Anesthesiology clinics of North America
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Anesthesiol Clin North America · Dec 2002
ReviewTraumatic complications of intubation and other airway management procedures.
Complications arising from intubation and other airway management procedures can have significant morbidity and mortality risks. With the increasing interventional techniques employed by the anesthesiologist to acquire and maintain an airway, there is a potential for increasing airway injury. Awareness of the potential "difficult" airway and employing the appropriate techniques to maximize airway visualization can minimize the risk of these complications.
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Normal respiration involves a highly detailed neurophysiologic process that results in the exchange of inspired and expired air through various anatomic structures. An understanding of these structures is important to the clinician involved in maintaining or reestablishing the normal airway. The following anatomic discussion focuses on the features crucial for the establishment and maintenance of a tracheal airway.
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Understanding the differences between the infant upper airway and the adult upper airway is important in properly managing the infant and pediatric airway. Proper history and physical examination and selection of the appropriate endotracheal tubes, LMAs, and laryngoscopes are key to managing the normal infant and pediatric airway. The difficult infant and pediatric airway requires planning, preparation, and teamwork. ⋯ Congenital syndromes associated with difficult airways pose a unique set of challenges. Postoperative problems include postextubation croup and obstructive sleep apnea. Extubating the infant or child with a difficult airway should be orchestrated as carefully as intubating the infant or child with a difficult airway.
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Anesthesiol Clin North America · Dec 2002
ReviewObstructive sleep apnea in the adult obese patient: implications for airway management.
Adult obese patients with suspected or sleep test confirmed OSA present a formidable challenge throughout the perioperative period. Life-threatening problems can arise with respect to tracheal intubation, tracheal extubation, and providing satisfactory postoperative analgesia. ⋯ If opioids are used for the extubated postoperative patient, then one must keep in mind an increased risk of pharyngeal collapse and consider the need for continuous visual and electronic monitoring. The exact management of each sleep apnea patient with regard to intubation, extubation, and pain control requires judgment and is a function of many anesthesia, medical, and surgical considerations.
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The ProSeal LMA is a major advance over the Classic LMA because of the following reasons: it allows ventilation at much higher airway pressures; it protects the lungs from aspiration and the stomach from gastric insufflation; it facilitates passage of a gastric tube and monitoring devices into the esophagus; it can be inserted like the Classic or Intubating LMA; it has its own built-in bite block; malposition is detected more readily; and, through use of techniques such as gum elastic bougie-guided insertion, correct positioning is almost guaranteed. The ProSeal can be considered a replacement device for the Classic LMA, but the Flexible LMA is still preferable for most intraoral procedures, and the Intubating LMA is still preferable whenever intubation is required. Limitations are that it is slightly more difficult to insert and requires more careful thought to use optimally.