Current opinion in anaesthesiology
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The purpose of this review is to examine recent evidence for the management of the difficult airway. ⋯ This review of algorithms for management of the difficult airway strengthens several generally accepted crucial points. What is always needed is expertise, which one can only get and maintain by daily practice.
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Curr Opin Anaesthesiol · Dec 2004
Alternative management techniques for the difficult airway: esophageal-tracheal Combitube.
To summarize knowledge about the esophageal-tracheal Combitube in emergency medicine and anesthesia, with special emphasis on uncommon indications. Papers published between August 2003 and July 2004 are reviewed. ⋯ The esophageal-tracheal Combitube is a useful and efficient alternative airway characterized by high success rates in emergency situations. We recommend the use of a laryngoscope for insertion and strict adherence to the manufacturer's guidelines in order to maximize success and minimize potential injury.
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Curr Opin Anaesthesiol · Dec 2004
The carrier gas in anaesthesia: nitrous oxide/oxygen, medical air/oxygen and pure oxygen.
The gas passing the module for the delivery of inhalation anaesthetics and carrying vapourized anaesthetics into the breathing system is called the carrier gas. Oxygen is the absolutely indispensable component of the carrier gas. Additive gaseous components can be medical air (nitrogen), nitrous oxide, cyclopropane, or xenon, the latter three being anaesthetic gases themselves. Cyclopropane is not used any more and xenon is not approved as a medical gas yet, leaving medical air and nitrous oxide as the only currently available adjuncts to oxygen. ⋯ Nitrous oxide should not be used routinely as a component of the carrier gas any more. A mixture of medical air and oxygen must be acknowledged to be the gold standard. Pure oxygen may be used as a carrier gas if medical air or properly performing flow controls for medical air are not available.
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Arterial blood gas analysis is the 'gold standard' method to measure the arterial partial pressure of carbon dioxide (PaCO2). However, arterial sampling including arterial catheterization is invasive and expensive. Cutaneous carbon dioxide tension (PcCO2) measurement is used as a noninvasive surrogate measure of PaCO2, which is used to either estimate PaCO2 or determine trend changes in the measurement. There has been considerable progress in the technical aspects of PcCO2 monitoring in the last few years. In this article, we evaluate recent developments and the renewed interest in the subject of PcCO2 monitoring in adults and discuss the technical aspects, clinical applications and the future outlook for this technique in the clinical setting. ⋯ The clinical settings in which PcCO2 monitoring can be applied include patient monitoring during and after anaesthesia, patients receiving noninvasive ventilation, post extubation, endoscopy under sedation, the sleep laboratory and the lung function laboratory. Although there is an overlap of the clinical indications when both PcCO2 and end-tidal carbon dioxide monitoring may be used, it is our opinion that both these methods have independent indications and are sometimes also complementary to each other in patient care.
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Curr Opin Anaesthesiol · Dec 2004
The Williams Airway Intubator, the Ovassapian Airway and the Berman Airway as upper airway conduits for fibreoptic bronchoscopy in patients with difficult airways.
In this article we will summarize the available information on airways that have been suggested to provide a conduit for the bronchoscope in its passage through the upper airway during fibreoptic intubation. ⋯ Though the Williams Airway Intubator and the Berman Oropharyngeal Airway are superior in this role, all the airways discussed here have major deficiencies in their function. Further research is needed in this field to meet the requirements of endoscopists in situations when it is crucial that equipment reliably fulfils its function.