Anesth Analg 2003;96:1531
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
Combined McCoy and Balloon Laryngoscopy for the Emergency Airway Management of a Patient with Acute Postoperative Airway Obstruction Due to Extreme Engorgement of the Tongue
Spyros D. Mentzelopoulos, MD DEAA,
Kostantinos V. Rellos, MD PhD,
George L. Magoufis, MD,
Chrysoula S. Gini, MD,
Stavros Tobris, MD, and
Argyris S. Michalopoulos, MD PhD, FCCM
Departments of Intensive Care Medicine, Interventional Radiology, and Anesthesiology, Henry Dunant General Hospital, Athens, Greece
To the Editor:
Imminent, postextubation airway obstruction secondary to excessive tongue engorgement (Fig. 1) was diagnosed in a 42-yr-old woman with tongue-venous malformation subjected to sclerotherapy. Clinical manifestations included tachypnea, diaphoresis, agitation, and low-pitched inspiratory stridor. Simplified airway risk index score amounted to 4 (1). Tongue size/shape precluded adequate mask ventilation (2). Emergency endotracheal intubation under general anesthesia/neuromuscular blockade was decided (3). After thiopental/succinylcholine administration, a number 4 McCoy laryngoscope blade with a 6F Fogarty catheter attached on its concave surface (4) was introduced into the upper airway. A grade IV laryngoscopic view was initially obtained (5), because the swollen tongue base was covering the epiglottis. McCoy lever was pressed, blade-tip was elevated ((Fig. 2A), tongue-base was displaced upwardly, and epiglottis-tip was exposed. Blade-tip was advanced into the vallecula and Fogarty catheter balloon inflated with 2 mL of air (Fig. 2B), resulting in arytenoids’ exposure. Subsequent, anterior blade elevation (6) and external thyroid pressure resulted in exposure of the posterior laryngeal aperture-half. A gum elastic bougie was then introduced into the larynx and a 6.5-mm ID endotracheal tube passed over it into the trachea (Fig. 1). Conclusively, combined McCoy-balloon laryngoscopy may be a useful alternative for the management of postsclerotherapy airway obstruction.
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Figure 1. The patient after the emergency, postsclerotherapy reintubation of the trachea described in the text.
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Figure 2. Representation of the two main steps of the employed, combined laryngoscopic technique for the emergency, postoperative reintubation of the trachea. A, McCoy blade tip elevation; B, Fogarty catheter balloon inflation (with 2 mL of air) with the McCoy blade tip being kept elevated.
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References
- El-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82: 1197–204.[Abstract]
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- Caplan R, Benumof JL, Berry FA, et al. Practice guidelines for the management of the difficult airway: a report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology 1993; 78: 597–602.[Web of Science][Medline]
- Mentzelopoulos SD, Romana CN, Corolanoglou DS, et al. Balloon versus conventional laryngoscopy: a comparison of laryngoscopic findings and intubation difficulty. Anesth Analg 2000; 91: 1513–9.[Abstract/Free Full Text]
- Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.[Web of Science][Medline]
- Mentzelopoulos S, Balas C, inventors. Laryngoscope with a flexible blade. United States Patent No. 6,251,069 B1. Date of Patent issuance: June 26, 2001.
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