Abstract
Background
Maxillofacial surgeries are known to have difficulty in airway management due to anatomical and functional reasons. Tumors of maxillofacial region and diseases of TM joint limit mouth opening as well as airway space. Various methods have been tried with success for nasotracheal intubation including fiberoptic-aided as well as blind nasal and light-guided intubation. Video laryngoscopy-assisted intubation uses visualization of glottis without the need of alignment of all the three axes of airway.
Purpose
Video laryngoscopy is being considered to increase the success rate in various different setups including critical care, pre-hospital and operating rooms. Flexible-tipped bougie guided by a video laryngoscope was used in patients with limited airway space undergoing maxillofacial surgery.
Methods
In present study, airway of five patients posted for various maxillofacial surgeries was secured by passing flexible-tipped bougie through the nasopharyngeal airway and, once under the view of a McGrath videolaryngoscope, was advanced toward the glottis; the rotation of the bougie with the required flexion of the tip helped a quick redirection of bougie to enter the larynx at an angle.
Results
Our experience of five cases with anticipated difficult intubation normally judged to be manageable with fiberoptic bronchoscopic intubation were managed without awake fiberoptic bronchoscopy using flexible-tipped bougie under vision of videolaryngoscopy. All patients were successfully managed with this technique.
Conclusion
Flexible-tipped bougie could take the direction toward glottis under a videolaryngoscope in an anticipated difficult airway, making a place for airway management in patients with limited mouth opening.
References
Chauhan V, Acharya G (2016) Nasal intubation: a comprehensive review. Indian J Crit Care Med 20:662–667
Angerman S, Kirves H, Nurmi J (2018) A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation. Anaesthesia 73:348–355
Bhanabhai L, Cormack J, Langley B (2019) Use of a flexible-tipped “Bougie” during videolaryngoscopic intubation in a patient with a base of tongue tumor: a case report. A&A Pract 13:91–92
Jiang J, Ma DX, Li B, Wu AS, Xue FS (2018) Videolaryngoscopy versus fiberoptic bronchoscope for awake intubation—a systematic review and meta-analysis of randomized controlled trials. Ther Clin Risk Manag 14:1955–1963
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Kumar, P., Sharma, J., Johar, S. et al. Guiding Flexible-Tipped Bougie Under Videolaryngoscopy: An Alternative to Fiberoptic Nasotracheal Intubation in Maxillofacial Surgeries. J. Maxillofac. Oral Surg. 19, 324–326 (2020). https://doi.org/10.1007/s12663-020-01327-w
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DOI: https://doi.org/10.1007/s12663-020-01327-w