General Anesthesia for a Patient with a Difficult Airway and a Full Stomach
A 26-yr-old female (American Society of Anesthesiologists physical status 2E), weight 124 kg, height 5′6″, is scheduled for an emergency appendectomy. She has a class 3 airway, but tells you that she has a previous history of a traumatic and difficult endotracheal intubation. She is otherwise healthy and takes no medication. She refuses a regional block, as she has back problems. You decide on a fiberoptic intubation, but you are fully aware that topical anesthesia and sedation must be kept to a minimum in an attempt to maintain the protective laryngeal reflexes and decrease the likelihood of gastric aspiration. What approach would you adopt for this case, based on anatomical and physiological observations?
KeywordsLower Esophageal Sphincter Topical Anesthesia Full Stomach Superior Laryngeal Nerve Cricoid Pressure
Unable to display preview. Download preview PDF.
- 2.Brock-Utne JG, Dow TGB, Welman S, Dimopoulos GE, Moshal MG. The effects of metoclopramide on the lower esophageal sphincter in late pregnancy. Anaesth Intens Care 1978;6:26-29.Google Scholar
- 3.Crawford S. Principles and Practice of Obstetric Anaesthesia. 3rd ed. Oxford: Blackwell Scientific Publications; 1999.Google Scholar
- 5.Brock-Utne JG, Downing JW, Humphrey D. Effects of ranitidine given before atropine sulphate on lower esophageal sphincter tone. Anaesth Intens Care 1984;12:140-142.Google Scholar
- 9.Hardman JG, Limbird LE. Goodman and Gilman’s: The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw Hill; 2001.Google Scholar