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Medicine (Baltimore) 2022 Mar 11;101(10):e29041. Epub 2022 Mar 11.

Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.

Rationale: Goiter, an abnormal enlargement of the thyroid gland, can induce airway distortion or tracheal compression. Airway management can be challenging for anesthesiologists, depending on the location and size of the mass as well as the patient's airway conditions, although it is reported that most cases can easily be managed by oral intubation.

Patient Concerns: A 61-year-old female patient who had planned for a total thyroidectomy due to a huge goiter was intubated with nerve integrity monitoring (NIM) tubes, using video laryngoscopy (VL) and oral fiberoptic bronchoscopy (FOB) alone. Read More

Air Med J 2022 Jan-Feb;41(1):147-150. Epub 2021 Oct 20.

LifeFlight Retrieval Medicine, Queensland, Australia.

A LifeFlight Retrieval Medicine air medical team was tasked to a rural facility 200 km away to manage and retrieve a 73-year-old woman with evolving airway obstruction. Resources at the referring site included a general practitioner with anesthetic skills training but no access to otorhinolaryngology (ear, nose, and throat) or flexible fiberoptic airway devices. On arrival of the LifeFlight Retrieval Medicine, the patient became agitated, with deterioration in her airway patency. Read More

Am J Emerg Med 2022 Apr 9;54:212-220. Epub 2022 Feb 9.

Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan. Electronic address:

Objective: Difficult airway situations, such as trismus and neck rigidity, may prohibit standard midline orotracheal intubation. An alternative route of intubation from the retromolar space using a fiberoptic scope or rigid intubation stylet has been reported. There is no study investigating the applicability of retromolar intubation using a video intubating stylet. Read More

J Cardiothorac Surg 2021 May 24;16(1):141. Epub 2021 May 24.

Cardiovascular Surgery Department, Athens Medical Center, Athens, Greece.

Background: The Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI) is a rare, inherited metabolic disease that results in progressive tissue accumulation of dermatan-sulfated glycosaminoglycans and inflammatory consequences that almost always affects the heart valves. From the anesthesia point of view, managing the airway and ventilation might be a serious challenge due to specific features of the syndrome. Additionally, it is more than probable that the surgical team will perform a non-straightforward procedure. Read More

J Formos Med Assoc 2022 Jan 26;121(1 Pt 1):108-116. Epub 2021 Feb 26.

Department of Anesthesiology, Taipei Veterans General Hospital, Taipei and Institute of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan. Electronic address:

Background/purpose: Increasing evidence indicates an association of video laryngoscopy with the success rate of airway management in patients with neck immobilization. Nevertheless, clinical practice protocols for tracheal intubation in patients immobilized using various types of cervical orthoses and the outcomes remain unclear.

Methods: We retrospectively assessed the tracheal intubation techniques selected for patients immobilized using cervical orthoses from 2015 to 2018. Read More

Ann Transl Med 2021 Jan;9(1):75

Department of Anesthesiology, Peking University Third Hospital, Beijing, China.

Diffuse idiopathic skeletal hyperostosis (DISH), asymptomatic in most cases, is a degenerative condition that commonly leads to anterior cervical osteophytes in most elderly patients. Clinically significant airway compression is rare. However, in some cases, the seemingly insignificant osteophytes could become a threat to airway management during intubation. Read More

Laryngoscope 2021 07 10;131(7):1647-1651. Epub 2020 Dec 10.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.

Objectives/hypothesis: The anatomy of children with severe Pierre Robin sequence can present a challenge for direct laryngoscopy and intubation. Advanced techniques including flexible fiberoptic laryngoscopic intubation have been described but require highly specialized skill and equipment. Rigid video laryngoscopy is more accessible but has not been described in this population. Read More

J Neurosurg Anesthesiol 2022 Jan;34(1):74-78

Neurological Surgery, Mayo Clinic, Jacksonville, FL.

Background: During awake craniotomy, securing the patient's airway might be necessary electively or emergently. The objective of this study was to compare the feasibility of airway management using a laryngeal mask airway (LMA) and 4 alternative airway management techniques in an awake craniotomy simulation.

Methods: After completing a questionnaire, 9 anesthesia providers attempted airway management in a cadaver positioned to simulate awake craniotomy conditions. Read More

World Neurosurg 2020 12 10;144:244-249. Epub 2020 Aug 10.

Department of Neurosurgery, Saint Louis University, St. Louis, Missouri, USA.

Background: Cervical arthroplasty has established itself as a safe and efficacious alternative to fusion in management of symptomatic cervical degenerative disease. Recent literature has indicated a trend toward decreased risk of reoperation with cervical arthroplasty, and reoperation in this subset commonly occurs secondary to recurrent pain and device-related complications. The instance of cervical arthroplasty migration, particularly in the setting of trauma, is particularly rare. Read More

BMC Anesthesiol 2019 12 30;19(1):244. Epub 2019 Dec 30.

