TY  - CHAP
M1  - Book, Section
TI  - Documentation of Difficult and Failed Airway Management
A1  - Foley, Lorraine J.
A1  - Murphy, Michael F.
A1  - R. Hung, Orlando
A2  - Hung, Orlando R.
A2  - Murphy, Michael F.
Y1  - 2017
N1  - 
T2  - Hung's Difficult and Failed Airway Management, 3e
AB  - An  obese  39-year-old  female  is  scheduled  for  a  laparoscopic  cholecystectomy  under  general  anesthesia.  She  takes  no  meds  and  has  no  allergies.  She  is  5′4″  (161  cm),  220  lb  (100  kg),  with  a  BMI  38.6  kg·m−2.  She  denies  reflux.  On  physical  exam,  she  has  a  Mallampati  Class  II  airway,  has  4  cm  mouth  opening,  and  a  good  neck  extension.  Her  hyomental  distance  is  also  less  than  5  cm  and  her  hypothyroid  distance  is  about  3  cm.  She  has  no  past  surgical  history  except  for  a  cesarean  section  under  epidural.  Upon  arrival  at  the  operating  room,  standard  monitors  are  placed  on  the  patient.  Following  denitrogenation  and  induction  of  anesthesia  with  200  mg  of  propofol,  rocuronium  (40  mg)  is  administered  for  muscle  relaxation.  Direct  laryngoscopy  is  attempted  with  #3  Macintosh  blade.  Only  a  large  epiglottis  is  seen  with  no  improvement  in  the  view  following  the  application  of  laryngeal  pressure.  A  #3  Miller  blade  is  then  used  to  lift  the  epiglottis,  but  vocal  cords  are  still  not  visible.  An  Eschmann  Tracheal  Introducer  (“bougie”)  repeatedly  goes  into  the  esophagus.  Bag-mask-ventilation  (BMV)  remains  adequate.  Help  and  the  difficult  airway  cart  are  summoned.  A  #3  Intubating  Laryngeal  Mask  Airway  (LMA-Fastrach)  is  placed,  resulting  in  adequate  ventilation.  An  attempt  at  blind  intubation  through  the  Intubating  Laryngeal  Mask  Airway  (ILMA)  is  unsuccessful.  In  a  further  attempt,  a  7.0-mm  ID  endotracheal  tube  (ETT)  is  loaded  onto  the  FAST  (Foley  fiberoptic  airway  stylet,  Clarus  Medical  LLC,  Minneapolis,  MN)  and  placed  through  the  ILMA.  The  ILMA  is  manipulated  till  vocal  cords  are  visualized  and  the  ETT  is  placed  into  trachea  without  difficulty.  Correct  ETT  placement  is  confirmed  by  means  of  end-tidal  CO2  and  auscultation.  The  surgical  procedure  proceeds  uneventfully.  At  the  conclusion  of  the  cholecystectomy,  tracheal  extubation  is  achieved  with  no  difficulties  when  the  patient  is  awake  and  alert.  Appropriate  monitoring  and  disposition  of  the  patient  are  provided.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/23
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1146620314
ER  -