Difficult Airway Letter

[narcusprince]

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Just want to send out a extra thank you to folks who put difficult airway letters in charts. This saves lives and makes everyones job easier! Well done!

 

[amyl]

Always do it.... But we have the best video laryngoscope imho so seems like a thing of the past

 

[Planktonmd]

Always do it.... But we have the best video laryngoscope imho so seems like a thing of the past

Which one is the best video laryngoscope?

 

[amyl]

I like the king scope. Small portable, easy to use.

 

[inmyslumber]

Just want to send out a extra thank you for to folks who put difficult airway letters in charts. This saves lives and makes everyones job easier! Well done!

This is a nice post.

 

[norwood]

I like the king scope. Small portable, easy to use.

We had the rep bring one by awhile back. I do like the size and the price, but I have to say I was not very impressed with the image quality. Also, it seemed best suited to places that won't use it a whole lot, because their plan is clearly to charge a lower price for the unit and then sell the (required and single use...) blades for something like $8-10 each IIRC. So if you're just keeping it around for emergencies and only using it enough to stay proficient, I could see it being cost effective. But if your plan is to intubate people with it all the time, those blades could really add up - no?

 

[jwk]

I like the king scope. Small portable, easy to use.

We got McGrath scopes recently just because our GlideScopes always seemed to be in use and we didn't want to invest in several more of those. The view from a larger screen device will just about always be superior to something like the McGrath or King, but I do like the smaller blade profile of the McGrath. If I have a choice, it will be the GlideScope.

 

[amyl]

I hate the McGrath. But that's just me. image quality is adequate for getting the airway w the king - One of my partners uses the king all the time, I'm more conservative but The bad airways it's turned into no prob has super impressed me

 

[narcusprince]

Amyl what happened to doing AFOI's? I have done maybe 3-4 since residency. They are much more of a time consumer but life saving.

 

[pgg]

Amyl what happened to doing AFOI's? I have done maybe 3-4 since residency. They are much more of a time consumer but life saving.

I don't understand what you're really asking -

Are you not doing them now, but you think you should? Bad on ya. 🙂

Or are you wondering why you don't see the need as often now? I think that's a simple answer - the reason you did more AFOIs in residency was probably because of
1) training value
2) more airway pathology in academics
3) nervous attendings (ivory tower factor?)

Sure AFOIs can be lifesavers, if done when indicated. That's not all that often though, in most practices.

 

[narcusprince]

I don't understand what you're really asking -

Are you not doing them now, but you think you should? Bad on ya. 🙂

Or are you wondering why you don't see the need as often now? I think that's a simple answer - the reason you did more AFOIs in residency was probably because of
1) training value
2) more airway pathology in academics
3) nervous attendings (ivory tower factor?)

Sure AFOIs can be lifesavers, if done when indicated. That's not all that often though, in most practices.

Let me simplify. Amyl are you doing many AFOIS now? In training we did many more then I do now. Airway indications were the indication for them however there was an attending who often added patients with full stomachs with questionable airways to the AFOI list. Maybe in private practice you see more airway pathology then I. I am not doing them now but if the indication arises I will. That should clarify PGG....

 

[Planktonmd]

If you want to stay proficient you need to do at least one fiberoptic intubation every week at least, it does not have to be awake though.

 

[pgg]

If you want to stay proficient you need to do at least one fiberoptic intubation every week at least, it does not have to be awake though.

Agreed

The problem with that (for me) is that now we've changed to disposable fiberoptic scopes. I'm sort of reluctant to drop $400 or whatever it is to do an elective asleep FOI. I did one a couple weeks ago during a code (that counts as asleep I guess 🙂) but not many more lately. Usually a resident is going to get first crack anyway.

 

[narcusprince]

Agreed

The problem with that (for me) is that now we've changed to disposable fiberoptic scopes. I'm sort of reluctant to drop $400 or whatever it is to do an elective asleep FOI. I did one a couple weeks ago during a code (that counts as asleep I guess 🙂) but not many more lately. Usually a resident is going to get first crack anyway.

I knew the disposable scope acquisition was going to be trouble. I guess someone will not have to complain about broken peds scopes anymore, maybe he can just complain about complaining. Here I try to do an asleep FOI monthly.

 

[pgg]

I knew the disposable scope acquisition was going to be trouble. I guess someone will not have to complain about broken peds scopes anymore, maybe he can just complain about complaining. Here I try to do an asleep FOI monthly.

Some clown or posse of clowns was breaking a scope every few weeks. It got to the point where $50,000 in annual repair costs buys a lot of disposables ...

 

[Planktonmd]

The disposable scopes are inevitable now that the scopes have to be re sterilized every couple of weeks even if they are not used.
This new requirement will significantly increase the cost and decrease the lives of these expensive scopes.
We are about to get the disposable ones and I can see how it will become increasingly difficult to justify the cost of opening a disposable scope unless absolutely necessary.

 

[amyl]

So in residency the last awake foi I did was a patient w arthrogryposis.... If I encountered her in pp she would get awake Foi. In pp I've just seen typical bad airways... Bmi 60 plus, no neck, significant submandibular adipose, etc. I feel like I have so many other toys and tricks I haven't needed foi. Last time I foi'ed it was asleep about a year ago and it was thru the LMA w an aintree w Zuras technique- I also did a semi awake bronch to view the airway in a colleagues patient with post op stridor but I guess technically I was the operator and a partner was anesthesia. A patient would have to be very symptomatic or have very strange anatomy for me to awake foi.

 

[Planktonmd]

So in residency the last awake foi I did was a patient w arthrogryposis.... If I encountered her in pp she would get awake Foi. In pp I've just seen typical bad airways... Bmi 60 plus, no neck, significant submandibular adipose, etc. I feel like I have so many other toys and tricks I haven't needed foi. Last time I foi'ed it was asleep about a year ago and it was thru the LMA w an aintree w Zuras technique- I also did a semi awake bronch to view the airway in a colleagues patient with post op stridor but I guess technically I was the operator and a partner was anesthesia. A patient would have to be very symptomatic or have very strange anatomy for me to awake foi.

But when you decide you need to do it you will be rusty at it, and that's the main reason many anesthesiologists are terrible at fiberoptic techniques, they simply don't practice.