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Brazilian Journal of Anesthesiology... 2018Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway... (Review)
Review
Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation.
Topics: Airway Management; Humans; Intubation, Intratracheal; Preoperative Care; Ultrasonography
PubMed: 30245096
DOI: 10.1016/j.bjan.2018.06.014 -
British Journal of Anaesthesia Sep 2020
Topics: Airway Management; Equipment Reuse; Humans; Laryngoscopy; Patient Care Team; Practice Guidelines as Topic
PubMed: 32624185
DOI: 10.1016/j.bja.2020.06.012 -
Anaesthesia Jul 2020
Topics: Airway Management; Anesthesia, General; Employment; Humans; Intubation, Intratracheal; Robotic Surgical Procedures; Robotics
PubMed: 31950484
DOI: 10.1111/anae.14986 -
Current Opinion in Otolaryngology &... Apr 2020Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer that is associated with significant morbidity and mortality. Because ATC is locally... (Review)
Review
PURPOSE OF REVIEW
Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer that is associated with significant morbidity and mortality. Because ATC is locally invasive, airway management is a critical component of treating these patients. Timely decisions regarding airway interventions can contribute to symptom relief and supportive care for patients. Over the last decade, there has been a paradigm shift in our recommendations for airway management. The purpose of this review is to summarize airway management, symptom relief and best supportive care for patients with ATC.
RECENT FINDINGS
More recent literature discusses the morbidities associated with tracheostomy and instead focuses on the benefits of supportive care and surgical resection. The multidisciplinary treating team should initiate early discussions for airway management, end-of-life care and palliative goals for patients with ATC. Tracheostomy should be offered to patients with careful thought and preoperative planning.
SUMMARY
Our goal in symptom relief and airway management is to improve the quality of life of patients with ATC and avoid the unnecessary morbidity of tracheostomy until clinically indicated.
Topics: Airway Management; Humans; Palliative Care; Prognosis; Quality of Life; Thyroid Carcinoma, Anaplastic; Tracheostomy
PubMed: 32022733
DOI: 10.1097/MOO.0000000000000619 -
Brazilian Journal of Otorhinolaryngology 2022Airway management following maxillofacial microvascular reconstruction is a fundamental part of the perioperative management. In oral cavity microvascular...
OBJECTIVES
Airway management following maxillofacial microvascular reconstruction is a fundamental part of the perioperative management. In oral cavity microvascular reconstruction, the airway is potentially compromised by airway edema, flap edema or bulkiness, hematoma formation, or upper airway sequelae from surgery. Classical teaching advocates elective tracheostomy in patients undergoing maxillofacial free flap reconstruction, while others keep patients intubated overnight (delayed extubation). The optimal method for perioperative airway management is still debated. This study aim was to evaluate the morbidity associated with elective tracheostomy in patients undergoing maxillofacial microvascular reconstruction and to recognize those patients who can avoid elective tracheostomy.
METHODS
Retrospective review of patients who underwent maxillofacial microvascular free flap reconstruction, between November 1 2010 and October 31 2019 in our center.
RESULTS
One-hundred and nine patients underwent microvascular reconstruction in the maxillofacial region. Sixty-one patients underwent an elective tracheostomy upon the primary surgery. Forty-eight patients were left intubated overnight. Seven patients underwent a late tracheostomy which was performed upon a neck re-exploration for postoperative complications, except for one patient which was due to failed extubation attempt. Patients who didn't receive an elective tracheostomy were younger and had a shorter duration of postoperative hospitalization. Seven patients suffered from tracheostomy- related complications, all of them underwent elective tracheostomy and none were from the late tracheostomy group.
CONCLUSIONS
Our results suggest, the routine use of elective tracheostomy in maxillofacial microvascular free flap reconstruction is unnecessary. Elective tracheostomy should be considered on case-to-case basis.
Topics: Humans; Tracheostomy; Airway Management; Surgical Flaps; Plastic Surgery Procedures; Retrospective Studies; Postoperative Complications; Head and Neck Neoplasms
PubMed: 34756557
DOI: 10.1016/j.bjorl.2021.07.007 -
British Journal of Anaesthesia Jun 2021
Topics: Adult; Airway Management; Anesthesia; Child; Europe; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Laryngoscopy; Prospective Studies
PubMed: 33867047
DOI: 10.1016/j.bja.2021.03.012 -
The Journal of Emergency Medicine Jul 2020Successful airway management is critical to the practice of emergency medicine. Emergency physicians must be ready to optimize and prepare for airway management in... (Review)
Review
BACKGROUND
Successful airway management is critical to the practice of emergency medicine. Emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this first part of a 2-part series.
OBJECTIVE
This narrative review presents an evidence-based approach to airway and patient management during endotracheal intubation in challenging cases that are commonly encountered in the emergency department.
DISCUSSION
Adverse events during emergent airway management are common, with postintubation cardiac arrest reported in as many as 1 in 25 intubations. Many of these adverse events can be avoided with the proper identification and understanding of the underlying physiology, preparation, and postintubation management. Patients with high-risk features including severe metabolic acidosis; shock and hypotension; obstructive lung disease; pulmonary hypertension, right ventricle failure, and pulmonary embolism; and severe hypoxemia must be managed with airway expertise.
CONCLUSIONS
This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.
Topics: Airway Management; Critical Illness; Emergency Service, Hospital; Humans; Hypotension; Intubation, Intratracheal
PubMed: 32563613
DOI: 10.1016/j.jemermed.2020.05.008 -
British Journal of Anaesthesia Jun 2021
Topics: Airway Management; Computer Simulation; Humans; Laryngeal Masks
PubMed: 33836852
DOI: 10.1016/j.bja.2021.03.003 -
Anaesthesia Aug 2018
Topics: Airway Management; Anesthesiology; Clinical Competence; Curriculum; Humans; Informed Consent; Personal Autonomy; Physicians; Teaching
PubMed: 29727029
DOI: 10.1111/anae.14313 -
Anaesthesia, Critical Care & Pain... Dec 2019To provide French guidelines about "Airway management during paediatric anaesthesia".
OBJECTIVE
To provide French guidelines about "Airway management during paediatric anaesthesia".
DESIGN
A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened. The entire process was conducted independently of any industry funding. The authors followed the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to assess the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised. Few recommendations were not graded.
METHODS
The panel focused on 7 questions: 1) Supraglottic Airway devices 2) Cuffed endotracheal tubes 3) Videolaryngoscopes 4) Neuromuscular blocking agents 5) Rapid sequence induction 6) Airway device removal 7) Airway management in the child with recent or ongoing upper respiratory tract infection. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the redaction of the recommendations were then conducted according to the GRADE® methodology.
RESULTS
The SFAR Guideline panel provides 17 statements on "airway management during paediatric anaesthesia". After two rounds of discussion and various amendments, a strong agreement was reached for 100% of the recommendations. Of these recommendations, 6 have a high level of evidence (Grade 1 ± ), 6 have a low level of evidence (Grade 2 ± ) and 5 are experts' opinions. No recommendation could be provided for 3 questions.
CONCLUSIONS
Substantial agreement exists among experts regarding many strong recommendations for paediatric airway management.
Topics: Administration, Topical; Airway Extubation; Airway Management; Algorithms; Child; Child, Preschool; Equipment Design; France; Humans; Infant; Intubation, Intratracheal; Laryngoscopy; Lidocaine; Neuromuscular Nondepolarizing Agents; Rapid Sequence Induction and Intubation; Respiratory Tract Infections; Video Recording
PubMed: 30807876
DOI: 10.1016/j.accpm.2019.02.004