Anesthesiology clinics
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The professional singer comes to the day of surgery with a measure of anxiety about the effects of anesthesia or surgery on his or her voice. A detailed informed consent should be obtained to discuss and document risks, as well as set realistic expectations for recovery. ⋯ Movement of the tube should be minimized, both during anesthesia, as well as in emergence. Postoperative care may be coordinated with an otolaryngologist and speech language pathologist as the singer plans a return to performance.
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Anesthesiology clinics · Jun 2015
ReviewPredictors of difficult intubation and the otolaryngology perioperative consult.
Airway management is one of the most important aspects of anesthesia care. Although the incidence of difficult intubation is low, predicting a potentially difficult airway can ensure that necessary staff and equipment are available. A preoperative airway evaluation should include a history and physical examination focusing on elements that can cause problems with intubation. ⋯ Specific patient and situational factors should be considered. Alternative plans should be defined before the initiation of anesthesia. Management of a complex airway should be a coordinated effort between anesthesiologists and otolaryngologists.
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Anesthesiology clinics · Jun 2015
ReviewWhat We All Should Know About Our Patient's Airway: Difficult Airway Communications, Database Registries, and Reporting Systems Registries.
Documentation and dissemination of patient information characterizing a difficult airway encounter is a critical safety link between past, present, and future health care providers. Effective communication of the nature of the difficulty encountered and the airway management techniques used consists of documentation in the patient's medical record for concurrent care providers and dissemination of that information to the patient and future providers for use during subsequent episodes of care. Significant progress has been made with developing national and international electronic patient record systems and airway databases, but full integration has yet to be achieved.
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Topical anesthesia of the airway is a necessary for awake intubation and is usually achieved using lidocaine delivered by various means. Although some experts favor the use of airway blocks, a more common approach is to use pure topical methods in combination with "spray as you go" techniques. ⋯ Nasal intubation requires additional topicalization of the nasal passages in conjunction with a vasoconstrictor. Finally, judicious sedation is frequently used when awake intubation is carried out.
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After a prolonged period of stagnation, many new airway devices have entered the clinical arena. Along with these, practice guidelines based primarily on expert opinion have been endorsed by specialty societies. These guidelines encourage a rational progression in strategies rather than persistent ineffective efforts. It is important to have an understanding of the strengths and limitations of the devices and strategies relating to ventilation by face mask and supraglottic airway, the variety of fiberoptic and video laryngoscopic techniques, and the methods of reestablishing the airway after failed extubation.