Anesthesiology clinics of North America
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Anesthesiologists traditionally approach airway management and maintenance of a patent airway through translaryngeal techniques. Most of the techniques and devices routinely used in clinical practice (orotracheal intubation, nasotracheal intubation, laryngeal mask airway, Combitube, fiberoptic intubation, and so forth) maintain airway patency by way of manipulation of components of the upper airway. Successful maintenance of a patient airway involves a detailed understanding of the interaction of each device or technique with the structures of the upper airway. The goals of this article are to review the skills commensurate with successful recognition of airway problems and management of the patient with a known or suspected difficult airway.
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The ETC is an easily inserted, double-lumen/double-balloon supraglottic airway device. The major indication of the ETC is as a back-up device for airway management. It is an excellent option for rescue ventilation in both in- and out-of-the-hospital environments and in situations of difficult ventilation and intubation. ⋯ Continued airway management with an ETC that has been placed is a reasonable option in many cases. Having thus secured the airway, it may not be necessary to abort the anesthetic or to continue with further airway management efforts. In order to avoid serious trauma to the esophagus or airway, redesigning the ETC using a softer material for the tube is advisable.
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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.