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British Journal of Anaesthesia Sep 2016
Topics: Airway Management; Anesthesiology; Clinical Competence; Education, Medical, Continuing; Humans; Intubation, Intratracheal; Mandatory Programs; Practice Guidelines as Topic
PubMed: 27276977
DOI: 10.1093/bja/aew129 -
Anaesthesia Mar 2015
Topics: Airway Management; Anesthesiology; Databases, Factual; Humans; Intubation, Intratracheal; Preoperative Care
PubMed: 25511477
DOI: 10.1111/anae.12989 -
British Journal of Anaesthesia Sep 2016Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first... (Review)
Review
Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
Topics: Airway Management; Anesthesia, General; Clinical Competence; Critical Care; Critical Illness; Emergencies; Humans; Hypotension; Intubation, Intratracheal; Oxygen Inhalation Therapy
PubMed: 27221259
DOI: 10.1093/bja/aew061 -
Journal of Clinical Monitoring and... Apr 2021Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st...
Although 1st and 2nd generation supraglottic airway devices (SADs) have many desirable features, they are nevertheless inserted in a similar 'blind' way as their 1st generation predecessors. Clinicians mostly still rely entirely on subjective indirect assessments to estimate correct placement which supposedly ensures a tight seal. Malpositioning and potential airway compromise occurs in more than half of placements. Vision-guided insertion can improve placement. In this article we propose the development of a 3rd generation supraglottic airway device, equipped with cameras and fiberoptic illumination, to visualise insertion of the device, enable immediate manoeuvres to optimise SAD position, verify whether correct 1st and 2nd seals are achieved and check whether size selected is appropriate. We do not provide technical details of such a '3rd generation' device, but rather present a theoretical analysis of its desirable properties, which are essential to overcome the remaining limitations of current 1st and 2nd generation devices. We also recommend that this further milestone improvement, i.e. ability to place the SAD accurately under direct vision, be eligible for the moniker '3rd generation'. Blind insertion of SADs should become the exception and we anticipate, as in other domains such as central venous cannulation and nerve block insertions, vision-guided placement becoming the gold standard.
Topics: Airway Management; Equipment Design; Fiber Optic Technology; Glottis; Humans; Intubation, Intratracheal; Laryngeal Masks; Vision, Ocular
PubMed: 32537697
DOI: 10.1007/s10877-020-00537-4 -
European Archives of... Jul 2021Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol... (Review)
Review
PURPOSE
Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons.
METHODS
To establish the Slovenian National Guidelines for airway management in cannot intubate-cannot ventilate situations in COVID-19 positive patients.
RESULTS
Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important.
CONCLUSION
The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.
Topics: Airway Management; COVID-19; Humans; Intubation, Intratracheal; Pandemics; SARS-CoV-2; Tracheostomy
PubMed: 32889621
DOI: 10.1007/s00405-020-06318-8 -
Anesthesia and Analgesia Sep 2020Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of... (Review)
Review
Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.
Topics: Adult; Airway Extubation; Airway Management; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Infection Control; Intubation, Intratracheal; Operating Rooms; Pandemics; Personal Protective Equipment; Pneumonia, Viral; SARS-CoV-2
PubMed: 32502132
DOI: 10.1213/ANE.0000000000005043 -
Academic Emergency Medicine : Official... May 2020
Topics: Airway Management; Dust; Emergency Medical Services; Heart Arrest; Humans; Intubation, Intratracheal; Poisons
PubMed: 32220122
DOI: 10.1111/acem.13926 -
The Western Journal of Emergency... Jun 2020In light of the rapid spread of coronavirus disease 2019 (COVID-19) across the United States, the Centers for Disease Control and Prevention (CDC) and hospitals... (Review)
Review
In light of the rapid spread of coronavirus disease 2019 (COVID-19) across the United States, the Centers for Disease Control and Prevention (CDC) and hospitals nationwide have developed new protocols to address infection control as well as the care of critical patients. Airway management has been particularly difficult; the challenge of quickly establishing an airway in patients must be balanced by the risk of aerosolizing respiratory secretions and putting the provider at risk of infection. Significant attention has been given to developing protocols for the emergency department and critical care units, but little guidance regarding establishing airway and respiratory support for patients in the prehospital setting has been made available. While some of the recommendations can be extrapolated from hospital guidelines, other factors such as environment and available resources make these protocols unfeasible. Through review of current literature the authors established recommendations regarding airway management and the provision of respiratory support to patients developing respiratory failure related to COVID-19.
Topics: Airway Management; Betacoronavirus; COVID-19; Coronavirus Infections; Emergency Medical Services; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Intubation, Intratracheal; Laryngoscopy; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Positive-Pressure Respiration; SARS-CoV-2; Video Recording
PubMed: 32726247
DOI: 10.5811/westjem.2020.5.47540 -
Annals of Cardiac Anaesthesia 2017
Topics: Airway Management; Anesthesiology; Humans
PubMed: 28074787
DOI: 10.4103/0971-9784.197814 -
Minerva Anestesiologica Aug 2017
Topics: Airway Management; Fiber Optic Technology; Humans; Intubation, Intratracheal; Laryngeal Masks; Wakefulness
PubMed: 28402095
DOI: 10.23736/S0375-9393.17.11943-7