Extubation of the difficult airway
Hi, My name is Keith Greenland. I'm an Anaesthetist in Brisbane Australia and this lecture is going to be covering the extubation of the difficult airway. This lecture will not be looking at the work that has already been performed by the Difficult Airway Society, UK. This slide shows one of three ofthe very important algorithms that that group has produced.
Instead what we're looking at is really a diagnosismanagement approach similar to what we've already been exploring in lectures of this series. Now it's the application of this to the extubation extubation of the anatomically difficult airway. This work has been a group effort from a number of our workers within our department.
Let's just take a case, first at the beginning of this lecture and we'll explore the answers towards the end. The 31 year old lady is presenting for drainage of a submandibular abscess which has started with a dental abscess. There are no other significant medicalhistory, patient's a nonsmoker, 90 kilograms,
submandibular abscess is unilateral, there is mild respiratory distress, limited mouth opening. An awake fibreoptic intubation's been successful with placement of a nasal reinforced endotracheal tube size 7 45 minutes after the procedure is finished there's been significant pus that's been drained,
what we're now looking at is performing a laryngoscopy. For instance direct laryngoscopy with a Macintosh 3 blade shows a CormackLehane Grade IIb if we are looking with CMac tutorial laryngoscope number 3 on the screen we've got a Grade I CormackLehane there's mild supraglottic swelling and in fact we find also is thatthere is a positive quot;leak testquot;, that is
there is a leak around that tube when it is blocked off so there is a significant amount of space between the tube and the pharyngeal mucosa. Now there are number of options here, first of all do we talk to ICU(intensive care) and look at the possibility of an ICU bed, request a HDU bed a high dependency unit bed and send the patient