CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dutta, A.
Right arrow Articles by Chari, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dutta, A.
Right arrow Articles by Chari, P.
Canadian Journal of Anesthesia 48:1048-1049 (2001)
© Canadian Anesthesiologists' Society, 2001

Correspondence

An unusual solution to unsuspected difficult airway: the esophageal dilator guide

Amitabh Dutta, MD, Y.K. Batra, MD MNAMS, A. Ram Mohan, MBBS and Pramila Chari, MD MNAMS FAMS

To the Editor:

A 40-yr-old (153 cm, 50 kg, ASA-I) woman was scheduled for excision of a recurrent ameloblastic carcinoma involving the right upper alveolus and maxilla. Earlier, she had received uneventful general anesthesia twice and radiotherapy. Airway assessment revealed a mouth opening of 4 cm, loose incisors, an absent left alveolar ridge with collapsed overlying cheek secondary to the previous left maxillectomy, a Mallampati1 class-I airway and a maxillary growth barely protruding over the right faucial pillars without obstructing the view of the oropharyngeal structures. Neck mobility was normal. An axial tomogram of the head showed the maxillary mass occupying both nares and a destroyed septum (Figure).



View larger version (146K):
[in this window]
[in a new window]
  		Computed tomography (axial view) of the head showing a maxillary mass occupying both nasal cavities with destruction of the nasal septum.

 
Following preoxygenation, anesthesia was induced with propofol 2.5 mg•kg–1 and suxamethonium 1.5 mg•kg–1 was administered intravenously after ensuring mask ventilation. Laryngoscopy with a No.2 Macintosh blade revealed a Cormack and Lehane2 grade 1 view of the vocal cords. An intubation attempt using a 7.0 mm ID endotracheal tube (ETT) failed, as the maxillary growth had reduced the available oropharyngeal space. Any further displacement of the tongue to the left resulted in the laryngoscope blade giving way at the missing alveolar ridge. We overcame this difficulty in a novel manner; a straight blade (Harlake No.2) was introduced and the tongue shifted as much possible to the left. An esophageal dilator (No.18, Porges Neoplex, France 4001) was advanced gently into the tracheal inlet along the flange, the laryngoscope removed and a 6.5 mm ETT was railroaded over it into the trachea.

Our case represents an unsuspected difficult airway, where the view at laryngoscopy was adequate but the oropharyngeal space insufficient to intubate. The esophageal bougie (90 cm, flexible, atraumatic tip) may prove a useful alternative to conventional guides3,4 and/or fibreoscope5 in situations where they are not readily available.

References

1 Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34.[Medline]

2 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.[Medline]

3 Dogra S, Falconer R, Latto IP. Successful difficult intubation. Tracheal tube placement over a gum-elastic bougie. Anaesthesia 1990; 45: 774–6.[Medline]

4 Carr R, Reyford H, Belani K, Boufflers E, Krivosic-Horber R, Palahniuk R. Evaluation of the Augustine guideTM for difficult tracheal intubation. Can J Anaesth 1995; 42: 1171–5.[Abstract/Free Full Text]

5 The difficult intubation. In: Ovassapian A (Ed). Fiberoptic Airway Endoscopy in Anesthesia and Critical Care. New York: Raven Press, 1990: 135–48.





This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dutta, A.
Right arrow Articles by Chari, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dutta, A.
Right arrow Articles by Chari, P.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS