Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2004
The Williams Airway Intubator, the Ovassapian Airway and the Berman Airway as upper airway conduits for fibreoptic bronchoscopy in patients with difficult airways.
In this article we will summarize the available information on airways that have been suggested to provide a conduit for the bronchoscope in its passage through the upper airway during fibreoptic intubation. ⋯ Though the Williams Airway Intubator and the Berman Oropharyngeal Airway are superior in this role, all the airways discussed here have major deficiencies in their function. Further research is needed in this field to meet the requirements of endoscopists in situations when it is crucial that equipment reliably fulfils its function.
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Curr Opin Anaesthesiol · Dec 2004
The carrier gas in anaesthesia: nitrous oxide/oxygen, medical air/oxygen and pure oxygen.
The gas passing the module for the delivery of inhalation anaesthetics and carrying vapourized anaesthetics into the breathing system is called the carrier gas. Oxygen is the absolutely indispensable component of the carrier gas. Additive gaseous components can be medical air (nitrogen), nitrous oxide, cyclopropane, or xenon, the latter three being anaesthetic gases themselves. Cyclopropane is not used any more and xenon is not approved as a medical gas yet, leaving medical air and nitrous oxide as the only currently available adjuncts to oxygen. ⋯ Nitrous oxide should not be used routinely as a component of the carrier gas any more. A mixture of medical air and oxygen must be acknowledged to be the gold standard. Pure oxygen may be used as a carrier gas if medical air or properly performing flow controls for medical air are not available.
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Curr Opin Anaesthesiol · Dec 2004
Alternative management techniques for the difficult airway: esophageal-tracheal Combitube.
To summarize knowledge about the esophageal-tracheal Combitube in emergency medicine and anesthesia, with special emphasis on uncommon indications. Papers published between August 2003 and July 2004 are reviewed. ⋯ The esophageal-tracheal Combitube is a useful and efficient alternative airway characterized by high success rates in emergency situations. We recommend the use of a laryngoscope for insertion and strict adherence to the manufacturer's guidelines in order to maximize success and minimize potential injury.
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To present recent advances in the role of the laryngeal mask airway (LMA) and its newer modifications in the management of difficult airway. ⋯ ILMA and PLMA have been shown to be effective in the management of difficult airway. We recommend that training in the use of these devices be made mandatory.
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This review will summarize the progress made during the last year in improving difficult-airway management. ⋯ Significant steps have been made in our management of the difficult airway, and the majority of the problems encountered can be solved with recourse to simple published guidelines.