School of Medicine, Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey.

Background: This study were designed to investigate the usefulness of the videolaryngoscope-guided insertion technique compared with the standard digital technique for the insertion success rate and insertion conditions of the Proseal™ laryngeal mask airway (PLMA).

Methods: Prospective, one hundred and nineteen patients (ASA I-II, aged 18-65 yr) were randomly divided for PLMA insertion using the videolaryngoscope-guided technique or the standard digital technique. The PLMA was inserted according to the manufacturer's instructions in the standard digital technique group. Read More

Acta Anaesthesiol Scand 2020 04 27;64(4):443-454. Epub 2019 Dec 27.

Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Background: Tracheal intubation in patients at risk for secondary spinal cord injury is potentially difficult and risky.

Objectives: To compare tracheal intubation techniques in adult patients at risk for secondary cervical spinal cord injury undergoing surgery. Primary outcome was first-attempt failure rate. Read More

Curr Opin Anaesthesiol 2019 Dec;32(6):764-768

Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.

Purpose Of Review: The difficult airway remains an ongoing concern in daily anesthesia practice, with awake intubation being an important component of its management. Classically, fiberoptic bronchoscope-assisted tracheal intubation was the method of choice in the awake patient. The development of new generation videolaryngoscopes has revolutionized the approach to tracheal intubation in the anesthetized patient. Read More

Eur J Pediatr 2019 Jul 23;178(7):1105-1111. Epub 2019 May 23.

Children's Acute Transport Service, Ormond House, 26-27 Boswell Street, London, UK.

Airway management in children is associated with anatomical and physiological challenges compared with adults. Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis, and cleft palate and related to a difficult airway. Both the Airtraq™ and GlideScope® have never been previously directly compared in PRS. Read More

Anesth Analg 2019 06;128(6):1264-1271

From the Department of Anesthesiology and Pain Medicine, Hospital de Manises, Valencia, Spain.

Background: Tracheal intubation failure in patients with difficult airway is still not uncommon. While videolaryngoscopes such as the Glidescope offer better glottic vision due to an acute-angled blade, this advantage does not always lead to an increased success rate because successful insertion of the tube through the vocal cords may be the limiting factor. We hypothesize that combined use of Glidescope and fiberscope used only as a dynamic guide facilitates tracheal intubation compared to a conventional Glidescope technique with a preshaped nondynamic stylet. Read More

J Neurosurg Anesthesiol 2020 Jul;32(3):249-255

Departments of Neuroanaesthesia and Neurocritical Care.

Background: Cervical spine movement during intubation with direct laryngoscopy can predispose to new-onset neurological deficits in patients with cervical spine instability. While fiberoptic-guided intubation (FGI) is mostly preferred in such patients, this is not always possible. Videolaryngoscopy results in less cervical spine movement than direct laryngoscopy and may be an alternative to FGI in patients with cervical spine instability. Read More

J Med Syst 2019 Feb 11;43(3):72. Epub 2019 Feb 11.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.

Few studies have examined the impact of video laryngoscopy (VL) on operating room efficiency. We hypothesized that VL reduces anesthesia control time (ACT), a metric of anesthesia efficiency, compared with fiberoptic intubation (FOI) in potentially difficult airways, but that direct laryngoscopy (DL) remains more efficient in routine cases. We performed a multi-institutional, retrospective chart review of anesthetic cases from 2015 to 2016. Read More

J Clin Anesth 2019 08 15;55:132-133. Epub 2019 Jan 15.

Department of Anaesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325, Section 2, Chenggung Road, Neihu, 114 Taipei, Taiwan, Republic of China. Electronic address:

Anesth Analg 2018 08;127(2):450-454

Harborview Medical Center, Seattle, Washington.

Background: Airway management in the presence of acute cervical spine injury (CSI) is challenging. Because it limits cervical spine motion during tracheal intubation and allows for neurological examination after the procedure, awake fiberoptic bronchoscopy (FOB) has traditionally been recommended. However, with the widespread availability of video laryngoscopy (VL), its use has declined dramatically. Read More

J Cardiothorac Vasc Anesth 2018 02 9;32(1):267-274. Epub 2017 May 9.

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.

Objective: To compare the incidence of fiberoptic bronchoscope (FOB) use (1) during verification of initial placement and (2) for reconfirmation of correct placement following repositioning, when either a double-lumen tube (DLT) or video double-lumen tube (VDLT) was used for lung isolation during thoracic surgery.

