Do videolaryngoscopes have a new role in the SIAARTI difficult airway management algorithm?
The rigid standard Macintosh laryngoscope is the instrument used to obtain an adequate view of the larynx in most patients. In cases of unpredicted severe laryngoscopic difficulties, the SIAARTI guidelines suggest waking the patient and using fiberoptic intubation with topical anesthesia. In the last decade, many videolaryngoscopes have been produced and introduced into clinical use. They provide an excellent view of the glottis. Their role in the SIAARTI algorithm for difficult airway management is now better defined. In fact, their use could be suggested in cases of unpredicted severe laryngoscopic difficulty as a step before awakening the patient. Moreover, they could be used in predicted severe intubation difficulty as an alternative to flexible fiberscope. (+info)
Self-poisoning suicide deaths in England: could improved medical management contribute to suicide prevention?
Management of a patient with an unexpected obstructing carinal mass.
Surgical procedures involving the airway or for mediastinal masses present considerable challenges for the anesthesiologist. Aside from the obvious technical challenges of providing ventilation, the anesthesiologist must share the airway with the surgeon. Careful and meticulous preoperative evaluation and preparation and intraoperative interaction with the surgical team is critical to assure control of the airway. We report a case of management of a patient with an unexpected near total obstruction of the airway from a carinal mass. (+info)
Propofol versus sevoflurane for fiberoptic intubation under spontaneous breathing anesthesia in patients difficult to intubate.
BACKGROUND: The most recommended technique for the management of patients with a difficult airway is fiberoptic intubation (FOI). The aim of this study was to compare propofol and sevoflurane for FOI performance in patients who were difficult to intubate. METHODS: Seventy-eight patients scheduled for maxillo-facial surgery were included in this prospective, randomized study. The airway was topically anesthetized with lidocaine 5% before performance of FOI with propofol TCI (group P) or sevoflurane (group S). The following parameters were recorded: rate of success, duration of the induction and of the FOI, BIS and PETCO2 values. A visual analogic scale (VAS) was used to monitor the technical difficulties as well as the recall of patients and their satisfaction. The respiratory and hemodynamic complications were also evaluated. RESULTS: Induction and procedure duration were significantly shorter in group S compared with group P. The rate of successful FOI was not different: 38 cases (97%) in group P and 35 cases (90%) in group S. No significant differences were observed between groups regarding BIS values and VAS values for technical difficulties and for patient recall and satisfaction. The incidence of hypertension or tachycardia was significantly higher in group S compared with group P. The incidence of respiratory complications was not significantly different between the groups, but three patients experienced obstructive dyspnea with hypoxemia. CONCLUSION: Propofol and sevoflurane provide a high success rate for the performance of FOI in patients who are difficult to intubate. (+info)
Manual hyperinflation is associated with a low rate of adverse events when performed by experienced and trained nurses in stable critically ill patients--a prospective observational study.
BACKGROUND: Manual hyperinflation (MH) can be performed as part of airway management in intubated and mechanically ventilated patients to mobilize airway secretions. Although previous studies demonstrated MH to be associated with hemodynamic and respiratory instability, we hypothesized MH to cause fewer adverse events (AEs) when performed by experienced and trained nurses in stable critically ill patients. METHODS: The incidence and type of AEs associated with MH were studied in a 28-bed mixed medical-surgical Intensive Care Unit. A difference in mean arterial pressure (MAP) or heart rate (HR) >15%, a decrease in peripheral oxygen saturation (SpO2) >5%, and a change in end-tidal (et)-CO2 >20% were considered AEs. A decrease of MAP to +info)
National census of airway management techniques used for anaesthesia in the UK: first phase of the Fourth National Audit Project at the Royal College of Anaesthetists.