Airway assessment and management

Failed Intubation ◽

Inhalational Induction ◽

Airway Assessment ◽

Rapid Sequence ◽

This chapter discusses the assessment and management of the airway. It begins with methods of assessing the airway and describes the approach to the unanticipated difficult airway. Topics covered include failed intubation, techniques for managing the anticipated difficult intubation, the cannot-intubate-cannot-ventilate scenario, the management of the obstructed airway, rapid sequence induction, inhalational induction, and awake fibreoptic intubation. It concludes with a discussion of extubating the patient after a difficult intubation.

Airway assessment and management

10.1093/med/9780198853053.003.0015 ◽

2021 ◽

pp. 361-404

Author(s):

Jules Cranshaw ◽

Emira Kursumovic ◽

Tim Cook

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Intubation ◽

Respiratory Viruses ◽

Airway Assessment ◽

Rapid Sequence ◽

Sequence Induction ◽

Practical Information ◽

Apnoeic Oxygenation

This chapter provides detailed, practical and up-to-date information on management of the airway. It demystifies airway terminology, outlines airway assessment, and describes the management of the unanticipated difficult airway in adults. It includes a new section on intubating critically ill patients using the vortex approach, and outlines the equipment and techniques used to aid airway management. It gives practical information on the emergency front of neck airway and strategies to approach the obstructed airway. It explains rapid sequence induction, inhalational induction, awake tracheal intubation, and extubation after difficult intubation. It contains new sections on apnoeic oxygenation and how to manage patients with airborne respiratory viruses.

Comparison of Plastic Single-use and Metal Reusable Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia

Anesthesiology ◽

10.1097/00000542-200601000-00011 ◽

2006 ◽

Vol 104 (1) ◽

pp. 60-64 ◽

Cited By ~ 34

Author(s):

Julien Amour ◽

Frédéric Marmion ◽

Aurélie Birenbaum ◽

Armelle Nicolas-Robin ◽

Pierre Coriat ◽

...

Keyword(s):

Orotracheal Intubation ◽

Failed Intubation ◽

Cluster Randomization ◽

Rapid Sequence ◽

Lehane Grade ◽

Sequence Induction ◽

Single Use ◽

S Period ◽

Laryngoscope Blades

Background Plastic single-use laryngoscope blades are inexpensive and carry a lower risk of infection compared with metal reusable blades, but their efficiency during rapid sequence induction remains a matter of debate. The authors therefore compared plastic and metal blades during rapid sequence induction in a prospective randomized trial. Methods Two hundred eighty-four adult patients undergoing general anesthesia requiring rapid sequence induction were randomly assigned on a weekly basis to either plastic single-use or reusable metal blades (cluster randomization). After induction, a 60-s period was allowed to complete intubation. In the case of failed intubation, a second attempt was performed using metal blade. The primary endpoint of the study was the rate of failed intubations, and the secondary endpoint was the incidence of complications (oxygen desaturation, lung aspiration, and oropharynx trauma). Results Both groups were similar in their main characteristics, including risk factors for difficult intubation. On the first attempt, the rate of failed intubation was significantly increased in plastic blade group (17 vs. 3%; P < 0.01). In metal blade group, 50% of failed intubations were still difficult after the second attempt. In plastic blade group, all initial failed intubations were successfully intubated using metal blade, with an improvement in Cormack and Lehane grade. There was a significant increase in the complication rate in plastic group (15 vs. 6%; P < 0.05). Conclusions In rapid sequence induction of anesthesia, the plastic laryngoscope blade is less efficient than a metal blade and thus should not be recommended for use in this clinical setting.

Use of a Proseal LMA for maintenance after failed intubation during a modified rapid sequence induction

Anaesthesia ◽

10.1046/j.1365-2044.2003.03497.x ◽

2003 ◽

Vol 58 (11) ◽

pp. 1132-1133 ◽

Cited By ~ 10

Author(s):

S. Baxter ◽

A. Brooks ◽

T. Cook

Keyword(s):

Failed Intubation ◽

Rapid Sequence ◽

Controversies in Pediatric Perioperative Airways

BioMed Research International ◽

10.1155/2015/368761 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 16

Author(s):

Jozef Klučka ◽

Petr Štourač ◽

Roman Štoudek ◽

Michaela Ťoukálková ◽

Hana Harazim ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Relevant Literature ◽

Pediatric Anesthesia ◽

Related Complication ◽

Pediatric Airway ◽

Anesthesia Practice ◽

Rapid Sequence ◽

Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.

