Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise


Was this #ILMA also helpful in developing some important #DiffAW concepts - Airway Rescue, Hybrid Intubation, Failed AW etc.?


There may be 7P’s to any #DiffAW, And the greatest of these is P3 for Position!


Thanks! Our societies @SOBA @ISPCOP_notes @ESPCOP have worked to promote safer #DiffAW management in #MObesity! #RCL from #IARS2017

NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017

Experience+Expertise>Equipment! #DiffAW


#Transillumination works well and should/could be practiced #IMHO as a #DiffAW adjunct/rescue?

Or hold the flashlight against the anterior tracheal wall skin? #transillumination HT Anesthesiology 2013, Vol.118, 1059-1064. Image- anesthesiology.pubs.asahq.org/data/journals/…

NaveenEipe's tweet image. Or hold the flashlight against the anterior tracheal wall skin?
#transillumination
HT
Anesthesiology 2013, Vol.118, 1059-1064. 
Image-
anesthesiology.pubs.asahq.org/data/journals/…


A *Modified Nasal Trumpet may be a *Closed alternative to BVM in hypoxic, morbidly obese &/or #DiffAW pts.? #COVID19

ET connector in trumpet= Modified Nasal Trumpet- works before & after!

NaveenEipe's tweet image. ET connector in trumpet= Modified Nasal Trumpet- works before & after!
NaveenEipe's tweet image. ET connector in trumpet= Modified Nasal Trumpet- works before & after!


Yes! And insert a universal connector from the ETtube into the Nasal Airway to get another literal #DiffAW life-saver! #ModifiedNasalTrumpet @AirwayMxAcademy @jducanto

Many of these pts. will hypoventilate or become intermittently apneic, especially with *excessive O2 supplementation! Nasal CPAP via a Modified Nasal Trumpet, may in some pts. & situations, prevent or treat dangerous hypoxia?

NaveenEipe's tweet image. Many of these pts. will hypoventilate or become intermittently apneic, especially with *excessive O2 supplementation!
Nasal CPAP via a Modified Nasal Trumpet,
may in some pts. & situations,
prevent or treat dangerous hypoxia?
NaveenEipe's tweet image. Many of these pts. will hypoventilate or become intermittently apneic, especially with *excessive O2 supplementation!
Nasal CPAP via a Modified Nasal Trumpet,
may in some pts. & situations,
prevent or treat dangerous hypoxia?


With sugammadex, succ should not be needed. If NMB may improve vent/intubation, use roc for a longer block. If not helpful Or unanticipated #DiffAW, then suga at high dose. Side effects and contraind for succ will likely make it obsolete #pediatricanesthesia #anesthesia


Agreed, #SGA probably only in a hypoxic pt., #DiffAW rescue or to facilitate smooth #coughfree extubation?



Maybe a good idea, but those wings held down by the FM will cause a loss of mask seal!? #MObesity #DiffAW Personally, for #DiffBMV prefer a light #Cricoid to create an oropharyngeal seal & prevent gastric insufflation during BMV! #CricoidParadox

See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!

NaveenEipe's tweet image. See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!


Anticipated #DiffAW? Maybe they need an app too? @AirwayMxAcademy

First thought? Source: drjbminterdvm. BTW, the patient is doing great.



#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!


Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex


Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

ทวีตนี้ไม่สามารถใช้งานได้อีกต่อไป

Soooo true! I often find myself saying “take a deep breath, NAVEEN…..” when dealing with a dangerously #DiffAW!

ทวีตนี้ไม่สามารถใช้งานได้อีกต่อไป

Again Brilliant! Something that has really helped when 'extubating an anticipated #DiffAW' is using #BaileysManeuver Ping @AirwayMxAcademy Here is a nice demo from @fibroanestesia


Anticipated #DiffAW? Maybe they need an app too? @AirwayMxAcademy

First thought? Source: drjbminterdvm. BTW, the patient is doing great.



#Transillumination works well and should/could be practiced #IMHO as a #DiffAW adjunct/rescue?

Or hold the flashlight against the anterior tracheal wall skin? #transillumination HT Anesthesiology 2013, Vol.118, 1059-1064. Image- anesthesiology.pubs.asahq.org/data/journals/…

NaveenEipe's tweet image. Or hold the flashlight against the anterior tracheal wall skin?
#transillumination
HT
Anesthesiology 2013, Vol.118, 1059-1064. 
Image-
anesthesiology.pubs.asahq.org/data/journals/…


ทวีตนี้ไม่สามารถใช้งานได้อีกต่อไป

There may be 7P’s to any #DiffAW, And the greatest of these is P3 for Position!


