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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While there are many predictors of difficult laryngoscopic intubation, they all have a low positive predictive value. Therefore, unanticipated difficult laryngoscopic intubation will likely occur in our day-to-day practice. This review discusses recent developments in alternative airway devices and techniques in addressing these difficulties. ⋯ The evidence to date does not always arm us with the ability to predict a difficult laryngoscopic intubation. Therefore, it is imperative that we equip ourselves with devices and techniques that will help us to maintain effective oxygenation and ventilation in a safe manner in the face of such failure.
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Simulators can be used to teach simple technical skills or used in more realistic settings to teach or assess various cognitive/affective skills. Although simulators have become widespread, their use and efficacy in these various areas have not been delineated and are still being explored. This review will discuss the present state of using medical simulation for airway-management training. ⋯ Simulators are here to stay. Presently their usage in teaching psychomotor skills has scientific validity in specific tasks but their efficacy for teaching higher-order cognitive skills is still evolving. Future studies will continue to delineate the usage in different areas by studying the outcome in skills training and retention.
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Curr Opin Anaesthesiol · Dec 2004
Alternative management techniques for the difficult airway: optical stylets.
We present the newest devices being promoted for difficult-airway management. Our focus is on optical stylets which offer a forward view from the stylet end positioned within the tip of the endotracheal tube. ⋯ Generally favorable experience with use of optical stylets continues to be reported. Our survey of clinicians' opinions reflects our own experience; these devices are unique and are attractive adjuncts to standard- and difficult-airway carts.
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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.