MedWorm: Airway Management

Lung Separation in the Morbidly Obese Patient

Advances in Urology — Mon, 06 Feb 2012 12:46:42 +0100

Lung separation techniques in the morbidly obese patient undergoing thoracic or esophageal surgery may be at risk of complications during airway management. Access to the airway in the obese patient can be a challenge because they have altered airway anatomy, including a short and redundant neck, limited neck extension and accumulation of fat deposition in the pharyngeal wall contributing to difficult laryngoscopy. Securing the airway is the first priority in these patients followed by appropriate techniques for lung separation with the use of a single-lumen endotracheal tube and a bronchial blocker or another alternative is with the use of a double-lumen endotracheal tube. This review is focused on the use of lung isolation devices in the obese patient. The recommendations are based upon ...

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Anesthetic Management of Direct Laryngoscopy and Dilatation of Subglottic Stenosis in a Patient with Severe Myasthenia Gravis

Advances in Pharmacological Sciences — Thu, 02 Feb 2012 18:35:24 +0100

We describe the anesthetic management of a patient with severe myasthenia gravis and tracheal stenosis; the patient was scheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several difficulties for anesthetic management. The airway is shared; therefore, any complications are also shared by the anesthesiologist and bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that anesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in a case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence for choosing one approach to general a...

Clinicopathological Profile, Airway Management, and Outcome in Huge Multinodular Goiters: An Institutional Experience from an Endemic Goiter Region

World Journal of Surgery — Thu, 02 Feb 2012 18:12:35 +0100

Conclusions Long-standing huge goiters are common in iodine-deficient endemic areas. The majority of patients have symptomatic or clinicoradiological evidence of airway involvement. The incidence of RSE, airway deformity, intubation difficulty, and tracheomalacia is high with huge goiters. The surgery is technically demanding with greater associated chances of injury to native structures. Malignancy influences the presentation and outcome in smaller goiters. In centers with experienced endocrine surgeons and dedicated anesthetists, huge goiters can be successfully managed with minimal short-term and long-term morbidity. Content Type Journal ArticlePages 1-6DOI 10.1007/s00268-012-1447-xAuthors Amit Agarwal, Department of Endocrine Surgery, Sanjay Gandhi Post Gradua...

The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized, noncrossover study with the Classic™ laryngeal mask airway

Pediatric Anesthesia — Thu, 02 Feb 2012 12:09:21 +0100

Conclusions: We conclude that the size 1 PLMA is a stable, safe, and efficacious airway control device during neonatal and infant anesthesia, allowing higher peak airway pressure during positive pressure ventilation, with fewer mask displacements and gastric insufflations than the cLMA. (Source: Pediatric Anesthesia)

The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized, noncrossover study with the Classic™ laryngeal mask airway.

Paediatric Anaesthesia — Wed, 01 Feb 2012 05:00:00 +0100

Emergency airway management: Training and experience of chief residents in otolaryngology and anesthesiology

Head and Neck — Fri, 27 Jan 2012 05:00:00 +0100

ConclusionOtolaryngology and anesthesiology emergency airway management experience/training is heterogeneous and nonstandardized. Many chief residents graduate with little exposure to airway emergencies, especially surgical airways. Resident confidence levels are high despite minimal experience. This high confidence‐low experience dichotomy may reflect novice overconfidence and suggests the need for improved training methods. © 2012 Wiley Periodicals, Inc. Head Neck, 2012 (Source: Head and Neck)

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Fetal Epignathus: The Case of an Early EXIT (Ex Utero Intrapartum Treatment).

Obstetrics and Gynecology — Thu, 26 Jan 2012 20:31:49 +0100

CONCLUSION: : Prenatal diagnosis of fetal epignathus is imperative so that all options can be discussed. An EXIT procedure may be necessary for airway management at birth. If preterm delivery is necessary, choice of uterine incision and fetal size are important factors to consider for a successful outcome. PMID: 22270441 [PubMed - in process] (Source: Obstetrics and Gynecology)

Awake GlideScope intubation in a critically ill pediatric patient

Pediatric Anesthesia — Mon, 23 Jan 2012 05:00:00 +0100

We report a challenging case of a 10‐year‐old boy with history of biventricular heart failure, pulmonary hypertension, severe asthma, and obesity with a BMI of 37. He presented to our hospital in acute decompensated heart failure. Our anesthesia team was consulted by the pediatric intensivist for urgent airway management in this rapidly deteriorating, premorbid patient. We describe here the use of the GlideScope® in an awake pediatric patient of ASA 4E status with a potentially difficult airway who required to remain in the seated position and thus necessitating a face‐to‐face approach. (Source: Pediatric Anesthesia)

A National Survey of Airway Management Training in U.S. Internal Medicine-Based Critical Care Fellowship Programs.

Respiratory Care — Mon, 23 Jan 2012 05:00:00 +0100

CONCLUSION: The majority of programs have a formal airway management program incorporating a variety of intubation techniques. Overall experience varies widely, however. PMID: 22273367 [PubMed - as supplied by publisher] (Source: Respiratory Care)

Development of an Instrument for a Primary Airway Provider's Performance With an ICU Multidisciplinary Team in Pediatric Respiratory Failure Using Simulation.

Respiratory Care — Mon, 23 Jan 2012 05:00:00 +0100

CONCLUSIONS: A task-based scoring instrument for a primary airway provider's performance with multidisciplinary Pediatric ICU team on simulated pediatric respiratory failure was developed. Reliability and validity evaluation supports the developed scale. PMID: 22273157 [PubMed - as supplied by publisher] (Source: Respiratory Care)

A case of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicating airway management.

Canadian Journal of Anaesthesia — Fri, 20 Jan 2012 05:00:00 +0100

CONCLUSION: We emphasize the need for early identification of DRESS syndrome as well as the possible airway implications associated with this increasingly recognized clinical entity. PMID: 22271506 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

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Airway management of recovered pediatric patients with severe head and neck burns: a review

Pediatric Anesthesia — Thu, 19 Jan 2012 05:00:00 +0100

This article aims to provide a comprehensive review of airway management in such patients, focusing on challenges encountered during mask ventilation and tracheal intubation, as well as the role of surgical release of neck contractures to facilitate tracheal intubation. Lessons learned from all reported cases identified in a thorough literature search are incorporated into this review. (Source: Pediatric Anesthesia)

Comparative quality analysis of hands-off time in simulated basic and advanced life support following European Resuscitation Council 2000 and 2005 guidelines

Emergency Medicine Journal — Wed, 11 Jan 2012 05:00:00 +0100

Conclusion The application of ERC guidelines of 2005 markedly reduced the first HOI and mean duration of HOI at the cost of delayed secure airway management and ECG analysis in this MCT model. (Source: Emergency Medicine Journal)

The key to advanced airways during CPR: well trained and early

Critical Care — Wed, 11 Jan 2012 05:00:00 +0100

Airway management during cardiac arrests is a controversial area. There are advantages to the provision of a patent airway with an airway adjunct, especially as this can optimize oxygenation and carbon dioxide clearance as well as facilitate continuous compressions. These advantages come at a potential cost, in particular errors in placement of the devices and interruption to compressions necessitated for insertion. The widespread availability of supraglottic airways (SGAs), their ease of insertion, and their ability to be inserted without interruptions to compressions have meant that the role of the definitive airway device - the endotracheal tube - is being challenged. In the previous issue of Critical Care, a study from Japan reported the use of advanced airways in more than 5,000 victi...

Current Emergency Medical Services Guidelines: Traumatic Cardiopulmonary Arrest And Prehospital Airway Management (Trauma CME)

EM Practice Guidelines Update — Sat, 31 Dec 2011 08:46:52 +0100

In this edition of EM Practice Guidelines Update, 2 clinical guidelines addressing critical aspects of emergency medical services (EMS) systems and their applicability to the emergency department (ED) are reviewed. (Source: EM Practice Guidelines Update)

Tracheo-brachiocephalic artery fistula after tracheostomy associated with thoracic deformity: a case report

BioMed Central — Wed, 28 Dec 2011 05:00:00 +0100

Conclusions: We suggest that before tracheostomy, the anatomic relationship between the trachea and brachiocephalic artery must be confirmed by contrast-enhanced chest computed tomography scan. (Source: BioMed Central)

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CT‐guided percutaneous lung biopsy under general anesthesia: a pediatric case series and literature review

Pediatric Anesthesia — Wed, 28 Dec 2011 05:00:00 +0100

We describe 14 consecutive children who received computed tomography‐guided percutaneous lung biopsy (CT‐PLB) under general anesthesia over an 18‐month period at our institution. Pulmonary hemorrhage (occurring in 36%) and pneumothorax (29%) were the two most common complications; the overall complication rate was 64%. When complications did occur, immediate airway management was facilitated by the presence of an endotracheal tube (ETT). We conclude as follows: (i) CT‐PLB in our series is associated with a high risk of both overall and severe complications; (ii) risk of complications is increased by both patient and procedure‐related factors; (iii) airway management with ETT may be preferable should a complication arise; (iv) severe complications may necessitate ICU admission, wh...

Use of GlideScope in airway management of a patient with osteogenesis imperfecta

Journal of Anesthesia — Tue, 27 Dec 2011 06:33:48 +0100

Content Type Journal ArticleCategory Letter to the EditorPages 1-2DOI 10.1007/s00540-011-1307-0Authors Faiza A. Khan, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 515, Little Rock, AR 72205, USASonia Shah, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 515, Little Rock, AR 72205, USAShailesh Shah, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 515, Little Rock, AR 72205, USAVictor Mandoff, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 515, Little Rock, AR 72205, USAW. Brooks Gentry, Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 W...

Left sleeve pneumonectomy via a clamshell incision for lung cancer with carinal invasion: report of a case

Surgery Today — Mon, 26 Dec 2011 16:45:46 +0100

We report how we successfully treated carinal invasion of primary lung cancer by performing left sleeve pneumonectomy through a clamshell incision, as bilateral thoracotomy through a transverse sternotomy. Without a cardiopulmonary assist device, adequate ventilation and oxygenation were maintained across the operative field with a spinal tube. Tracheo-bronchial anastomosis was relatively easy to perform, with an excellent surgical view. The patient had an uneventful postoperative course and was discharged from hospital without oxygen support. There was no evidence of complications at the anastomosis on chest computed tomography and no sign of recurrence during 6 months of follow-up. The clamshell incision approach provided an excellent surgical view without the need to change t...

