Tag Archives: anaesthesiology

Airway Pic-of-the-Week 2014_0825

Kudos to those that responded with answers to the last picture – I hope you found it stimulating!  Jesse Mumba gets the virtual prize (perhaps a sponsor of real prizes will manifest!) for sending in a complete and thorough answer first.  He correctly identified a tracheosophageal fistula on the Gross C (Voit 3B) type, which is the most common (about 86% of cases).  To be fair, it could be the much rarer Gross D, which features a proximal fistula with the oesophagus as well, but this is very unlikely.
The main anaesthetic challenge (other than surgery in a small neonate with a significant chance of other, including cardiac, abnormalities) is the difficult in providing positive pressure ventilation, as the gas flows preferentially into the stomach via the fistula rather than the lungs.  The conventional technique is to maintain spontaneous ventilation through a gas induction until the fistula can be occluded.  We achieved this in the above case by passing a Fogarty balloon catheter into the fistula under vision with a 2mm rigid telescope and then intubating with a 2.5mm ETT.  Significant simultaneous tachycardia and sympathetic stimulation was noted in the anaesthetic personnel, but the infant did very well.
This week’s picture of the week comes with complements of the September edition of Anesthesiology:
Reproduced from Anaesthesiology online (article and image openly accessible by clicking the image above); credit to the authors, dos Reis Falcão et al.
Reproduced from Anaesthesiology online (article and image openly accessible by clicking the image above); credit to the authors, dos Reis Falcão et al.
Transorbital intubation!  Yip, you read that right.  The case report in the September 2014 edition of Anaesthesiology is accessible here and will fill in the details.  Remarkably, this is not the first time this technique has been described in the literature, although prior reports involved the use of a fibreoptic scope rather than direct laryngoscopy.  It goes a long way to illustrate that a good knowledge of the anatomy, technical skill with a wide variety of devices and a flexible approach are the cornerstones of excellence in airway management.
Eye can’t beat that this week…nor will anyone else around the globe.

SASA 2014 – Rough Notes – Full Set

SASA 2014 Synergy Logo

What a whirlwind!  The 2014 South African Society of Anaesthesiologist’s national congress has come and gone, and the full 6 days are a barely distinguishable blur in my mind.  After presenting 5 talks and workshops, sitting in every lecture I could attend and the nearly daily evening functions I am completely exhausted but still exhilarated.  Kudos to the organisers and staff.

As usual, I have made a set of rough notes, which you may download here.  Please feel free to share the link if they are useful.  Beware that there may be errors or misunderstandings, as I take these down in real time during the talks and often only write what I consider to the be core messages.  There are some links in the notes to other web resources and presentations.  My presentations are accessible here.  Click the link below to open and/or download the full set of my rough notes:

SASA 2014 – Ross’ Rough Notes – Full Set

In the spirit of #FOAMed, Eric Hodgson and Prof Robert Dyer have also allowed links to their talks and resources.  You can open or download these here:

Eric Hodgson – What’s Changed in Airway Management – SASA 2014

Eric Hodgson – Heart Failure: Not only Systolic – SASA 2014

Prof Rob Dyer – Trends in Anaesthetic Management of PPH – SASA2014

If you are a speaker or have resources you’d like hosted online for open access, I am very happy to facilitate this free of charge (I maintain this site at my own expense, and am dedicated to open science and education).  You comments are welcomed – post below or drop me a mail.