title: Intubation of patients with angioedema: A retrospective study of different methods over three year period.
abstract: BACKGROUND
  Angioedema (AE) is edema of the skin, subcutaneous tissue and/or submucosal tissues, resulting from extravasation of intravascular fluid. Swelling of the supraglottic mucosa can lead to airway obstruction with consequent hypoxia, brain damage and death. To date, fiberoptic bronchoscope (FOB) intubation of the spontaneously breathing patient is the preferred method for an anticipated difficult intubation. However, other alternative devices can be utilized to intubate angioedema successfully.
  
  
  METHODS
  A retrospective chart review was performed over a three-year period (2008-2010) of all patients with angioedema that required airway intervention. We hypothesized that fiberoptic intubation would have a higher success rate for intubation attempts; however, would take longer to perform when compared to videolaryngoscopic (VL) intubation. Outcomes for FOB versus VL intubations were reviewed, along with alternative miscellaneous methods of tracheal intubation in the setting of angioedema.
  
  
  RESULTS
  Thirty-three patients were grouped, according to the chosen method of intubation into FOB (n=12), VL (n=11), and miscellaneous (n=10) groups. No significant difference was found in first intubation attempts or number of intubation attempts between the three groups. Duration of time to perform successful intubation revealed a significantly shorter intubation time (P<0.05) in the VL group (6.9±0.9 min) and miscellaneous group (9.1±2.0 min) than that of the FOB group (10.4±0.7 min).
  
  
  CONCLUSIONS
  This retrospective review of intubation methods showed that VL could be performed faster than FOB without an increase in adverse events.
authors: Department of Anesthesiology, WSU/DMC Harper Hospital, 3990 John R Road, Box 162 Detroit, MI 48201, USA.
authors: Aaron
authors: A
authors: Wood
authors: Dominik
authors: D
authors: Choromanski
authors: Marc
authors: M
authors: Orlewicz
keywords: Airway obstruction; angioedema; bronchoscope; bronchoscopy; intubation–laryngeal mask; videolaryngoscope
references: Laryngoscope. 2000 Dec;110(12):2016-9
references: 11129012
references: Anaesthesia. 2011 Jul;66(7):550-5
references: 21564041
references: Anesthesiol Clin North Am. 2002 Dec;20(4):933-51
references: 12512270
references: Anaesthesia. 2004 Mar;59(3):283-9
references: 14984528
references: Can J Anaesth. 1999 Oct;46(10):975-8
references: 10522586
references: Ann Otol Rhinol Laryngol. 2001 Sep;110(9):834-40
references: 11558759
references: Br J Anaesth. 2009 Jan;102(1):128-34
references: 19059923
references: Can J Anaesth. 2004 May;51(5):520-1
references: 15128649
references: Ann Allergy Asthma Immunol. 2008 Apr;100(4):327-32
references: 18450117
references: Am J Med. 2008 Apr;121(4):282-6
references: 18374684
references: Can J Anaesth. 2007 Jan;54(1):54-7
references: 17197469
references: Laryngoscope. 2010 Jan;120(1):62-4
references: 19890965
references: Otolaryngol Head Neck Surg. 1999 Sep;121(3):263-8
references: 10471868
references: Chest. 2004 Aug;126(2):400-4
references: 15302724
references: Anesth Analg. 2007 Jun;104(6):1610-1; discussion 1611
references: 17513677
references: Can J Anaesth. 2006 Oct;53(10):994-1003
references: 16987854
references: Anesthesiology. 2011 Jan;114(1):3-6
references: 21139498