Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Dec 2005
ReviewStrategies and algorithms for management of the difficult airway.
Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.
-
Best Pract Res Clin Anaesthesiol · Dec 2005
ReviewEvaluation of the airway and preparation for difficulty.
Preoperative airway evaluation is essential to consider which is the best method of maintaining and protecting the airway during surgery and whether problems with airway management are likely. In general surgical patients, the prevalence of difficult intubation is low and tests have poor predictive power. ⋯ The absence of reliable prediction in general surgical patients means that airway strategy holds the key to successful management. Where there are obvious abnormalities in the history, examination or imaging the preoperative evaluation will allow choice of the most appropriate airway strategy which may include preparation of the patient, assembling of alternative airway equipment, advice and help from a more senior or skilled anaesthetist or aid from a surgical colleague or assistant.
-
Best Pract Res Clin Anaesthesiol · Dec 2005
ReviewSafety culture and crisis resource management in airway management: general principles to enhance patient safety in critical airway situations.
Airway management is a cornerstone of patient safety in anaesthesiology and in emergency and critical care medicine. Deficiencies in airway management could have catastrophic results for the patient. In anaesthesia patients, in particular, a high level of safety should be expected. ⋯ Concepts of the high reliability organizations (HROs) are now ready to be adapted to medicine and offer promising improvements in health care. This paper applies some of the HRO principles to airway management and illustrates how to transform more general strategies to practical application in the clinical world. This includes the use of key elements of crisis resource management (CRM) and the development of a checklist for safety in airway management.
-
Airway management involves far more than just proficiency with tracheal intubation techniques. There are several infraglottic techniques available and the method chosen will depend on the accessibility of equipment, the level of training and expertise, and the patient's specific injury or disease. Endotracheal intubation is most commonly performed by direct laryngoscopy. ⋯ Successful intubation, however, requires considerable experience, as in intubation techniques using flexible fibrescopes. Both the EasyTube and the Combitube serve as an infraglottic or a supraglottic airway. The tip of the EasyTube resembles the one of an endotracheal tube, whereas the Combitube is much more bulky.
-
Supraglottic airway devices are developed with increasing frequency following the overwhelming success of the laryngeal mask airway (LMA). Currently, the LMA, the ProSeal laryngeal mask airway (PLMA), the laryngeal tube (LT), the laryngeal tube with integrated suctioning tube (LTS) and the oesophageal tracheal combitube (OTC) are the best evaluated and most widespread devices. ⋯ LT and LTS are primarily intended as emergency airway devices, but have also been successfully used during controlled ventilation in adults. The OTC, though advocated for emergency as well as routine use, is limited by high airway morbidity and possible serious complications.