From the Guidelines
Tracheal release maneuvers should include optimal external laryngeal manipulation, backwards upwards rightward pressure, and reduction or release of cricoid force to improve the laryngoscopic view or ease of intubation in a correctly positioned and adequately paralyzed patient. When attempting tracheal intubation, it is essential to have a primary plan and a plan for failure, and to be trained and proficient in all the techniques intended to be used 1. The operator should be supported by a trained, briefed team. If one laryngoscopy attempt fails, ensure the FONA set is immediately to hand and senior help is summoned. The number of attempts is limited to three. Following a failed intubation attempt, maneuvers to improve the laryngoscopic view or ease of intubation include:
- Different device or blade
- Partial withdrawal of the blade to facilitate a wider field of view
- Different operator
- Suction
- Reduction or release of cricoid force
- Optimal external laryngeal manipulation or backwards upwards rightward pressure, aided by videolaryngoscopy with a screen visible to all 1. In addition, the use of a bougie or stylet is recommended when the laryngeal opening is poorly seen (Grade 2b or 3a views) or when using a hyper-angulated videolaryngoscope 1. It is also crucial to ensure full neuromuscular blockade before tracheal intubation is attempted, and to use a vasopressor for bolus or infusion to manage hypotension 1.
From the Research
Tracheal Release Maneuvers
Tracheal release maneuvers are specialized surgical techniques designed to permit low tension end-to-end primary reconstruction after tracheal sleeve resection 2. The release procedures include:
- Dissection of the pretracheal plane
- Cervical flexion
- Laryngeal and hilar release Dissection of the pretracheal plane and cervical flexion are the most commonly employed techniques 2.
Types of Release Maneuvers
Different types of release maneuvers can be used depending on the location of the tracheal resection:
- Laryngeal and suprahyoid release maneuvers can be helpful for cervical tracheal resections 3
- Hilar and pericardial release maneuvers can be beneficial in thoracic tracheal resections 3 Simple maneuvers such as neck flexion and dissection of the avascular pretracheal plane can also be used to improve anastomotic tension 3.
Emergency Interventions
In cases of unanticipated difficult mask ventilation, emergency interventions such as the Heimlich maneuver and chest compression may be effective 4. These maneuvers can help relieve airway obstruction caused by asymptomatic supraglottic masses.
Airway Management
Tracheal intubation is used when a clear airway is difficult to achieve with a face mask or laryngeal mask, or if there is a risk of dislodgement of other forms of airway control 5. Supraglottic airways, such as the laryngeal mask airway, can be used as an advanced airway device in difficult airway and ventilation management 6.