Additional Information
Book Details
Abstract
Anesthesiologists, residents, and advanced practice practitioners alike rely upon the comprehensive content of Hagberg and Benumof’s Airway Management to remain proficient in this essential area. The 4th Edition, by Drs. Carin A. Hagberg, Carlos A. Artime, and Michael F. Aziz, continues the tradition of excellence with coverage of new devices and algorithms, new research, new outcomes reporting, and much more – while retaining a concise, how-to approach; carefully chosen illustrations; and case examples and analysis throughout.
- Offers expert, full-color guidance on pre- and post-intubation techniques and protocols, from equipment selection through management of complications.
- Includes the latest ASA guidelines, as well as six all-new chapters including airway management in nonoperating room locations (NORA), airway management and outcomes reporting, and more.
- Features completely rewritten chapters on airway pharmacology, algorithms for management of the difficult airway, airway assessment, video-assisted laryngoscopy, and many more.
- Reviews new airway devices and techniques, along with indications for and confirmation of tracheal intubation.
- Brings you up to date with the latest devices, the DAS extubation algorithm, the Vortex approach, and emergency cricothyrotomy.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Hagberg and Benumof's Airway Management | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Foreword | xv | ||
| Preface | xvii | ||
| Acknowledgments | xix | ||
| Table Of Contents | xxi | ||
| Video Contents | xxiii | ||
| Second Half title page | xxv | ||
| 1 Basic Clinical Science Considerations | 1 | ||
| 1 Functional Anatomy of the Airway | 2 | ||
| Chapter Outline | 2 | ||
| Introduction | 2 | ||
| Upper Airway | 2 | ||
| Nose | 2 | ||
| Structure | 2 | ||
| Function | 3 | ||
| Pharynx | 4 | ||
| Structure | 4 | ||
| Function | 4 | ||
| Upper Airway Obstruction | 5 | ||
| Sedation and Anesthesia | 5 | ||
| Obstructive Sleep Apnea | 5 | ||
| Larynx | 6 | ||
| Structure | 6 | ||
| Bones of the Larynx | 6 | ||
| Cartilages of the Larynx | 7 | ||
| Thyroid Cartilage. | 7 | ||
| Cricoid Cartilage. | 7 | ||
| Arytenoids. | 8 | ||
| Epiglottis. | 8 | ||
| Cuneiform and Corniculate Cartilages. | 9 | ||
| False and True Vocal Cords | 9 | ||
| Laryngeal Cavity | 9 | ||
| Muscles of the Larynx | 10 | ||
| Extrinsic Muscles of the Larynx. | 10 | ||
| Intrinsic Muscles of the Larynx. | 10 | ||
| Blood Supply of the Larynx | 12 | ||
| Function | 12 | ||
| Innervation of the Larynx | 12 | ||
| Glottic Closure and Laryngeal Spasm | 12 | ||
| Vocal Cord Palsies | 13 | ||
| Lower Airway | 14 | ||
| Trachea and Bronchi | 14 | ||
| Structure | 14 | ||
| Blood Supply | 15 | ||
| Function | 16 | ||
| Airway Epithelium | 16 | ||
| Forces Acting on the Airway | 16 | ||
| Relationship Between Structure and Function | 17 | ||
| Conclusion | 17 | ||
| Clinical Pearls | 18 | ||
| Selected References | 18 | ||
| References | 18.e1 | ||
| 2 Radiographic and Cross-Sectional Imaging of the Airway | 19 | ||
| Chapter Outline | 19 | ||
| Introduction | 19 | ||
| Imaging Modalities | 20 | ||
| Conventional Radiograph (Plain Film, X-Ray) and Digital Radiograph | 20 | ||
| Computed Tomography | 20 | ||
| Magnetic Resonance Imaging | 20 | ||
| Basics of Radiograph Interpretation | 21 | ||
| Cervical Spine Radiography | 21 | ||
| Radiologic Anatomy | 21 | ||
| Cervical Spine Anatomy and Pathology | 22 | ||
| Cervical Airway Anatomy and Pathology | 27 | ||
| Chest Radiography | 33 | ||
| Radiology Overview | 33 | ||
| Chest Anatomy and Pathology | 35 | ||
| Cross-Sectional Anatomy and Pathology: Computed Tomography and Magnetic Resonance Imaging | 38 | ||
| Nose, Nasal Cavity, and Sinuses | 38 | ||
| Development and Structure | 38 | ||
| Imaging Anatomy and Pertinent Pathology | 39 | ||
| Congenital Anomalies | 41 | ||
| Rhinosinusitis and Polyps | 42 | ||
| Trauma | 42 | ||
| Tumors and Other Pathology | 43 | ||
| Oral Cavity | 44 | ||
| Development and Structure | 44 | ||
| Imaging Anatomy and Pertinent Pathology | 46 | ||
| Macroglossia | 49 | ||
| Micrognathia and Retrognathia | 50 | ||
| Exostosis | 50 | ||
| Tumors | 50 | ||
| Pharynx | 52 | ||
| Nasopharynx | 52 | ||
| Adenoidal Hypertrophy | 52 | ||
| Tornwaldt Cyst | 54 | ||
| Infection and Abscess | 58 | ||
| Tumors | 58 | ||
| Oropharynx | 58 | ||
| Tonsillar Hypertrophy | 60 | ||
| Tonsillitis and Peritonsillar Abscess | 60 | ||