Was this #ILMA also helpful in developing some important #DiffAW concepts - Airway Rescue, Hybrid Intubation, Failed AW etc.?


Challenging case #DiffAW #CSpine with @phanmd @TOH_DoS 'Neurogenic shock in a patient with cervical myelopathy from severe cervical kyphoscoliosis' @CJA_Journal #Images link.springer.com/article/10.100…


Again Brilliant! Something that has really helped when 'extubating an anticipated #DiffAW' is using #BaileysManeuver Ping @AirwayMxAcademy Here is a nice demo from @fibroanestesia

Baileys Maneuver for extubation of a potentially difficult airway! @fibroanestesia #Brilliant HT: BAILEY MANEUVER: AS YOU HAVE NEVER SEEN BEFORE youtu.be/SdYiu_mu0c0 via @YouTube

NaveenEipe's tweet card. Dr.Valenzia

youtube.com

YouTube

Dr.Valenzia



#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!


Experience+Expertise>Equipment! #DiffAW


Great question! Somewhat simplified answer- look at the #DiffAW algorithms of the past- #ASA2003 vs #ASA2013! For us #OldGuys, like Hans & I et al, who trained #preVL- there was either DL or FOI & some SGAs, but if all else failed, SxAW! “Turn back, see how far we have come!”

Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?


Soooo true! I often find myself saying “take a deep breath, NAVEEN…..” when dealing with a dangerously #DiffAW!

ทวีตนี้ไม่สามารถใช้งานได้อีกต่อไป

Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise


Maybe a good idea, but those wings held down by the FM will cause a loss of mask seal!? #MObesity #DiffAW Personally, for #DiffBMV prefer a light #Cricoid to create an oropharyngeal seal & prevent gastric insufflation during BMV! #CricoidParadox

See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!

NaveenEipe's tweet image. See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!


And we #OldDogs keep our skills up and learn new tricks too by teaching newbies & others! [#DiffAW management, like many other clinical areas, has been advanced both by research & training *learners!]


Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex



Thanks! Our societies @SOBA @ISPCOP_notes @ESPCOP have worked to promote safer #DiffAW management in #MObesity! #RCL from #IARS2017

NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017

Agreed, #SGA probably only in a hypoxic pt., #DiffAW rescue or to facilitate smooth #coughfree extubation?


A *Modified Nasal Trumpet may be a *Closed alternative to BVM in hypoxic, morbidly obese &/or #DiffAW pts.? #COVID19

ET connector in trumpet= Modified Nasal Trumpet- works before & after!

NaveenEipe's tweet image. ET connector in trumpet= Modified Nasal Trumpet- works before & after!
NaveenEipe's tweet image. ET connector in trumpet= Modified Nasal Trumpet- works before & after!


Any mention of the #ObAirway becoming like the #MObesity #DiffAW? Once again, P3 #Position is so very important!

NaveenEipe's tweet image. Any mention of the #ObAirway becoming like the #MObesity #DiffAW?
Once again, P3 #Position is so very important!
NaveenEipe's tweet image. Any mention of the #ObAirway becoming like the #MObesity #DiffAW?
Once again, P3 #Position is so very important!

Agreed! #HateBlind VL has changed #DiffAW so much, but rare occasions require calling up some old #Crazy skills! *Blind Nasal *Retrograde etc. #CantLoseWhatUNeverHad #ABBForever

NaveenEipe's tweet image. Agreed!
#HateBlind
VL has changed #DiffAW so much, 
but rare occasions require calling up some old #Crazy skills!
*Blind Nasal
*Retrograde
etc.
#CantLoseWhatUNeverHad #ABBForever

Experience+Expertise>Equipment! #DiffAW


Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise


Thanks! Our societies @SOBA @ISPCOP_notes @ESPCOP have worked to promote safer #DiffAW management in #MObesity! #RCL from #IARS2017

NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017
NaveenEipe's tweet image. Thanks!
Our societies @SOBA @ISPCOP_notes @ESPCOP 
have worked to promote safer #DiffAW management in #MObesity!