Comparison between intubation through ILMA and Airtraq, in different non-conventional patient positions: a manikin study

Emergency Medicine Journal — Tue, 20 Dec 2011 05:00:00 +0100

Conclusions These preliminary data in manikins could indicate the applicability of the methods to the prehospital setting. (Source: Emergency Medicine Journal)

Laryngeal Radiation Fibrosis: A Case of Failed Awake Flexible Fibreoptic Intubation

Infectious Diseases in Obstetrics and Gynecology — Mon, 19 Dec 2011 15:45:15 +0100

We present an unusual severe case of radiation induced changes to the larynx, with limited clinical symptoms, that caused failure of the fibreoptic intubation technique. A review of the known literature on radiation fibrosis and airway management is presented. (Source: Infectious Diseases in Obstetrics and Gynecology)

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Tapia’s Syndrome: An Unexpected but Real Complication of Rhinoplasty: Case Report and Literature Review

Aesthetic Plastic Surgery — Sat, 17 Dec 2011 06:45:32 +0100

We report such a case after an otherwise uncomplicated rhinoplasty. After reviewing the other nine reported cases of Tapia’s syndrome, we found that half of the patients had undergone rhinoplasty or septorhinoplasty. The risk factors, etiology, clinical course, recovery potential, and preventive measures are analyzed and discussed. Although Tapia’s syndrome after rhinoplasty/septorhinoplasty appears to be rare, it should be considered by both the anesthetist and the plastic surgeon, and most importantly, special attention should be paid to preventive strategies. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00266-011-9849-yAuthors Efstathios G. Lykoudis, Department of Plastic Surgery, Ioannina University School of Medicine, University Campus, 45110 Io...

Evolution of the Extraglottic Airway: A Review of Its History, Applications, and Practical Tips for Success.

Anesthesia and Analgesia — Fri, 16 Dec 2011 05:00:00 +0100

Authors: Hernandez MR, Klock PA, Ovassapian A Abstract The development of the laryngeal mask airway in 1981 was an important first step toward widespread use and acceptance of the extraglottic airway (EGA). The term extraglottic is used in this review to encompass those airways that do not violate the larynx, in addition to those with a supraglottic position. Although the term extraglottic may be broad and include airways such as tracheostomy tubes, the term supraglottic does not describe a large number of devices with subglottic components and is too narrow for a discussion of modern devices. EGAs have flourished in practice, and now a wide variety of devices are available for an ever-expanding array of applications. In this review we attempt to clarify the current state of EGA de...

Simulating face-to-face tracheal intubation of a trapped patient: a randomized comparison of the LMA Fastrach™, the GlideScope™, and the Airtraq™ laryngoscope

British Journal of Anaesthesia — Mon, 12 Dec 2011 05:00:00 +0100

Conclusions The Airtraq™ laryngoscope was superior to both the GlideScope™ and LMA Fastrach™ during simulated face-to-face difficult tracheal intubation. (Source: British Journal of Anaesthesia)

[Cricothyrotomy for airways management: Current data and interest for combat casualty care.]

Annales Francaises d'Anesthesie et de Reanimation — Tue, 06 Dec 2011 05:00:00 +0100

CONCLUSION: This review of literature and the analysis of commercial kits prompt us to suggest safe methods that can be performed on battlefield. Surgical methods and MiniTrach II kit™ (Portex) seem to be particularly suitable for battlefield situations. An airways management algorithm for combat casualty care is also proposed. PMID: 22154441 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Ballistic Injuries In The Emergency Department (Trauma CME)

Emergency Medicine Practice — Thu, 01 Dec 2011 08:13:52 +0100

This issue reviews the physics of ballistics as it relates to the tracts and patterns of tissue injury caused by different types of firearms and missiles, and it takes a regional approach to reviewing the current evidence for managing gunshot wounds to the head, neck, thorax, abdomen, genitourinary (GU) system, extremities, and soft tissues. Current guidelines as well as new research and evidence regarding fluid resuscitation, airway management, evaluation strategies, drug therapies, and documentation are discussed. (Source: Emergency Medicine Practice)

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The Neonate After Cardiac Surgery: What do You Need to Worry About in the Emergency Department?

Clinical Pediatric Emergency Medicine — Thu, 01 Dec 2011 05:00:00 +0100

This article focuses on common surgeries in neonates with congenital heart disease as well as postoperative complications that may be encountered in the emergency department. The recognition and management of hemodynamic, infectious, and intrathoracic derangements as well as common postoperative dysrhythmias will be discussed. Approaches to airway management, vascular access, and procedural sedation in this patient population will also be addressed. (Source: Clinical Pediatric Emergency Medicine)

A randomised controlled study comparing the effects of laryngeal mask airway and endotracheal tube on early postoperative pulmonary functions.

Singapore Medical Journal — Thu, 01 Dec 2011 05:00:00 +0100

Conclusion: The use of LMA instead of TT for airway management during peripheral limb surgeries causes less depression of pulmonary functions during the early postoperative period. The incidence of coughing is also significantly lower. PMID: 22159929 [PubMed - in process] (Source: Singapore Medical Journal)

[Awake fiberoptic intubation].

Der Anaesthesist — Thu, 01 Dec 2011 05:00:00 +0100

Authors: Gerheuser F, Gürtler K Abstract Airway management is a core task for anesthesiologists. Deficiencies in training or equipment as well as fateful complications in this field are responsible for a significant proportion of anesthesia-associated morbidity and mortality. Nowadays there are a variety of advanced technical aids on the market to overcome the difficult airway. Nevertheless, the "cannot intubate cannot ventilate scenario" still occurs and regularly results in poor outcome, such as permanent neurological deficits or even death. Therefore, awake fiberoptic intubation remains the gold standard in the expected difficult airway because when applied correctly this technique never leads to a point where a patient's respiration is compromised as a result of medical measur...

Ketamine in adult emergency medicine: controversies and recent advances.

The Annals of Pharmacotherapy — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSIONS: Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides sufficient confidence to consider use of this agent in the ED. PMID: 22147144 [PubMed - in process] (Source: The Annals of Pharmacotherapy)

Surgical management of distal tracheal stenosis in children

The Laryngoscope — Fri, 25 Nov 2011 08:40:15 +0100

Conclusions:Improvements in operative techniques and perioperative management have led to significant decreases in morbidity and mortality. At our institution, slide tracheoplasty has become the preferred technique for all except very short segment stenosis, and cardiopulmonary bypass is used in all cases involving the distal trachea. Laryngoscope, 121:2665–2671, 2011 (Source: The Laryngoscope)

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Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy

Journal of Anesthesia — Thu, 24 Nov 2011 17:50:37 +0100

We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia...

Early detection of deteriorating ventilation by monitoring bilateral chest wall dynamics in the rabbit

Intensive Care Medicine — Tue, 22 Nov 2011 06:55:25 +0100

Conclusions Monitoring the local TDi is a sensitive method for detecting changes in tidal volume and enables early detection of developing asymmetric ventilation. Content Type Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-011-2398-7Authors Dan Waisman, Department of Neonatology, Carmel Medical Center, and Faculty of Medicine, Technion – Israel Institute of Technology, 7 Michal St, 34362 Haifa, IsraelAnna Faingersh, Faculty of Biomedical Engineering, Technion – Israel Institute of Technology, Haifa, IsraelCarmit Levy, Faculty of Biomedical Engineering, Technion – Israel Institute of Technology, Haifa, IsraelEugene Konyukhov, Faculty of Biomedical Engineering, Technion – Israel Institute of Technology, Haifa, IsraelFatmi Ifat Colman Klotzman, ...

Calendar

Annals of Emergency Medicine — Sat, 19 Nov 2011 07:39:15 +0100

Practical Emergency Airway Management Course. December 1-2, 2011. Baltimore, MD. Sponsor: Jefferson Med Colg. Fee: $1,495.00. Contact: Vaughn Wurst, 1020 Locust Street #M%, Philadelphia, PA, 19107. Email: vaughn.wurst@jefferson.edu 215-955-6992. (15.75) (Source: Annals of Emergency Medicine)

In silico modelling of physiologic systems

Best Practice and Research. Clinical Anaesthesiology — Sat, 19 Nov 2011 00:52:00 +0100

We present a review illustrating by example how in silico modelling has been applied to a number of cardio-respiratory problems in states of health and disease, the purpose of which is to give the reader a sense of the complexity and assumptions which underlie this diverse and underappreciated research strategy, as well as an introduction to a research strategy that will likely continue to grow in importance. (Source: Best Practice and Research. Clinical Anaesthesiology)

[Emergency anesthesia, airway management and ventilation in major trauma : Background and key messages of the interdisciplinary S3 guidelines for major trauma patients.]

Der Anaesthesist — Fri, 18 Nov 2011 05:00:00 +0100

[Emergency anesthesia, airway management and ventilation in major trauma : Background and key messages of the interdisciplinary S3 guidelines for major trauma patients.] Anaesthesist. 2011 Nov 18; Authors: Bernhard M, Matthes G, Kanz KG, Waydhas C, Fischbacher M, Fischer M, Böttiger BW Abstract Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate < 6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2) < 90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS) < 9], trauma-associated hemodynamic instability [systolic blood pressure (SBP) < 90 mmHg] and se...

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Developing expert opinion in airway management

Anaesthesia — Sun, 13 Nov 2011 00:50:42 +0100

(Source: Anaesthesia)

Tracheal Intubation Through the I-gelTM Supraglottic Airway Versus the LMA FastrachTM: A Randomized Controlled Trial.

