VLVids: Dual endoscopy intubation with compressive thyroid mass

Here’s a great example of using a dual endoscopy technique not only to manage a potentially difficult airway, but also to give more insight into the pathology itself. This short video shows the intubation of a patient who presented for thyroid surgery with a large mass compressing the trachea, as well as some other predictors of difficult intubation: slightly limited mouth opening, a short neck, and potentially challenging dentition. We wanted to see the position and degree of tracheal compression present before advancing the tracheal tube, but also to place the modified tube with nerve monitoring sensor precisely at the right depth.

Video laryngoscopy with a Mackintosh-style blade provided good access to the airway, and allowed us to spray the vocal cords and trachea with local anaesthetic, avoiding neuromuscular blockers. We could then place the tip of the tube through the vocal cords and observe the trachea and subglottic space using the Bonfils optical stylet. Both images are displayed side-by-side to coordinate view. It’s a good tip to put the device in your left hand on the left side of the screen (and corresponding right-handed device on the right) to promote good orientation.

If you’ve tired dual endoscopy for a clinical case, pop a description or brief story in the comments!

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Split-screen dual endoscopy

Some new devices/monitors such as the Glidescope Core or Storz CMAC 8404 now allow viewing two video feeds on one display, either as a “picture-in-picture” or side-by-side display. Here is a demo of split-screen dual endoscopy with Macintosh-blade VL and optical stylet:

Dual endoscopy using split screen. It would have been good to have warmed the optical stylet (right) to prevent fogging of the lens. Orienting the VL on the left and stylet on the right improves coordination between left and right hands holding the devices.

For more discussion on dual endoscopy, see the original post from 2018 here on OpenAirway which is being updated over time.

IAMM 2023

The International Airway Management Society’s (IAMS) 2023 annual meeting is going to be held on 5-7 August 2023 in hybrid format – both at the University of Pennsylvania in Philadelphia, USA, and online.

The main meeting runs over most of Saturday 5 and Sunday 6, with an in-person tour of the hospital and university facilities on Monday 7 August. Sessions include oxygenation strategies, innovation in airway management, paediatric and obstetric patients, ENT, battlefield, trauma, emergency and thoracic airway management, and diagnosis and management of the difficult airway. Look out for a link here to the final program when published!

Live broadcasting will be available from the Miller Voice of Anaesthesia during the meeting; in-person attendees will be able to engage in the Smilow Commons Auditorium, Smilow Center for Translational Research, 3400 Civic Centre Blvd, Philadelphia, PA 19104, USA.

International airway meetings in 2023

DAS (UK), SAM (USA) and EAMS (Europe) have recently released their locations ans dates for 2023… put then in the diary if you fancy travel for some airway education! Latest update – IAMS has announced their 2023 meeting to be held in hybrid format.

IAMM 2023 – 5-7 August 2023 – University of Pennsylvania

DAS 2021 – Awake Video Laryngoscopy

Selected references can be accessed online via the links here. If you are unable to access a reference, or wish to download a larger set for furhter reading, please click the link for the archive at the bottom.

If you’re struggling access the articles above or would like an EndNote library and further references, you can access a share folder here.

A brief video describing a challenging case managed with awake VL using the CMAC Video Stylet is shown below. (Video prepared for the 2021 Virtual Guy’s Airway Management Course)

COVID Airways Podcast on Critical Care Scenarios

I was honoured to be invited back on the Critical Care Scenarios (@icuscenarios) podcast, to chat this time about airway management in COVID-19, but also talking about how it’s helping to focus improving our emergency airway management in general. Check it out at this link:

http://icuscenarios.com/episode-37-airway-management-for-covid-19/

Open access meducation for all aspects of airway management