Current opinion in anaesthesiology
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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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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.
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Curr Opin Anaesthesiol · Dec 2004
Recent trends in tracheal intubation: emphasis on the difficult airway.
Difficult airways can lead to critical incidents during anaesthesia, and death. Although many cases can be anticipated, some still go undiscovered before induction, thereby exposing the patient to unexpected risks and the anaesthesiologist to unexpected challenges. In addition to improving prediction of difficult airways, education for skill acquisition and management planning, and a quest for superior management techniques and airway tools are of the utmost importance in preventing airway catastrophes. ⋯ Improving reproducibility and reliability in predicting a difficult airway may limit the number of unpredicted difficult intubations. A safer approach to management of the difficult airway can be achieved by improving airway management skills and adhering to universally accepted and proven airway algorithms, including developing approaches to management of predicted and unpredicted difficult airways. Improving on existing airway techniques and tools (of which there are many), rather than creating new devices, is a desirable trend that may contribute to safer airway management in the future.