Fiber optic intubation

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Fiberoptic Endotracheal Intubation

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Fiber optic intubation

  1. 1. Fiber Optic Intubation Three Case Reports Reid Rubsamen, M.D.
  2. 2. Known Difficult Intubation <ul><li>Case Report </li></ul><ul><ul><li>63 y/o woman for left breast lumpectomy and node dissection </li></ul></ul><ul><ul><li>Known difficult intubation </li></ul></ul><ul><ul><li>Easy to mask ventilate for previous surgery </li></ul></ul>
  3. 3. Known Difficult Intubation <ul><li>Case Report (Continued) </li></ul><ul><ul><li>General anesthesia induced with propofol/fentanyl/cisatracurium </li></ul></ul><ul><ul><li>Tongue withdrawn by assistant holding gauze square </li></ul></ul>
  4. 4. Pharyngeal Carcinoma <ul><li>Case Report </li></ul><ul><ul><li>75 y/o man with oral pharyngeal carcinoma for open G-Tube placement </li></ul></ul><ul><ul><li>Mouth opens 3cm at teeth </li></ul></ul>
  5. 5. Pharyngeal Carcinoma <ul><li>Case Report (Continued) </li></ul><ul><ul><li>Pre Rx midazolam </li></ul></ul><ul><ul><li>Topicalized using xylocaine ointment on progressively larger oral airways </li></ul></ul><ul><ul><li>Xylocaine 4% sprayed x1 with Mucosal Atomization Device (MAD) </li></ul></ul><ul><ul><li>Olympus bite-block airway inserted </li></ul></ul><ul><ul><ul><li>Patient’s mouth would not open to accommodate Ovassapian airway </li></ul></ul></ul>
  6. 6. External Tracheal Compression <ul><li>47 y/o woman with toxic, obstructive multinodular goiter </li></ul><ul><li>Progressive wheeze x 6 months </li></ul><ul><li>“ My endocrinologist wants to know how you’re going to get the breathing tube in” </li></ul>
  7. 7. External Tracheal Compression
  8. 8. External Tracheal Compression <ul><li>Case Report (Continued) </li></ul><ul><ul><li>Pre Rx midazolam </li></ul></ul><ul><ul><li>Topicalized using xylocaine ointment on progressively larger oral airways </li></ul></ul><ul><ul><li>Xylocaine 4% sprayed x1 with Mucosal Atomization Device (MAD) </li></ul></ul><ul><ul><li>Ovassapian airway inserted </li></ul></ul>
  9. 9. External Tracheal Compression <ul><li>Case Report (Continued) </li></ul><ul><ul><li>Intraoperative comment from surgeon: </li></ul></ul><ul><ul><ul><li>“ This patient has a small trachea” </li></ul></ul></ul><ul><ul><li>Nodule removed without median sternotomy </li></ul></ul><ul><ul><li>Path report: </li></ul></ul><ul><ul><ul><li>“ Thyroid goiter 7.5cm x 6cm x 4cm” </li></ul></ul></ul>

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