Anesthesia and Analgesia — Thu, 10 Nov 2011 05:00:00 +0100

Conclusions:On first attempts, successful blind tracheal intubation was obtained at comparable rates using the i-gel and the LMA Fastrach. However, when the first attempt was unsuccessful, subsequent attempts through the i-gel did not significantly increase tracheal intubation success rate. The LMA Fastrach yielded a higher overall intubation success rate. PMID: 22075016 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

Cervical spine radiology

Anaesthesia and intensive care medicine — Tue, 01 Nov 2011 04:00:00 +0100

Abstract: The lateral cervical spine radiograph is frequently utilized in the assessment of trauma patients and in perioperative care. Used in conjunction with a thorough clinical assessment it can demonstrate an unstable spine, be it due to trauma or rheumatological disease thus alerting the anaesthetist of the need for advanced precautions in airway management. In this article we review a systematic approach to the lateral cervical spine radiograph focussing on unstable cervical spines. (Source: Anaesthesia and intensive care medicine)

The Pentax-AWS video laryngoscope for emergency airway management

The American Journal of Emergency Medicine — Tue, 01 Nov 2011 04:00:00 +0100

We describe our experience on acutely ill, unprepared ICU patients requiring immediate orotracheal intubation. An 11-month prospective observational study (May 2010 to April 2011) was conducted in the ICU of “GB Morgagni-Pierantoni” Hospital, Forlì, using the AWS. We used the AWS as a rescue technique after failed DL (Cormack-Lehane grade 3 or 4) or as the first-line method in patients with known or suspected difficulty. All patients received initial bag-mask ventilation. Optimal positioning and noninvasive maneuvers such as the BURP were applied as needed. Information was recorded by the operators on a datasheet at a convenient time, after patient stabilization, in the same work suite. Data collected include identification of the operator, patient demographics, success or failure to ...

Prompt restoration of airway along with rapid neurological recovery following ultrasonography-guided needle aspiration of a tubercular retropharyngeal abscess causing airway obstruction.

Singapore Medical Journal — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Borgohain B Abstract Upper respiratory obstruction in cervical spine tuberculosis rarely occurs due to retropharyngeal cold abscess or secondarily from its rupture. Options for securing the airway are intubation, tracheostomy and needle aspiration or surgical drainage. A young boy presented with neck pain, quadriparesis and stridor, suggesting subacute airway obstruction in advanced tubercular spondylodiscitis of cervical spine C3-C4 (cervical 3rd and 4th level) with extradural compressive myelopathy (C3-C5) and a large retropharyngeal cold abscess. An urgent ultrasonography-guided needle aspiration with a head low position through the left posterior triangle was performed with adequate precautions and back-up for advanced airway management. Needle aspiration yielded 200 m...

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Airway management in the patient with potential cervical spine instability: Continuing Professional Development.

Canadian Journal of Anaesthesia — Thu, 27 Oct 2011 04:00:00 +0100

CONCLUSION: Adequate airway management in the patient with potential C-spine injury demands an understanding of C-spine anatomy, the criteria required to clear the C-spine, and the indications, techniques, and pitfalls of C-spine immobilization. When choosing an airway technique, minimization of C-spine motion should be considered, but the method of choice should also incorporate the broader clinical context. PMID: 22033859 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Laypersons can successfully place supraglottic airways with 3 minutes of training. A comparison of four different devices in the manikin.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Mon, 24 Oct 2011 04:00:00 +0100

IntroductionSupraglottic airway devices have frequently been shown to facilitate airway management and are implemented in the ILCOR resuscitation algorithm. Limited data exists concerning laypersons without any medical or paramedical background. We hypothesized that even laymen would be able to operate supraglottic airway devices after a brief training session. Methods: Four different supraglottic airway devices: Laryngeal Mask Classic (LMA), Laryngeal Tube (LT), Intubating Laryngeal Mask (FT) and CobraPLA (Cobra) were tested in 141 volunteers recruited in a technical university cafeteria and in a shopping mall. All volunteers received a brief standardised training session. Primary endpoint was the time required to definitive insertion. In a short questionnaire applicants were asked to ass...

King Systems Launches KingVISION Video Laryngoscope

Medgadget Anesthesiology — Tue, 18 Oct 2011 19:26:40 +0100

Indiana-based King Systems, a manufacturer of airway management, anesthesia, and respiratory medical supplies and devices, has introduced their KingVISION video laryngoscope system at the American Society of Anesthesiologists annual meeting, currently convening in Chicago. The laryngoscope consists of a reusable lightweight, modular, 2.4″ non-glare, scratch-resistant QVGA color OLED display powered by standard AAA batteries mated to disposable, rigid polycarbonate/ABS standard or channeled MAC 3 blades with self-contained VGA CMOS camera optics and a white LED light source. The standard blade fits in mouth openings as small as 13mm while the channeled blade (used to facilitate advancement of an endotracheal tube through the glottis) fits mouth openings as small as 18mm, which sho...

Developing the skill of endotracheal intubation: implication for emergency medicine

Acta Anaesthesiologica Scandinavica — Fri, 14 Oct 2011 23:49:48 +0100

ConclusionThe increasing rate of relative ETI success and the decreasing rate of necessary attempts for successful airway management suggest a steadily increasing gain in ETI experience. The complications that developed during the first 200 ETI procedures justify supervision by a specialist in the field or a senior physician. Moreover, these results may influence the minimum requirement for qualification in anaesthesiology and emergency medicine. (Source: Acta Anaesthesiologica Scandinavica)

A5 Characteristics of ambulance category B calls

Emergency Medicine Journal — Fri, 14 Oct 2011 04:00:00 +0100

Conclusions Category B calls comprise a population of patients without time dependant conditions and response time is therefore a poor indicator of the quality of care for this patient group. (Source: Emergency Medicine Journal)

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The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Thu, 13 Oct 2011 04:00:00 +0100

Conclusion: A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

Percutaneous Dilational Tracheotomy for Airway Management in a Newborn With Pierre-Robin Syndrome and a Glossopharyngeal Web.

Respiratory Care — Thu, 13 Oct 2011 04:00:00 +0100

We present the use of percutaneous dilational tracheotomy (PDT) for airway management of a newborn with PRS and a glossopharyngeal web. A 2-day- old term newborn with PRS and severe obstructive dyspnea was evaluated by the anesthesiology team for airway management. A direct laryngoscopy revealed a glossopharyngeal web extending from base of the tongue to the posterior pharyngeal wall. The baby was spontaneously breathing through a 2 mm diameter fistula in the center of this web. It was decided that endotracheal intubation is impossible and a PDT was planned. The trachea of the newborn was cannulated, using a 20 gauge peripheral venous catheter and a 0.028 inch guide wire was introduced through this catheter. Using 5 F, 7 F, 9 F, and 11 F central venous catheter kit dilators, staged tracheo...

SLIPA™ may be more useful than other LMADs for difficult airway management.

Canadian Journal of Anaesthesia — Thu, 13 Oct 2011 04:00:00 +0100

Authors: Lim BG, Kim KJ, Kong MH, Kim NS, Lim SH, Lee MK, Lee IO PMID: 21994006 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Severe post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique

Journal of Anesthesia — Mon, 10 Oct 2011 15:06:38 +0100

In conclusion, it can be emphasized that the application of tumescent anesthesia is an important anesthetic tool in patients with predicted difficult airway management. Content Type Journal ArticleCategory Clinical ReportPages 1-3DOI 10.1007/s00540-011-1246-9Authors Mukesh Kumar Prasad, Department of Anaesthesiology, Government Medical College, Rampur Road, Haldwani, Nainital, 263139 Uttrakhand, IndiaPulak Puneet, Department of Anaesthesiology, Government Medical College, Rampur Road, Haldwani, Nainital, 263139 Uttrakhand, IndiaKanchan Rani, Department of Obstetrics and Gynaecology, Government Medical College, Rampur Road, Haldwani, Nainital, 263139 Uttrakhand, IndiaDivya Shree, Department of Radiodiagnosis, Government Medical College, Rampur Road, Haldwani, Nainital, 263139 Uttrak...

Feasibility of written instructions in airway management training of laryngeal tube

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: We found that in this pilot study majority of emergency care providers could insert LT with one or two attempts with written instructions, pictures and verbal instruction. This may provide an option to simplify the training of airway management with LT. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

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Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest

Critical Care — Mon, 10 Oct 2011 04:00:00 +0100

Conclusions: There was no difference in neurological favorable outcome from witnessed OHCA for ETI versus SGA. Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes. (Source: Critical Care)

Airway Management in Cardiac Arrest

Emergency Medicine Clinics of North America — Mon, 10 Oct 2011 04:00:00 +0100

This article reviews the current state of the literature regarding airway management of the patient in cardiac arrest. Ventilatory management strategies are also discussed. (Source: Emergency Medicine Clinics of North America)

Anesthetic management of congenital tracheoesophageal fistula.

