scholarly journals The Difficult Airway Trolley: A Narrative Review and Practical Guide

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Martin F. Bjurström ◽  
Mikael Bodelsson ◽  
Louise W. Sturesson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Future Research ◽  
Clinical Settings ◽  
Airway Equipment ◽  
National Expert ◽  
Airway Devices ◽  
Facemask Ventilation

Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.

scholarly journals Airway management in critically sick in intensive care

2020 ◽  
Author(s):  
S. K. Malhotra ◽  
Komal Gandhi
Keyword(s):  
Intensive Care ◽  
Airway Management ◽  
Difficult Airway ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Operation Theatre ◽  
Physiological Reserve ◽  
Airway Equipment ◽  
One Airway ◽  
Airway Devices

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

scholarly journals Difficult Airway Management in Neonates and Infants: Knowledge of Devices and a Device-Oriented Strategy

2021 ◽  
Vol 9 ◽  
Author(s):  
Teiji Sawa ◽  
Atsushi Kainuma ◽  
Koichi Akiyama ◽  
Mao Kinoshita ◽  
Masayuki Shibasaki
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Airway Device ◽  
Supraglottic Airway ◽  
Outer Diameter ◽  
Difficult Airway Management ◽  
Supraglottic Airway Device ◽  
Endotracheal Tubes ◽  
Inner Diameter ◽  
Neonates And Infants

Difficult airway management (DAM) in neonates and infants requires anesthesiologists and critical care clinicians to respond rapidly with appropriate evaluation of specific situations. Therefore, organizing information regarding DAM devices and device-oriented guidance for neonate and infant DAM treatment will help practitioners select the safest and most effective strategy. Based on DAM device information and reported literature, there are three modern options for DAM in neonates and infants that can be selected according to the anatomical difficulty and device-oriented strategy: (1) video laryngoscope (VLS), (2) supraglottic airway device (SAD), and (3) flexible fiberoptic scope (FOS). Some VLSs are equipped with small blades for infants. Advanced SADs have small sizes for infants, and some effectively function as conduits for endotracheal intubation. The smallest FOS has an outer diameter of 2.2 mm and enables intubation with endotracheal tubes with an inner diameter of 3.0 mm. DAM in neonates and infants can be improved by effectively selecting the appropriate device combination and ensuring that available providers have the necessary skills.

Difficult Airway

2017 ◽  
Author(s):  
Romina G. Ilic
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Awake Intubation ◽  
Supraglottic Airway ◽  
Patient Evaluation ◽  
Advanced Airway ◽  
Supraglottic Airway Devices ◽  
Surgical Airway ◽  
Airway Exchange ◽  
Airway Devices

The difficult airway chapter focuses on preparing the clinician for a challenging airway. Management of both the expected, as well as the unexpected, difficult airway is critical to the care of the perioperative patient. Proper patient evaluation, organization, and preparation with a variety of airway tools are imperative to successfully securing the airway. The chapter reviews the difficult airway algorithm and discusses advanced airway techniques such as the use of awake intubation, airway exchange catheters, supraglottic airway devices, and surgical airway. Gaining familiarity with and using these advanced airway techniques in non-urgent situations will help ensure success when they are needed in emergencies.

Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia

2021 ◽  
Vol 6 (3) ◽  
pp. 24-30
Author(s):  
Amani Alenazi ◽  
Bashayr Alotaibi ◽  
Najla Saleh ◽  
Abdullah Alshibani ◽  
Meshal Alharbi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Airway Management ◽  
Success Rate ◽  
Phase 1 ◽  
Adult Patients ◽  
Supraglottic Airway ◽  
Future Research ◽  
Phase 2 ◽  
Advanced Airway ◽  
Supraglottic Airway Devices

Objective: The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management.Method: The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs’ success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics’ perception of advanced airway management.Result: In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1‐5 TIs or SADs a year.Conclusion: Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.

Safe emergency neonatal airway management: current challenges and potential approaches

2021 ◽  
pp. fetalneonatal-2020-319398
Author(s):  
Joyce E O'Shea ◽  
Alexandra Scrivens ◽  
Gemma Edwards ◽  
Charles Christoph Roehr
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Neonatal Resuscitation ◽  
Laryngeal Mask ◽  
Viable Alternative ◽  
Supraglottic Airway ◽  
Success Rates ◽  
Facemask Ventilation

This review examines the airway adjuncts currently used to acutely manage the neonatal airway. It describes the challenges encountered with facemask ventilation and intubation. Evidence is presented on how to optimise intubation safety and success rates with the use of videolaryngoscopy and attention to the intubation environment. The supraglottic airway (laryngeal mask airway) is emerging as a promising neonatal airway adjunct. It can be used effectively with little training to provide a viable alternative to facemask ventilation and intubation in neonatal resuscitation and be used as an alternative conduit for the administration of surfactant.

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