Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Practice Guideline
The difficult airway with recommendations for management - Part 1 - Difficult tracheal intubation encountered in an unconscious/induced patient.
Previously active in the mid-1990s, the Canadian Airway Focus Group (CAFG) studied the unanticipated difficult airway and made recommendations on management in a 1998 publication. The CAFG has since reconvened to examine more recent scientific literature on airway management. The Focus Group's mandate for this article was to arrive at updated practice recommendations for management of the unconscious/induced patient in whom difficult or failed tracheal intubation is encountered. ⋯ The clinician must be aware of the potential for harm to the patient that can occur with multiple attempts at tracheal intubation. This likelihood can be minimized by moving early from an unsuccessful primary intubation technique to an alternative "Plan B" technique if oxygenation by face mask or ventilation using a supraglottic device is non-problematic. Irrespective of the technique(s) used, failure to achieve successful tracheal intubation in a maximum of three attempts defines failed tracheal intubation and signals the need to engage an exit strategy. Failure to oxygenate by face mask or supraglottic device ventilation occurring in conjunction with failed tracheal intubation defines a failed oxygenation, "cannot intubate, cannot oxygenate" situation. Cricothyrotomy must then be undertaken without delay, although if not already tried, an expedited and concurrent attempt can be made to place a supraglottic device.
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To review and report maternal and neonatal outcomes after cardiac arrest during pregnancy in a large tertiary care centre and to consider steps to improve the outcomes. ⋯ This series of five cases highlights the challenges to meeting the rule of initiating PMCD within four minutes of maternal cardiac arrest onset. We suggest focusing on the quality of ongoing resuscitation efforts and early delivery as our experience shows that mother and neonate can survive beyond five minutes after arrest. Improved documentation and creation of a national database for these rare events should be considered.