Paediatric Anaesthesia — Sun, 09 Oct 2011 19:19:08 +0100

This article reviews (a) risk factors and preoperative considerations of the patient with tracheoesophageal fistula, (b) anesthetic management, including (i) airway management, (ii) induction of anesthesia and monitoring and (iii) postoperative disposition, (c) considerations for concomitant congenital heart disease, (d) considerations for thoracoscopic repair and (e) long-term outcomes and considerations of the patient with repaired esophageal atresia/tracheoesophageal fistula. PMID: 20723095 [PubMed - in process] (Source: Paediatric Anaesthesia)

Cardiopulmonary Resuscitation Update

Emergency Medicine Clinics of North America — Mon, 03 Oct 2011 04:00:00 +0100

Cardiopulmonary resuscitation (CPR) is vital therapy in cardiac arrest care by lay and trained rescuers. Chest compressions are the key component of CPR. Ventilation and airway management should be secondary to high-quality and continuous chest compressions in patients receiving CPR. Only after the patient has had return of spontaneous circulation or completed a cycle of CPR with defibrillation (if appropriate) should attempts at securing an advanced airway be made. Even then, interruptions of chest compressions should be minimized to maintain cardiocerebral perfusion and increase survival. Finally, the ventilation rate should be no more than 8 to 10 breaths per minute. (Source: Emergency Medicine Clinics of North America)

Author Tony Garcia, BS, BSN, RN/EMT-P, responds

JEMS: Journal of Emergency Medical Services — Sat, 01 Oct 2011 04:00:00 +0100

I appreciate a healthy debate; it keeps the mind sharp. Although here, I'm not sure Dr. Cummins and I are that far apart. I tried to maintain a certain degree of neutrality while writing the article since I've witnessed the good, bad, and the ugly of ETI, both in the field and in the hospital. However, I'm a firm believer that the “art” of airway management has been lost to an over-emphasis in ETI. (Source: JEMS: Journal of Emergency Medical Services)

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Avoiding Pitfalls: How to handle prehospital airway management challenges

JEMS: Journal of Emergency Medical Services — Sat, 01 Oct 2011 04:00:00 +0100

Author's note: This hypothetical case is abstracted from current literature on pitfalls in airway management and is not an actual patient care case. A 52-year-old male suffers a sudden cardiac arrest in a public venue. Bystanders initiate CPR. A BLS crew from the first-arriving ambulance continues CPR and applies an automated external defibrillator (AED) and defibrillates the patient once prior to arrival of an ALS ambulance. CPR is continued, and the patient is determined to be in ventricular fibrillation (v fib) after reviewing the rhythm on the ALS unit's monitor. (Source: JEMS: Journal of Emergency Medical Services)

Evolving role of video laryngoscopy for airway management in the emergency department

Emergency Medicine Australasia — Sat, 01 Oct 2011 04:00:00 +0100

(Source: Emergency Medicine Australasia)

New device for application of video endoscope laryngeal (vel) 70° at oral and maxillofacial surgery

International Journal of Oral and Maxillofacial Surgery — Sat, 01 Oct 2011 04:00:00 +0100

The result of all cases was; improved mandibular function, adequate facial contour, improvement of the upper airway and a decrease of the surgical time. Airway management to perform surgical procedures in the oral and maxillofacial surgery specialty becomes difficult in different situations. The reason may be diverse pathologies or conditions of the patient impedimenting the appropriate mouth opening. It becomes a challenge for the anesthesiologist to guaranty the airway. Therefore, in the last years, many devices have been design to help the intubation in difficult circumstances. Recently, in 2002, the Venezuelan doctor, Douglas Cedeño, design a video endoscope method labeled VEL 70°, wich improves the field of vision. The present literature revision has as objective to analyze the use...

Campomelic dysplasia: airway management in two patients and an update on clinical-molecular correlations in the head and neck.

The Annals of Otology, Rhinology, and Laryngology — Sat, 01 Oct 2011 04:00:00 +0100

We describe our approach to managing the airway in these patients, and review recent advances in understanding how SOX9 mutations lead to the spectrum of abnormalities seen in the head and neck. PMID: 22097155 [PubMed - in process] (Source: The Annals of Otology, Rhinology, and Laryngology)

Impact of resuscitation system errors on survival from in-hospital cardiac arrest

Resuscitation — Wed, 28 Sep 2011 04:00:00 +0100

Conclusions: The presence of resuscitation system errors that are evident from review of the resuscitation record is associated with decreased survival from IHCA in adults. Hospitals should target the training of first responders and code team personnel to emphasize the importance of early defibrillation, early use of vasoconstrictor medication, and compliance with ACLS protocols. (Source: Resuscitation)

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Rapid sequence induction with rocuronium - a challenge to the gold standard

Critical Care — Fri, 23 Sep 2011 04:00:00 +0100

Succinylcholine has been indicted on account of the diverse risks associated with its administration, which include hyperkalaemia, vagal arrest and malignant hyperthermia. However, it reliably provides excellent intubating conditions quickly, a characteristic that sustains its appeal for use in intensive care, where airway management is challenging. There is an increasing body of evidence, outlined herein, that rocuronium is an acceptable alternative to succinylcholine (Source: Critical Care)

A Phased Approach to Cardiac Arrest Resuscitation Involving Ventricular Fibrillation and Pulseless Ventricular Tachycardia

Emergency Medicine Clinics of North America — Thu, 22 Sep 2011 04:00:00 +0100

With the release of the 2010 American Heart Association (AHA) Guidelines for cardiopulmonary resuscitation and emergency cardiac care, evidence regarding management of out-of-hospital cardiac arrest suggests a more fundamental approach. To aid in understanding and learning, this article proposes a method that optimizes the timing and delivery of evidence-proven therapies with a 3-phase approach for out-of-hospital resuscitation from ventricular fibrillation and pulseless ventricular tachycardia. Although this model is not a new concept, it is largely based on the 2010 AHA Guidelines, enhancing the philosophy of the “CAB” concept (Chest compressions/Airway management/Breathing rescue). (Source: Emergency Medicine Clinics of North America)

Preparing fellows to learn: an advanced paediatric airway management workshop

Medical Education — Tue, 20 Sep 2011 04:00:00 +0100

(Source: Medical Education)

Short answer question case series: treatment of persistent, refractory seizures

Emergency Medicine Journal — Wed, 14 Sep 2011 04:00:00 +0100

Discussion 1. The first priority is to ensure cardiopulmonary stability. She should be given supplemental oxygen, a thorough airway evaluation, and airway management as needed. Immediate vascular access must be obtained and blood glucose checked. Hypoglycaemia is a common treatable cause of seizures and altered mental status. Further, fluids... (Source: Emergency Medicine Journal)

A Randomized Crossover Study to Determine the Effect of a 30{degrees} Head-Up Versus a Supine Position on the Functional Residual Capacity of Term Parturients.

Anesthesia and Analgesia — Wed, 14 Sep 2011 04:00:00 +0100

Conclusions:We have demonstrated that the FRC of healthy term parturients increases significantly in the 30° head-up position in comparison with supine. PMID: 21918160 [PubMed - as supplied by publisher] (Source: Anesthesia and Analgesia)

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Massive macroglossia after palatoplasty

European Journal of Pediatrics — Tue, 13 Sep 2011 05:57:23 +0100

Conclusion: Macroglossia can occur even 3–5 days after surgery and can be maintained by the pressure of the endotracheal tube to the tongue ground. Knowledge and avoidance of these risk factors are as important as early treatment of respiratory compromise. Content Type Journal ArticleCategory Original PaperPages 1-5DOI 10.1007/s00431-011-1567-6Authors Shino Junghaenel, Department of Neonatology and Paediatric Intensive Care, University Hospital of Cologne, Children’s Hospital, Kerpener Str. 62, 50937 Cologne, GermanyTitus Keller, Department of Neonatology and Paediatric Intensive Care, University Hospital of Cologne, Children’s Hospital, Kerpener Str. 62, 50937 Cologne, GermanyRobert Mischkowski, Department of Craniomaxillofacial and Plastic Surgery, University Hospital ...

Comparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study

Journal of Anesthesia — Thu, 08 Sep 2011 06:06:03 +0100

Conclusion The AWS was superior to McL and ATQ for endotracheal intubation during simulated cervical stabilization and chest compression. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00540-011-1218-0Authors Nobuyasu Komasawa, Department of Anesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, JapanRyusuke Ueki, Department of Anesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, JapanHanako Kohama, Division of Intensive Care Unit, Hyogo College of Medicine, Nishinomiya, JapanShin-ichi Nishi, Division of Intensive Care Unit, Hyogo College of Medicine, Nishinomiya, JapanYoshiroh Kaminoh, Department of Surgical Centre, Hyogo College of Medicine, Nishinomiya, Japan Jo...

Complex procedural skills are retained for a minimum of 1 yr after a single high-fidelity simulation training session

British Journal of Anaesthesia — Thu, 08 Sep 2011 04:00:00 +0100

Conclusions After a single simulation training session, improvements in cricothyroidotomy skills are retained for at least 1 yr. These findings suggest that high-fidelity simulation training, along with practice and feedback, can be used to maintain complex procedural skills for at least 1 yr. (Source: British Journal of Anaesthesia)

Ultrasonography in the management of the airway

Acta Anaesthesiologica Scandinavica — Wed, 07 Sep 2011 04:00:00 +0100

In this study, it is described how to use ultrasonography (US) for real‐time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway – it is safe, quick, repeatable, portable, widely available, and it must be used dynamically for maximum benefit in airway management, in direct conjunction with the airway management, i.e. immediately before, during, and after airway interventions. US can be used for direct observation of whether the tube enters the trachea or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circ...

ORL emergencies boot camp: Using simulation to onboard residents

The Laryngoscope — Mon, 05 Sep 2011 23:00:00 +0100

Conclusions:An intensive, simulation‐based Boot Camp addressing airway, bleeding, and other otolaryngology emergencies was successful in improving junior otolaryngology residents' confidence and was perceived as useful in developing knowledge, technical skills, self‐confidence, and improving clinical performance. (Source: The Laryngoscope)

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Continuous capnography and ultrasound-based airway management

Resuscitation — Fri, 02 Sep 2011 04:00:00 +0100

We reported that capnography is the most reliable method to confirm tracheal tube placement in prehospital emergencies, with 100% sensitivity and specificity in arrest and non-arrest patients. In our opinion, end-tidal carbon dioxide levels should be monitored during CPR because they are of prognostic value for determining the outcome of resuscitative efforts and when to cease CPR in the field. In our recent pilot study, we showed that the combination of capnography and focused echocardiography (FE) with modified treatment improved survival in pulseless electrical activity (PEA) out-of-hospital cardiac arrest (OHCA). Preliminary results in our prospective study confirm that the combination of ultrasound examination and continuous capnography can improve identification of oesophageal and en...

Prospective randomized comparison of the EasyTube and the esophageal-tracheal Combitube airway devices during general anesthesia with mechanical ventilation

Journal of Clinical Anesthesia — Thu, 01 Sep 2011 04:00:00 +0100

Conclusion: The EzT has distinct advantages over the ETC in airway management, including shorter time to achieve an effective airway and easier insertion. (Source: Journal of Clinical Anesthesia)

[Invasive airway management update 2011].

