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19ap6 Refer en CIA Poster en Esa
19ap6 Refer en CIA Poster en Esa
19ap6 Refer en CIA Poster en Esa
F. Llobell, P. Marzal, M. Echeverri, L. Hoke, Y. Bryan Anesthesiology and Critical Care, Hospital G.U.
Marina Alta, Denia, Alicante, Spain
Background and Goal of Study: Intubation algorithms for patients with difficult airways (DA) and
extubation guidelines in ICU patients exist (1). Extubation of patients with difficult airways is less
standardized despite many complications reported after extubation (2, 3). We created an extubation
protocol in patients with a known difficult airway consisting of an airway device table used to bridge
extubation. We present our experience with this protocol and table for extubating patients with difficult
airways.
Materials and Methods: We created a table for extubation of the difficult airway divided into 4 quadrants
according to function (see Figure 1). By moving clockwise, the four quadrants are; 1) oral and nasal
airways, LMA s to improve oxygenation and ventilation; 2) airway exchange catheters, stylets, and
guidewires to delay extubation or assist in reintubation; 3) FFB and Bonfils to visualize glottis; 4)
cricothyrotomy kit and TTJV for surgical access.
Results and Discussion: We used the algorithm and table for extubation in 4 patients (see Table 1). No
patients experienced any complications and the mean time to extubation was 58 (range of 30, 90) minutes.
Table 1
Case Age Weight Intubation Extubation
Sex Diagnosis Surgery
ID (years) (kg) devices Devices
Prostate
1 72 75 Male Radical prostatectomy Airtraq Proseal LMA
cancer
Acute
2 68 60 Female Exploratory laparotomy FFB nasal CAEC
abdomen
Microsuspension
3 65 70 Male Dysphonia FFB oral CAEC
laryngoscopy
4 75 68 Male Vocal cord Microsuspension Airtraq CAEC
nodule laryngoscopy
Conclusion(s): The protocol and table during extubations enhanced the safety in patients with difficult
airways. The availability of devices at extubation prepares one for different airway scenarios. Further
research is required regarding extubation protocols in patients with difficult airways.
References: 1) Anesth 2003; 98:126977. 2) Anesth Analg 2007; 105:118285. 3) Anesth Analg 2007;
105:135762.
Citation: F. Llobell, P. Marzal, M. Echeverri, L. Hoke, Y. Bryan. Strategy for extubation of the difficult
airway: A protocol and table of airway devices. Eur J Anaesthesiol 2008; 25 (Suppl 44): 19AP68
Presentation Time: Monday, June 2, 2008 4:00 PM 5:30 PM
Session Info: 19 Airway Management 19AP6
Room: Hall A1 ROW 20A