Head&Neck Surgery Anesthesia


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When Videolaryngoscopy fails, you should have a quick response.
First, if feasible, you may try with an introducer.
But if the view is impeded, an introducer may provoke some damage.

Our second line rescue approach, when VL fails is VAFI:
Our intubation station has a single use fiberscope always ready to use.

But remember: you don't have so many hand as Kali goddess, so CALL FOR HELP first!
A colleague will use the fiberscope while you are maintaining the VL view on the field. When the tip of fiberscope appears, switch your eye to the FBS view and complete the task.

LAST BUT NOT LEAST:
VAFI is a rescue approach, it's not an alternative to awake intubation when indicated.

Take a look to this video:
https://youtu.be/GI6b6WU8Yz0

We presented the preliminary results of our study at the European Airway Management Society Congress in Baveno.

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Peri-Oxigenation (Pre-Oxygenation + Apneic Oxygenation) is the new black, but how to measure its efficacy? Results will be published soon

Should these patients to be routinely admitted to ICU after surgery?
ERAS Guidelines say no: JAMA Otolaryngol Head Neck Surg. 2017;143(3):292-303. doi:10.1001/jamaoto.2016.2981

"In absence of these factors, there are no data to support the use of routine ICU care. Funding issues, ICU work load, standing costs (in the ICU and elsewhere), and the availability of skills and resources outside of the ICU must be considered in the determination of optimal postoperative location of care and this needs to be individualized to each health care facility."
In our institution patients are routinely admitted to the otholaryngology ward, but they obviously deserve adequate monitoring.

We tested recently the Radical-7 Pulse CO-Oximeter by Masimo, with the added value to permit continuous monitoring of ECG, respiratory rate, temperature, patient's position, SpO2, SpHb, SpOC and Perfusion Index in association with the clinical/doppler evaluation of the flap.

We think this means quality and safety for our patients.

The presence of a narrow laryngeal stenosis was managed by videolaryngoscopic assisted fiberoptic intubation after first attempt with s-guide introducer
... yes, it's a new surgical procedure in the same patient of the previous blog article of May 2

See the procedure on VVAS Youtube Channel: https://youtu.be/KyU4E3FlM6M

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Tritube and Flow-Controlled Ventilation is an ideal approach for tracheal resection.
  • Easier and safe nasotracheal awake intubation
  • No field intubation needed, due to the ultra-thin 4.4mm OD tube.
  • Easier fiberoptic assessment of sutures and vocal cords movement at the end of surgery
  • Sweet extubation, due to the smaller size of the tube
A TUTORIAL HERE: http://www.vvas.it/tracheal-resection

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Anil Patel, from The Royal National Throat Nose and Ear Hospital, London, UK, in 2015 described the use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange technique to prolong the apnoea time during difficult airways management.

His paper, published on Anaesthesia, can be downloaded here:
https://doi.org/10.1111/anae.12923


Incontro con Alessandro Simonini - OSPEDALE DI VITTORIO VENETO -AULA G. DE BASTIANI - 21 NOVEMBRE 2022 - ORE 15:30  -  LIVE & MEET 

L'adenotonsillectomia rappresenta il più comune intervento chirurgico eseguito in età pediatrica, tuttavia, a fronte di una bassa complessità chirurgica, presenta un rischio di complicanze respiratorie non trascurabile.
In questo incontro, insieme al Dott. Alessandro Simonini, cercheremo di affrontare gli aspetti anestesiologici più rilevanti nella gestione del paziente pediatrico, al fine di ricavarne utili consigli di best practice da applicare nel proprio contesto lavorativo.

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Flow-Controlled Ventilation - How it works?

An emerging ventilation technique to linearize expiratory flow is flow-controlled ventilation (FCV), provided by the new ventilator Evone (Ventinova Medical B.V., Eindhoven, the Netherlands).
This device provides a constant positive flow during inspiration and a constant negative flow during expiration. Thereby pressure increases linearly during inspiration [comparable to volume-controlled ventilation (VCV)] and decreases linearly during expiration. Linearizing the expiratory flow improved lung recruitment, the homogeneity of lung aeration, gas exchange and further attenuated experimental lung injury.

Moreover, Evone enables the use of an ultra-thin tube, with an outer diameter of only 4.4mm: Tritube (Ventinova Medical B.V., Eindhoven, the Netherlands).

Filauro et al., recently published a nice case series based of their initial experience with Evone and Tritube. The images in attach, clearly show the advantage of using such device.

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(A-C) preoperative office flexible view of idiopathic subglottic stenosis (Cotton-Myer grade III); (B-D) the tritube provides minimal traumatic intubation and guarantees an ideal working space and exposure by maintaining stable ventilation; (E) an advanced case of RRP (Derkay site score: 12; Derkay clinical score: 7); (F) this difficult intubation can be achieved by small-lumen ventilation, such as Evone®. This latter, compared to HFJV, protects against aerosolisation of papillomavirus in the operating theatre; (G) the larynx of a patient repeatedly treated for RRP with a posterior glottic stenosis (Bogdasarian II); (H) the use of a narrow tube allows the treatment of the posterior compartment of the larynx, despite the presence of the posterior web.

© vvas.it 2022