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Humpich M, Byhahn C Abstract Invasive airway management techniques are still challenging even for skilled anesthesiologists, intensivists and emergency physicians. All current percutaneous tracheostomy techniques are based on Seldinger's principle. Using the recent introduced Blue Dolphin Kit is feasible and safe, but without clear advantage compared to other kits. There is no data available to generally support performing early (<8 days) tracheostomy in intensive care patients requiring mechanical ventilation. Experimental data show promising results of supporting expiration through a small bore catheter using ejectors based on Bernoulli's principle in terms of minimizing risk of barotrauma during emergency transtracheal high frequency jet ventilation. PMID: 218945...

[Supraglottic airway devices].

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Bein B, Francksen H, Steinfath M Abstract Supraglottic airway devices are developed with increasing frequency following the overwhelming success of the laryngeal mask airway (LMA). In contrast to the first generation devices such as the 'classic' LMA and the laryngeal tube second generation devices usually offer an oesophageal drainage tube and/or an improved oropharyngeal leak pressure during positive pressure ventilation such as the laryngeal mask ProSeal and the laryngeal tube S. Recently the disposable versions of these supraglottic airway devices and the novel I-Gel mask have gained increasing interest. Both the LMA and the PLMA have been shown to be perfectly suitable for routine anaesthesia and emergency airway management. While the lacking protection against aspira...

[Airwaymanagement - Video-assisted airway management].

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Cavus E, Bein B, Dörges V Abstract Endotracheal intubation remains the "goldstandard" in airway management. If with use of conventional techniques intubation of the patient fails, or if an anticipated difficult airway is present, video-assisted techniques may help to increase intubation success. Video-assisted techniques give the possibility to indirectly visualise the laryngeal structures with fibreoptical or camerachip-technique, and to display the videopicture on an external or integrated monitor. For the anticipated difficult airway, awake flexible fibreoptical intubation still is the first choice. However, if Oxygenation and Ventilation can be established with bag-mask ventilation or supraglottic airways, the use of an endoscopic optical stylet or a videolaryngoscope...

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Magnesium sulfate as an adjunct therapy in the management of severe generalized tetanus in a dog

Journal of Veterinary Emergency and Critical Care — Thu, 01 Sep 2011 04:00:00 +0100

AbstractObjectiveTo describe the use of magnesium sulfate in a case of generalized tetanus in a dog.Case SummaryA 1.5‐year‐old golden retriever was presented for a digital wound on the right thoracic limb and clinical signs associated with generalized tetanus. Initial case management consisted of wound debridement, treatment with metronidazole, tetanus immunoglobulin, methocarbamol, airway management via tracheostomy, and nursing care. Sedation to control severe muscle spasms became insufficient despite increasing doses of benzodiazepine, methocarbamol, and barbiturate continuous rate infusions. A magnesium sulfate continuous rate infusion was instituted on day 7 and muscle rigidity improved within 16 hours allowing discontinuation of sedative infusions over the subsequent 2 days. Clin...

Analysis of HEMS Individual Endotracheal Intubation Attempt

Air Medical Journal — Thu, 01 Sep 2011 04:00:00 +0100

Introduction: Helicopter EMS (HEMS) airway management literature consistently reports the overall success rate of endotracheal intubation to be in the high 90% range; however, few studies describe the individual endotracheal intubation attempts. The purpose of this retrospective study was to investigate the effect of patient, provider, and transport variables on the success rate of the individual endotracheal intubation attempt. (Source: Air Medical Journal)

F272 airway management and epidural block in pediatric anesthesia

European Journal of Pain Supplements — Thu, 01 Sep 2011 04:00:00 +0100

(Source: European Journal of Pain Supplements)

Emergency and intensive care: assessing and managing the airway.

British Journal of Nursing — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Higginson R, Jones B, Davies K Abstract Airway assessment and management skills are vital in an emergency department (ED) as they are the most sensitive indicator of patient deterioration. Problems as common as head injury or alcohol intoxication are associated with an inadequate airway or diminished respiratory function and can cause a patient's condition to decline rapidly. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management. The key is a thorough assessment to determine whether the airway is patent or not. This paper will discuss the importance and practicalities of airway management and...

Pierre Robin sequence: An institutional experience in the multidisciplinary management of airway, feeding and serous otitis media challenges

International Journal of Pediatric Otorhinolaryngology — Sat, 27 Aug 2011 16:00:43 +0100

Conclusion: Airway management in the majority of PRS can be successfully achieved by conservative methods. Even in the presence of an adequate airway, many patients will require supplemental feeding. Early audiological assessment is necessary as many patients will need tympanostomy tube placement to ensure adequate speech and language development. (Source: International Journal of Pediatric Otorhinolaryngology)

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Airway management in adult patients with epidermolysis bullosa dystrophica: a case series

Anaesthesia — Fri, 12 Aug 2011 14:42:41 +0100

(Source: Anaesthesia)

The Supreme Laryngeal Mask Airway™ (LMA): A new neonatal supraglottic device: Comparison with Classic and ProSeal LMA in a manikin

Resuscitation — Fri, 12 Aug 2011 04:00:00 +0100

Abstract: Aim: The study aims to compare the performances (ease of insertion, time to establish effective ventilation and maximal inflation pressure) of classic™ (cLMA), ProSeal™ (PLMA) and Supreme™ (SLMA) Laryngeal Mask Airway when used in a neonatal airway management manikin by inexperienced delivery room trainees. The quality of the three devices, as perceived by participants, was also evaluated.Methods: Health-care professional trainees were given a brief supervised training with the three devices. Every trainee was then observed positioning each of the three different LMAs in a single occasion. Success rate, time (IT) and maximal inflation pressure (PImax) were recorded by a single unblinded observer. A 4-point scale was used to rate participants’ perceived quality.Results: A ...

Percutaneous Dilatational Tracheostomy: Review of Technique and Evidence for Its Use

Journal of Oral and Maxillofacial Surgery — Mon, 08 Aug 2011 04:00:00 +0100

Tracheostomy is a technique for airway management commonly used by surgeons who care for critically ill patients. Patients with traumatic facial injuries, severe odontogenic infections, and head and neck malignancies are often recipients of tracheostomies. As such, the oral and maxillofacial surgeon who frequently treats such patients should be well-trained in tracheostomy placement. For decades, the standard technique for tracheostomy was the open surgical technique. However, during the past 20 years, the use of percutaneous dilatational tracheostomy has increased. The purpose of the present report is to review the percutaneous dilatational tracheostomy technique, describe the use of intensive care units as proxies for the operating room, and review the available evidence comparing percut...

Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase

Endoscopy — Mon, 01 Aug 2011 23:00:00 +0100

Conclusion: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Endoscopy)

Introduction to Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010

Emergency Medicine Australasia — Sun, 31 Jul 2011 23:00:00 +0100

• Introduction to Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010• Planning for Neonatal Resuscitation and Identification of the Newborn Infant at Risk. ARC and NZRC Guideline 2010• Assessment of the Newborn Infant. ARC and NZRC Guideline 2010• Airway Management and Mask Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010• Tracheal Intubation and Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010• Chest Compressions during Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010• Medication or Fluids for the Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010• The Resuscitation of the Newborn Infant in Special Circumstances. ARC and NZRC Guideline 2010• After the Resuscitation of a Newborn Infa...

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Airway Management and Mask Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010

Emergency Medicine Australasia — Sun, 31 Jul 2011 23:00:00 +0100

(Source: Emergency Medicine Australasia)

Emergency Airway Management in Japan: Interim Analysis of a Multi-center Prospective Observational Study

The Journal of Emergency Medicine — Sun, 31 Jul 2011 23:00:00 +0100

Emergency medicine is increasingly recognized as a medical specialty in Japan, however, comprehensive studies evaluating current ED airway management are lacking. We sought to characterize ED airway management in Japan using a large multi-center registry. (Source: The Journal of Emergency Medicine)

Trauma Resuscitation Errors and Computer-assisted Decision Support: Fitzgerald M, Cameron P, Mackenzie C, et al. Arch Surg 2011;146:218–25.

The Journal of Emergency Medicine — Sun, 31 Jul 2011 23:00:00 +0100

This prospective, randomized, controlled interventional study evaluated the effect of real-time, computer-prompted, evidence-based decision and action algorithms on error occurrence during initial resuscitation of trauma patients between January 24, 2006 and February 25, 2008 at a level I adult trauma center in Melbourne, Australia. There, four trauma resuscitation bays were equipped with identical resuscitation equipment, layout, and trauma teams. Two of the trauma rooms (the study arm) were equipped with computerized equipment that provided aid in decisions and management. The other two rooms (control arm) had similar monitors, but did not provide the algorithmic aid in decision-making. Thirty-three experienced emergency, anesthesiology, surgical, and critical care medical and nursing st...

Anaesthesia for facial trauma

Anaesthesia and intensive care medicine — Sat, 30 Jul 2011 14:50:47 +0100

This article considers the causes of facial trauma and the differing patterns of injury seen. The relative strengths of the facial bones and Le Fort fractures lines are described. The important airway and other management issues for the initial acute phase and the later second-stage management for surgical treatment of facial fractures are discussed. The concern regarding actual and potential cerebrospinal fluid leak from Le Fort 2- and 3-level fractures is reviewed, and different strategies for airway management put forward. Specific difficulties with endotracheal intubation of patients with facial trauma are examined. The maintenance of anaesthesia and extubation problems are then discussed. (Source: Anaesthesia and intensive care medicine)

Fibreoptic intubation

Anaesthesia and intensive care medicine — Sat, 30 Jul 2011 14:50:46 +0100

This article describes the variety of methods available for awake and asleep fibreoptic intubation, as well as techniques for anesthetizing the airway. (Source: Anaesthesia and intensive care medicine)

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Nurse Anesthesia Pocket Guide

AORN Journal — Fri, 29 Jul 2011 16:03:24 +0100

This pocket handbook is intended primarily for certified RN anesthetist (CRNA) students and practicing CRNAs; however, the user-friendly format, which includes water-resistant, tear-proof pages with sections divided by tabs; helpful tables and figures; and concise presentation of relevant information, makes this book a useful resource for any nurse interested in anesthetic agents, complications associated with anesthesia, and specialty patient populations that require anesthesia. The handbook is divided into 11 sections, including anesthesia information, airway management, IV fluids and blood components, pharmacology, anesthesia for specific patient populations (eg, obstetric and pediatric anesthesia), and types of anesthesia (eg, local, spinal, and epidural; peripheral nerve blocks; cardi...

