Articles: intubation.
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Airway management is a defining skill that demands mastery by emergency physicians. Airway emergencies pose considerable morbidity and mortality risks. Familiarity with, and mastery of, a variety of airway management approaches and equipment can prove invaluable for management of anatomically and physiologically difficult airways. ⋯ A 67-year-old woman presented to a level II trauma after a motor vehicle collision. Emergency medical services reported left-sided injuries, including diminished breath sounds. She arrived in extremis with dyspnea and hypoxia refractory to supplemental oxygen. A portable chest x-ray study showed a considerable traumatic diaphragmatic hernia. Initial attempts at intubation via video laryngoscopy were unsuccessful. Difficulties were attributed to anatomic variation, possibly due to the traumatic diaphragmatic hernia, and hematemesis. The airway was repositioned after removal of a cervical collar and suction-assisted laryngoscopy airway decontamination was performed under video guidance. During airway decontamination, the tip of a DuCanto suction catheter (SSCOR) became located at the level of the vocal cords, prompting the decision to control the airway via utilization of the DuCanto suction catheter and a bougie. The suction tubing was disconnected, a bougie was inserted through the catheter, and the DuCanto was subsequently removed and replaced with a cuffed endotracheal tube. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Airway emergencies are imminent life threats. Familiarity with a variety of tools and techniques allows for definitive airway management via primary, back-up, and contingency plans to secure anatomically or physiologically difficult airway.
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Paediatric anaesthesia · Feb 2024
Case ReportsA case of antenatally undiagnosed laryngeal atresia with tracheo-esophageal fistula with airway obstruction at birth and its management.
Laryngeal atresia is a rare congenital anomaly that is usually diagnosed by antenatal ultrasound, however, if undiagnosed presents with desaturation after birth. A term neonate presented with airway obstruction after birth with multiple failed attempts at intubation and was rescued by proseal laryngeal mask airway (LMA). An esophagoscopy using an Ambuscope utilizing a modified connector assembly revealed an opening on the anterior wall of the esophagus with no esophageal atresia, leading to a diagnosis of H-type tracheo-esophageal fistula (TEF) with laryngeal atresia. The ability to ventilate the neonate via LMA with an absent glottic opening raised the possibility of TEF.
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Pediatr Crit Care Me · Feb 2024
Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019).
To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019. ⋯ TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.
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Acta Anaesthesiol Scand · Feb 2024
Observational StudyFlexible bronchoscopic intubation through a supraglottic airway device: An evaluation of consultant anaesthetist performance.
Few clinical studies investigate technical skill performance in experienced clinicians. ⋯ Consultant anaesthetists had a median global rating scale score of 29.7 when using a SAD as conduit for FBI. However, despite reporting high procedural confidence, at least one global rating scale domain was deemed 'not competent' in 30% of cases, which indicates a clear potential for improvement of skill competence among professionals.
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The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients' physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term "pilots of the human biosphere"). In anesthesia, increased safety seems coupled with increased technology and innovation. This article gives an overview of the technological developments over the past decades, both in terms of pharmacological and mechanical robots, which have laid the groundwork for robotic anesthesia: target-controlled drug infusion systems, closed-loop administration of anesthesia and sedation, mechanical robots for intubation, and the latest development in the world of communication with the arrival of artificial intelligence (AI)-derived chatbots are presented.