| Retropharyngeal Abscess | 60 | ||
| Tortuous Internal or Common Carotid Artery | 61 | ||
| Tumors | 61 | ||
| Hypopharynx | 62 | ||
| Pharyngitis | 62 | ||
| Pharyngocele | 62 | ||
| Zenker Diverticulum | 62 | ||
| Trauma | 62 | ||
| Tumors and Other Pathology | 63 | ||
| Larynx | 63 | ||
| Structure and Function | 63 | ||
| Imaging Anatomy and Pertinent Pathology | 64 | ||
| Congenital Lesions | 66 | ||
| Trauma | 66 | ||
| Vocal Cord Paralysis | 67 | ||
| Tumors and Other Pathology | 67 | ||
| Trachea | 67 | ||
| Development and Structure | 67 | ||
| Imaging Anatomy and Pertinent Pathology | 68 | ||
| Extrinsic Tracheal Pathology | 68 | ||
| Intrinsic Tracheal Pathology | 69 | ||
| Conclusion | 70 | ||
| Clinical Pearls | 71 | ||
| Selected References | 73 | ||
| References | 73.e1 | ||
| 3 Ultrasonography in Airway Management | 74 | ||
| Chapter Outline | 74 | ||
| Introduction | 74 | ||
| The Ultrasound Image and How to Obtain It | 74 | ||
| Visualizing the Airway and the Adjacent Structures | 75 | ||
| Mouth and Tongue | 75 | ||
| Oropharynx | 77 | ||
| Hypopharynx | 77 | ||
| Hyoid Bone | 77 | ||
| Larynx | 77 | ||
| Vocal Cords | 78 | ||
| Cricothyroid Membrane and Cricoid Cartilage | 78 | ||
| Trachea | 78 | ||
| Esophagus | 78 | ||
| Lower Trachea and Bronchi | 79 | ||
| Peripheral Lung and Pleura | 79 | ||
| Diaphragm | 80 | ||
| Gastric Antrum | 81 | ||
| Clinical Applications | 81 | ||
| Prediction of Difficult Laryngoscopy and Intubation in Surgical Patients | 81 | ||
| Evaluation of Pathology That May Influence the Choice of Airway Management Technique | 81 | ||
| Diagnosis of Obstructive Sleep Apnea | 81 | ||
| Evaluation of Prandial Status | 82 | ||
| Prediction of the Appropriate Diameter of an Endotracheal, Endobronchial, or Tracheostomy Tube | 82 | ||
| Localization of the Trachea | 82 | ||
| Localization of the Cricothyroid Membrane | 83 | ||
| Airway-Related Nerve Blocks | 85 | ||
| Ultrasound-Guided Intubation | 85 | ||
| Confirmation of Endotracheal Tube Placement | 85 | ||
| Tracheostomy | 86 | ||
| Confirmation of Gastric Tube Placement | 86 | ||
| Diagnosis of Pneumothorax | 87 | ||
| Differentiation Among Different Types of Lung and Pleura Pathology | 87 | ||
| Prediction of Successful Extubation | 87 | ||
| Ultrasonography and the Pediatric Airway | 89 | ||
| Special Techniques and Future Aspects | 89 | ||
| Learning Ultrasonography | 90 | ||
| Conclusion | 90 | ||
| Clinical Pearls | 90 | ||
| Acknowledgments | 90 | ||
| Selected References | 90 | ||
| References | 91.e1 | ||
| 4 Physics of the Airway | 92 | ||
| Chapter Outline | 92 | ||
| The Gas Laws | 92 | ||
| Ideal Gases | 92 | ||
| Nonideal Gases: The van der Waals Effect | 93 | ||
| Diffusion of Gases | 93 | ||
| Pressure, Flow, and Resistance | 93 | ||
| Example: Transtracheal Jet Ventilation | 94 | ||
| Analysis | 95 | ||
| Gas Flow | 95 | ||
| Laminar Flow | 95 | ||
| Laminar Flow Example | 96 | ||
| Turbulent Flow | 96 | ||
| Reynolds Number Calculation Example | 96 | ||
| Critical Velocity | 97 | ||
| Critical Velocity Calculation Example | 97 | ||
| Flow Through an Orifice | 97 | ||
| Helium-Oxygen Mixtures | 98 | ||
| Clinical Vignettes | 98 | ||
| Pressure Differences | 98 | ||
| Resistance to Gas Flow | 99 | ||
| Endotracheal Tube Resistance | 99 | ||
| Work of Breathing | 101 | ||
| Pulmonary Biomechanics | 103 | ||
| Respiratory Mechanics Equation | 103 | ||
| Pulmonary Time Constant | 103 | ||
| Determination of Rohrer’s Constants | 103 | ||
| Compliance | 104 | ||
| Advanced Formulation of the Respiratory Mechanics Equation | 104 | ||
| Anesthesia at Moderate Altitude | 104 | ||
| Altered Partial Pressure of Gases | 105 | ||
| Oxygen Analyzers | 105 | ||
| Carbon Dioxide Analyzers and Vapor Analyzers | 105 | ||
| Vapors and Vaporizers | 105 | ||
| Flowmeters | 105 | ||
| Flowmeter Calibration | 105 | ||
| Example Calculation 1 | 106 | ||
| Example Calculation 2 | 106 | ||
| Anesthetic Implications | 106 | ||
| Estimation of Gas Rates | 106 | ||
| Estimation of Carbon Dioxide Production Rate | 106 | ||
| Estimation of Oxygen Consumption Rate | 106 | ||
| Interpretation of Carbon Dioxide Production and Oxygen Consumption Rates | 107 | ||
| Ventilation via Narrow-Bore Catheters | 107 | ||
| Selected Dimensional Equivalents | 107 | ||
| Conclusion | 107 | ||
| Clinical Pearls | 108 | ||
| Selected References | 108 | ||
| References | 109.e1 | ||
| 5 Physiology of the Airway | 110 | ||
| Chapter Outline | 110 | ||
| Normal Respiratory Physiology (Nonanesthetized) | 110 | ||
