Anesthesiology clinics of North America
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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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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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Management of the difficult airway remains one of the most challenging tasks for anesthesia care providers. Most airway problems can be solved with relatively simple devices and techniques, but clinical judgment borne of experience is crucial to their application. ⋯ Each airway device has unique properties that may be advantageous in certain situations, yet limiting in others. Specific airway management techniques are greatly influenced by individual disease and anatomy, and successful management may require combinations of devices and techniques.
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Despite many recent innovations in equipment for difficult airway management, it remains the leading cause of the most devastating adverse outcomes in anesthesia. Fiberoptic airway management is among the most versatile of techniques for difficult airway management. ⋯ It is most frequently used when difficult airway management is predicted but also may be appropriate when unforeseen difficulty arises. It cannot be too strongly emphasized, however, that this technique takes time and should be entertained only if the anesthesia care provider is able to maintain adequate oxygenation and ventilation until the airway is secured.
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Although this article merely glances the surface of some of the more fundamental aspects of managing the simple airway, one can see that an exhaustive discussion would require much more space than allotted herein. Although the author has attempted to reflect in a more clinically relevant tone in text, the best and most effective way to learn and remember such techniques is to perform them together with an experienced clinician. Attention to detail, subtleties, and nuances of the basic airway techniques, along with a willingness to refine this lost art of airway management, will re-solidify the foundation of excellent anesthesia and airway management.