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British Journal of Anaesthesia Sep 2016
Topics: Airway Management; Anesthesia, General; Humans; Quality Improvement
PubMed: 27566787
DOI: 10.1093/bja/aew220 -
Current Opinion in Anaesthesiology Dec 2017Successful and sustainable training and learning of the management of difficult and normal airway is essential for all clinically active anesthesiologists. We emphasize... (Review)
Review
PURPOSE OF REVIEW
Successful and sustainable training and learning of the management of difficult and normal airway is essential for all clinically active anesthesiologists. We emphasize the importance of a continuously updated learning and training environment based on actual knowledge, best available equipment, standardized procedures, and educational theory.
RECENT FINDINGS
In the past, most of the training were based on 'learning by doing' under the supervision of superiors or experienced colleagues. This has been recognized as insufficient and training has evolved to its recent level by structuring it into technical, methodological, and behavioral components. Additionally, a large part of it has been shifted away from learning on patients to simulated scenarios in designated environments. The contents, structure, components, and succession of components have been refined according to the steadily evolving and available instruments. Increasingly, team interaction and behavioral aspects gained more attention and became part of standardized education units that are tailored to the learners' clinical role and level of experience.
SUMMARY
We present the details of the Zurich Airway Training and Simulation program, which has been constantly updated to the actual state of knowledge and available equipment.
Topics: Airway Management; Anesthesiology; Clinical Competence; Communication; Educational Measurement; Feedback; Humans; Simulation Training
PubMed: 28957878
DOI: 10.1097/ACO.0000000000000523 -
Respiratory Care Jun 2014Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a... (Review)
Review
Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a considerable risk of complication or failure. Mechanical ventilation is associated with significant complications that are time-dependent in nature, with a longer duration of intubation resulting in a higher incidence of complications, including ventilator-associated pneumonia, and increased mortality. Extubation failure and subsequent re-intubation are associated with an overall increase in the duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical costs. These risks demand that the process of extubation be managed by practitioners with a detailed understanding of the causes of extubation failure and the potential complications. A pre-established extubation plan with considerations made for the possible need for re-intubation is of the utmost importance.
Topics: Airway Extubation; Decision Making; Equipment Design; Humans; Intubation, Intratracheal; Respiration, Artificial; Risk Factors; Treatment Failure; Ventilator Weaning
PubMed: 24891203
DOI: 10.4187/respcare.02926 -
British Journal of Anaesthesia Dec 2022Patients worldwide die every year from unrecognised oesophageal intubation, which is an avoidable complication of airway management usually resulting from human error.... (Review)
Review
Patients worldwide die every year from unrecognised oesophageal intubation, which is an avoidable complication of airway management usually resulting from human error. Unrecognised oesophageal intubation can occur in any patient of any age whenever intubation occurs regardless of the seniority or experience of the airway practitioner or others involved in the patient's airway management. The tragic fact is that it continues to happen despite improvements in monitoring, airway devices, and medical education. We review these improvements with strategies to eliminate this problem.
Topics: Humans; Intubation, Intratracheal; Esophagus; Airway Management
PubMed: 36192220
DOI: 10.1016/j.bja.2022.08.027 -
Acta Clinica Croatica Apr 2023Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general... (Review)
Review
Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general anesthesia than in the non-obstetric population. The inability to ventilate and oxygenate is one of the most common causes of morbidity and mortality associated with general anesthesia for cesarean section. The aim of this paper is to present and analyze modern guidelines and algorithms for the management of difficult airway in obstetrics as an important segment of anesthesiology practice. Modern difficult airway management guidelines for pregnant women describe the procedure of difficult facemask ventilation, difficult airway management by using supraglottic devices, difficult endotracheal intubation, and emergency cricothyrotomy or tracheotomy in a situation where oxygenation and ventilation are impossible. Algorithms describe the procedures and equipment for each variant of difficult airway and decision-making strategies in situations when neither airway nor adequate oxygenation can be provided. Croatian anesthesiologists in most obstetric departments have appropriate equipment, as well as necessary experience in difficult airway management for pregnant women, and modern algorithms from the most developed countries can be adopted and accommodated to our daily practice, as well as incorporated into the training curricula of residents.
Topics: Humans; Airway Management; Pregnancy; Female; Practice Guidelines as Topic; Intubation, Intratracheal; Algorithms; Anesthesia, Obstetrical; Obstetrics
PubMed: 38746607
DOI: 10.20471/acc.2023.62.s1.10 -
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 -
Anaesthesia Aug 2018
Topics: Airway Management; Anesthesiology; Clinical Competence; Curriculum; Humans; Informed Consent; Personal Autonomy; Physicians; Teaching
PubMed: 29727029
DOI: 10.1111/anae.14313 -
Respiratory Care Jun 2014Supraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced... (Review)
Review
Supraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Second-generation devices have further improved efficacy and utility by incorporating design changes. Individual second-generation SADs have allowed more dependable positive-pressure ventilation, are made of disposable materials, have integrated bite blocks, are better able to act as conduits for tracheal tube placement, and have reduced risk of pulmonary aspiration of gastric contents. SADs now provide successful rescue ventilation in > 90% of patients in whom mask ventilation or tracheal intubation is found to be impossible. However, some concerns with these devices remain, including failing to adequately ventilate, causing airway damage, and increasing the likelihood of pulmonary aspiration of gastric contents. Careful patient selection and excellent technical skills are necessary for successful use of these devices.
Topics: Airway Extubation; Airway Management; Bronchoscopy; Emergency Treatment; Fiber Optic Technology; Glottis; Humans; Intubation, Intratracheal; Laryngoscopy; Patient Positioning; Risk Factors
PubMed: 24891199
DOI: 10.4187/respcare.02976 -
Heart Failure Reviews Sep 2022Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both... (Review)
Review
Meticulous risk stratification is essential when considering intubation of a patient with decompensated pulmonary hypertension (dPH). It is paramount to understand both the pathophysiology of dPH (and associated right ventricular failure) and the complications related to a high-risk intubation before attempting the procedure. There are few recommendations in this area and the literature, guiding these recommendations, is limited to expert opinion and very few case reports/case series. This review will discuss the complex pathophysiology of dPH, the complications associated with intubation, the debates surrounding induction agents, and the available options for the intubation procedure, with specific emphasis on the emerging role for awake fiberoptic intubation. All patients should be evaluated for candidacy for veno-arterial extracorporeal membrane oxygen as a bridge to recovery, lung transplantation, or pulmonary endarterectomy prior to intubation. Only an experienced proceduralist who is both comfortable with high-risk intubations and the pathophysiology of dPH should perform these intubations.
Topics: Airway Management; Endarterectomy; Extracorporeal Membrane Oxygenation; Humans; Hypertension, Pulmonary; Intubation, Intratracheal
PubMed: 34476657
DOI: 10.1007/s10741-021-10168-9 -
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