| Gravity-Determined Distribution of Perfusion and Ventilation | 110 | ||
| Distribution of Pulmonary Perfusion | 110 | ||
| Distribution of Ventilation | 112 | ||
| The Ventilation-Perfusion Ratio | 113 | ||
| Nongravitational Determinants of Blood Flow Distribution | 115 | ||
| Passive Processes | 115 | ||
| Cardiac Output | 115 | ||
| Lung Volume | 115 | ||
| Active Processes and Pulmonary Vascular Tone | 116 | ||
| Tissue (Endothelial- and Smooth Muscle–Derived) Products | 116 | ||
| Alveolar Gases | 117 | ||
| Neural Influences on Pulmonary Vascular Tone | 118 | ||
| Humoral Influences on Pulmonary Vascular Tone | 119 | ||
| Alternative (Nonalveolar) Pathways of Blood Flow Through the Lung | 119 | ||
| Nongravitational Determinants of Pulmonary Compliance, Resistance, Lung Volume, Ventilation, and Work of Breathing | 120 | ||
| Pulmonary Compliance | 120 | ||
| Airway Resistance | 120 | ||
| Different Regional Lung Time Constants | 121 | ||
| Pathways of Collateral Ventilation | 122 | ||
| Work of Breathing | 122 | ||
| Lung Volumes, Functional Residual Capacity, and Closing Capacity | 123 | ||
| Lung Volumes and Functional Residual Capacity | 123 | ||
| Airway Closure and Closing Capacity | 124 | ||
| Patient With Normal Lungs. | 125 | ||
| Patients With Abnormal Lungs. | 126 | ||
| Measurement of Closing Capacity. | 126 | ||
| Relationship Between Functional Residual Capacity and Closing Capacity. | 126 | ||
| Oxygen and Carbon Dioxide Transport | 127 | ||
| Alveolar and Dead Space Ventilation and Alveolar Gas Tensions | 127 | ||
| Oxygen Transport | 128 | ||
| Overview | 128 | ||
| Oxygen-Hemoglobin Dissociation Curve | 129 | ||
| Effect of Q̇s/Q̇t on Alveolar Oxygen Tension | 131 | ||
| Effect of Q̇t and V̇o2 on Arterial Oxygen Content | 131 | ||
| Fick Principle | 132 | ||
| Carbon Dioxide Transport | 133 | ||
| Bohr and Haldane Effects | 133 | ||
| Pulmonary Microcirculation, Interstitial Space, and Fluid (Pulmonary Edema) | 133 | ||
| Respiratory Function During Anesthesia | 135 | ||
| Anesthetic Depth and Respiratory Pattern | 135 | ||
| Anesthetic Depth and Spontaneous Minute Ventilation | 136 | ||
| Preexisting Respiratory Dysfunction | 136 | ||
| Special Intraoperative Conditions | 136 | ||
| Mechanisms of Hypoxemia During Anesthesia | 137 | ||
| Equipment Malfunction | 137 | ||
| Mechanical Failure of Anesthesia Apparatus to Deliver Oxygen to the Patient | 137 | ||
| Improper Endotracheal Tube Position | 137 | ||
| Hypoventilation | 137 | ||
| Hyperventilation | 137 | ||
| Decrease in Functional Residual Capacity | 138 | ||
| Supine Position | 138 | ||
| Induction of General Anesthesia: Change in Thoracic Cage Muscle Tone | 138 | ||
| Neuromuscular Blockade | 138 | ||
| Light or Inadequate Anesthesia and Active Expiration | 139 | ||
| Increased Airway Resistance | 139 | ||
| Supine Position, Immobility, and Excessive Intravenous Fluid Administration | 139 | ||
| High Inspired Oxygen Concentration and Absorption Atelectasis | 140 | ||
| Surgical Position | 140 | ||
| Ventilation Pattern (Rapid Shallow Breathing) | 140 | ||
| Decreased Removal of Secretions (Decreased Mucociliary Flow) | 140 | ||
| Decreased Cardiac Output and Increased Oxygen Consumption | 141 | ||
| Inhibition of Hypoxic Pulmonary Vasoconstriction | 141 | ||
| Neuromuscular Blockade | 141 | ||
| Right-to-Left Interatrial Shunting | 142 | ||
| Involvement of Mechanisms of Hypoxemia in Specific Diseases | 142 | ||
| Mechanisms of Hypercapnia and Hypocapnia During Anesthesia | 143 | ||
| Hypoventilation | 143 | ||
| Increased Dead Space Ventilation | 143 | ||
| Increased Carbon Dioxide Production | 143 | ||
| Inadvertent Switching Off of a Carbon Dioxide Absorber | 144 | ||
| Hypocapnia | 144 | ||
| Physiologic Effects of Abnormalities in Respiratory Gases | 144 | ||
| Hypoxia | 144 | ||
| Hyperoxia (Oxygen Toxicity) | 145 | ||
| Hypercapnia | 146 | ||
| Hypocapnia | 146 | ||
| Conclusion | 147 | ||
| Clinical Pearls | 147 | ||
| Selected References | 148 | ||
| References | 148.e1 | ||
| 6 Airway Pharmacology | 149 | ||
| Chapter Outline | 149 | ||
| Introduction | 149 | ||
| General Pharmacologic Concepts and Clinical Considerations | 150 | ||
| Pharmacologic Concepts | 150 | ||
| Pharmacodynamics | 150 | ||
| Pharmacokinetics | 150 | ||
| Adverse Reactions, Side Effects, and Toxicity | 150 | ||
| Routes of Drug Administration to the Airway | 150 | ||
| Anatomy and Physiology of the Airway | 151 | ||
| Anatomy | 151 | ||
