
advanced search

Updated Sep. 1, 2010

Clinical Anesthesiology Pain Medicine Policy & Management In Brief Technology Guest Editorial Commentary Finance PRN Pharmacology Ad Lib Correspondence Web Exclusives

Bench to Bedside Patient Guides Pocket Guides Procedural Breakthrough Special Reports Webinar

GUIDE TO AIRWAY MANAGEMENT

Introduction
The intent of the American Society of Anesthesiologists Task Force on the Management of the Difficult Airway was to reduce adverse airway outcomes. The group suggested that our ability to communicate meaningfully about airway problems required precise collection of data and meaningful definitions, and proposed four definitions relating to difficult face mask ventilation, difficult laryngoscopy, and difficult and failed endotracheal intubation. But do those definitions serve us well?
AUGUST 2010

Laryngeal Mask Airway Devices: Three Maneuvers For Any Clinical Situation
During the past 2 decades, the laryngeal mask airway (LMA; LMA North America) and its variants have proved to be safe, effective, and minimally invasive airways in a wide variety of surgical procedures for patients who have fasted. The 3 maneuvers described below, developed by clinicians with considerable expertise in the use of these products, can help practitioners optimize their skill with these devices.
AUGUST 2010

Managing the Unusual Airway: Case Studies in Complexity
Difficult airways are by definition complex to manage. But some of these cases are more challenging than others. We asked several clinicians to give us examples of their more memorable airway cases.
AUGUST 2010

Endotracheal Tube Cuffs: Design and Function
Endotracheal tube (ETT) cuffs have advanced modestly in design since they were first introduced commercially in the mid-20th century. Until that time, ETTs were packed on either side of the subglottis by anesthetic swabs to prevent gas escape, and ribbon gauze was sewn on by hand to aid extraction at extubation.
AUGUST 2010

The Flexible Fiberscope For Airway Management and Diagnosis of Airway Pathology
The transmission of a recognizable image through a flexible fiber-optic bundle was first reported by Hopkins and Kapany in 1954. Three years later, the flexible fiber-optic gastroscope was introduced. In 1967, Murphy reported the first tracheal intubation assisted by fiber optics, using a choledochoscope. The practice of “flexible fiber-optic bronchoscopy” was introduced by pulmonologists the following year.
AUGUST 2010

Video Laryngoscopy In Obese Patients
The goal of laryngoscopy is to obtain the best possible view of the larynx and vocal cords. Laryngoscopes are used to aid the visualization of the airway structures, thereby facilitating tracheal intubation. The availability of instruments designed to assist direct laryngoscopy (DL) and to eliminate blind tracheal intubation dates back to 1895, with the invention of the “autoscope.” Modifications and refinement of this simple yet effective design are evident in the Macintosh and Miller laryngoscope blades commonly used today.
AUGUST 2010

Low-Tidal Volume Ventilation: Why Should We Care?
Mechanical ventilation is applied daily in operating rooms (ORs) worldwide as a lifesaving therapy. It has become a mainstay for the management of patients with acute respiratory failure. However, during the past decades, complications of mechanical ventilation also have become apparent.
AUGUST 2010

Obstructive Sleep Apnea And the Surgical Patient: What the Anesthesiologist Should Know
An alarming number of Americans experience obstructive sleep apnea(OSA), a disorder in which oropharyngeal soft tissue intermittently obstructs the airway during sleep. If undetected, OSA can lead to serious health problems and is associated with important perioperative complications.
AUGUST 2010

Airway Management and Patient Positioning: A Clinical Perspective
Patient positioning is an important aspect of anesthesia practice. Based on data from the American Society of Anesthesiologists Closed Claims Project database, advancements in research, improvements in airway management and education, and development of airway devices have resulted in a substantial decrease in respiratory complications—at one time the major cause of anesthesia-related morbidity and mortality. Meanwhile, other factors have started to be reported as sources of liability—including complications related to patient positioning
AUGUST 2010

What’s New in Supraglottic Airways? Three Decades of Evolution to Tract Separation
Many newer supraglottic airways—such as the LMA ProSeal (LMA North America, Inc), LMA Supreme (LMA North America, Inc), i-gel Intersurgical Inc), and King LTS-D (King Systems/VBM Medizintechnik GmbH)—include a gastric port in the design to overcome limitations of the LMA Classic (LMA North America, Inc). Although much emphasis is placed on the gastric port as potential protection against aspiration, there is far less emphasis on another advantage of the gastric port, that is, as a diagnostic tool in confirming proper positioning of the supraglottic airway (SGA).
AUGUST 2010

Awake Intubation: A Technique We Should Master
In Memory of Dr. Andranik Ovassapian
Numerous pathologic and anatomical factors contribute to the difficulty of tracheal intubation. The six basic mechanisms responsible for difficult tracheal intubation appear in Table 1.
AUGUST 2010

GUIDE TO AIRWAY MANAGEMENT ARCHIVES


•	Managing the Unusual Airway: Case Studies in Complexity
•	Unanswered Questions Linger for Postsurgical Intra-articular Injections
•	Endotracheal Tube Cuffs: Design and Function
•	OR Gases Pose Ecologic Risk, Economic Reward
•	Escape the Carnage of the ‘ACO’


•	Difficult CPB Weaning Predicts Diastolic Dysfunction 2
•	APSF Urges Ways To Improve Med Safety in the OR 6
•	OR Gases Pose Ecologic Risk, Economic Reward 1
•	Ketamine Combo Shows Promise for Long-term CRPS-1 Relief 2
•	Anesthesia Tech, Mike Davis, Uses MAC 4 Blade as Lure 1