Rapid Sequence Induction and the Difficult Airway Module

10.31440/dftb.30071 ◽

2020 ◽

Author(s):

Team DFTB

Keyword(s):

Difficult Airway ◽

Rapid Sequence ◽

Difficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2009.03.012 ◽

2009 ◽

Vol 18 (4) ◽

pp. 408-412 ◽

Cited By ~ 7

Author(s):

V. Sood ◽

D.A. Robinson ◽

I. Suri

Keyword(s):

Difficult Intubation ◽

Ehlers Danlos Syndrome ◽

Rapid Sequence ◽

Sequence Induction ◽

Danlos Syndrome

Comparison of Single-use and Reusable Metal Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia

Anesthesiology ◽

10.1097/aln.0b013e3181c92111 ◽

2010 ◽

Vol 112 (2) ◽

pp. 325-332 ◽

Cited By ~ 14

Author(s):

Julien Amour ◽

Yannick Le Manach ◽

Marie Borel ◽

François Lenfant ◽

Armelle Nicolas-Robin ◽

...

Keyword(s):

Statistical Significance ◽

Cluster Randomized Trial ◽

Orotracheal Intubation ◽

Failed Intubation ◽

Rapid Sequence ◽

Sequence Induction ◽

Single Use ◽

Laryngoscope Blades ◽

Cluster Randomized

Background Single-use metal laryngoscope blades are cheaper and carry a lower risk of infection than reusable metal blades. The authors compared single-use and reusable metal blades during rapid sequence induction of anesthesia in a multicenter cluster randomized trial. Methods One thousand seventy-two adult patients undergoing general anesthesia under emergency conditions and requiring rapid sequence induction were randomly assigned on a weekly basis to either single-use or reusable metal blades (cluster randomization). After induction, a 60-s period was allowed to complete intubation. In the case of failed intubation, a second attempt was performed using the opposite type of blade. The primary endpoint was the rate of failed intubation, and the secondary endpoints were the incidence of complications (oxygen desaturation, lung aspiration, and/or oropharynx trauma) and the Cormack and Lehane score. Results Both groups were similar in their main characteristics, including the risk factors for difficult intubation. The rate of failed intubation was significantly decreased with single-use metal blades at the first attempt compared with reusable blades (2.8 vs. 5.4%, P < 0.05). In addition, the proportion of grades III and IV in Cormack and Lehane score were also significantly decreased with single-use metal blades (6 vs. 10%, P < 0.05). The global complication rate did not reach statistical significance, although the same trend was noted (6.8% vs. 11.5%, P = not significant). An investigator survey and a measure of illumination pointed that illumination might have been responsible for this result. Conclusions The single-use metal blade was more efficient than a reusable metal blade in rapid sequence induction of anesthesia.

Airway

Emergencies in Anaesthesia ◽

10.1093/med/9780199560820.003.0003 ◽

2009 ◽

pp. 65-104

Keyword(s):

Emergency Management ◽

Difficult Intubation ◽

Tracheal Extubation ◽

Mask Ventilation ◽

Rapid Sequence ◽

Sequence Induction ◽

Bronchial Intubation ◽

Oesophageal Intubation ◽

Unexpected Difficulty

Difficult mask ventilation 66 Unanticipated difficult intubation 68 Can’t intubate … can’t ventilate (CICV) 76 Emergency management of the obstructed airway 80 Rapid sequence induction 86 Oesophageal intubation 90 Bronchial intubation 92 Laryngospasm 94 Aspiration 96 Difficult tracheal extubation 100 Airway fire 102 Unexpected difficulty in mask ventilation of the anaesthetized patient....