| Neuromuscular Function | 151 | ||
| Autonomic Nervous System | 151 | ||
| Voluntary Regulation of Airway Patency | 152 | ||
| Disease Affecting the Airway | 152 | ||
| Clinical Issues Regarding the Airway | 152 | ||
| Airway Patency | 152 | ||
| Airway Protection | 152 | ||
| Airway Reactivity and Resistance | 152 | ||
| Anesthetic Drugs and Effect on the Airway | 153 | ||
| Local Anesthetics | 153 | ||
| Adrenergic Drugs | 154 | ||
| Volatile Anesthetics | 154 | ||
| Intravenous Anesthetics | 154 | ||
| Benzodiazepines | 155 | ||
| Opioids | 155 | ||
| Neuromuscular Blocking Drugs | 156 | ||
| Reversal Agents for Neuromuscular Blocking Drugs | 156 | ||
| Airway Pharmacology for Reactive Airway Disease | 157 | ||
| Overview | 157 | ||
| Pathology | 157 | ||
| Treatment of Asthma | 157 | ||
| Drug Treatments for Asthma | 158 | ||
| β-Adrenergic Agonists | 158 | ||
| Glucocorticoids | 158 | ||
| Methylxanthines | 159 | ||
| Leukotriene Modifiers | 159 | ||
| Anticholinergic Agents | 159 | ||
| Chromoglycates | 160 | ||
| Alternative Agents and Future Directions | 160 | ||
| Perioperative Approach to the Patient With a Reactive Airway | 160 | ||
| Proactive Management—Prevention of Bronchospasm | 160 | ||
| Reactive Management—Treatment of Bronchospasm | 161 | ||
| Conclusion | 162 | ||
| Clinical Pearls | 162 | ||
| Selected References | 162 | ||
| References | 162.e1 | ||
| 7 Physiologic and Pathophysiologic Responses to Intubation | 163 | ||
| Chapter Outline | 163 | ||
| Background | 163 | ||
| Cardiovascular Responses During Airway Manipulation | 163 | ||
| Cardiovascular Reflexes | 163 | ||
| Intubation in the Presence of Cardiovascular Disease | 164 | ||
| Implications for Patients With Neurovascular Disease | 164 | ||
| Intubation in Patients With Neuropathologic Disorders | 164 | ||
| Neuromuscular Blocking Drugs and Cardiovascular Responses | 165 | ||
| Cardiopulmonary Consequences of Positive-Pressure Ventilation | 165 | ||
| Prevention of Cardiovascular Responses | 166 | ||
| Technical Considerations: Minimizing Stimulation of Airway Sensory Receptors | 166 | ||
| Topical and Regional Anesthesia | 167 | ||
| Inhalational Anesthetics | 167 | ||
| Intravenous Agents | 168 | ||
| Nonanesthetic Adjuvant Agents | 169 | ||
| Airway Effects of Endotracheal Intubation | 169 | ||
| Upper Airway Reflexes | 169 | ||
| Dead Space | 169 | ||
| Upper Airway Resistance | 169 | ||
| Lower Airway Resistance | 170 | ||
| Endotracheal Tube Resistance and Exhalation | 171 | ||
| Functional Residual Capacity | 171 | ||
| Cough | 172 | ||
| Humidification of Gases | 172 | ||
| Control and Treatment of the Respiratory Responses to Airway Instrumentation | 172 | ||
| Preventing Upper Airway Responses | 172 | ||
| Technical Considerations: Minimizing Airway Stimulation | 172 | ||
| Regional and Topical Anesthesia | 172 | ||
| Intravenous Agents | 173 | ||
| Preventing Bronchoconstriction | 173 | ||
| Technical Considerations: Minimizing Airway Stimulation | 173 | ||
| Topical Anesthesia | 174 | ||
| Intravenous Agents | 174 | ||
| Inhaled Agents | 174 | ||
| Choice of Neuromuscular Blocking Drug | 174 | ||
| Conclusion | 175 | ||
| Clinical Pearls | 175 | ||
| Selected References | 176 | ||
| References | 176.e1 | ||
| 2 The Difficult Airway: Definition, Assessment, Planning, and Algorithms | 177 | ||
| 8 Definition and Incidence of the Difficult Airway | 178 | ||
| Chapter Outline | 178 | ||
| Introduction | 178 | ||
| Definition and Classification of the Difficult Airway | 178 | ||
| Difficult or Impossible Face Mask Ventilation | 178 | ||
| Causes of Difficult Mask Ventilation | 178 | ||
| Definition of Difficult Mask Ventilation | 179 | ||
| Incidence of Difficult Mask Ventilation | 180 | ||
| Difficulties With Supraglottic Airways | 180 | ||
| Definition of Difficult Placement | 180 | ||
| Incidence of Success | 180 | ||
| Difficult Direct Laryngoscopy | 180 | ||
| Laryngeal Visualization | 180 | ||
| Incidence of Difficult Laryngeal Visualization | 181 | ||
| Difficult Intubation During Direct Laryngoscopy | 182 | ||
| Incidence of Difficult Intubation | 182 | ||
| Combined Difficult Mask Ventilation and Difficult Intubation | 182 | ||
| Impossible Mask Ventilation and Intubation | 182 | ||
| Variability in Incidence of Difficult Laryngoscopy and Difficult Intubation | 182 | ||
| Complications of Difficult Laryngoscopy and Difficult Intubation | 182 | ||
| Difficult Video-Assisted Laryngoscopy | 182 | ||
| Difficult Flexible Scope Intubation | 183 | ||
