Anesthesiology clinics
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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.
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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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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.