Anesthesiology clinics of North America
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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.
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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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Anesthesiol Clin North America · Dec 2002
Using the laryngeal mask airway to manage the difficult airway.
Before 1990, the choice of an airway device essentially was limited to the facemask or the endotracheal tube. Since then, a number of novel supraglottic airway devices have been developed. ⋯ Perhaps more importantly, the LMA also has proved extremely useful in managing the difficult airway. This article reviews the use of the various LMA devices to manage the difficult upper airway.
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Safe and effective airway management techniques have become a hallmark of modern anesthesiology practice, but even such overwhelmingly successful and life-saving practices come with a cost. This cost is morbidity and mortality secondary to the techniques themselves. Closed claims analysis has shown that adverse outcomes secondary to respiratory events constitute the single largest source of injury to patients (75%). ⋯ Thorough knowledge of the mechanisms of airway injury associated with different airway management techniques may allow for better patient outcomes. This chapter reviews complications of airway management involving the placement of endotracheal tubes. In addition, because laryngeal mask airways (LMAs) have gained increasing prominence in airway management use in the past 10 years, complications relating to their use will also be reviewed.
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The number of patients who have preoperative anxiety over possibly "waking up" in the middle of surgery has increased dramatically over the last decade. McCleane and Cooper found that more than 50% of 247 patients were concerned that they would not be asleep during their surgery. Even after having an adequate anesthetic, 25% were still worried about being asleep with future anesthetics. ⋯ For the patient, awareness or recall while under general anesthesia is a frightening experience that can lead to debilitating emotional injury and even post-traumatic stress disorder. For anesthesiologists, awareness under anesthesia ranks second only to death as a "dreaded" complication. This chapter reviews the incidence, etiology, psychological sequelae, medicolegal consequences, and prevention of awareness during anesthesia.