AANA journal
-
Case Reports
Laryngospasm as a Cause of Unsuccessful Placement of Laryngeal Mask Airway ProSeal: A Case Report.
Laryngospasm is a potential complication encountered during anesthesia using a laryngeal mask airway (LMA). We report a case in which laryngospasm resulted in unsuccessful placement of an LMA ProSeal Airway (Teleflex Inc), and we discuss the various causes of unsuccessful placement of this type of airway device. ⋯ In this case report, the laryngospasm-induced increased resistance to gas flow was manifested by exaggerated outward movement of the LMA ProSeal following its connection to gas flows and thus resulted in failed airway placement. The possibility of laryngospasm as a cause of failed placement of an LMA ProSeal must be considered in clinical practice.
-
The use of a supraglottic airway, also called laryngeal mask airway (LMA), is gaining in popularity for delivery of general anesthesia in certain situations and is shown to be safe. Use of infraglottic airways (tracheal tubes) allows for positive pressure ventilation and maneuvers, such as holding continuous positive pressure in the airway to check for pleural and dural leaks. We describe the successful use of the LMA (Teleflex Inc) for general anesthesia, in which continuous positive airway pressure of 15 cm H2O held for 20 seconds allowed the neurosurgeon to identify the site of a cerebrospinal fluid (CSF) leak and successfully repair the leak. A well-seated LMA can be successfully used to produce continuous positive pressure in the airway not exceeding 20 cm H2O for 20 seconds to facilitate surgical identification of CSF leaks.
-
A difficult intubation poses one of the most challenging tasks for anesthesia professionals, representing 27% of all adverse respiratory events, 93% of which are unanticipated. Unanticipated difficult mask ventilation and intubation may result in serious complications. Safe airway management requires a proper and thorough preoperative airway evaluation and a plan to secure the airway, with alternate plans available when the initial plan fails. ⋯ Nine articles were selected for appraisal in this literature review: 6 randomized control trials, 2 prospective studies, and 1 retrospective study. Multiple apneic oxygenation techniques, including nasopharyngeal catheter, nasal prongs, endotracheal tube, intratracheal catheter, and high-flow transnasal humidified oxygen, demonstrated effectiveness at delaying the onset of hypoxemia during the apnea period. Prolonging the apneic window changes the nature of airway management in patients at high risk of desaturation and when an unanticipated difficult airway arises.
-
This article provides a systematic review of awareness with recall, also called intraoperative awareness. Major topics of this review include the incidence and causes of this phenomenon, in addition to an examination of current strategies for prevention of intraoperative awareness. ⋯ This Journal course explores evidence related to the utility and limitations of this monitor in clinical practice. It also reviews evidence-based practices that may decrease the incidence of awareness with recall, including avoidance of muscle relaxants and protocol-driven approaches to awareness prevention.
-
The purpose of this evidence-based, quality improvement practice project was to increase anesthesia providers’ knowledge and awareness of the taping practice for securing the endotracheal (ET) tube that increases the patient’s exposure to pathogens and the risk of nosocomial infections. A change in the taping practice by anesthesia providers was the desired outcome. Participants completed an anonymous questionnaire about their knowledge and use of a taping practice to secure the ET tube. ⋯ A Mann-Whitney U test demonstrated statistical significance (U = 55, P = .003). Additionally, anesthesia providers gave a strong indication that they would not use adhesive tape that had fallen to the floor (U = 78, P = .04, Mann-Whitney U test). This project demonstrated that a change in practice occurred after an intervention regarding securing the ET tube with adhesive tape.