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Efficacy of bronchofiberscope double-lumen tracheal tube intubation combined with McGRATH MAC for difficult airway
362
Correspondence
Figure (A) P = pleura; SA = subclavian artery; yellow arrows = supraclavicular plexus. (B) N = needle; P = pleura; SA = subclavian artery; yellow arrows = supraclavicular plexus. anesthesiologist: part 2. bone, viscera, subcutaneous tissue, and foreign bodies. Reg Anesth Pain Med 2010;35:281-9. [6] Abell DJ, Barrington MJ. Pneumothorax after ultrasound-guided supraclavicular block: presenting features, risk, and related training. Reg Anesth Pain Med 2014;39:164-7. [7] Macfarlane AJ, Perlas A, Chan VW, Brull R. Eight ball, corner pocket ultrasound-guided supraclavicular block: avoiding a scratch. Reg Anesth Pain Med 2008;33:502-3. [8] Brull R, Chan VW. The corner pocket revisited. Reg Anesth Pain Med 2011;36:308.
Efficacy of bronchofiberscope doublelumen tracheal tube intubation combined with McGRATH MAC for difficult airway☆,☆☆,★ To the Editor, We report a case of difficult double-lumen tracheal tube intubation in which fiberoptic bronchoscope (FOB) application under McGRATH MAC (McGRATH; Aircraft Medical Ltd, Edinburgh, United Kingdom) video laryngoscope observation was effective. A 79-year-old woman was scheduled to undergo lower lung resection surgery for primary lung cancer. She could not tilt her head due to a previous upper cervical spine surgery, a small jaw, and restricted mouth opening (3.5 cm), which we surmised would indicate a difficult airway. After continuous administration of remifentanil and propofol, mask ventilation was possible with the jaw-thrust maneuver. After administration of 60 mg of rocronium, we performed laryngoscopy with the McGRATH, which revealed Cormack III, and double-lumen tube intubation was impossible. Gum elastic budgie-guided intubation with McGRATH was also unsuccessful. Next, we performed FOB-guided tracheal intubation, which was difficult due to target the glottis. ☆
Conflict of interest: none. Details of author contributions: YI and NK performed critical management of the case and wrote the manuscript; and TM prepared the manuscript, provided critical comments, and approved the final version. ★ Patient consent: written consent was obtained from the parent of the patient in this report. ☆☆
Then, we tried to perform double-lumen tube intubation with FOB under McGRATH observation. Under the guidance of the McGRATH monitor, we were able to guide the tip of the FOB into the trachea smoothly, leading to successful intubation with a 35F catheter double-lumen tracheal tube. Airway management for this patient presented 2 difficulties: an anatomically difficult airway and doublelumen tube intubation [1]. We could not intubate orally with the McGRATH or under FOB alone, although we could observe the epiglottis but could not find the lower edge of the glottis with the McGRATH [2]. Under McGRATH monitor observation, we could guide the tip of FOB and facilitate smooth tracheal intubation of the double-lumen tracheal tube with good orientation. Combination of McGRATH and FOB may be effective for difficult double-lumen tracheal tube intubation. Yukihiro Imajo, MD (Resident) Nobuyasu Komasawa, MD, PhD (Assistant Professor)* Toshiaki Minami, MD, PhD (Professor and Chief) Department of Anesthesiology, Osaka Medical College Osaka, Japan *Corresponding author. Department of Anesthesiology Osaka Medical College, Daigaku-machi 2-7, Takatsuki Osaka 569-8686, Japan Tel.: +81 72 683 2368; fax: + 81 72 684 6552 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.03.012
References [1] Campos JH, Hallam EA, Van Natta T, Kemstine KH. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology 2006;104:261-6. [2] Taylor AM, Peck M, Launcelott S, Hung OR, Law JA, MacQuarrie K, et al. The McGrath® Series 5 video laryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013;68:142-7.