#RCL from #IARS2017

All ^^^BMIs not same! @SOBAuk Highlights the need to distinguish central vs peripheral obesity for #MObesity #DiffAW prediction, see their excellent single sheet. @AirwayMxAcademy @ISPCOP_notes @dasairway #GAMC18

NaveenEipe's tweet image. All ^^^BMIs not same!
@SOBAuk 
Highlights the need to distinguish central vs peripheral obesity for #MObesity #DiffAW prediction, see their excellent single sheet.
@AirwayMxAcademy @ISPCOP_notes @dasairway #GAMC18

I also think that preoperative #DiffAW prediction has an important role in #clinicalretrospect, especially when faced with unanticipated difficulty #LookBack #PredictPlanPrepare

NaveenEipe's tweet image. I also think that preoperative #DiffAW prediction has an important role in #clinicalretrospect,
especially when faced with unanticipated difficulty
#LookBack
#PredictPlanPrepare

Please ask @mmargarson how #Age influences #DiffAW in #MObesity more than BMI? "Physiology trumps Anatomy" Age+BMI>100 (#NaveensFormula) is #Huge predictor of #MODA @AirwayMxAcademy @ISPCOP_notes #GAMC18

NaveenEipe's tweet image. Please ask @mmargarson how #Age influences #DiffAW in #MObesity more than BMI? 
"Physiology trumps Anatomy"
Age+BMI>100 
(#NaveensFormula) is #Huge predictor of #MODA
@AirwayMxAcademy @ISPCOP_notes #GAMC18

A lot of tips & tricks by @AirwayMxAcademy & Co. (Free to download @iTunes) In an #DiffAW that cannot be topicalized, would use #Dexmed (Or Remi+PPF) Maybe go thru a #SplitNasalAW with #ModNasalTrumpet to maintain conduit and control (sim below)

NaveenEipe's tweet image. A lot of tips & tricks by @AirwayMxAcademy & Co.
(Free to download @iTunes)
In an #DiffAW that cannot be topicalized, would use #Dexmed (Or Remi+PPF) 
Maybe go thru a #SplitNasalAW with #ModNasalTrumpet to maintain conduit and control (sim below)
NaveenEipe's tweet image. A lot of tips & tricks by @AirwayMxAcademy & Co.
(Free to download @iTunes)
In an #DiffAW that cannot be topicalized, would use #Dexmed (Or Remi+PPF) 
Maybe go thru a #SplitNasalAW with #ModNasalTrumpet to maintain conduit and control (sim below)

#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!


Agree fully with NMB for tracheal intubation, but am quite sure that Sux is not ideal to achieve this, esp. in elective-fasted pts. #MObesity! [Thanks for the engaging #DiffAW discussion, happy to hear how differently the same #MODA problems are approached]

NaveenEipe's tweet image. Agree fully with NMB for tracheal intubation, but am quite sure that Sux is not ideal to achieve this, 
esp. in elective-fasted pts. #MObesity!
[Thanks for the engaging #DiffAW discussion, happy to hear how differently the same #MODA problems are approached]

And when faced with 'unpredicted' #DiffAW always look back to see what was missed! #WorkForSuccess Or maybe load the data on The Airway Triage App? @AirwayMxAcademy @french9a vimeo.com/247634208

NaveenEipe's tweet image. And when faced with 'unpredicted' #DiffAW always look back to see what was missed!
#WorkForSuccess
Or maybe load the data on The Airway Triage App?
@AirwayMxAcademy 
@french9a vimeo.com/247634208

While 'Asleep & Paralyzed' vs 'Awake & Breathing' may have been at opposite ends of the classic #DiffAW spectrum, this discussion seems to make them look less further away than that.

NaveenEipe's tweet image. While 'Asleep & Paralyzed' vs 'Awake & Breathing' 
may have been at opposite ends of the classic #DiffAW spectrum,
this discussion seems to make them look less further away than that.

@QueensPeriopMed Thanks for the VP invite! Looking forward to presenting June 13th Grand Rounds on #ObesityAnesthesia Sharing @OttawaHospital @OttAnesthesia experience with #MObesity #DiffAW Ping @queensu

NaveenEipe's tweet image. @QueensPeriopMed 
Thanks for the VP invite!
Looking forward to presenting June 13th Grand Rounds on #ObesityAnesthesia
Sharing @OttawaHospital @OttAnesthesia experience with #MObesity #DiffAW
Ping @queensu


Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
NaveenEipe's tweet image. Still believe these are invaluable summaries of what is being done in 2021?!

Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?

ThankU, And I yours! EM/ED/ER pts., acuity, etiology & urgency etc. are often very different from #Anesthesia #Periops, so whether it is #DiffAW or #AcutePain, I respect your perspective, experience and practice! #Respect


Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex


And we #OldDogs keep our skills up and learn new tricks too by teaching newbies & others! [#DiffAW management, like many other clinical areas, has been advanced both by research & training *learners!]


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