International anesthesiology clinics
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Int Anesthesiol Clin · Jan 2000
ReviewThe traumatic airway: the anesthesiologist's role in the emergency room.
An approach to the airway is addressed in Table 1. A summary of induction/NMB agents and doses is given on Table 2; indications for the different agents are noted on Table 3. ⋯ The backup plan might involve the use of BVM ventilation, blind digital intubation, fiberoptic bronchoscope-aided intubation, retrograde techniques, light wand intubation, laryngeal mask airway techniques, posterior pharyngeal endotracheal tube placement ventilation, or a surgical airway. Most of these approaches are reviewed elsewhere.
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Int Anesthesiol Clin · Jan 2000
ReviewTechniques to avoid intubation: noninvasive positive pressure ventilation and heliox therapy.
NPPV is useful in decreasing the intubation rate in carefully selected patients with acute respiratory failure--particularly in patients with COPD. The results of some studies also suggest a survival benefit for use of NPPV with acute respiratory failure associated with COPD. ⋯ The use of heliox for other indications is unclear. Heliox may adversely affect the function of respiratory care equipment such as flow meters, ventilators, nebulizers, and pulmonary function monitors.
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The difficult airway, although rare, still occurs with a frequency sufficient to require that all personnel associated with airway management be familiar with methods to use when confronted with a challenging airway. Methods of airway assessment are helpful but lack adequate sensitivity and specificity. The most effective means of anticipating a difficult airway lies in an integrated approach utilizing the history, physical exam, and the patient's medical record. ⋯ Most importantly, extubation must only occur after a plan has been designed to ensure that the patient may be adequately supported in the event of a premature extubation. Certain injuries to the airway and esophagus are more common in patients in whom intubation was difficult. Such patients should be closely watched and informed about the signs and symptoms of tracheal and esophageal injury.