| Definition of Difficult Flexible Scope Intubation | 183 | ||
| Incidence of Difficult or Failed Flexible Scope Intubation | 183 | ||
| Conclusion | 183 | ||
| Clinical Pearls | 184 | ||
| Selected References | 184 | ||
| References | 184.e1 | ||
| 9 Airway Assessment and Prediction of the Difficult Airway | 185 | ||
| Chapter Outline | 185 | ||
| Introduction | 185 | ||
| Patient History | 185 | ||
| Psychosocial Context | 185 | ||
| History of a Difficult Airway | 185 | ||
| Medical Conditions | 186 | ||
| Diabetes | 186 | ||
| Rheumatoid Arthritis | 186 | ||
| Ankylosing Spondylitis | 186 | ||
| Temporomandibular Disorders | 186 | ||
| Bleeding Risk | 186 | ||
| Cardiopulmonary Illness | 187 | ||
| Congenital Abnormalities | 187 | ||
| Masses of the Head, Neck, and Airway | 187 | ||
| Burns | 187 | ||
| Acromegaly | 187 | ||
| Obesity | 188 | ||
| Obstructive Sleep Apnea | 188 | ||
| Pregnancy | 188 | ||
| Aspiration Risk | 188 | ||
| Physical Examination | 188 | ||
| Oral Aperture | 188 | ||
| Dentition | 189 | ||
| Tongue | 190 | ||
| Mallampati Classification | 190 | ||
| Thyromental Distance | 190 | ||
| Sternomental Distance | 191 | ||
| Neck Anatomy and Mobility | 191 | ||
| Nasal Characteristics | 192 | ||
| Mandibular Protrusion | 192 | ||
| Facial Features | 192 | ||
| Diagnostic Studies | 193 | ||
| Challenges to Studying Airway Assessment | 193 | ||
| Conclusion | 194 | ||
| Clinical Pearls | 195 | ||
| Selected References | 195 | ||
| References | 196.e1 | ||
| 10 Development of an Airway Management Plan | 197 | ||
| Chapter Outline | 197 | ||
| Introduction | 197 | ||
| Decision Making | 197 | ||
| Evaluation of the Airway | 198 | ||
| The Need to Control the Airway | 198 | ||
| Laryngoscopy and Intubation | 198 | ||
| Airway Evaluation Indices | 199 | ||
| Practitioner Experience | 199 | ||
| Device Availability | 199 | ||
| Summary | 199 | ||
| Ventilation | 199 | ||
| Risk of Gastric Contents Aspiration | 200 | ||
| Tolerance of Apnea | 200 | ||
| Percutaneous Emergency Airway Access | 201 | ||
| Integration: The Airway Approach Algorithm | 201 | ||
| Conclusion | 202 | ||
| Clinical Pearls | 202 | ||
| Selected References | 202 | ||
| References | 202.e1 | ||
| 11 Algorithms for Management of the Difficult Airway | 203 | ||
| Chapter Outline | 203 | ||
| Introduction | 203 | ||
| Usefulness of Airway Algorithms | 203 | ||
| Definition of Terms and Degree of Obligation | 204 | ||
| National Anesthesia Society Guidelines | 204 | ||
| American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway | 205 | ||
| Difficult Airway Society Guidelines for Management of Unanticipated Difficult Intubation in Adults | 207 | ||
| Canadian Airway Focus Group Guidelines | 208 | ||
| Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care Medicine’s Recommendation for Airway Control and Difficult Airway Management | 209 | ||
| French Society of Anesthesiology and Resuscitation’s Guidelines on Difficult Airway Management | 209 | ||
| German Society of Anaesthesiology and Intensive Care Medicine Guidelines on Airway Management | 209 | ||
| Chinese Society of Anesthesiology Guidelines for Management of the Difficult Airway | 209 | ||
| Japanese Society of Anesthesiologists Airway Management Guidelines | 210 | ||
| The Vortex Approach to Airway Management | 210 | ||
| Difficult Airway Scenarios—Comparison Between National Societies | 211 | ||
| Extubation of the Difficult Airway | 213 | ||
| Follow-Up Care of a Patient With a Difficult Airway | 213 | ||
| Conclusion | 214 | ||
| Clinical Pearls | 214 | ||
| Selected References | 214 | ||
| References | 214.e1 | ||
| 3 Preintubation-Ventilation Procedures | 215 | ||
| 12 Preparation of the Patient for Awake Intubation | 216 | ||
| Chapter Outline | 216 | ||
| Introduction | 216 | ||
| Preoperative Preparations | 217 | ||
| Chart Review | 217 | ||
| The Patient Interview | 217 | ||
| Staff | 218 | ||
| Monitors | 218 | ||
| Supplemental Oxygen | 218 | ||
| Airway Equipment | 218 | ||
| Premedication and Sedation | 218 | ||
| Antisialagogues | 218 | ||
| Glycopyrrolate | 219 | ||
| Scopolamine | 219 | ||
| Atropine | 219 | ||
| Nasal Mucosal Vasoconstrictors | 219 | ||
| Aspiration Prophylaxis | 219 | ||
| Antacids | 219 | ||
| Histamine Receptor Antagonists | 219 | ||
| Proton Pump Inhibitors | 219 | ||
| Metoclopramide | 219 | ||
| Sedatives/Hypnotics | 220 | ||
| Benzodiazepines | 220 | ||
| Midazolam | 220 | ||
| Diazepam and Lorazepam | 220 | ||
| Precautions | 220 | ||
| Opioids | 221 | ||
