Lin TC, Lai YW, Wu SH. Emergent use of tube tip in pharynx technique in “cannot intubate cannot oxygenate” situation: A case report. World J Clin Cases 2022; 10(34): 12631-12636 [PMID: 36579099 DOI: 10.12998/wjcc.v10.i34.12631]
Corresponding Author of This Article
Shang-Hung Wu, MD, Attending Doctor, Department of Anesthesiology, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404, Taiwan. harrison61103@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 6, 2022; 10(34): 12631-12636 Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12631
Emergent use of tube tip in pharynx technique in “cannot intubate cannot oxygenate” situation: A case report
Tzu-Chiao Lin, Yu-Wen Lai, Shang-Hung Wu
Tzu-Chiao Lin, Yu-Wen Lai, Shang-Hung Wu, Department of Anesthesiology, China Medical University Hospital, Taichung City 404, Taiwan
Author contributions: Lin TC and Wu SW wrote the manuscript; Lai YW was involved in data collection and analysis; Wu SW contributed to manuscript finalizing.
Informed consent statement: The patient provided written informed consent for the publication of this case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shang-Hung Wu, MD, Attending Doctor, Department of Anesthesiology, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City 404, Taiwan. harrison61103@gmail.com
Received: September 3, 2022 Peer-review started: September 3, 2022 First decision: September 26, 2022 Revised: September 30, 2022 Accepted: November 7, 2022 Article in press: November 7, 2022 Published online: December 6, 2022
Abstract
BACKGROUND
A “cannot intubate, cannot oxygenate (CICO)” situation is a life-threatening condition that requires emergent management to establish a route for oxygenation to prevent oxygen desaturation. In this paper, we describe airway management in a patient with an extended parotid tumor that invaded the airways during CICO using the endotracheal tube tip in the pharynx (TTIP) technique.
CASE SUMMARY
A 43-year-old man was diagnosed with parotid tumor for > 10 years. Computed tomography and nasopharyngeal fiberoptic examination revealed a substantial mass from the right parotid region with a deep extension through the lateral pharyngeal region to the retropharyngeal region and obliteration of the nasopharynx to the oropharynx. Tumor excision was arranged. However, we encountered CICO during anesthesia induction. An endotracheal tube was used as an emergency supraglottic airway device (TTIP) to ventilate the patient in a CICO situation where other tools such as laryngeal mask airway or mask ventilation were not suitable for this complicated and difficult airway. The patient did not experience desaturation despite sudden loss of definite airway. During tracheostomy, the pulse oximetry remained 100% with our technique of ventilating the patient. The arterial blood gas analysis revealed PaCO2 35.7 mmHg and PaO2 242.5 mmHg upon 50% oxygenation afterward.
CONCLUSION
Using an endotracheal tube as a supraglottic airway device, patients may have increased survival without experiencing life-threatening desaturation.
Core Tip: In the induction of a patient with an extended parotid tumor that invaded the airways, sudden loss of a definite airway occurred. We applied the endotracheal tube tip in the pharynx technique by leaving the tip of the endotracheal tube in front of the glottis outlet with our hand enclosing the patient’s nose and mouth to initiate ventilation. This technique not only buys us time to perform front-of-neck access of the airway or prepare other tools for reintubation but also avoids life-threatening desaturation in a “cannot intubate, cannot oxygenate” situation.
