https://doi.org/10.4081/amsa.2024.33

Awake intubation in a patient with morbid obesity in the emergency department: our experience

Vol. 2 No. 1 (2024)
Submitted: 22 September 2023
Accepted: 27 May 2024
Published: 4 July 2024
Awake intubation, obesity, guidelines
Abstract Views: 61
PDF: 18
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Authors

Gianmaria Chicone
gchicone@gmail.com
Department of Anesthesia and Intensive Care, Ospedale del Mare, Napoli, Italy.
Viviana Miccichè
Department of Anesthesia and Intensive Care, Ospedale del Mare, Napoli, Italy.
Rosa Gallo
Department of Anesthesia and Intensive Care, Azienza Ospedaliera Cosenza, Italy.
Francesco Maiarota
Department of Anesthesia and Intensive Care, Azienza Ospedaliera Cosenza, Italy.
Roberta Toto
Department of Anesthesia and Intensive Care, Ospedale del Mare, Napoli, Italy.
Ciro Fittipaldi
Department of Anesthesia and Intensive Care, Ospedale del Mare, Napoli, Italy.
Michele Iannuzzi
Department of Anesthesia and Intensive Care, Ospedale del Mare, Napoli, Italy.

Awake intubation is considered the standard of care for the management of the anticipated difficult airway. For its pharmacological properties, remifentanil is ideal for managing difficult endotracheal insertions. This process is augmented by the use of transtracheal injection of lidocaine as it disperses evenly around the area and facilitates the action of remifentanil further. A 48-year-old male patient, weight 200 kg, 184cm tall (BMI>40) came into the emergency room for severe hypercapnic hypoxic respiratory failure. Awake fiberoptic intubation was the option to secure the airway. Successful airway management is critical to the practice of emergency medicine. All anesthesiologists should be familiar with the airway management of obese patients.

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Scopus
Google Scholar
Europe PMC
Jeffrey L. Apfelbaum, Carin A, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31-81. DOI: https://doi.org/10.1097/ALN.0000000000004002
Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs 2005;65:1793–823. DOI: https://doi.org/10.2165/00003495-200565130-00007
Law JA, Duggan LV, Asselin M, et al. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth 2021;68:1405-36. DOI: https://doi.org/10.1007/s12630-021-02008-z
Rosenstock CV, Nørskov AK, Wetterslev J, et al. Emergency surgical airway management in Denmark: a cohort study of 452 461 patients registered in the Danish Anaesthesia Database. Br J Anaesth 2016;117suppl 1i75i82. DOI: https://doi.org/10.1093/bja/aew190
Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011;106:617631. DOI: https://doi.org/10.1093/bja/aer058
Neidhart G, Bremerich DH, Kessler P. Fiberoptic intubation during remifentanil propofol sedation. Anaesthesist 2001;50:242-7. DOI: https://doi.org/10.1007/s001010050998
Reusche MD, Egan TD. Remifentanil for conscious sedation and analgesia during awake fiberoptic tracheal intubation: a case report with pharmacokinetic simulations. J Clin Anesth 1999;11:64-8.
Reusche MD, Egan TD. Remifentanil for conscious sedation and analgesia during awake fiberoptic tracheal intubation: a case report with pharmacokinetic simulations. J Clin Anesth 1999;11:64-8. DOI: https://doi.org/10.1016/S0952-8180(98)00127-5
Wahidi MM, Jain P, Jantz M et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest 2011;140:1342–50. DOI: https://doi.org/10.1378/chest.10-3361
Patel A, Pearce A. Progress in management of the obstructed airway. Anaesthesia 2011;66:93–100. DOI: https://doi.org/10.1111/j.1365-2044.2011.06938.x
Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020;75:509-28. DOI: https://doi.org/10.1111/anae.14904
Petrini F, Di Giacinto I, Cataldo R, et al. Perioperative and periprocedural airway management and respiratory safety for the obese patient: 2016 SIAARTI Consensus. Minerva Anestesiol 2016;82:1314-35.

How to Cite

Chicone, G., Miccichè, V., Gallo, R., Maiarota, F., Toto, R., Fittipaldi, C., & Iannuzzi, M. (2024). Awake intubation in a patient with morbid obesity in the emergency department: our experience. Acute Care Medicine Surgery and Anesthesia, 2(1). https://doi.org/10.4081/amsa.2024.33
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