Articles: intubation.
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Review
Management of the difficult adult airway. With special emphasis on awake tracheal intubation.
Difficulty in managing the airway is the single most important cause of major anesthesia-related morbidity and mortality. Successful management of a difficult airway begins with recognizing the potential problem. All patients should be examined for their ability to open their mouth widely and for the structures visible upon mouth opening, the size of the mandibular space, and ability to assume the sniff position. ⋯ Eighty percent of the 127 references in this article were published after 1985. However, there is much more to learn with regard to recognition of the difficult airway, preparation of the patient for an awake intubation, new techniques of endotracheal intubation, and establishment of gas exchange in patients who cannot be intubated or ventilated by mask. As the anesthesiologist's ability to manage the difficult airway significantly improves, respiratory-related morbidity and mortality will decrease.
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Surg. Clin. North Am. · Dec 1991
ReviewAirway injury after tracheotomy and endotracheal intubation.
Iatrogenic airway injury after tracheotomy and endotracheal intubation continues to be a serious clinical problem. Endotracheal tubes cause pressure injury to the glottis and may result in severe commissural scarring that is difficult to treat. ⋯ The technique of laryngotracheal resection and reconstruction has been well developed and may be applied successfully to most patients with subglottic and tracheal stenosis. The surgical treatment of glottic stenosis remains a challenge.
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All critical care physicians should be adept at medical management of the airway, including basic and advanced life support measures. Proper head and neck positioning, use of non-definitive airways, and ability to oxygenate and ventilate the patient with bag-valve-mask should be part of the armamentarium of every critical care physician. ⋯ Oral intubation is preferred for emergency establishment of a definitive airway in most situations. Skillful intubation technique and meticulous daily management of the upper airway should diminish the risk of complications of translaryngeal intubation.