Masui. The Japanese journal of anesthesiology
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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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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.
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As a variety of new airway devices has been introduced, the practice of airway management has seemingly become more complex. Among them laryngeal mask airway (LMA) is the single most important development in the past 10 years. It has become a commonly accepted device for routine and rescue airway management, and is now listed in the American Society of Anesthesiologists (ASA) Difficult Airway Management Algorithm as an airway and a conduit for tracheal intubation. ⋯ Recent information about standardization work of ISO for rigid laryngoscopes, tracheal tubes and supralaryngeal airway devices are also discussed. Each airway devices has unique properties that may be advantageous in certain situations but disadvantageous in others. Choice and combination of device based on experienced clinical judgment may be crucial to their application.
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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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Perioperative management including anesthesia may alter long-term outcome of surgical patients. We have reviewed abstracts for meeting and articles published recently concerning effects of anesthetic depth, volatile anesthetic preconditioning, beta-blockers, alpha-agonists, statins, and glucose control on long-term outcome. Although research in this area has just been started, we, anesthesiologists should recognize its importance.