Current opinion in anaesthesiology
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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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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.
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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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The purpose of this review is to examine recent evidence for the management of the difficult airway. ⋯ This review of algorithms for management of the difficult airway strengthens several generally accepted crucial points. What is always needed is expertise, which one can only get and maintain by daily practice.
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Capnography has been used in the operating room by anesthesiologists for over a decade. Along with pulse oximetry, it has reduced anesthesia-related morbidity and mortality. Traditionally, capnography has been used to confirm the placement of the endotracheal tube. This review looks into the literature for an update on the use of capnography in the spontaneously breathing patient. ⋯ Capnography has become a mandatory or recommended monitoring tool in the practice of anesthesiology. It is making inroads into other medical specialties as a monitoring and diagnostic tool. The use of this technology by non-anesthesiologists will continue to increase. In the opinion of the authors capnography should be used in all cases requiring sedation either in or out of the operating room.