Design: A randomized controlled study.

Setting: Single-center university teaching hospital. Read More

Paediatr Anaesth 2017 Nov 20;27(11):1115-1119. Epub 2017 Sep 20.

Department of Anesthesiology, Jikei University, Minato-ku, Tokyo, Japan.

Background: With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused.

Aim: We aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation.

Methods: We retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. Read More

J Emerg Med 2017 Oct 4;53(4):550-553. Epub 2017 Sep 4.

Department of Emergency Medicine, University of California-Los Angeles, Los Angeles, California.

Background: An obstructive neck lesion presents an airway challenge for any emergency physician. Retrograde intubation is an infrequently used airway alternative that can be employed in the difficult airway algorithm that requires little training and is less invasive than surgical cricothyrotomy.

Case Report: We report a case of a 31-year-old male patient who presented with respiratory distress progressing to respiratory failure from upper airway obstruction. Read More

BMJ Open 2017 Sep 1;7(8):e015307. Epub 2017 Sep 1.

Department of Trauma Surgery and Orthopedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.

Introduction: Emergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Read More

J Emerg Med 2017 Aug 9;53(2):163-171. Epub 2017 Jun 9.

Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona; Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, University of Arizona College of Medicine, Tucson, Arizona.

Background: Patients with difficult airways are sometimes encountered in the emergency department (ED), however, there is a little data available regarding their management.

Objectives: To determine the incidence, management, and outcomes of patients with predicted difficult airways in the ED.

Methods: Over the 1-year period from July 1, 2015 to June 30, 2016, data were prospectively collected on all patients intubated in an academic ED. Read More

Indian J Anaesth 2017 Jan;61(1):36-41

Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post-graduate Medical Education and Research, Puducherry, India.

Background And Aims: The difficulty during flexible fiber-optic bronchoscopy (FOB) guided tracheal intubation could be because of inability in visualising glottis, advancing and railroading of endotracheal tube. Several methods are available for visualising glottis, but none is ideal. Hence, this randomised controlled study was designed to evaluate the simple pre-determined length insertion technique (SPLIT) during oral FOB. Read More

J Clin Anesth 2017 Feb 1;36:127-132. Epub 2016 Dec 1.

Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.

Study Objectives: To identify airway management and tracheal intubation techniques for glossopexy in infants with preexisting airway obstruction under general anesthesia.

Design: Retrospective, observational study.

Settings: Operating room of a university hospital between January 2003 and March 2015. Read More

A A Case Rep 2017 Mar;8(6):139-141

From the *Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada; and †Department of Otolaryngology, Queen's University, Hotel Dieu Hospital, Kingston, Ontario, Canada.

Airway management in trauma is a crucial skill, because patients are at risk of aspiration, hypoxia, and hypoventilation, all of which may be fatal in the setting of increased intracranial pressure. The King Laryngeal Tube reusable supraglottic airway (King Systems, Noblesville, IN) allows for temporary management of a difficult airway but poses a challenge when an attempt is made to exchange the device for an endotracheal tube, often managed by emergency tracheostomy. We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube. Read More

J Anaesthesiol Clin Pharmacol 2016 Oct-Dec;32(4):515-518

Department of Anaesthesiology, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, India.

Background And Aims: Direct laryngoscopy is hazardous in patients with cervical posterior intervertebral disc prolapse (PIVD) as it may worsen the existing cord compression. To achieve smooth intubation, many adjuncts such as fiberoptic bronchoscope (FOB), video laryngoscopes, lighted stylets, and intubating laryngeal mask airways (ILMAs) are available. However, there is a paucity of literature comparing ILMA with fiberoptic intubation in patients with PIVD. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2016 Nov 24;51(11-12):656-663. Epub 2016 Nov 24.

Department of Anesthesia & Peri-operative Medicine, Western University, London, Ontario, Canada.

Introduction: Awake video laryngoscopy is a novel option in airway management that is drawing more and more attention as an alternative to awake endoscopic guided intubation.Main issues: Intubation under preserved spontaneous breathing is the safest method to secure the expected difficult airway. In direct comparisons to awake flexible endoscopic intubation, awake video laryngoscopy achieves satisfactory intubation times and a high acceptance of patients and anesthesiologists. Read More

Acta Anaesthesiol Scand 2017 Jan 3;61(1):23-30. Epub 2016 Nov 3.

Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.

Introduction: supraglottic airway devices remain, despite advances in video laryngoscopy, important tools in the management of unexpected difficult airways. Intubation through a functioning supraglottic airway device with the aid of a fiberoptic bronchoscope is a well-known technique usually performed in apnoea. With a simple modification, the patient can be ventilated during this procedure. Read More