Journal of Head & Neck Anesthesia最新文献

{"title":"Incidental findings of bilateral vocal cord polyps and asymptomatic pulmonary embolism during EBUS-guided mediastinal staging: a case report highlighting teamwork in management decision making","authors":"B. Abdelmalak, Humberto K. Choi, Paul C Bryson","doi":"10.1097/HN9.0000000000000045","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000045","url":null,"abstract":"We report on two significant incidental findings in a patient during the course of a routine Endobronchial ultrasound (EBUS) guided trans-bronchial needle aspiration (TBNA) procedure, namely smoking related bilateral vocal cord polyps, and pulmonary embolism. We discuss the sequence of events, the needed reassessment of risk/benefit analysis of the planned procedure and the rationale behind the decisions made as the case has evolved. Thoughtful stepwise approach to diagnosis and management through a real-time multidisciplinary collaboration resulted in a favorable outcome despite the complex medical scenario.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127042092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized controlled trial assessing intubation time with and without an aerosol biocontainment device","authors":"Michael A. Kohanski, Heather Ungerer, Katherine Xu, J. Douglas, R. Carey, Christopher Rassekh, T. Chao, Mitchell L. Weinstein, J. Atkins","doi":"10.1097/HN9.0000000000000043","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000043","url":null,"abstract":"Introduction: The emergence of the coronavirus disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and methods to reduce risk of airborne respiratory pathogen transmission. This has led to the development of novel aerosol protective devices for which clinical and aerosol protective features have not been fully characterized. The relative efficacy of these devices for use during airway procedures has not been assessed in randomized controlled trials. Materials and Methods: We recruited anesthesiology attendings, residents, and certified registered nurse anesthetists to perform intubations with an aerosol biocontainment device (ABCD). Thirty-seven patients undergoing procedures requiring intubation in the operating room were recruited and randomized (2:1) to intubation with (25) or without (12) the ABCD. Primary endpoints were time to secure the airway and adverse events. Secondary endpoints were a number of intubation attempts, access to the patient and airway equipment through the device ports, user assessment of ABCD function and technical burden, and patient experience in the ABCD. Results: Intubation time with the ABCD (46 s) was not significantly different compared to intubation without the ABCD (37 s; P=0.06). There were 3 adverse events with the ABCD (1 claustrophobia, 2 unanticipated difficult airways) that required device removal for intubation. In general, patients tolerated the device well and ABCD users felt the device functioned as intended but increased the technical burden associated with intubation. Discussion: It is feasible to use an aerosol protective device for intubation. The introduction of novel devices into high acuity airway procedures should be approached with caution and should account for the risk mitigation gained from the device balanced against the increased procedural complexity and potential safety risks associated with restricted access to the airway.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"147 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115814871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational analysis of criteria for a difficult airway alert","authors":"A. Milne, Gregory R. Dobson, Stewart J. Forbes","doi":"10.1097/HN9.0000000000000044","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000044","url":null,"abstract":"Introduction: Difficult airway alerts are a tool used to document difficulties encountered with the patient’s airway and assist with future management. There is no universally accepted criterion as to who should get a difficult airway alert and the indication for these alerts may be changing with the proliferation of videolaryngoscopes. The purpose of this study was to characterize the airway events that were encountered in patients who had been assigned a difficult airway alert by staff anesthesiologists. Methods: This retrospective study analyzed the airway details of patients who were assigned a difficult airway letter at an academic teaching institution between November 2011 and January 2016. Electronic records of intraoperative airway management and difficult airway letters were reviewed for the methods used, difficulties encountered, and what recommendations were provided for future airway management. Results: A cohort of 107 adult patients (62 males and 45 females) issued difficult airway letters identified for analysis. The mean age (SD) of the cohort was 57 (±13) years, and the mean body mass index was 31 (±7) kg/m2. Direct laryngoscopy failed in 68 of 89 cases, with 77 reported grade III views and 9 grade IV views. Videolaryngoscopy (VL) was used successfully in 63 cases, with 8 documented VL failures. Ten patients were intubated awake with a flexible bronchoscope (FB), and 6 cases were managed using an asleep FB technique. The most common methods suggested for future airway management were VL (57 cases) or either awake or asleep FB (31 cases). Conclusions: Patients with difficult direct laryngoscopy were predominant in this cohort who were assigned a difficult airway alert. Many of the difficult airways were successfully managed using VL, however, FB was required in some cases. Staff preferentially recommended VL over flexible bronchoscopy for future management of the known difficult airway.