Best practice & research. Clinical anaesthesiology
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The inability to secure the airway, with consequent failure of oxygenation and ventilation, is a life-threatening complication. Failure of oxygenation leads to hypoxia followed by brain damage, cardiovascular dysfunction, and finally death. Time is a very crucial factor in this context. ⋯ To minimize injury to the patient, the anesthesiologist should examine the patient's airway carefully, identify any potential problems, devise a plan that involves the least risk for injury, and have a back-up plan immediately available. Each anesthesiology department should establish guidelines/algorithms specific to their institution. Unfortunately, a reliable test for detecting all patients at risk does not exist.
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Best Pract Res Clin Anaesthesiol · Dec 2005
ReviewSurgical approach in difficult airway management.
In all difficult airway algorithms, cricothyroidotomy is the life-saving procedure and is the final 'cannot ventilate, cannot intubate' option, whether in pre-hospital, emergency department, intensive care unit, or operating room patients. Cricothyroidotomy is a relatively safe and rapid means of securing an emergency airway. As with all other critical procedures in emergency medicine, a thorough knowledge of the technique and adequate practice prior to attempting to perform an emergency cricothyroidotomy are essential.
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Securing and monitoring the airway are among the key requirements of appropriate therapy in emergency patients. Failures to secure the airways can drastically increase morbidity and mortality of patients within a very short time. Therefore, the entire range of measures needed to secure the airway in an emergency, without intermediate ventilation and oxygenation, is limited to 30-40 seconds. ⋯ The most commonly occurring adverse respiratory events are failure to intubate, failure to recognize oesophageal intubation, and failure to ventilate. Thus, it is essential that every anaesthesiologist working on the labour and delivery ward is comfortable with the algorithm for the management of failed intubation. The algorithm for emergency airway management describing the sequence of various procedures has to be adapted to internal standards and to techniques that are available.
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Despite the use of alternative training methods and efforts to structure training, it remains a challenge to ensure that every anaesthesia trainee gains sufficient experience in the use of core techniques of airway management. As less time is spent in the operating room during training, it becomes less likely that trainees will be exposed to an adequate number of challenging airway cases that enable them to practise advanced techniques of airway management under supervision. ⋯ Therefore, particularly in the light of increasing economic pressures, it is necessary to address the responsibilities of everyone involved in the training process. Here, we critically review traditional and recent modalities of anaesthesia training, assess their value, and describe a multi-modal approach to airway management education.
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Fiberoptic intubation of the spontaneously breathing patient is the gold standard and technique of choice for the elective management of a difficult airway. In the hands of the properly trained and experienced user, it is also an excellent 'plan B' alternative when direct laryngoscopy unexpectedly fails. ⋯ Portable fiberscopes can be used in remote settings, increasing patient safety. This review discusses current fiberoptic intubation techniques and their applications in the management of both the anticipated and unanticipated difficult airway.