A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

Hi, I'm Dr.Maria Zeto from the Department of Anesthesiology at the Children's Hospital of Michigan. Hi, I'm Dr.Roland Kado from the Department of Anesthesiology at St.Jude Children's Research Hospital. As anesthesiologists, we provide medical care to patients before, during, and after surgical procedures.

This includes the safe delivery of anesthesia to patients, maintenance of intraoperative life support, and especially airway management. Airway management can be challenging. Often airway difficulty can be predicted beforehand.

Other times, an anesthesiologist may face unexpected difficult airway during the induction of anesthesia. Much physician education focuses on the difficult and failed airway. This teaching often includes rescue strategies as well as the utilization of airway devices.Okay.

Many airway aids exist for the rescue of patients when unexpected scenario of cannot ventilate, cannot intubate occurs. These devices include the laryngeal mask, airway, the fiber optic scope, the light stylette, and the video laryngoscope to name a few. However, most airway aids take time and additional hands to initiate.

Today we will show you a novel and simple rescue technique for difficult ventilation in a child. We will demonstrate how an endotracheal tube can be used to create a temporary artificial airway. This readily available tube can be placed in the oropharynx or nasopharynx while sealing the mouth and nose and applying positive pressure ventilation.

It's that easy. With the establishment of this temporary airway and with improved oxygenation, the stress of a difficult pediatric airway can be alleviated. It is the ability to rescue a lost airway rapidly and effectively that makes the simple maneuver so important to learn.

So let's get started. To prepare for this procedure first, select an endotracheal tube size or ETT that is appropriate for the patient's age by using this formula. ETT size equals age in years divided by four plus four.

In this demonstration, we'll use an uncuffed ETT that is one size smaller in case the nasal endotracheal intubation fails. After the patient is put to sleep a mask, anesthetic induction is performed, eyes are protected with tape and monitors are placed. Next, measure the approximate distance from the anesthetized patient's nose to the level of the vocal cords, which is usually at the level of the mid thyroid cartilage.

To reduce the risk of bleeding, spray a decongest and lubricant into the nose and lubricate the ETT before insertion. Now insert the ETT nasally or orally to a level just above the vocal cords. Seal the mouth and nose of the patient by hand.

Then attach the anesthesia circuit to the ETT connector with appropriate seal of the mouth and nose After insertion of the ETT, the lungs can be adequately ventilated as confirmed by noticing the end tidal carbon dioxide wave forms on the monitor, chest rising of the patient, and good oxygen saturation. On the pulse oximeter, We've shown you a novel and simple rescue technique for difficult ventilation in a child by using an endotracheal tube to create a temporary artificial airway. When doing this procedure, it's important to remember to insert endotracheal tube to the level of the posterior pharynx to ventilate the airway and minimize the air into the stomach.

It's also important to have a good seal of the mouth and nose so that positive pressure ventilation is effective. Remember that in an emergency, it is easier to use the tools that you are used to using rather than new and fancy equipment with, which you may not be familiar. It is the ability to rescue a lost airway rapidly and effectively with simple tools that makes this maneuver so important to learn.

So that's it. Thanks for watching and good luck with your patience.