MC 5640
Stanford, CA 94305
Facsímil: (650) 725-8544
University of California, San Francisco, San Francisco, CA, United States of America, 6/15/2003
Beth Israel Deaconess Medical Center, Boston, MA, 6/25/2004
Massachusetts General Hospital, Boston, MA, 11/24/2007
Anesthesiology, American Board of Anesthesiology
View details for DOI 10.7759/cureus.10691
View details for Web of Science ID 000573185700003
View details for DOI 10.1097/SLA.0000000000004474
View details for PubMedID 32889879
View details for DOI 10.1213/ANE.0000000000005040
View details for PubMedID 32511105
View details for DOI 10.1097/SLA.0000000000004124
View details for PubMedID 32541233
View details for DOI 10.1213/ANE.0000000000004938
View details for PubMedID 32366770
View details for DOI 10.1213/ANE.0000000000005134
View details for PubMedID 32701549
View details for DOI 10.1213/ANE.0000000000004921
View details for PubMedID 32345854
View details for PubMedCentralID PMC7202114
In this report, we present a case of a patient with a history of complex airway anatomy secondary toSagliker syndrome(SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency.The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan.The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family.Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation.She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities.This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.
View details for DOI 10.7759/cureus.10691
View details for PubMedID 33133856
View details for PubMedCentralID PMC7593211
View details for DOI 10.1213/ANE.0000000000005136
View details for PubMedID 32701548
View details for DOI 10.1097/AIA.0000000000000235
View details for Web of Science ID 000471668300013
View details for DOI 10.1097/AIA.0000000000000238
View details for Web of Science ID 000471668300010
View details for DOI 10.1097/AIA.0000000000000235
View details for PubMedID 31577244
View details for DOI 10.1097/AIA.0000000000000238
View details for PubMedID 31577241
View details for PubMedID 28319544