Vol 8 | Issue 1 | January-April 2022 | Page: 12-13 | Dhwani Sanjiv Walavalkar, Disha Kapadia, Nirav M. Kotak, Rajendra D. Patel
DOI: 10.13107/jaccr.2022.v08i01.195
Author: Dhwani Sanjiv Walavalkar [1], Disha Kapadia [1], Nirav M. Kotak [1], Rajendra D. Patel [1]
[1] Department of Anaesthesiology and Critical Care, Seth GSMC and KEM hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Dhwani Sanjiv Walavalkar,
Department of Anaesthesiology and Critical Care, Seth GSMC and KEM hospital, Mumbai, Maharashtra, India.
E-mail: dhwani.walavalkar@yahoo.com
Abstract
Rheumatoid Arthritis is a chronic systemic disease affecting various systems. For the anaesthesiologist, out of all the organ system involved, the airway involvement presents a unique challenge. In such cases of anticipated difficult airway, all the conventional instruments in the difficult airway armamentarium must be employed. In the case we present, the instruments available to us failed to provide a sufficient glottic view required for tracheal intubation. An unconventional manoeuvre of Backward Upward Leftward Pressure (BULP) was attempted which resulted in a well centralized view of the lateralized vocal cords.
Keywords: Rheumatoid Arthritis, Difficult Airway, Airtraq, Truview laryngoscope, BULP
References
1. Harris ED Jr. Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med 1990; 322:1277–89
2. Felix N Fombon, FRCA, Jonathan P Thompson, BSc MD FRCA, Anaesthesia for the adult patient with rheumatoid arthritis, Continuing Education in Anaesthesia Critical Care & Pain, Volume 6, Issue 6, December 2006, Pages 235–239
3. Gaszyński T. Airway management for general anesthesia in patients with rheumatic diseases – new possibilities. Reumatologia. 2019;57(2):69-71. doi:10.5114/reum.2019.84810
4. Samanta, R., K. Shoukrey, and R. Griffiths. “Rheumatoid arthritis and anaesthesia.” Anaesthesia 66.12 (2011): 1146-1159.
5. Calder I, Calder J, Crockard HA. Difficult direct laryngoscopy in patients with cervical spine disease. Anaesthesia 1995; 50: 756–63.
6. Janssens, Marc, and Gary Hartstein. “Management of difficult intubation.” European journal of anaesthesiology 18.1 (2001): 3-12.
7. Babu TR, Haridas A, Gurudatt CL. A comparative study of airtraq® and McCoy laryngoscopes for endotracheal intubation in adult patients with simulated difficult airway using a rigid cervical collar in elective surgeries under general anaesthesia. Sri Lankan Journal of Anaesthesiology. 2019 Feb 6;27(1).
8. Rai E, Ramamani, Jacob R. Truview EVO2 Laryngoscope. J AnaesthClinPharmacol. 2009;25:199–202.
9. Knill RL. Difficult laryngoscopy made easy with a “BURP”. Canadian journal of anaesthesia. 1993 Mar;40(3):279-82.
| How to Cite this Article: Walavalkar DS, Kapadia D, Kotak NM, Patel RD | BULP: Conventional Difficult Airway Instruments Using Unconventional Manoeuvre in Patient with Rheumatoid Arthritis | Journal of Anaesthesia and Critical Care Case Reports | January-April 2022; 8(3): 12-13. |