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You are the duty anaesthetist at a busy tertiary hospital. Your provisional fellow calls you for
urgent assistance with an airway emergency.
They have performed a rapid sequence induction and attempted to intubate a 22-year-old man
for a Per-Oral Endoscopic Myotomy (POEM) procedure for type 2 achalasia in the main
theatres.
Intubation was attempted with a videolaryngoscope and hyperangulated blade. The percentage
of glottic opening visible was 10% and they were unable to pass the endotracheal tube or a
gum elastic bougie. They were then unable to bag-mask ventilate the patient but successfully
placed a second generation supraglottic airway. Ventilation has been restored, and green
tinged fluid has been noted in the gastric port.
Current observations are:
HR 95 bpm
BP 97/56 mmHg
SpO2 90% on FiO2 1.0
ETCO2 41 mmHg (5.47 kPa)
TV 400 mL with a small air leak
Weight 169 kg
Height 199 cm
BMI 42 kg/m2
Past Medical History
Type 2 achalasia
Class III obesity
Attention deficit hyperactivity disorder
Mild developmental delay
Severe anxiety
Medication
Lisdexamfetamine 70 mg once daily
Melatonin 4 mg nocte
Diazepam 10 mg was given orally preoperatively
Allergies
Nil known
What are your priorities in managing this situation?
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The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.
Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.
This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.
The medical information is provided “as is” without any representations or warranties, express or implied.
The presenter makes no representations or warranties in relation to the medical information on this video.
You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.
You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode’
Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing
The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.
The information presented here does not represent the views of any hospital or ANZCA.
These videos are solely for training and education of medical
New Zealand