Authors: Yuko Ono Yoshinobu Abe Kazuaki Shinohara
Publish Date: 2014/09/26
Volume: 29, Issue: 2, Pages: 320-320
Abstract
A 72yearold obese male was brought to the hospital after being involved in a home fire He had inhaled massive hot air and developed severe dyspnea On admission he exhibited hoarseness and superficial dermal burns over his entire face He had labored breathing and orthopnea Fiberoptic bronchoscopic FOB examination revealed severe upperairway edema Airway collapse appeared imminent We attempted awake endotracheal intubation ETI with emergency surgical airway ESA backup After the patient was adequately oxygenated topical anesthesia was applied followed by intravenous midazolam 2 mg and fentanyl 01 mg This allowed him to be lightly sedated but still able to communicate Unfortunately two direct laryngoscopies failed and progression of upperairway edema and low respiratory reserve made FOB intubation impossible Before performing an ESA we attempted ETI with the Pentax Airway Scope AWS We could elevate the swollen epiglottis directly with the blade of the AWS but increasing laryngeal edema had displaced the glottis We then asked the patient to vocalize Lateral movement and vibration of the vocal cords helped us to identify the glottis and we achieved ETI with a 70mm endotracheal tube After discharge the patient returned to his normal activitiesUnique to our experience was the successful identification of the displaced glottis by having the patient vocalize This technique may work in other intubation attempts including FOB insertion and direct laryngoscopy In this challenging case the highquality monitor of the AWS provided a clear image of vocal cord movement which greatly aided in identifying the glottis Controlled sedation and analgesia are paramount in achieving this intervention
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