| Fentanyl | 221 | ||
| Sufentanil | 221 | ||
| Alfentanil | 221 | ||
| Remifentanil | 221 | ||
| Precautions | 221 | ||
| Intravenous Anesthetics | 222 | ||
| Propofol | 222 | ||
| Dexmedetomidine | 222 | ||
| Ketamine | 222 | ||
| Droperidol | 222 | ||
| Topicalization | 223 | ||
| Lidocaine | 223 | ||
| Cocaine | 223 | ||
| Other Local Anesthetics | 223 | ||
| Application Techniques | 224 | ||
| Direct Application | 224 | ||
| Atomizers | 224 | ||
| Nebulizers | 224 | ||
| Spray-as-You-Go | 225 | ||
| Nerve Blocks | 226 | ||
| Nasal Cavity and Nasopharynx | 226 | ||
| Anatomy | 226 | ||
| Sphenopalatine Nerve Block | 227 | ||
| Nasal Approach | 227 | ||
| Oral Approach | 227 | ||
| Anterior Ethmoidal Nerve Block | 227 | ||
| Oropharynx | 227 | ||
| Anatomy | 227 | ||
| Glossopharyngeal Nerve Block | 228 | ||
| Posterior Approach (Palatopharyngeal Fold) | 228 | ||
| Anterior Approach (Palatoglossal Fold) | 228 | ||
| External Approach (Peristyloid) | 228 | ||
| Larynx | 229 | ||
| Anatomy | 229 | ||
| Superior Laryngeal Nerve Block | 230 | ||
| External Approach | 230 | ||
| Greater Horn of the Hyoid. | 230 | ||
| Superior Horn of the Thyroid. | 230 | ||
| Thyroid Notch. | 230 | ||
| Ultrasound-Guided. | 231 | ||
| Internal Approach | 231 | ||
| Trachea and Vocal Cords | 232 | ||
| Anatomy | 232 | ||
| Transtracheal (Translaryngeal) Anesthesia | 232 | ||
| Positioning and Landmarks | 232 | ||
| Technique | 232 | ||
| Conclusion | 233 | ||
| Clinical Pearls | 234 | ||
| Selected References | 234 | ||
| References | 234.e1 | ||
| 13 Aspiration Prevention and Prophylaxis | 235 | ||
| Chapter Outline | 235 | ||
| Perioperative Aspiration | 235 | ||
| Incidence | 235 | ||
| Consequences | 236 | ||
| Risk Factors | 236 | ||
| Demographic | 236 | ||
| Barrier Pressure | 237 | ||
| Obesity | 237 | ||
| Systemic Diseases | 237 | ||
| Pregnancy | 237 | ||
| Pain and Analgesics | 238 | ||
| Pathophysiology | 238 | ||
| Determinants of Morbidity | 239 | ||
| pH and Volume of Aspirate | 239 | ||
| Particulate Matter | 239 | ||
| Prevention of Aspiration | 239 | ||
| Preoperative Fasting | 240 | ||
| Pediatric Patients | 240 | ||
| Adult Patients | 240 | ||
| Pregnant Patients | 240 | ||
| Role of Preoperative Ultrasonography | 241 | ||
| Preinduction Gastric Emptying | 241 | ||
| Awake Tracheal Intubation | 242 | ||
| Rapid Sequence Induction and Cricoid Pressure | 242 | ||
| Tracheal Extubation | 243 | ||
| Medical Prophylaxis of Aspiration | 243 | ||
| Gastroesophageal Motility | 243 | ||
| Metoclopramide | 244 | ||
| Erythromycin | 244 | ||
| Reduction of Gastric Acid Content | 245 | ||
| Neutralization of Gastric Acid | 245 | ||
| Inhibition of Gastric Acid Secretion | 245 | ||
| H2-Receptor Blockade | 245 | ||
| Cimetidine. | 245 | ||
| Ranitidine. | 246 | ||
| Other H2-Receptor Blockers. | 246 | ||
| Proton Pump Inhibition | 246 | ||
| Management of Pulmonary Aspiration | 247 | ||
| Conclusion | 248 | ||
| Clinical Pearls | 248 | ||
| Selected References | 248 | ||
| References | 248.e1 | ||
| 14 Preoxygenation | 249 | ||
| Chapter Outline | 249 | ||
| Introduction | 249 | ||
| Physiologic Considerations | 249 | ||
| Body Oxygen Stores | 250 | ||
| Physiology of Apnea | 251 | ||
| Apneic Oxygenation | 251 | ||
| Mechanism | 251 | ||
| Effect on Clearance of Carbon Dioxide | 252 | ||
| Efficacy and Efficiency of Preoxygenation | 252 | ||
| Efficacy of Preoxygenation | 252 | ||
| Fraction of Inspired Oxygen | 253 | ||
| Duration of Breathing, Functional Residual Capacity, and Alveolar Ventilation | 253 | ||
| Efficiency of Preoxygenation | 253 | ||
| Techniques for Preoxygenation and Prolongation of Apnea Time | 254 | ||
| Techniques for Preoxygenation | 254 | ||
| Tidal Volume Breathing | 254 | ||
| Deep Breathing Techniques | 255 | ||
| Head-Up Positioning | 257 | ||
| Noninvasive Positive-Pressure Ventilation | 257 | ||
| Techniques for Prolongation of Apnea Time | 258 | ||
| Nasal Oxygen During Efforts Securing a Tube | 258 | ||
| Pharyngeal Oxygen Insufflation | 258 | ||
| THRIVE | 258 | ||
| Breathing Systems for Preoxygenation | 259 | ||
| Special Situations | 260 | ||
| Pregnancy | 260 | ||
| Morbid Obesity | 261 | ||
| Pediatric Patients | 262 | ||
| Critically Ill Patients | 263 | ||
| Complications of Preoxygenation | 264 | ||
| Conclusion | 264 | ||
| Clinical Pearls | 264 | ||
| Selected References | 264 | ||
| References | 264.e1 | ||
| 15 Techniques to Induce General Anesthesia | 265 | ||
| Chapter Outline | 265 | ||
