Manual jet ventilation to rescue a patient with pinhole tracheal stenosis: A case report

Background: Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. Case: A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established. Conclusion: Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.

A Comparative Study between Dexmedetomidine and Propofol for Fibre-optic Intubation.

Background: Providing adequate anxiolysis and sedation with a patent airway while performing fiberoptic bronchoscopic intubation is a challenging task to an anaesthetist. Ideal sedation would ensure calm and cooperative patient maintaining spontaneous ventilation. Dexmedetomidine is such a α2a adrenergic agonist with sympatholytic, analgesic, and sedative properties. Though its role is very well documented for sedation, proving it better than propofol for the procedure is being considered in this study. Methods: In total of 60 patients, after nebulizing with 5 ml of 4% lignocaine over 10 minutes, 30 patients were infused with dexmedetomidine @1μg/kg over 10 minutes followed by 0.3μg/kg and rest with propofol @1mg/kg. Fiber-optic bronchoscopy was done after 10 minutes of infusion. Monitoring was done considering heart rate, blood pressure, Ramsay sedation score and patient tolerance. Results: had shown successful intubation in both cases but dexmedetomidine had a better outcome with respect to sympathetic response and patient tolerance. P value was significant for sedation score, pre and post bronchoscopic intubation sympathetic response. No episodes of airway obstruction and hypoxia were noted with dexmedetomidine as compared with propofol. Mean Ramsay sedation score was 3.77 as compared to 2.33 with propofol. Conclusion: In our comparative study, Dexmedetomidine had offered better patient tolerance with adequate sedation and preservation of airway as compared to propofol and a reduced hemodynamic response to intubation.

Timely Intervention Instead of the Type of Equipment Does Change the Outcome in a Life Threatening Condition: A Case Report.

We report a case of use of semi rigid intubating bougie to intubate a patient with large thyroid swelling in life threatening airway emergency in the absence of sophisticated equipments.