both of us!

In an emergency, that's the one piece of information you want to pass on when you meet your anesthesiologist.

There are alternate intubation methods that we'll go to earlier if we know you're tough to tube. Personally, I like intubating through an LMA. That works well with arthritic spines because we don't have to move your neck much. It's also pretty easy on your throat.

Another method is doing a fiberoptic bronchoscopy and sliding the tube over the scope.

Hope you're healing well after the appy.

Answer 3

This is one for Pangolin. The number of patients I have intubated is barely into double digits, but I imagine if you are difficult enough they could use a fiber-optic scope.

Answer 4

hey...you answered my question about Vericocele...would you mind sending me an email I would like to ask you more about it. Thanks.
Email:
[e-mail]

Answer 5

same way same procedure same approach. The anesthisiologist will handle it.