| Introduction | 265 | ||
| Standard Intravenous Induction With Neuromuscular Blockade | 265 | ||
| Intravenous Induction Without Neuromuscular Blockade | 265 | ||
| Rapid Sequence Induction and Intubation | 266 | ||
| Inhalational Induction | 267 | ||
| Clinical Pearls | 268 | ||
| Selected References | 268 | ||
| References | 268.e1 | ||
| 4 The Airway Techniques | 269 | ||
| 16 History of Airway Management | 270 | ||
| Chapter Outline | 270 | ||
| Before Anesthesia | 270 | ||
| Introduction | 270 | ||
| A Patent Airway | 270 | ||
| Early Anatomic and Physiologic Experiments | 270 | ||
| Resuscitation | 271 | ||
| Neonatal Resuscitation | 271 | ||
| A New Approach in Adults | 271 | ||
| Introduction of Anesthesia | 272 | ||
| Airway Obstruction | 272 | ||
| Simple Airway Management | 272 | ||
| Oral Airways | 273 | ||
| Nasal Airways | 273 | ||
| Infection—A Different Airway Challenge | 273 | ||
| Intubation for Anesthesia | 274 | ||
| The Trendelenburg Cone | 274 | ||
| Early Experience With Intubation for Anesthesia | 274 | ||
| Surgical Requirements | 275 | ||
| Pressure Chambers | 275 | ||
| Respiration Without Breathing—Insufflation Anesthesia | 275 | ||
| Wide-Bore Tracheal Tubes | 275 | ||
| Improvements to Tracheal Tubes | 276 | ||
| Airway Protection—Cricoid Pressure | 277 | ||
| Visualizing the Larynx | 277 | ||
| Early Laryngoscope Development | 277 | ||
| Laryngoscopes for Anesthesia | 278 | ||
| Further Development of Pharyngeal Airways | 280 | ||
| Cuffed Pharyngeal Airways | 280 | ||
| Development of the Laryngeal Mask Airway | 280 | ||
| Refinements of the Laryngeal Mask Airway | 281 | ||
| Other Supraglottic Airway Devices | 281 | ||
| Difficult Airway Management | 281 | ||
| Recognition and Early Approaches | 281 | ||
| Bougies and Stylets | 281 | ||
| Laryngoscopes for Difficult Intubations | 282 | ||
| Transtracheal Ventilation | 282 | ||
| Airway Classification | 283 | ||
| Technological Advances | 283 | ||
| Flexible Fiberoptic Laryngoscopes | 283 | ||
| Intubating Stylets | 283 | ||
| Indirect Laryngoscopes | 283 | ||
| Videos in Laryngoscopy | 284 | ||
| Video Laryngoscopes | 284 | ||
| Difficult Airway Planning | 284 | ||
| Difficult Airway Trolley | 284 | ||
| Difficult Airway Algorithms | 285 | ||
| Conclusion | 285 | ||
| Clinical Pearls | 285 | ||
| Selected References | 285 | ||
| References | 286.e1 | ||
| 17 Oxygen Delivery Systems, Inhalation, and Respiratory Therapy | 287 | ||
| Chapter Outline | 287 | ||
| Introduction | 287 | ||
| Oxygen Therapy | 287 | ||
| Indications | 287 | ||
| Oxygen Delivery Systems | 288 | ||
| Low-Flow Oxygen Systems | 289 | ||
| High-Flow Oxygen Systems | 289 | ||
| Oxygen Delivery Devices | 289 | ||
| Low-Flow Devices | 289 | ||
| Nasal Cannulas | 289 | ||
| Simple Face Mask | 290 | ||
| Partial Rebreathing Mask | 291 | ||
| Nonrebreathing Mask | 291 | ||
| Tracheostomy Collars | 292 | ||
| High-Flow Devices | 292 | ||
| Venturi Masks | 292 | ||
| High-Flow Nasal Cannulas | 293 | ||
| Aerosol Masks and T-Pieces With Nebulizers or Air-Oxygen Blenders | 293 | ||
| Humidifiers | 293 | ||
| Manual Resuscitation Bags | 295 | ||
| Complications | 295 | ||
| Techniques of Respiratory Care | 296 | ||
| Suctioning | 296 | ||
| Indications | 296 | ||
| Equipment | 296 | ||
| Technique | 297 | ||
| Complications | 297 | ||
| Chest Physical Therapy | 297 | ||
| Postural Drainage and Positional Changes | 297 | ||
| Percussion and Vibration Therapy | 299 | ||
| Incentive Spirometry | 299 | ||
| Intermittent Positive-Pressure Breathing | 300 | ||
| Indications | 300 | ||
| Administration | 300 | ||
| Noninvasive Ventilation | 301 | ||
| Indications | 301 | ||
| Noninvasive Ventilation in Cardiothoracic and Upper Abdominal Surgical Patient | 301 | ||
| Noninvasive Ventilation in Obese Surgical Patients | 302 | ||
| Noninvasive Ventilation in the Operating Room | 302 | ||
| Noninvasive Ventilation for Preoxygenation | 302 | ||
| Limitations | 302 | ||
| Inhalation Therapy | 302 | ||
| Basic Pharmacologic Principles | 303 | ||
| Aerosolized Drug Delivery Systems | 303 | ||
| Pharmacologic Agents | 304 | ||
| Mucokinetic Drugs | 304 | ||
| Hypoviscosity Agents | 305 | ||
| Mucolytic Agents | 305 | ||
| Bronchodilators and Antiasthmatic Drugs | 305 | ||
| Sympathomimetics | 305 | ||
| Anticholinergic Agents and Antibiotics | 307 | ||
| Antiallergy and Asthmatic Agents | 307 | ||
| Conclusion | 307 | ||
| Clinical Pearls | 308 | ||
| Acknowledgments | 308 | ||
| Selected References | 308 | ||