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128591341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole-organ deceased donor tracheal allograft transplantation for the treatment of refractory tracheal stenosis: a case report","authors":"S. Dickerson, E. Genden, Caroline R. Gross, S. Florman, E. Franz, Daniel R. Chang, S. DeMaria","doi":"10.1097/hn9.0000000000000041","DOIUrl":"https://doi.org/10.1097/hn9.0000000000000041","url":null,"abstract":"","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126558244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single-center pilot study comparing dexmedetomidine continuous infusion versus propofol TCI for drug-induced sleep endoscopy (DISE)","authors":"Ilaria Alicino, R. Corso, Michele Barbara, Valentina I. Dibenedetto, F. Barbara, M. De Benedetto, N. Fossati, D. Cattano","doi":"10.1097/HN9.0000000000000040","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000040","url":null,"abstract":"Background: Drug-induced sleep endoscopy (DISE) has become a routine diagnostic tool to assess the upper airway in obstructive sleep apnea patients, enabling effective diagnosis and appropriate treatment of the obstruction site. A number of protocols with different drugs and availability of target-controlled infusion (TCI) systems have been reported and published, making comparisons between studies difficult. In recent years, dexmedetomidine has claimed a role as a potential alternative to propofol for DISE sedation. In a real-life study we compared the effects of dexmedetomidine continuous infusion or propofol-TCI in patients undergoing DISE on time to reach adequate observation conditions, cardio-respiratory parameters, and recovery. Methods: Pilot prospective, randomized not blinded, single center study. A total of 28 patients scheduled to have DISE were randomly assigned to either group P (N=14; propofol-TCI, initial propofol effect-site target concentration 2.0 µg/mL, increased by 0.3 µg/mL every 2 min) or group D (N=14; dexmedetomidine bolus 1 µg/kg over 10 min, followed by infusion at 0.7 µg/kg/h). Hemodynamic and respiratory variables (including SpO2 nadir), time to reach the observation window and overall DISE duration were recorded. Results: A total of 28 patients were enrolled and completed the study: the cohort included 26 males (92.85%) and 2 females (7.14%). The mean age was 45.4±11.1 years [interquartile (IQ), 25.0–65.0], body mass index 30.5±3.4 kg/m2 (IQ, 21.0–36.0), and apnea-hypopnea index 36.9±21.1 events/hour (IQ, 7.8–95.0). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Epworth Sleepiness Scale score, preprocedural SpO2 nadir, age, sex, or body mass index. Compared with group P, group D showed significant differences in SpO2 (higher nadir during DISE, 87.09±5.4% vs. 75.0±11.0; P<0.001) and heart rate (80.4±8.9 vs. 62.8±6.6; P<0.001). While group D had longer duration of endoscopic examination times and emergence time from sedation, the grading of site of obstructions were similar in the 2 groups. Conclusions: Dexmedetomidine seems a limited, if viable, clinical alternative for DISE when propofol is contraindicated or not available: while causing higher SpO2 nadirs compared with propofol, it has a slow onset and longer recovery time, increasing total procedural time. Studies with greater patient numbers are needed to confirm these observations.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131679083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development, implementation, and efficacy of a perioperative briefing communication and treatment planning tool and its adaptation to the COVID-19 pandemic","authors":"C. Rassekh, J. Atkins, B. O'Malley, A. Chalian, R. Brody, D. Basu, Ellen A. Paul, G. Weinstein","doi":"10.1097/HN9.0000000000000036","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000036","url":null,"abstract":"Background: Effective communication and team alignment are critical elements in overall preparedness for surgery. We sought to assess staff perceptions of a newly implemented perioperative communication mechanism and evaluate its ongoing efficacy. Methods: A perioperative email briefing tool was developed as a virtual “huddle” process. A survey of the care team was then done after the first 6 months of its use. Implementation of the briefing for new faculty and a pandemic was observed. Results: After 6 months, all 4 head and neck surgeons had adopted this tool and utilized it for nearly 100% of cases, and the instrument was adopted by all other faculty subsequently joining the practice group. In the initial assessment, 98% of all respondents felt the process should continue. In a follow-up survey, over 88% believed the briefings reduced the risk of serious errors, near misses, and complications. Conclusions: An email perioperative briefing is feasible and improved workflow and safety.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128265511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in the criteria for a difficult intubation alert in the age of videolaryngoscopy: a scenario-based, multidisciplinary, multi-institutional provider survey","authors":"J. Allyn, C. Curry, P. R. Hubbs, Anne Hicks, W. Craig, Emily Muns, Philip Susser, J. Richard, J. Atkins","doi":"10.1097/HN9.0000000000000037","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000037","url":null,"abstract":"Supplemental Digital Content is available in the text. Introduction: Our goal was to characterize further variability in how providers both define a difficult intubation and apply a difficult tracheal intubation alert. Materiala and Methods: We developed a survey describing 26 different intubation scenarios encompassing a range of clinical complexity and equipment. Scenarios included multiple factors hypothesized to impact a provider’s definition of a difficult intubation and the threshold for a difficult intubation alert. Provider responses were then assessed for variability and agreement. The survey was distributed at 2 academic medical centers, 1 in Portland, ME (1 teaching hospital, 600 beds) and 1 in Philadelphia, PA (2 teaching hospitals, 1180 total beds). Electronic surveys were sent to anesthesia and emergency medicine providers (total N=617). Providers were asked to grade the difficulty of the scenario presented and whether they would activate the difficult intubation alert in the electronic health record. Responses were pooled and summarized as a frequency (%) and analyzed by provider type and institution. Results: Providers lacked agreement about scenarios that were very difficult or when an alert should be used. This variability was similar among provider types and institutions. Providers assessed scenarios as being more difficult and were more likely to apply an alert when videolaryngoscopy was not available. Conclusions: Substantial variability was demonstrated in providers’ definition of a difficult intubation and the threshold to activate a difficult intubation alert. This variability is consistent with related findings by other groups and represents a latent patient safety threat. The availability alone of videolaryngoscopy influences a provider’s definition of a difficult intubation, resulting in the grading of a scenario as less difficult. The associated risks may be mitigated by the delineation of specific criteria for difficult intubation designation and alert activation at the hospital or health system level.