Anesthesiology clinics
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Anesthesiology clinics · Jun 2015
ReviewIs there a gold standard for management of the difficult airway?
Numerous practice guidelines have been developed to assist clinicians in the management of the difficult airway. The nature of difficult airway management, however, does not provide a practical way of comparing different guidelines or algorithms; no evidence supports one set of guidelines over another. Nevertheless they play an important role in patient safety as dissemination of such guidelines encourages airway practitioners to consider their strategies and formulate specific plans for the management of a predicted or unexpected difficult airway.
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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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Infectious and inflammatory conditions of the head and neck may present with impaired airways. An understanding of the pathophysiology will allow for accurate diagnosis and prompt intervention. Preintervention discussion and planning by members of the airway team are crucial in developing a primary and backup plans for safely securing the airway.
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A prepared airway practitioner performs safe airway management, displaying skill, knowledge, and a full awareness of human factors, within a culture of safety. The education of prepared practitioners should include deliberate practice and distributed learning and should aim for expertise rather than mere competence. Translational outcomes from improved education and training can significantly decrease patient morbidity and mortality.