• Challenge of a Difficult Airway and Anesthetic Management in a Patient with Still's Disease

      Donald, Ranita R.; Taylor, Emi; Gallen, Thomas; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology with articular and extra-articular (systemic) manifestations. The disorder owes its name to Sir George Frederick Still, who in 1897 described 22 children with symptoms consistent with what is currently known as systemic onset juvenile idiopathic arthritis. AOSD was established almost a century later in 1971, when Eric Bywaters encountered and described adult patients presenting with pediatric Still’s disease symptoms. Compared to rheumatoid arthritis in adults, AOSD runs a much more acute course, quite often affecting many parts of the body before settling in the various joints. Diagnosis of AOSD is difficult to establish due to the nonspecific clinical and laboratory findings. Tracheal intubation may become difficult due to impairment of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). Patients with chronic articular disease have more disability and worse prognosis than patients with only systemic symptoms.
    • Use of the Video RIFL (Rigid Flexible Laryngoscope) as an Adjunct to Direct Laryngoscopy

      Setty, Harsha; Gallen, Thomas; Dubin, Stevin; Department of Anesthesiology and Perioperative Medicine (Society for Airway Management, 2010-09)
      The ASA difficult airway algorithm incorporates different modalities in its progression. It is not uncommon for the user to fail at direct laryngoscopy, thus requiring an alternate method for securing an airway. Frequently, the alternate modalities include supraglottic airways, rigid videolaryngoscopes, or flexible fiberoptic bronchoscopes. We retrospectively reviewed charts from February 2009 to February 2010 on patients intubated in the operating room using the Video RIFL.