Hsien-Yong Lai

Emergency tracheal intubation in an ankylosing spondylitis patient in the lateral position using the GlideScope.

Anesthesia for ankylosing spondylitis (AS) patients with difficult airway is of great stress to anesthesiologists. If tracheal intubation is not mandatory for general anesthesia, laryngeal mask airway (LMA) may suffice for adequate ventilation. Yet, in certain circumstances, no one can guarantee that LMA will reliably serve the purpose in surgical AS patients, especially in operations performed in the lateral decubitus position. We present here an AS patient with difficult airway scheduled for hip surgery. General anesthesia with sevoflurane conveyed by an LMA through spontaneous ventilation in the lateral decubitus position was planned, and the induction was smoothly done. Unfortunately, laryngospasm and oxygen desaturation occurred during the operation; the patient was successfully rescued by nasal intubation with a GlideScope in the lateral decubitus position without interrupting the operation.

The use of the GlideScope® for tracheal intubation in patients with halo vest

OBJECTIVE GlideScope® provides better laryngoscopic view and is advantageous in tracheal intubation in ankylosing spondylitis patients with difficult airway. METHODS This study was performed to investigate the use of the GlideScope® for tracheal intubation in 15 patients wearing halo vests scheduled for elective surgery under general anesthesia. Preoperative airway assessments were evaluated to predict the difficulty of tracheal intubation. Before intubation, all patients were given a modified Cormack and Lehane (MCLS) grade and percentage of glottic opening (POGO) score by the intubating anesthesiologist having resorted to direct laryngoscopy (DL) with a Macintosh Size 3 blade depiction. Then intubation with the GlideScope® was performed, during which the larynx was inspected and given another MCLS grade and POGO score. RESULTS Fourteen of the 15 patients had MCLS Grade III or IV by direct Macintosh laryngoscopy and were considered to have a difficult laryngoscopy. Nasal tracheal intubation by the GlideScope® was successful on all occasions. The GlideScope® improved the MCLS grade and POGO score in all patients who had put on a halo vest as compared with those on DL (p<0.01). The GlideScope® also provided a better laryngoscopic view than that by a DL. All of the patients who wore halo vests and presented with suspected difficult airways could be intubated successfully with the GlideScope®. CONCLUSION The use of the GlideScope® for tracheal intubation could be an alternative option in patients with a difficult airway, whose surgery was circumscribed under general anesthesia with tracheal intubation.

Pentax-Airway Scope for tracheal intubation breaks through the limitation of neck motion in an ankylosing spondylitis patient wearing halo vest–A case report

The Airway Scope (AWS) provides better glottic view than the conventional direct laryngoscopy in tracheal intubation. With it, the endotracheal tube can be more easily inserted into the tracheal lumen easily. We hereby presented a 24-year-old ankylosing spondylitis (AS) patient wearing a halo vest who was successfully intubated for undergoing cervical spine surgery involving C1 and C2 under general anesthesia. Pre-operative airway assessment revealed that he was a case of difficult intubation. An AWS was used for oral tracheal intubation which was achieved smoothly in the first attempt. AWS can be an alternative device for airway management in a patient wearing halo vest.

Accidental pulmonary emboli noted by TEE during aortic valve replacement: a case report

Pulmonary embolism (PE) is difficult to diagnose clinically. In a patient who was scheduled for elective aortic valve replacement, several fresh emboli were recognized in the right atrium on transesophageal echocardiography (TEE). The PEs then disappeared on the echocardiographic image, with significant immediate hemodynamic changes noted by real-time monitors, such as tachycardia and increased pulmonary artery (PA) pressure. Pulmonary embolism was highly suspected. After cardiopulmonary bypass and aortic valve replacement, PA thromboembolectomy was performed successfully. The patient survived and was discharged from the hospital 17 days later without sequelae.

Determination of Spread of Injectate After Ultrasound-guided Interscalene and Supraclavicular Brachial Plexus Block: A Fresh Cadaveric Study

Abstract Objective The aim of this anatomical study was to establish the likely spread of local anesthetics in vivo and the segmental nerve involvement resulting from ultrasound-guided interscalene brachial plexus blocks and supraclavicular brachial plexus blocks. Materials and Methods We performed ultrasound-guided injections of different alinine dyes into the right brachial plexus at the interscalene and supraclavicular levels in seven fresh human cadavers. We then dissected the cadavers to determine the extent of dye spread and the nerve that was dyed. Results The cadavers provided excellent sonographic images during nerve blocks. After excluding one pilot specimen, six right brachial plexus blocks were successfully performed and dissected. The extent of dye spread and nerve involvement were different in the interscalene brachial plexus blocks and supraclavicular brachial plexus blocks. The phrenic nerve with dye was identified in the interscalene brachial plexus block. Conclusion This study showed that the extent of dye spread and nerve involvement differs in interscalene and supraclavicular brachial plexus blocks. Phrenic nerve involvement in the interscalene block was confirmed through dissection. Fresh human cadavers, by providing excellent sono-graphic images, are potential learning and practice models in ultrasound-guided brachial plexus blocks.