Submited on: 19 Dec 2012 04:55:21 AM GMT
Published on: 19 Dec 2012 05:32:52 PM GMT
 

  • What are the main claims of the paper and how important are they?

    The main topic of this manuscript is the management of difficult airway in a patient presenting clinical evidence of problematic airway as consequence of severe burn lesion. The management of airway is one of the more important aspect of the anaesthesiological practice.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Not at all! This is one of the most popular and more studied topic in anaesthesia; this reputation come from the simple fact that an adequate management of the airways is of vital importance for the survival of our patients. Tecniques, devices and drugs reported in this manuscript are well known and several studies are available: if you put in PubMed the MeSh "difficult airway management” you can get more than 5000 pubblications on this topic.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    NA


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    NA


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Not in my opinion. The main reason is that I would used a prudent i.v. titration of drugs like fentanil and midazolam (there are specific antagonists available in case of need) instead of i.m. administration of a fixed dose.


  • Other Comments:

    1. English could be better.
    2. Topicalization is a difficult word; in English language: (linguistics) emphasis placed on the topic or focus of a sentence by preposing it to the beginning of the sentence; placing the topic at the beginning of the sentence is typical for English; "`Those girls, they giggle when they see me' and `Cigarettes, you couldn't pay me to smoke them' are examples of topicalization"
    3. I know Mallampati, but not MALLAM PATI
    4. The surgery scheduled for this patient is not described
    5. References should be in superscripts or in brackets

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    G. Zanette, C. Ori, N. Zadra, F. Giusti, G. Pittoni " Hangman's fracture in a paediatric patient: considerations for anaesthesia ". Paediatric Anaesthesia, 1997, 7, 473 - 475. Micaglio M, Trevisanuto D, Doglioni N, Zanette G, Zanardo V, Ori C. The size 1 LMA-ProSealTM: Comparison with the LMA-ClassicTM during pressure controlled ventilation in a neonatal intubation manikin. Resuscitation, 2007; 72: 124-127. G. Zanette, E. Facco, M. Micaglio, N. Zadra, A. U. Behr, G. Manani. ProSeal™ laryngeal mask airway (PS-LMA) for long lasting surgical procedures: seven clinical cases. Acta Anaesth Ital 2009; 60: 57-65.

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Zanette G .Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002414
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    Authors have managed a case of anticipated difficult airway very systemetically. Step by step approach avoided the episode of convulsion altogather in a patient of epilepsy disorder. Planning is the most important step while approaching such difficult airway situation.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    As such claims are not novel per se. Many such case reports are available in the literature. Although taking correct desicion timely ie opting for the correct approach in a given anticipated difficult airway gives us the take home message.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not Applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Diagramatic representation of blocking nerves in relation with airway anatomy would have been a good idea.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Not outstanding, but a good example of approaching an anticipated difficult airway.


  • Other Comments:

    Rationale of pre-madication technique is missing.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Have been working with such difficult airway situations in patients of oral cancers.

  • How to cite:  Goyal G .Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture [Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002413
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    In this interesting presentation, the authors have highlighted a very difficult situation whose mismanagement can turn into a catastrophe for every anesthesiologist. Despite of general belief, similar cases to be considered as difficult airway are not rare, not eliminating the near misses. Numerous methods have been/ are devised to overcome this problem. In this article, the authors have introduced a new set of measures for anesthesia of such patients.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Novel yet challenging


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    1. It would add more to the value of the article, if the type of the surgery is added. For instance, it is of value to know if the surgery was performed in a shared field with the anesthesia. In such conditions using spiral tubes is more logical as they would not be obstructed due to the abnormal airways or manipulations throughout the surgical procedure.
    2. The type of the muscle relaxation could also be added as in this special case; having history of burn could alter the selection of muscle relaxant agents.
    3. I was wondering how Mallampati scoring was made as mouth opening was almost impossible.
    4. Maybe some photographs of the laryngeal view would add to the value of the work, provided that their fibreoptic setting would have allowed the authors to do so.
    5. Administration of thiopental in this special case was wise.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes


  • Other Comments:

    1. The most important comment or concern: Opting for either using premedication or not in these patients is also difficult. However, in case we opt for premedication, it is not a good idea to perform it outside the operating room as even small doses could lead to apnea which in this case would have been catastrophic as even face mask ventilation is reported to be difficult in such patients.
    2. What is missing here is administration of volatile agents. Volatile agents are excellent choices for difficult airway cases. They not only are not associated with apnea and provide spontaneous breathing securing airway but also can provide amnesia in subhypnotic doses. That’s why I believe that in addition to the three alternative methods, the authors should add volatile anesthesia to the list as well.
    3. The last but not the least, fibreoptic devices are rarely found in the hospitals of the developing countries and even when they exist, not all anesthesiologist have mastered using them in usual cases, let alone difficult airway cases as your case. Whereas volatile agents can be safely used for such emergency cases by almost all anesthesiologists.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    1. Soleimanpour H, Vahdati SS, Mahmoodpoor A, Panahi JR, Afhami M, Pouraghaei M, Golzari SE. Modified cricothyroidotomy in skill laboratory. Journal of Cardiovascular and Thoracic Research. 2012;4(3):73-76. 2. Soleimanpour H, Sarahrudi K, Hadju S, Golzari SE. How to overcome difficult-bag-mask-ventilation: recent approaches. Emergency Medicine 2:e116.

