Abstract
A 26-year-old female (ASA 2E), weight 260 lbs., height 5′6″, and BMI 43, is scheduled for an emergency appendectomy. She has a class 3 airway but tells you that she has a previous history of a traumatic and difficult endotracheal intubation. She is otherwise healthy and takes no medication. She refuses a regional block, as she has a lot of back problems. You decide on a fiber-optic intubation, but you are fully aware that topical anesthesia and sedation must be kept to a minimum in an attempt to maintain the patient’s protective laryngeal reflexes and decrease the likelihood of gastric aspiration.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Rothfleisch R, Davis LL, Kubel DA, de Boisblanc BP. Facilitation of fiberoptic nasotracheal intubation in a morbidly obese patient by simultaneous use of nasal CPAP. Chest. 1994;106:287–8.
Dow TGB, Brock-Utne JG, Rubin J, Welman S, Dimopoulos GE, Moshal MG. The effect of atropine on the lower esophageal sphincter in late pregnancy. Obstet Gynecol. 1978;51:426–30.
Brock-Utne JG, Dow TGB, Welman S, Dimopoulos GE, Moshal MG. The effects of metoclopramide on the lower oesophageal sphincter in late pregnancy. Anaesth Intens Care. 1978;6:26–9.
Crawford S. Principles and practice of obstetric anaesthesia. 3rd ed. Oxford: Blackwell Scientific Publications; 1972.
Andrews AD, Brock-Utne JG, Downing JW. Protection against pulmonary acid aspiration with ranitidine. Anaesthesia. 1982;37:22–5.
Brock-Utne JG, Downing JW, Humphrey D. Effects of ranitidine given before atropine sulphate on lower esophageal sphincter tone. Anaesth Intens Care. 1984;12:140–2.
Murphy DF, Nally B, Gardiner J. Effect of metoclopramide on gastric emptying before elective and emergency Caesarean section. BJA. 1984;56:1113–6.
Hunter AR, Moir DD. Confidential enquiry into maternal deaths. BJA. 1983;55:367–9.
Brock-Utne JGI. Cricoid Pressure necessary? (Editorial). Paediatric Anaesthesia. 2002;12:1–4.
Hardman JG, Limbird LE. Goodman and Gilman’s: The Pharmacological basis of Therapeutics, vol. 502. 12th ed. New York: McGraw Hill; 2011.
Doyle DJ, Zura A, Ramachandran M, Lin J, et al. Airway management in a 980-lb patient: use of the Aintree intubation catheter. J Clin Anesth. 2007;19:37–9.
Brock-Utne JG, Jaffe RA. Tracheal intubation with the patient is a sitting position. BJA. 1991;67:225–6.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Brock-Utne, J.G. (2017). Case 26: General Anesthesia for a Patient with a Difficult Airway and Full Stomach. In: Clinical Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-71467-7_26
Download citation
DOI: https://doi.org/10.1007/978-3-319-71467-7_26
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-71466-0
Online ISBN: 978-3-319-71467-7
eBook Packages: MedicineMedicine (R0)