Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2004
Recent trends in tracheal intubation: emphasis on the difficult airway.
Difficult airways can lead to critical incidents during anaesthesia, and death. Although many cases can be anticipated, some still go undiscovered before induction, thereby exposing the patient to unexpected risks and the anaesthesiologist to unexpected challenges. In addition to improving prediction of difficult airways, education for skill acquisition and management planning, and a quest for superior management techniques and airway tools are of the utmost importance in preventing airway catastrophes. ⋯ Improving reproducibility and reliability in predicting a difficult airway may limit the number of unpredicted difficult intubations. A safer approach to management of the difficult airway can be achieved by improving airway management skills and adhering to universally accepted and proven airway algorithms, including developing approaches to management of predicted and unpredicted difficult airways. Improving on existing airway techniques and tools (of which there are many), rather than creating new devices, is a desirable trend that may contribute to safer airway management in the future.
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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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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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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.