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Golzari S E.Patients With Post Burn Contracture: Anesthesia Challenge[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002412
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    The authors are describing elecive managment of a case of difficult airway of a epileptic patient with post burn neck contracture. They utilised technique of awake fiberoptic intubation in elective manner which put the patient in safe zone eliminating the grave risk of "cant ventilate and cant intubate" scenario. This article making the readers aware of clinical situation in which awake fibreoptic intubation could be useful.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Although technique of awake fibreoptic intubation is not new one but authors successfully used this techique in right clinical scenario.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Not applicable


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes, the authors successfully used right balance of drugs to sedate the patients so as not to stimulate the seizures and in the mean time patient was comfortable allowing  for bronchoscopic intubation.


  • Other Comments:

    This type of clinical situation is quite perplexing for anaesthesiologists. The authors described a clinical scenario in which use of awake fibreoptic inubation is justified. This aricle will be useful to readers who are encountering such type of patients.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Assistant professor in anaesthesiology. frequently doing awake fibreoptic intubation in oncology and post burn patients

  • How to cite:  Khuba .Review of Article Citing Case Report of Management of Difficult Airway in a Epileptic Patient with Post Burn Neck Contracture[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002409
1 2 3 4 5 6 7 8 9
Report abuse
 

  • What are the main claims of the paper and how important are they?

    This is a case report about the management of a difficult airway in a patient with severe post burn neck contracture configuring a can't intubate can't ventilate situation.

    It is always important to learn about others' experience of difficult situation as this may help us in the future.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Quite novel with regard to the severe contracture presentation and the issues it raises. 

    The intubation technique per se is not particularly novel, just a common fiberoptic assisted intubation.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Not outstanding, but interesting. A case report has its limitation but also relevance for those who may face a similar situation.


  • Other Comments:

    Interesting case report that reminds us how difficult might be to manage an airway.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Senior consultant anaesthetist with 20 years of experience

  • How to cite:  Luchetti M .Management Of Difficult Airway In a Patient With Severe Post Burn Neck Contracture[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002408
1 2 3 4 5 6 7 8 9
Report abuse
 
Good Update on Post-Burn-Related Airway Management
Posted by Dr. Deepak Gupta on 20 Dec 2012 06:04:25 AM GMT

  • What are the main claims of the paper and how important are they?

    Post-Burn Management is unique in many aspects and the presented scenario may be common in developing countries wherein potentially delayed access to plastic surgery (due to surgical costs, patients' self-payments model and lack of awareness among general population especially in rural areas) may present these case scenarios of severe neck contractures to anesthesiologists. Thanks for presenting this case scenario and updating for this difficult airway management. It would have been good to know what the scheduled surgery was and whether she will be coming back for any other surgeries so that she can avoid any future catastrophies. It will be great to inform patient of the difficult airway management that the authors performed for her future anesthesia teams. It will also be great to know if any plastic surgical procedure is due for her neck contracture so that her difficult airway issue can be resolved.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Novel for developed world to understand the type of difficult case scenarios that developing world still encounter in present days and the type of airway management that they are attempting in these case scenarios.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Not applicable


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Case report presentation is good


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    It is great as published case report


  • Other Comments:

    None

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    General Anesthesia

  • How to cite:  Gupta D .Good Update on Post-Burn-Related Airway Management[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002407
1 2 3 4 5 6 7 8 9
Report abuse
 
Excellent Case Presentation
Posted by Dr. John D Mitchell on 19 Dec 2012 07:04:08 PM GMT

  • What are the main claims of the paper and how important are they?

    It is important to identify difficult airways and manage them proactively by reviewing all options and making the best plan. Neck contractures from burns can limit the ability of physicians to mask ventilate or use standard techniques to anesthetize the airway for awake fiberoptic intubations Judicious use of topical and intramuscular agents helps to facilitate awake fiberoptic intubation when topical or infiltration anesthetics can't be properly completed due to anatomic limiatations.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    None are novel, but this is a good demonstration of these claims in action.


  • Are the claims properly placed in the context of the previous literature?

    Yes, a reasonable literature review was conducted and shared with the audience.


  • Do the results support the claims? If not, what other evidence is required?

    Yes, claims are supported.  My only other question is why IM morphine was selected as a premedication instead of an interavenous dose or an anxiolytic agent?  It seems to have been very effective, but it would help to hear some of the rationale for this approach (even if the rationale is that it is standard practice for the authors).


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    A sound and reasonable approach to a difficult problem


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    An illustration of the anatomy of the nerves of the airway would be useful.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Interesting, but not outstanding.  Still, a very good case report and review for resident level learners.


  • Other Comments:

    The authors should be commended for their careful management of a complex patient and appropriate discussion of the issues.  It is an interesting case presentation with several issues worth exploring.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Anesthesiologist

  • How to cite:  Mitchell J D.Excellent Case Presentation[Review of the article 'Management Of Difficult Airway In An Epileptic Patient With Severe Post Burn Contracture ' by Chauhan H].WebmedCentral 2012;3(12):WMCRW002406
1 2 3 4 5 6 7 8 9
Report abuse