Nursing use of laryngeal masks in cardiopulmonary resuscitation: an integrative literature review

Texto e Contexto - Enfermagem — Wed, 27 Jul 2011 10:07:20 +0100

This study aimed to identify available evidence in literature about airway management by nurses through the insertion of the laryngeal mask during cardiopulmonary resuscitation in adult patients. In order to do so, the integrative literature review method was adopted, which aims to join and synthesize existing knowledge on the proposed theme. The following databases were accessed: LILACS, PUBMED, CINAHL and COCHRANE, using the controlled descriptors "laryngeal masks", "cardiopulmonary resuscitation", and "nursing". After exhaustive reading of the relevant articles, 18 references were selected. The results evidence that laryngeal masks are fundamentally important for airway management in critical situations and require training for their use. Laryngeal masks also proved themselves to be eff...

The laryngeal mask airway and otorhinolaryngology head and neck surgery

The Laryngoscope — Tue, 26 Jul 2011 18:31:40 +0100

Conclusions:The relationship between surgeon and anesthetist is particularly strong in otorhinolaryngology. The impact of airway management on the surgical field and perioperative conditions requires the surgeon to be aware of contemporary tools and techniques available. The LMA has been shown to be safe and efficacious by both the literature and clinical practice. Its use in selected patients should be encouraged. (Source: The Laryngoscope)

Invited Commentary

Journal of the American College of Surgeons — Mon, 25 Jul 2011 16:11:50 +0100

It is increasingly recognized that hospitals are unsafe. Approximately 1 in every 150 patients admitted to a hospital dies as a consequence of an adverse event. The use of checklists, routine in other industries to promote quality and safety, has been advocated as a means to improve quality and patient safety in health care. Within hospitals the use of checklists has been demonstrated to reduce medical error and reduce error-associated morbidity and mortality. Examples of the successful use of checklists in medicine include those implemented to reduce catheter-related blood stream infections, reduce ventilator-associated pneumonia, improve airway management during induction of anesthesia, and improve postmyocardial infarction care. (Source: Journal of the American College of Surgeons)

What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population?

Resuscitation — Mon, 25 Jul 2011 04:00:00 +0100

Conclusions: Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions. (Source: Resuscitation)

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Principles of Airway Management (4th edition)

Anaesthesia — Sun, 24 Jul 2011 23:00:00 +0100

(Source: Anaesthesia)

The C-MAC videolaryngoscope for prehospital emergency intubation

Emergency Medicine Journal — Sun, 24 Jul 2011 23:00:00 +0100

Tracheal intubation has long been regarded as the gold standard in airway management. Although this has been debated in the context of prehospital emergency airway management,1 there are undoubtedly a number of advantages to securing the airway with a cuffed tracheal tube. Subsequently, a number of different devices have evolved to assist with difficult airway management. Alternative airways to the tracheal tube that do not involve seeing the vocal cords directly (supraglottic airways) are becoming increasingly popular, and in situations where tracheal intubation is to be attempted, devices that assist in the visualisation of the vocal cords have been embraced with enthusiasm by many prehospital and hospital providers alike. In their article, Cavus and his colleagues discuss the results of...

Calendar

Annals of Emergency Medicine — Sat, 23 Jul 2011 16:42:11 +0100

Practical Emergency Airway Management Course. August 4-5, 2011. Baltimore, MD. Sponsor: Jefferson Med Colg. Fee: $1,495.00. Contact: Vaughn Wurst, 1020 Locust Street #M%, Philadelphia, PA, 19107. Email: vaughn.wurst@jefferson.edu. 215-955-6992. (15.75) (Source: Annals of Emergency Medicine)

Airway Management of Tetanus After the Haitian Earthquake: New Aspects of Old Observations.

Anesthesia and Analgesia — Wed, 20 Jul 2011 23:00:00 +0100

Authors: Firth PG, Solomon JB, Roberts LL, Gleeson TD Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. Severe masseter and intercostal muscle spasm impaired airway access and ventilation. Propofol and sevoflurane relieved the tetany, allowing airway control and ventilation without intubation or neuromuscular blocking drugs during wound debridement. Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limit...

Comparison of prehospital insertion success rates and time to insertion between standard endotracheal intubation and a supraglottic airway

Resuscitation — Fri, 15 Jul 2011 04:00:00 +0100

Conclusion: In this study, no differences in placement success rate or time to insertion were detected between the King LTS-D and ETI. (Source: Resuscitation)

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[Anesthesia and bariatric surgery.]

Der Anaesthesist — Thu, 14 Jul 2011 23:00:00 +0100

Authors: Konrad FM, Kramer KM, Schroeder TH, Stubbig K Today obesity is accepted as an independent disease. The WHO describes obesity as an epidemic disease occurring worldwide and associated comorbidities affect all organ systems. Bariatric operations lead to an improvement or even complete remission of obesity-correlated comorbidities. Bariatric operations are conducted as restrictive, malabsorptive, or mixed procedures. The preoperative anesthetic evaluation of comorbidities is carried out with a special focus on preexisting impairments of cardiac and lung function (e.g. cardiomyopathy, obstructive respiratory dysfunctions). Extremely obese patients are at risk of aspiration. Airway management at anesthesia induction includes normal intubation or, if additional risk factors are pres...

Comparison of the LMA SupremeTM with the LMA ProsealTM for airway management in patients anaesthetized in prone position

British Journal of Anaesthesia — Wed, 13 Jul 2011 23:00:00 +0100

Conclusions Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure. (Source: British Journal of Anaesthesia)

How Well Do Emergency Physicians Document Confirmation of Endotracheal Tube Placement?

American Journal of Medical Quality — Wed, 13 Jul 2011 23:00:00 +0100

This study indicates that educational interventions are warranted to improve physicians’ awareness of the importance of documenting correct tube placement. (Source: American Journal of Medical Quality)

Extubation of the Difficult Airway

Journal of Intensive Care Medicine — Wed, 13 Jul 2011 23:00:00 +0100

Managing the airway in the intensive care unit (ICU) is complicated by a wide array of physiologic factors. Difficult airway may be a consequence of patient’s anatomy or airway edema developed during the ICU stay and mechanical ventilation. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. In this article, we will provide a framework for identifying a difficult airway, criteria for safe extubation, as well as review the devices that are available for airway management in the ICU. Proficiency in identifying a potentially difficult airway and thorough familiarity with strategies and techniques of securing the airway are necessary for safe practice of critic...

Successful use of the I-gel supraglottic airway as a conduit for blind pre-hospital intubation during resuscitation

Resuscitation — Wed, 13 Jul 2011 04:00:00 +0100

We report on a medical emergency, which was handled at dusk in the forecourt of a neighbouring rehabilitation clinic. A 58-year-old male patient, who had undergone a triple CABG-operation 11 days before, collapsed and fell on his face. Primarily, he suffered from ventricular fibrillation. Despite problematic conditions for intubation (position of the patient, lighting conditions, and intraoral bleeding), an I-gel supraglottic airway (I-gel), size 4, was easily placed without having to cease thorax compression in the neutral position. Ventilation with adequate thoracic excursion was possible without any leakage of air. Following successful defibrillation, an endotracheal tube, size 7 (Rüsch Company, Kernen, Germany) was placed without difficulty to achieve complete and successful airway ma...

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King LT-D use by urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest

Resuscitation — Wed, 13 Jul 2011 04:00:00 +0100

Conclusion: In this analysis of OOHCA airway management, first attempt BLS King LT-D placement success exceeded that of first attempt paramedic ETI success. In addition, patients in the King LT-D group were more likely to have had an advanced airway attempted and to have had a successful advanced airway placed when multiple attempts were required. (Source: Resuscitation)

Hearing loss and airway problems in children with mucopolysaccharidoses.

Acta Otorrinolaringologica Espanola — Mon, 11 Jul 2011 23:00:00 +0100

CONCLUSIONS: Children with MPS are at increased risk for developing sensorineural hearing loss. The OSAHS syndrome appears in greater proportion than in the general child population, and recurrences may occur more frequently after surgery. Such children can also be risk patients in airway management. PMID: 21757178 [PubMed - as supplied by publisher] (Source: Acta Otorrinolaringologica Espanola)

Ludwig's Angina—A Controversial Surgical Emergency: How We Do It

Advances in Pharmacological Sciences — Wed, 06 Jul 2011 14:50:08 +0100

Conclusion. Recently, management of Ludwig's angina has evolved from aggressive airway management into a more conservative one. This is based on close airway observation on a specialised airway unit and a serial clinical airway assessment. Improved imaging modalities, antibiotic therapy, surgical skills, and clinical experience are the key factors behind this change in practice. (Source: Advances in Pharmacological Sciences)

Use of a tracheoscopic ventilation tube for endotracheal intubation in the difficult airway

Journal of Clinical Anesthesia — Sun, 03 Jul 2011 23:00:00 +0100

Abstract: Difficult endotracheal intubation is a clinical challenge for anesthesiologists and other practitioners of airway management. The use of a tracheoscopic ventilation tube, a novel airway device, for endotracheal intubation during general anesthesia in two patients with difficult airways after unsuccessful direct laryngoscopy is presented. (Source: Journal of Clinical Anesthesia)

Simulation and training of procedural sedation

Techniques in Gastrointestinal Endoscopy — Fri, 01 Jul 2011 04:00:00 +0100

Simulation offers a unique and possibly essential tool to train endoscopists in safe and successful gastrointestinal endoscopy using procedural sedation. In turn, it is becoming more common to integrate procedural trainers into full-scale environments to allow simulation of both technical and behavioral skills required to perform sedated procedures, as well as communication skills that are fundamental in effective and high-quality endoscopy teams. Generally speaking, simulation can be used to “animate the textbook” by creating simulated encounters around a myriad of sedation regimens to teach and reinforce safe practice through a deepened understanding of pharmacology and patient–drug interactions. In this chapter, we present our experience designing full-scale simulated endoscopy sc...

