Palmo Anest

Airway emergency

The other day my friend Chen had a Bleeding day in their OT, today, I have an airway day. 1st of all, the Capnograph not working on our philip monitor, had to change to an old side stream capnograph.

I'm running Dental/Maxillofacial OT. My 1st patient is an obese lady with BMI of 40. Well, I was anticipating some problem but it was a smooth take off and landing (induction and extubation). I've planned to blind nasal intubate all my today's patients so that I'd master this technique. However seeing my patient's size, I give up on trying blind nasal intubation. In fact her saturation droped very fast, before the suxamethonium works, while her feet was still fasciculate, her saturation already starts to drop. I didn't wait untill she finished fasciculate, intubate her with a Nasal RAE tube, her saturation never fell below 94% during intubation.

Another case, a young man coming in for dental clearance under GA, had receding chin with Thyro-Mental-Distance about 2.5 cm; limited mouth opening of less then 3 cm. So I wouldn't try blind nasal intubation on him also. I was telling the 3 student MA about how to assess the airway and anticipate problem intubation for this case, what's our options etc etc... Guess what I got? A Cormack-Lehane class 4 laryngoscopy! Goodness, that is the most difficult airway, together with his limited mouth opening making it worst. Luckily I can mantain the airway with simple bag and mask!

I tried to push the nasal tube into the trachel with Mcgill forcep but can't. CHange to a Oral ETT, twice I pushed it into oesophagus. This guy is really a classic, with strong cricoid pressure still unable to visualised the vocal cord... not even 0part of the damn hold.

Called my consultant, called surgeon to stand-by for tracheostomy. Luckily God is with us that I can ventilate him very well with the bag and mask. My consultant anaesthetist took over the intubation part and he also struggled a lot. Finally he get him intubated with a much smaller size ETT, size 7. If we couldn't maintain his airway, by the time the surgeon arrived, my boss might probably poke a QuickTrach down his troat already...

The dental surgeon is a sprot. he kept remind us that not to worry, he can cancell the case, no problem.. :)

posted by LT @ 8:26 PM