Articles: intubation.
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Anesthesia and analgesia · Sep 1991
Randomized Controlled Trial Comparative Study Clinical TrialEmergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients.
We compared the differences in oxygen saturation and airway-related complications after tracheal extubation in pediatric patients undergoing elective strabismus surgery or adenoidectomy and/or tonsillectomy who were awake versus anesthetized. Seventy otherwise healthy patients between 2 and 8 yr of age were studied. Anesthesia was induced with halothane or thiamylal and maintained with nitrous oxide and halothane. ⋯ There were no differences between the two groups in the number of patients requiring supplemental oxygen. The incidence of airway-related complications such as laryngospasm, croup, sore throat, excessive coughing, and arrhythmias was not different between the two groups. We conclude that the anesthesiologist's preference or surgical requirements may dictate the choice of extubation technique in otherwise healthy children undergoing elective surgery.
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All critical care physicians should be adept at medical management of the airway, including basic and advanced life support measures. Proper head and neck positioning, use of non-definitive airways, and ability to oxygenate and ventilate the patient with bag-valve-mask should be part of the armamentarium of every critical care physician. ⋯ Oral intubation is preferred for emergency establishment of a definitive airway in most situations. Skillful intubation technique and meticulous daily management of the upper airway should diminish the risk of complications of translaryngeal intubation.
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For clinicians involved in airway management, a plan of action for dealing with the difficult airway or a failed intubation should be developed well in advance of encountering a patient in whom intubation is not routine. When difficulty is anticipated, the equipment necessary for performing a difficult intubation should be immediately available. It also is prudent to have a surgeon skilled in performing a tracheotomy and a criothyroidotomy stand by. ⋯ On a third attempt, traction to the tongue can be applied by an assistant, a tube changer could be used to enter the larynx, or one of the other special techniques previously described can be used. If this third attempt fails, it may be helpful to have a physician more experienced in airway management attempt intubation after oxygen has been administered to the patient. If all attempts are unsuccessful, then invasive techniques to secure the airway will have to be performed.