Anesthesiology clinics
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A prepared airway practitioner performs safe airway management, displaying skill, knowledge, and a full awareness of human factors, within a culture of safety. The education of prepared practitioners should include deliberate practice and distributed learning and should aim for expertise rather than mere competence. Translational outcomes from improved education and training can significantly decrease patient morbidity and mortality.
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Anesthesiology clinics · Jun 2015
ReviewObstructive sleep apnea, sleep disorders, and perioperative considerations.
Data suggest that surgical patients with obstructive sleep apnea (OSA) may be difficult to ventilate and intubate, and may be prone to postoperative complications. This article addresses the identification of patients at risk for OSA, epidemiology of the disorder, and treatment options, as well as the perioperative management of this population.
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Anesthesiology clinics · Jun 2015
ReviewIntegration of a difficult airway response team into a hospital emergency response system.
Hospital-wide emergency response teams have been an area of development for several decades. Highly specialized to address emergent needs, they mimic the cardiac-pulmonary arrest teams established at hospitals nationwide, such as heart attack, brain attack, medical emergency, rapid response, and difficult airway response teams (DART). The DART at Johns Hopkins Hospital is a collaboration of the Anesthesiology and Critical Care Medicine, Otolaryngology-Head and Neck Surgery, General Surgery, and Emergency Medicine departments. This successful model may be used by other hospitals to establish improved and comprehensive care of the difficult airway patient.
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Anesthesiology clinics · Jun 2015
ReviewWhat We All Should Know About Our Patient's Airway: Difficult Airway Communications, Database Registries, and Reporting Systems Registries.
Documentation and dissemination of patient information characterizing a difficult airway encounter is a critical safety link between past, present, and future health care providers. Effective communication of the nature of the difficulty encountered and the airway management techniques used consists of documentation in the patient's medical record for concurrent care providers and dissemination of that information to the patient and future providers for use during subsequent episodes of care. Significant progress has been made with developing national and international electronic patient record systems and airway databases, but full integration has yet to be achieved.
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Topical anesthesia of the airway is a necessary for awake intubation and is usually achieved using lidocaine delivered by various means. Although some experts favor the use of airway blocks, a more common approach is to use pure topical methods in combination with "spray as you go" techniques. ⋯ Nasal intubation requires additional topicalization of the nasal passages in conjunction with a vasoconstrictor. Finally, judicious sedation is frequently used when awake intubation is carried out.