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Addressing Airway Issues: How to keep ETI a prehospital skill

JEMS: Journal of Emergency Medical Services — Thu, 30 Jun 2011 23:00:00 +0100

One theme that continues to re-emerge in the prehospital arena is the practice of airway management. Throughout the U.S., endotracheal intubation (ETI) has been universally accepted as the “gold standard” for definitive airway management. It has also been characterized as having as much influence on patient outcomes as defibrillation. However, various authors have suggested that the practice of out-of-hospital ETI is too risky considering the lack of evidence suggesting improved outcomes. There's no doubt that problems exist and solutions must be found, but eliminating the practice might be hailed as a knee-jerk reaction throughout the EMS community. (Source: JEMS: Journal of Emergency Medical Services)

[Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room].

Journal of Southern Medical University — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Li MM, Zhang QH, Liu YH, Yue L, Liu ZH, Hao JH To observe the anesthetic effect and safety of differential airway management in patients with mental retardation (MR) during autologous peripheral blood mononuclear cell transplantation (APBMCT) outside the operating room. PMID: 21764693 [PubMed - in process] (Source: Journal of Southern Medical University)

Tracheostomy in infants: parent education for home care.

Neonatal Network — Thu, 30 Jun 2011 23:00:00 +0100

This article is intended to help neonatal and pediatric nurses to effectively prepare the parents of an infant with a tracheostomy to provide safe, quality care to their child after being discharged from an acute care setting to their home. This article discusses the knowledge, attitudes, and skills the parents are required to acquire prior to the infant's discharge. Home ventilation, airway management, suctioning, tracheostomy care, emergency management, safe home environment, equipment for continuous or intermittent ventilation, and supplies necessary for care are some of the topics discussed. PMID: 21729854 [PubMed - in process] (Source: Neonatal Network)

Obstructive sleep apnoea and anaesthesia

Anaesthesia and intensive care medicine — Mon, 27 Jun 2011 16:26:01 +0100

Abstract: Obstructive sleep apnoea (OSA) is a common condition affecting approximately 4% of middle-aged individuals. The condition is more common in men with a history of snoring. Patients experience fragmented sleep caused by repetitive obstruction of the upper airway during sleep. There is mounting evidence that OSA is associated with metabolic syndrome. Metabolic syndrome comprises hypertension and type 2 diabetes, with associated disturbances of lipid metabolism and central obesity that predisposes to cardiovascular disease. Sleep disruption causes excessive daytime sleepiness and patients may be a danger to themselves or others, especially when driving. Anaesthetists meet the condition frequently, and should have a high index of suspicion when assessing overweight middle-aged patient...

Anatomy of the nose and pharynx

Anaesthesia and intensive care medicine — Mon, 27 Jun 2011 16:26:00 +0100

Abstract: Successful airway management requires an understanding of the upper and lower airway structures and functions. The nose and pharynx are important structures in the upper airway, providing: air quality control; protection of the lower airway; phonation and safe passage of food. (Source: Anaesthesia and intensive care medicine)

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The Difficult Airway Society ‘ADEPT’ Guidance on selecting airway devices: the basis of a strategy for equipment evaluation

Anaesthesia — Mon, 27 Jun 2011 16:23:54 +0100

We describe how widespread adoption of this professional standard can act as a driver to create an infrastructure in which the required evidence can be obtained. Essential elements are that: (i) the Difficult Airway Society facilitates a coherent national network of research‐active units; and (ii) individual anaesthetists in hospital trusts play a more active role in local purchasing decisions, applying the relevant evidence and communicating their purchasing decisions to the Difficult Airway Society. (Source: Anaesthesia)

Drug-Assisted Intubation in the Prehospital Setting

Annals of Emergency Medicine — Mon, 20 Jun 2011 17:19:13 +0100

[Ann Emerg Med. 2011;58:113-114.] The American College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), and the National Association of EMS Physicians (NAEMSP) recognize that expert prehospital airway management by trained, non-physician, EMS providers is of paramount importance in the treatment of critically ill and injured patients. Endotracheal intubation (ETI) may be difficult or impossible, especially if the patient is combative or has intact airway reflexes. The scope of prehospital care may include drug-assisted intubation (DAI) to facilitate ETI. (Source: Annals of Emergency Medicine)

Emergency airway management in a patient with a Montgomery T-tube in situ

British Journal of Anaesthesia — Thu, 16 Jun 2011 23:00:00 +0100

(Source: British Journal of Anaesthesia)

Role of Anesthesiology Curriculum in Improving Bag-mask Ventilation and Intubation Success Rates of Emergency Medicine Residents: A Prospective Descriptive Study

BMC Emergency Medicine — Wed, 15 Jun 2011 23:00:00 +0100

Conclusions: The success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.Key words: Education, Curriculum, Anesthesiology, Emergency Medicine (Source: BMC Emergency Medicine)

Reply to Letter: Is Airtraq® optical laryngoscope a high-efficiency device for emergent tracheal intubation during infant chest compression?

Resuscitation — Wed, 15 Jun 2011 23:00:00 +0100

First, we would like to thank Dr. Xue and colleagues for their interest in our recent manuscript. It is possible that preparation of the Airtraq® (ATQ; Prodol Meditec, Vizcaya, Spain) requires time to open the package, lubricate the tracheal tube and load the tube to the guiding channel. However, we would point out that preparation of the Miller laryngoscope (Mil) also requires preparation time to connect and check the blade and laryngoscope, lubricate the tracheal tube and insert the stylet. The European Resuscitation Council (ERC) cardiopulmonary resuscitation (CPR) guidelines emphasize delivery of continuous chest compression with as few interruptions as possible, including pauses for airway management efforts. Thus, the primary aim of our study design was to evaluate success rates for...

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Airway management in simulated restricted access to a patient - can manikin-based studies provide relevant data?

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Sun, 12 Jun 2011 23:00:00 +0100

Conclusions: The amount of time used to secure an airway with supraglottic devices was low for both scenarios, while classic ETI was time consuming and had a low success rate in the simulated restricted access condition. This study also demonstrates that there is a substantial training effect when simulating airway management with airway manikins. This effect must be considered when performing future studies. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

Congenital cystic mass of the tongue

Archives of Disease in Childhood - Fetal and Neonatal Edition — Sat, 11 Jun 2011 23:00:00 +0100

We present a rare case of a congenital lingual teratoma found antenatally by fetal ultrasound. A 25-year-old pregnant patient was seen at our Fetal Medicine Unit at 21 weeks' gestation with a fetal anomaly. A 19 mm mass was visible in the mouth of the fetus on ultrasound. The mass consisted of two distinct cystic components (figure 1) which occupied the entire oral cavity. No other abnormalities were seen. The patient was followed up with regular ultrasound scans. The fetus was seen to have sucking movement and absence of polyhydramnios suggested intact swallowing, but there was concern about airway obstruction after birth. A female infant was delivered at 38 weeks by elective caesarean section with normal Apgar scores. An ENT surgeon was present for emergency airway management but this wa...

Impact of the use of an automated chest-compression device on airway management during out-of-hospital cardiopulmonary resuscitation: The PLAINT study

Resuscitation — Fri, 10 Jun 2011 04:00:00 +0100

Conclusion: Due to the major role of compression during CPR, we suggest that the ACCD should not be systematically switched off for routine intubation. (Source: Resuscitation)

Laser surgical management of bilateral vocal fold immobility

Operative Techniques in Otolaryngology - Head and Neck Surgery — Wed, 01 Jun 2011 04:00:00 +0100

Bilateral immobility of the vocal folds can have a dramatic impact on both airway and voice. The diagnosis is based on history and physical examination and is supported by some objective tests such as computed tomography or magnetic resonance imaging evaluations. Although airway management is often the first consideration, a critical determination that is important both to an assessment of prognosis and to surgical planning is the differentiation between fixation and paralysis. The focus of surgical therapy has predominantly been directed at vocal fold lateralization, although there is growing interest in reinnervation and laryngeal pacing. There are a number of reliable lateralization and traditional techniques that are best performed with a tracheostomy in place. A lateralization procedu...

Airway management and CO2 laser treatment of subglottic and tracheal stenosis using flexible bronchoscope and laryngeal mask anesthesia

Operative Techniques in Otolaryngology - Head and Neck Surgery — Wed, 01 Jun 2011 04:00:00 +0100

This article presents the authors' endoscopic surgical technique using laryngeal mask anesthesia during CO2 laser treatment of subglottic and tracheal stenosis. A flexible bronchoscope is passed through a laryngeal mask airway and permits continuous ventilation during treatment with a flexible CO2 laser fiber or balloon dilator. This technique allows excellent airway control, access, and visualization during surgery and is easily mastered by anesthesiologists and otolaryngologists. (Source: Operative Techniques in Otolaryngology - Head and Neck Surgery)

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Clinical Action for Post Operative Respiratory Depression of Pacu Related Rapid Response Team (RRT) Calls

Journal of PeriAnesthesia Nursing — Tue, 31 May 2011 23:00:00 +0100

A PACU nurse is often faced with a challenge of balancing adequate pain management and airway management with adequate ventilation in the immediate post operative period. Data gathered from 2007 - 2008 yielded an increasing number of over sedation RRT calls to nursing units involving PACU patients. During a nine month time period, there were 48 incidences of post operative respiratory depression (PORD) perceived to be PACU related, ten of which were related to PACU. (Source: Journal of PeriAnesthesia Nursing)

Who teaches surgical airway management and how do they teach it? A survey of United States anesthesiology training programs

Journal of Clinical Anesthesia — Tue, 31 May 2011 23:00:00 +0100

Conclusions: The majority of anesthesiology training programs accredited by the Accreditation Council for Graduate Medical Education provide some form of skill-based instruction in surgical airway management for their residents. (Source: Journal of Clinical Anesthesia)

Successful difficult airway management for a rare case of iatrogenic tracheal foreign body

Journal of Clinical Anesthesia — Tue, 31 May 2011 23:00:00 +0100

Use of the Aintree Intubation Catheter (AIC; Cook Medical, Bloomington, IN, USA) as an airway exchange catheter to facilitate intubation through the Laryngeal Mask Airway has been reported . A case of an iatrogenic tracheal foreign body resulting from a broken AIC during tracheal intubation via a classical Laryngeal Mask Airway (cLMA) is presented. (Source: Journal of Clinical Anesthesia)

Evolving challenges and opportunities for difficult airway management guidelines.