Correspondence
Figure (A) P = pleura; SA = subclavian artery; yellow arrows = supraclavicular plexus. (B) N = needle; P = pleura; SA = subclavian artery; yellow arrows = supraclavicular plexus. anesthesiologist: part 2. bone, viscera, subcutaneous tissue, and foreign bodies. Reg Anesth Pain Med 2010;35:281-9. [6] Abell DJ, Barrington MJ. Pneumothorax after ultrasound-guided supraclavicular block: presenting features, risk, and related training. Reg Anesth Pain Med 2014;39:164-7. [7] Macfarlane AJ, Perlas A, Chan VW, Brull R. Eight ball, corner pocket ultrasound-guided supraclavicular block: avoiding a scratch. Reg Anesth Pain Med 2008;33:502-3. [8] Brull R, Chan VW. The corner pocket revisited. Reg Anesth Pain Med 2011;36:308.
Efficacy of bronchofiberscope doublelumen tracheal tube intubation combined with McGRATH MAC for difficult airway☆,☆☆,★ To the Editor, We report a case of difficult double-lumen tracheal tube intubation in which fiberoptic bronchoscope (FOB) application under McGRATH MAC (McGRATH; Aircraft Medical Ltd, Edinburgh, United Kingdom) video laryngoscope observation was effective. A 79-year-old woman was scheduled to undergo lower lung resection surgery for primary lung cancer. She could not tilt her head due to a previous upper cervical spine surgery, a small jaw, and restricted mouth opening (3.5 cm), which we surmised would indicate a difficult airway. After continuous administration of remifentanil and propofol, mask ventilation was possible with the jaw-thrust maneuver. After administration of 60 mg of rocronium, we performed laryngoscopy with the McGRATH, which revealed Cormack III, and double-lumen tube intubation was impossible. Gum elastic budgie-guided intubation with McGRATH was also unsuccessful. Next, we performed FOB-guided tracheal intubation, which was difficult due to target the glottis. ☆
Conflict of interest: none. Details of author contributions: YI and NK performed critical management of the case and wrote the manuscript; and TM prepared the manuscript, provided critical comments, and approved the final version. ★ Patient consent: written consent was obtained from the parent of the patient in this report. ☆☆
Then, we tried to perform double-lumen tube intubation with FOB under McGRATH observation. Under the guidance of the McGRATH monitor, we were able to guide the tip of the FOB into the trachea smoothly, leading to successful intubation with a 35F catheter double-lumen tracheal tube. Airway management for this patient presented 2 difficulties: an anatomically difficult airway and doublelumen tube intubation [1]. We could not intubate orally with the McGRATH or under FOB alone, although we could observe the epiglottis but could not find the lower edge of the glottis with the McGRATH [2]. Under McGRATH monitor observation, we could guide the tip of FOB and facilitate smooth tracheal intubation of the double-lumen tracheal tube with good orientation. Combination of McGRATH and FOB may be effective for difficult double-lumen tracheal tube intubation. Yukihiro Imajo, MD (Resident) Nobuyasu Komasawa, MD, PhD (Assistant Professor)* Toshiaki Minami, MD, PhD (Professor and Chief) Department of Anesthesiology, Osaka Medical College Osaka, Japan *Corresponding author. Department of Anesthesiology Osaka Medical College, Daigaku-machi 2-7, Takatsuki Osaka 569-8686, Japan Tel.: +81 72 683 2368; fax: + 81 72 684 6552 E-mail address: [email protected] http://dx.doi.org/10.1016/j.jclinane.2015.03.012
References [1] Campos JH, Hallam EA, Van Natta T, Kemstine KH. Devices for lung isolation used by anesthesiologists with limited thoracic experience: comparison of double-lumen endotracheal tube, Univent torque control blocker, and Arndt wire-guided endobronchial blocker. Anesthesiology 2006;104:261-6. [2] Taylor AM, Peck M, Launcelott S, Hung OR, Law JA, MacQuarrie K, et al. The McGrath® Series 5 video laryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013;68:142-7.