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Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases

View Article: PubMed Central - PubMed

ABSTRACT

Aim:: The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients.

Settings and design:: A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications.

Materials and methods:: Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded.

Results:: Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat.

Conclusion:: In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

No MeSH data available.


Difficult airway management protocol
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Figure 1: Difficult airway management protocol

Mentions: All TMJ ankylosis patients were evaluated for the airway assessment with a standard proforma which included previous anesthetic problem, general appearance of face, neck, maxilla and mandible, jaw movement, head extension and movement, teeth and oropharynx, nasal obstruction or deviated nasal septum, soft tissues of the neck, thyroid enlargement, recent chest and cervical spine radiographs, and for any gross anatomical distortion. Patients were assessed for spontaneous ventilatory exchange and an intact cough reflex. The difficulty of intubation was evaluated based on LEMON assessment[78] and recorded. Patient's ability to follow simple verbal commands such as “open your mouth” and “take a deep breath” were confirmed. Patients with nasal obstruction, restricted neck movements, neck swelling, serious bleeding disorders, and uncooperative patients were deferred for blind awake intubation. Blind awake intubation procedure, possibility of tracheostomy, and requirement of postoperative ventilatory support were explained to the patient and guardian. Informed consent was taken from the patient and patient's guardian. Airway management was done according to our anesthesiology department protocol [Figure 1].


Retrospective evaluation of airway management with blind awake intubation in temporomandibular joint ankylosis patients: A review of 48 cases
Difficult airway management protocol
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979344&req=5

Figure 1: Difficult airway management protocol
Mentions: All TMJ ankylosis patients were evaluated for the airway assessment with a standard proforma which included previous anesthetic problem, general appearance of face, neck, maxilla and mandible, jaw movement, head extension and movement, teeth and oropharynx, nasal obstruction or deviated nasal septum, soft tissues of the neck, thyroid enlargement, recent chest and cervical spine radiographs, and for any gross anatomical distortion. Patients were assessed for spontaneous ventilatory exchange and an intact cough reflex. The difficulty of intubation was evaluated based on LEMON assessment[78] and recorded. Patient's ability to follow simple verbal commands such as “open your mouth” and “take a deep breath” were confirmed. Patients with nasal obstruction, restricted neck movements, neck swelling, serious bleeding disorders, and uncooperative patients were deferred for blind awake intubation. Blind awake intubation procedure, possibility of tracheostomy, and requirement of postoperative ventilatory support were explained to the patient and guardian. Informed consent was taken from the patient and patient's guardian. Airway management was done according to our anesthesiology department protocol [Figure 1].

View Article: PubMed Central - PubMed

ABSTRACT

Aim:: The aim was to determine the morbidity or mortality associated with the blind awake intubation technique in temporomandibular ankylosis patients.

Settings and design:: A total of 48 cases with radiographically and clinically confirmed cases of temporomandibular joint (TMJ) ankylosis were included in the study for evaluation of anesthetic management and its complications.

Materials and methods:: Airway assessment was done with standard proforma including Look externally, evaluate 3-3-2 rule, Mallampati classification, Obstruction, Neck mobility (LEMON) score assessment in all TMJ ankylosis patients. The intubation was carried out with the standard departmental anesthetic protocol in all the patients. The preoperative difficulty assessment and postoperative outcome were recorded.

Results:: Blind awake intubation was done in 92% of cases, 6% of cases were intubated by fiberoptic awake intubation, and 2% patient required surgical airway. Ninety-eight percent of the patients were cooperative during the awake intubation. The frequent complications encountered during the blind awake intubation were epistaxis and sore throat.

Conclusion:: In an anesthetic setup, where fiberoptic intubation is not available, blind awake intubation could be considered in the anesthetic management algorithm.

No MeSH data available.