Canadian Journal of Anaesthesia — Tue, 31 May 2011 23:00:00 +0100

Authors: Boet S, Bould MD, Diemunsch P PMID: 21630117 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

The GlideScope in current clinical practice

Journal of Clinical Anesthesia — Tue, 31 May 2011 23:00:00 +0100

Use of the GlideScope video laryngoscope (Verathon, Bothell, WA, USA) has increased endotracheal intubation success rates, reduced the time required to perform tracheal intubation, reduced the need for additional maneuvers, and reduced the potential for dental trauma . The GlideScope has been proven to be useful both as a primary and a rescue device for difficult airway management in different patient populations: adult , pediatric , infant , and parturient . (Source: Journal of Clinical Anesthesia)

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Cervical spine disease and anaesthesia

Anaesthesia and intensive care medicine — Thu, 26 May 2011 14:17:48 +0100

Abstract: Surgery on the surgical spine is commonly performed to relieve compression of the spinal cord (myelopathy), a nerve root (radiculopathy) or to provide bony stabilization to prevent secondary neurological injury. The pathological causes of myelopathy and radiculopathy are a common consequence of osteoarthritis or less commonly due to tumours, trauma, disc herniation, infection and multisystem disease and in some conditions as a result of their associated pathologically or surgically induced instability. Successful anaesthetic management should involve a meticulous preoperative assessment of the patient’s airway, a systemic review especially in patients with comorbidities & multisystem disease and attention to their medication and analgesic requirements. Preoperative discussion w...

Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia

Medscape Today Headlines — Wed, 25 May 2011 11:04:39 +0100

Airway management is fundamental to safe anaesthetic practice and is usually uncomplicated, but when problems do occur the consequences can be serious. British Journal of Anaesthesia (Source: Medscape Today Headlines)

Dentoalveolar Infections

Oral and Maxillofacial Surgery Clinics — Tue, 24 May 2011 23:00:00 +0100

Dentoalveolar infections represent a wide spectrum of conditions, from simple localized abscesses to deep neck space infections. The initial assessment of the patient with a dentoalveolar infection requires considerable clinical skill and experience, and determines the need for further airway management or emergent surgical therapy. Knowledge of head and neck fascial space anatomy is essential in diagnosing, understanding spread, and surgically managing these infections. Oral and maxillofacial surgeons must make use of their wide spectrum of clinical skill and knowledge to effectively evaluate and treat patients with dentoalveolar infections. (Source: Oral and Maxillofacial Surgery Clinics)

Principles of Airway Management [Book and Media Reviews]

JAMA — Mon, 23 May 2011 23:00:00 +0100

(Source: JAMA)

Intersurgical Extends its Eco Range of Products

Hospital Management — Fri, 06 May 2011 06:17:12 +0100

Intersurgical announces the launch of another product in its Eco range of low environmental impact products. The Eco adult tracheostomy mask This new mask has 82% less impact on the environment compared to its PVC equivalent. The quick release elastic system ensures that it can be removed and refitted easily, simplifying hygiene procedures. A soft 'seal' provides an improved level of comfort, while a fully rotational 22mm connector ensures optimum orientation for the attachment of humidifier tubing, venturi valves and nebulisers. Lowering the environmental impact Geoff Wond, E... Read More Related Links: Intersurgical Extends its Eco Range of ProductsIntroducing the New InTube Range of Endotracheal TubesSolus Satin Laryngeal Mask Airwa...

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Capnography urged to cut ICU airway management complications

MedWire News - Anesthesiology — Fri, 06 May 2011 00:00:00 +0100

About a quarter of major airway events in UK hospitals occur in intensive care units and emergency departments, but about three-quarters of these could be prevented, or their impact lessened, by routine use of capnography, shows a major audit. (Source: MedWire News - Anesthesiology)

Pre-Hospital Intubation is Associated with Increased Mortality After Traumatic Brain Injury1

Journal of Surgical Research — Wed, 04 May 2011 23:00:00 +0100

Conclusions: Pre-hospital endotracheal intubation in isolated, moderate to severe TBI patients is associated with a nearly 5-fold increase in mortality. Further prospective studies are required to establish guidelines for optimal pre-hospital management of this critically injured patient population. (Source: Journal of Surgical Research)

Airway Management in the Air Medical Setting

Air Medical Journal — Sat, 30 Apr 2011 23:00:00 +0100

Conclusion: We provide pooled estimates for airway management procedural success rates in the air medical setting. These data can be used by program managers and medical directors in determining the most appropriate airway management procedures to incorporate into their services and for benchmarking in quality improvement activities. (Source: Air Medical Journal)

Ex-utero intrapartum treatment procedure for giant neck masses—fetal and maternal outcomes

Journal of Pediatric Surgery — Sat, 30 Apr 2011 23:00:00 +0100

Conclusions: Ex-utero intrapartum treatment procedure for giant neck mass can be performed safely for both mother and child. Most fetuses can be orotracheally intubated with minimal long-term morbidity. The potential for future pregnancies is preserved. (Source: Journal of Pediatric Surgery)

Anaesthetic management of bronchopleural fistula in a patient with myasthenia gravis.

Singapore Medical Journal — Sat, 30 Apr 2011 23:00:00 +0100

Authors: Singh P, Poopalalingam R Patients with bronchopleural fistula present with specific airway management and ventilatory concerns, which makes the anaesthetic management of these patients challenging. Myasthenia gravis is another condition requiring specific anaesthetic management, with possible unpredictable delays in recovery. A combination of both these conditions in a patient makes management even more difficult. Our patient with myasthenia gravis underwent repair of the bronchopleural fistula, during which a multimodal approach to intraoperative and postoperative analgesia was adopted. Positive pressure ventilation was started only after we confirmed the isolation of the lung. PMID: 21633754 [PubMed - in process] (Source: Singapore Medical Journal)

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Airway management in pediatric patients with a rigid external distractor in situ.

Paediatric Anaesthesia — Fri, 29 Apr 2011 14:32:39 +0100

Authors: Xue FS, Liao X, Liu JH, Yuan YJ, Wang Q PMID: 21518105 [PubMed - in process] (Source: Paediatric Anaesthesia)

Airway management in pediatric patients with a rigid external distractor in situ

Pediatric Anesthesia — Mon, 25 Apr 2011 18:31:10 +0100

(Source: Pediatric Anesthesia)

Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: A randomised manikin trial

Resuscitation — Sun, 24 Apr 2011 23:00:00 +0100

Conclusion: Supraglottic devices appear to be a reasonable emergency airway management strategy, even for inexperienced personnel. (Source: Resuscitation)

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Annals of Emergency Medicine — Fri, 22 Apr 2011 16:39:26 +0100

Avoiding Common Errors in the Emergency Department is a fairly comprehensive pocketbook that succinctly describes 398 errors, with practical tips for avoiding these pitfalls. Each error is described in a short clinical scenario, followed by a discussion of how and why the error occurs, with tips on how to avoid or ameliorate problems. Most of the emergency medicine topics are covered and include psychiatry, pediatrics, poisonings, cardiology, obstetrics and gynecology, trauma, general surgery, orthopedics, infectious diseases, gastroenterology, renal, anesthesia and airway management, urology, oral and maxillofacial surgery, and ear, nose, and throat. The only notable missing exception is topics related to dermatology. (Source: Annals of Emergency Medicine)

Perioperative Airway Management Strategy and Posttransplant Successful Tracheal Resection and Reconstruction in a Heart Transplant Candidate with Post-intubation Stenosis

The Thoracic and Cardiovascular Surgeon — Wed, 20 Apr 2011 23:00:00 +0100

We present a patient suffering from end-stage heart failure and post-intubation tracheal stenosis along with our treatment strategy.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Perioperative Airway Management Strategy and Posttransplant Successful Tracheal Resection and Reconstruction in a Heart Transplant Candidate with Post-intubation Stenosis.

The Thoracic and Cardiovascular Surgeon — Wed, 20 Apr 2011 23:00:00 +0100

We present a patient suffering from end-stage heart failure and post-intubation tracheal stenosis along with our treatment strategy. PMID: 21512978 [PubMed - as supplied by publisher] (Source: The Thoracic and Cardiovascular Surgeon)

Successful management of a morbidly obese patient for electroconvulsive therapy with elective tracheostomy

Journal of Clinical Anesthesia — Tue, 19 Apr 2011 23:00:00 +0100

We report the successful airway management of a morbidly obese ECT patient via elective tracheostomy. (Source: Journal of Clinical Anesthesia)

Complete peripartum airway management of a large epignathus teratoma: EXIT to resection

International Journal of Pediatric Otorhinolaryngology — Tue, 19 Apr 2011 17:12:40 +0100

We present a case of a female infant that was diagnosed on prenatal ultrasound with an oral mass, and subsequently underwent a planned EXIT procedure to secure the airway. Ultimately the epignathus teratoma was excised at 3 days of age. The number of cases in which neonates have survived epignathus teratomas has increased in the past decade due to improved prenatal imaging and the development of the EXIT procedure. This case demonstrates the importance of a multidisciplinary approach that must be established when a prenatal diagnosis raises concern for airway compromise, and the thorough work-up required for definitive management. (Source: International Journal of Pediatric Otorhinolaryngology)

Should non-anaesthetists perform pre-hospital rapid sequence induction? an observational study

Emergency Medicine Journal — Mon, 18 Apr 2011 23:00:00 +0100

Conclusions Non-anaesthetic practitioners have a higher tracheal intubation failure rate during pre-hospital RSI. This likely reflects a lack of training opportunities and infrequency of clinical experience. Strategies to improve pre-hospital airway management are required. (Source: Emergency Medicine Journal)