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"225 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132140909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert consensus statement on the perioperative management of adult patients undergoing head and neck surgery and free tissue reconstruction from the society for head and neck anesthesia","authors":"D. Healy, Benjamin H Cloyd, T. Straker, M. Brenner, E. Damrose, M. Spector, Amit R. Saxena, J. Atkins, R. J. Ramamurthi, Arpan Mehta, M. Aziz, D. Cattano, A. Levine, S. Schechtman, L. Cavallone, B. Abdelmalak","doi":"10.1097/HN9.0000000000000038","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000038","url":null,"abstract":"Supplemental Digital Content is available in the text. The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The Modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near-consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116864976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying patterns of utilization of single-use video laryngoscopy and supraglottic airway devices to reduce waste","authors":"Timothy Baerg, S. Klapman, Benjamin H Cloyd, David Hovord, T. Edelman, D. Healy, S. Schechtman","doi":"10.1097/HN9.0000000000000035","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000035","url":null,"abstract":"Supplemental Digital Content is available in the text. Introduction: Lean management, a systematic method of reducing waste in manufacturing, is an approach that has led to quality improvement and cost reduction in health systems. Utilization of single-use airway equipment, such as videolaryngoscope (VL) blades and supraglottic airways (SGAs) has helped reduce the risk of cross-contamination and the time and cost associated with reprocessing and sterilization. Methods: We examined the efficiency of single-use VL blades and SGAs within our tertiary care health system. Purchasing data were reviewed and compared with device utilization within the electronic medical record to determine the amount of waste of disposable airway equipment. Direct observations (Gemba walks) were made in the operating rooms to assess device utilization. For SGAs, a diagnostic questionnaire was sent to providers regarding approaches to use. Results: We found the total cost of opened but unused VL blades equaled $29,267. For SGAs, we found that devices were often opened before use and that there is a 16.67% first-time failure rate for placement of SGAs. Conclusions: Through education and organizing device setup, and streamlining communication, there is a possibility to reduce future waste.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129853161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of high flow nasal oxygen in a patient with Duchenne muscular dystrophy with severe restrictive lung disease requiring dental extractions: a case report","authors":"D. Desjardins, Leila W. Zuo","doi":"10.1097/HN9.0000000000000034","DOIUrl":"https://doi.org/10.1097/HN9.0000000000000034","url":null,"abstract":"Presentation: A 22-year-old man with Duchenne muscular dystrophy (DMD) presented for removal of impacted third molars in his baseline health status. Comorbidities included decreased mobility, restrictive lung disease [forced vital capacity (FVC) 35% at baseline], adrenal insufficiency, and obstructive sleep apnea. Anesthetic challenge: General anesthetics are problematic in this population. The airway is typically compromised by macroglossia. Patients have reduced functional residual capacity, so time to desaturation after induction is reduced; in patients with FVC<50% there is high risk of postoperative pulmonary complications. Those with FVC<30% face further increased risk. The use of depolarizing neuromuscular blockade is contraindicated due to the risk of hyperkalemia. Residual nondepolarizing neuromuscular blockade could compromise postoperative pulmonary status further. Controversy remains regarding use of inhaled anesthetics, but they are generally avoided given the risk of rhabdomyolysis. In addition, DMD patients often have cardiomyopathy, further complicating management. The overall challenge was to avoid general anesthetics in this patient. How it was done: After a full discussion with the patient and family, we decided sedation with local anesthetic was the safest anesthetic plan. As a safeguard, inhaled anesthetics were removed, the machine was flushed, and filters were placed in the circuit; a Glidescope was available. We proceeded with moderate sedation with propofol and dexmedetomidine infusions. Given his reduced pulmonary function and need for oral access, the patient was placed on high-flow nasal cannula to provide supplemental oxygen and provide positive end-expiratory pressure. Opioids were kept to a minimum: 50 mcg fentanyl was given with local anesthetic injection. The anesthetic and dental teams talked the patient through his discomfort for much of the procedure. Music of the patient’s choosing was played. Overall the patient did well with a combination of sedation, local anesthesia, and coaching by the surgery and anesthesia teams. He was discharged same day without noted complications of anesthesia. Conclusion: Preparation for this apparently “simple” case in a complex patient was key to our success. By addressing the known pulmonary changes in DMD, we employed high-flow nasal cannula in a dental surgery—a new use for this device. By using all the tools available to us as anesthesiologists we were able to avoid an intubation and the possibility of a prolonged hospital stay for our patient.","PeriodicalId":404380,"journal":{"name":"Journal of Head & Neck Anesthesia","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131180518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}