Best practice & research. Clinical anaesthesiology
-
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.
-
Anaesthesiologists, paediatricians, paediatric intensivists and emergency physicians are routinely challenged with airway management in children and infants. There are important differences from adult airway management as a result of specific features of paediatric anatomy and physiology, which are more relevant the younger the child. In addition, a number of inherited and acquired pathological syndromes have significant impact on airway management in this age group. ⋯ Important new studies have gathered evidence about risks and benefits of certain confounding variables for airway problems and specific techniques for solving them. Airway-related morbidity and mortality in children and infants during the perioperative period are still high, and only a thorough risk determination prior to and continuous attention during the procedure can reduce these risks. Appropriate preparation of the available equipment and frequent training in management algorithms for all personnel involved appear to be very important.
-
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.
-
Best Pract Res Clin Anaesthesiol · Sep 2005
Review Historical ArticleInhaled anesthetics: an historical overview.
Inhalational agents have played a pivotal role in anesthesia history. The first publicly demonstrated anesthetic of the modern era, diethyl ether, was an inhalational anesthetic. The attributes of a good agent, ability to rapidly induce anesthesia, with limited side effects has led research efforts for over a hundred and fifty years. ⋯ Rapid emergence, with limited nausea and vomiting continue to drive discovery efforts, yet the 'modern' agents continue to improve upon those in the past. The future holds promise, but perhaps the most interesting contrast over time is the ability to rapidly introduce new agents into practice. From James Young Simpson's dinner table one evening to the operating suite the next day, modern agents take decades from first synthesis to clinical introduction.
-
Best Pract Res Clin Anaesthesiol · Sep 2005
ReviewNew and alternative delivery concepts and techniques.
The suitability of any method of delivering anaesthetic vapours to the breathing system can be judged only if seen in relation to the fresh gas flow. Due to its advantage in essentially reducing anaesthetic gas and vapour consumption, low-flow anaesthesia has become the acknowledged method of performing inhalational anaesthesia. Conventional plenum vaporizers, connected to the fresh gas supply, meet all technical needs for efficient, safe and simple performance of low-flow and minimal-flow anaesthesia. ⋯ The injection of liquid anaesthetics into the breathing system with the aid of a motor syringe seems most promising; however, such a technique is not approved, and in its simple version contravenes several regulations of the technical norm. Closed-loop feedback control of metering anaesthetic gases and vapours, as realized in the PhysioFlex and ZEUS anaesthetic workstations, allows the realization of 'quantitative closed-system anaesthesia' in clinical practice. If complex anaesthetic gas compositions are used, including for instance nitrous oxide, closed-system anaesthesia can be performed in clinical practice only with such sophisticated machines.