EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

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Case Report
A different airway management in double lumen tube intubation due to unexpected difficult airway
Abstract
A difficult airway is when an experienced anesthesiologist has difficulty in providing ventilation with a mask and/or endotracheal intubation. In cases where intubation cannot be achieved with laryngoscopy, devices such as laryngeal mask airway (LMA) or fiberoptic bronchoscope (FOB) can greatly contribute to the management of the difficult airway. This process may be further complicated when direct laryngoscopy and DLT intubation fail. In this case, the first goal should be to reach the airway. For this purpose, a single-lumen tube can be used first. Although there is not yet a clear algorithm for difficult intubation in DLT insertion, the gum elastic bougie (GEB) is widely used in clinical practice for this purpose. In this case report, we wanted to highlight two of our cases in which we encountered unexpected difficult intubation and we achieved successful endobronchial intubation with FOB-guided GEB through the LMA.

Keywords : Difficult intubation, difficult airway, laryngeal mask airway, double lumen tube, gum elastic bougie

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1. Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubationin apparently normal patients: a meta-analysis of bedside screening testperformance. Anesthesiol. 2005;103(2):429-437. doi: 10.1097/00000542-200508000-00027
2. Cattano D, Panicucci E, Paolicchi A, Forfori F, Giunta F, Hagberg C.Risk factors assessment of the difficult airway: an Italian survey of1956 patients. Anesth Analg. 2004;99(6):1774-1779. doi: 10.1213/01.ANE.0000136772.38754.01
3. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predictdifficult tracheal intubation: a prospective study. Can Anaesth Soc J.1985;32(4):429-434. doi: 10.1007/BF03011357
4. Williams PJ, Bailey PM. Management of failed oral fibreoptic intubationwith laryngeal mask airway insertion under topical anaesthesia. Can JAnaesth. 1993;40(3):287. doi: 10.1007/BF03037045
5. Runciman WB, Kluger MT, Morris RW, Paix AD, Watterson LM,Webb RK. Crisis management during anaesthesia: the developmentof an anaesthetic crisis management manual. Qual Saf Health Care.2005;14(3):e1. doi: 10.1136/qshc.2002.004101
6. Benumof JL. Difficult tubes and difficult airways. J Cardiothorac VascAnesth. 1998;12(2):131-132. doi: 10.1016/s1053-0770(98)90317-2
7. Stix MS, Ata S, Wolckenhaar M, Kaufman MD. Double-lumen tubes:which lumen for the gum elastic bougie? Anesth Analg. 2010;110(1):258-259. doi: 10.1213/ANE.0b013e3181c293cf
8. Paix AD, Williamson JA, Runciman WB. Crisis management duringanaesthesia: difficult intubation. Qual Saf Health Care. 2005;14(3):e5.doi: 10.1136/qshc.2002.004135
9. Brain AI, Verghese C, Addy EV, Kapila A, Brimacombe J. Theintubating laryngeal mask. II: a preliminary clinical report of a newmeans of intubating the trachea. Br J Anaesth. 1997;79(6):704-709. doi:10.1093/bja/79.6.704
10. Roth D, Pace NL, Lee A, et al. Airway physical examination testsfor detection of difficult airway management in apparently normaladult patients. Cochrane Database Syst Rev. 2018;5:CD008874. doi:10.1002/14651858.CD008874.pub2
11. Çeliker V, Çelebi N, Uzun Ş. Zor Havayolu ve Yönetimi. Türkiye Klin JSurg Med Sci. 2006;2:40-46.
12. Apfelbaum JL, Hagberg CA, Caplan RA, et al. American Society ofAnesthesiologists task force on management of the difficult airway.Practice guidelines for management of the difficult airway: an updatedreport by the American Society of Anesthesiologists task force onmanagement of the difficult airway. Anesthesiol. 2013;118(2):251-270.doi: 10.1097/ALN.0b013e31827773b2
13. Kheterpal S, Martin L, Shanks AM, Tremper KK. Prediction andoutcomes of impossible mask ventilation: a review of 50,000 anesthetics.Anesthesiol. 2009;110(4):891-897. doi: 10.1097/ALN.0b013e31819b5b87
14. Kadry M, Popat M. Pharyngeal wall perforation--an unusualcomplication of blind intubation with a gum elastic bougie.Anaesthesia. 1999;54(4):404-405. doi: 10.1046/j.1365-2044.1999.00876.x
15. van Zundert TCRV, Brimacombe JR, Ferson DZ, Bacon DR, WilkinsonDJ. Archie Brain: celebrating 30 years of development in laryngeal maskairways. Anaesthesia. 2012;67(12):1375-1385. doi: 10.1111/anae.12003.x
16. Barash BG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC. KlinikAnestezi. 5th ed. Nobel Tıp Kitabevi: 2012.
17. Kumar R, Prashast, Wadhwa A, Akhtar S. The upside-down intubatinglaryngeal mask airway: a technique for cases of fixed flexed neckdeformity. Anesth Analg. 2002;95(5):1454-1458. doi: 10.1097/00000539-200211000-00066
18. Wong DT, Yang JJ, Mak HY, et al. Use of intubation introducers througha supraglottic airway to facilitate tracheal intubation: a brief review. Can JAnaesth. 2012;59(7):704-715. doi: 10.1007/s12630-012-9714-8
19. Tunç M, Sazak H, Baldemir R, Alagöz A. Unexpected difficultintubation with a double-lumen tube in a case of asymptomaticvallecular cyst. Turk J Anaesthesiol Reanim. 2021;49(4):334-337. doi:10.5152/TJAR.2021.291
20. Watson NC, Hokanson M, Maltby JR, Todesco JM. The intubatinglaryngeal mask airway in failed fibreoptic intubation. Can J Anaesth.1999;46(4):376-378. doi: 10.1007/BF03013232
Article available in :
Volume 1, Issue 1, 2024
Page : 20-23
https://doi.org/10.51271/EAJAIC-0005
Article Information
Received : 08 Oca 2024
Accepted : 29 Oca 2024
Published : 12 Şub 2024
Corresponding Author :

Musa Zengin: Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Arıcan D, Zengin M, Kabal O, Baldemir R, Alagöz A. A different airway management in double lumen tube intubation due to unexpected difficult airway. Eur J Anesthesiol Intensive Care. 2024;1(1):20-23.

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