Masui. The Japanese journal of anesthesiology
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Anesthesiologists should be familiar with the management of airway and be able to recognize and identify potential difficult airway. These entities include congenital craniofacial deformities with micrognathia (e.g. Robin sequence, Treacher Collins, Goldenhar's, Crouzon's syndromes) and metabolic diseases causing the deposit of accumulated by-products (e.g., Hurler's, Morquio's, Beckwith-Wiedemann syndromes). ⋯ Intubation with a fiberscope can be utilized through LMA or through a specially designed face mask. Face mask designed for fiberoptic intubation has a 15 mm port for connection with the breathing circuit and another 22 mm port covered with a rubber membrane through which the fiberscope is introduced and directed to the larynx and trachea followed by the tracheal tube while ventilating and anesthetizing the pediatric patients with inhalational anesthetics. Getting used to these two modalities, LMA and fiberoptic intubation of the trachea, gives a great advantage in handling of difficult pediatric airway and intubation.
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Review
[Quality assurance in airway management: education and training for difficult airway management].
Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. ⋯ The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.
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The endotracheal intubation and laryngeal mask airway confer many advantages for surgical patients. However, a number of problems and complications with airway management by endotracheal intubation and laryngeal mask airway have been documented. In this report, several problems by using endotracheal intubation (e.g. hoarseness, arytenoids dislocation) and laryngeal mask airway (e.g. aspiration, oropharyngeal leak, gastric distension) are summarized.
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Maintenance of patent airway has an essential role in respiratory management. The management of difficult airway is one of problems associated with the maintenance of airway patency. "Cannot intubate, cannot ventilate (CICV)" scenario is rare, but it usually leads to serious morbidity and mortality related to anesthesia. ⋯ However, the recent practice of airway management seems to be very complex, depending on the introduction of new airway devices including laryngeal mask airway (LMA). In order to provide the reader with valuable information as to the new devices and airway-associated problems, five experts in this field contributed to this special issue of difficult airway problems.
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Review Case Reports
[Cannot intubate, cannot ventilate: airway management of difficult airways in adults].
Cannot intubate, cannot ventilate (CICV) is one major cause of death associated with general anesthesia and thus proper airway management plans are necessary. To achieve safe airway management, it is necessary first to predict if the patient's trachea can be difficult to intubate or the lungs difficult to ventilate. ⋯ To make a right decision, it is necessary to know the advantages and disadvantages of each option, as well as of each airway device, and to be acquainted with these devices during routine anesthesia. In this article, I will present six typical cases of difficult airways, and will discuss appropriate options for safer airway management.