| References | 308.e1 | ||
| 18 Noninvasive Management of the Airway | 309 | ||
| Chapter Outline | 309 | ||
| Overview | 309 | ||
| Introduction | 309 | ||
| The Enduring Importance of Face Mask Ventilation | 310 | ||
| Functional Anatomy and Its Role in Upper Airway Obstruction | 310 | ||
| Upper Airway Functional Anatomy | 310 | ||
| Upper Airway Collapsibility and Obstruction | 310 | ||
| Airway Maneuvers Applied to Bony Structures | 311 | ||
| Understanding Anatomical Links Between Soft Tissues of the Airway and the Mobile Solid Structures | 312 | ||
| Cause of Airway Obstruction Unrelated to Soft Tissue Collapse | 312 | ||
| Techniques and Devices Used to Secure Airway Patency | 312 | ||
| Validated Airway Maneuvers | 312 | ||
| Resuscitation/Anesthesia Face Mask Design and Techniques for Use | 313 | ||
| Artificial Airway Devices to Support Noninvasive Ventilation | 315 | ||
| Oropharyngeal Airways | 315 | ||
| Nasopharyngeal Airways | 317 | ||
| Face Mask Ventilation Techniques | 318 | ||
| One-Handed Mask Ventilation Techniques | 318 | ||
| “E-C” Grip | 318 | ||
| “Chin-Lift” Grip | 319 | ||
| Two-Handed Mask Ventilation Techniques | 319 | ||
| Measuring Face Mask Ventilation Efficiency | 319 | ||
| Subjective Markers | 319 | ||
| Objective Markers | 319 | ||
| Strategies to Minimize Gastric Insufflation | 320 | ||
| Difficult Mask Ventilation | 321 | ||
| Predictors | 321 | ||
| Patient Factors | 321 | ||
| Provider Factors | 322 | ||
| Device Factors | 323 | ||
| A Practical Approach to Difficult Mask Ventilation | 323 | ||
| Strategies for an Optimal Attempt at Face Mask Ventilation | 323 | ||
| Patient Head and Body Position | 324 | ||
| Expected Difficult Mask Ventilation | 324 | ||
| Unexpected Difficult Mask Ventilation | 324 | ||
| Face Mask Ventilation With Neuromuscular Relaxants | 324 | ||
| Controlled Ventilation by Face Mask | 324 | ||
| Anesthesia Circle System (Anesthesia Machine) | 325 | ||
| Resuscitator Units | 325 | ||
| The Air-Mask-Bag Unit | 325 | ||
| Automatic Resuscitation Management System | 325 | ||
| Conclusion | 325 | ||
| Clinical Pearls | 326 | ||
| Selected References | 326 | ||
| References | 327.e1 | ||
| 19 Supraglottic Airway Techniques | 328 | ||
| Chapter Outline | 328 | ||
| Introduction | 328 | ||
| Nomenclature | 330 | ||
| Terminology | 330 | ||
| Classification | 330 | ||
| Pragmatic Classification | 330 | ||
| Anatomico-Mechanistic Classification | 331 | ||
| Standards in Evaluation | 332 | ||
| Important Features | 332 | ||
| Design Features | 332 | ||
| Efficacy Features | 333 | ||
| Insertion Success | 333 | ||
| Maintaining a Patent Airway and Enabling Ventilation | 333 | ||
| Access to the Airway | 333 | ||
| Safety Features | 333 | ||
| Aspiration Protection | 333 | ||
| Atraumatic Insertion | 334 | ||
| Indications for Use | 335 | ||
| Basic Indications | 335 | ||
| Routine Use | 335 | ||
| Controlled Ventilation | 335 | ||
| Rescue Indications | 336 | ||
| Cardiopulmonary Resuscitation | 336 | ||
| Management of the Unexpected Difficult Airway | 336 | ||
| Advanced Indications | 336 | ||
| Management of the Expected Difficult Airway | 336 | ||
| Head, Neck, and Shared Airway Surgery | 337 | ||
| Assessment of the Larynx and Respiratory Tree | 337 | ||
| Surgery in the Prone Position | 337 | ||
| Prolonged Surgery | 338 | ||
| Minor Laparoscopic Surgery | 338 | ||
| Obese Patients | 338 | ||
| Pregnant Patients | 338 | ||
| Fundamentals of Correct Use | 339 | ||
| Essential Techniques for Optimal Insertion | 339 | ||
| Basic LMA Insertion Technique | 339 | ||
| Insertion Techniques for the ProSeal and Supreme LMA | 340 | ||
| Insertion Technique for the Intubating LMA | 341 | ||
| Flexible Scope Technique | 341 | ||
| Blind Technique | 341 | ||
| Insertion Technique for the Prone Patient | 343 | ||
| Predictors of Difficult or Failed Subglottic Airway Use | 343 | ||
| Identification of Malposition | 343 | ||
| Position Testing | 345 | ||
| The Soap or “Bubble” Test | 345 | ||
| Suprasternal Notch Test | 345 | ||
| Inserting a Gastric Tube | 345 | ||
| External Landmarks | 345 | ||
| Performance Testing | 345 | ||
| Oropharyngeal Leak Pressure Test | 345 | ||
| Maximum Minute Ventilation Test | 346 | ||
| Important Consideration for Safe Use During Maintenance and Emergence | 346 | ||
| Cuff Pressure | 346 | ||
| Maintenance of an Adequate Depth of Anesthesia | 346 | ||
| Management of Regurgitation and Aspiration | 346 | ||
| Optimal Conditions and Timing for Removal | 346 | ||
| Selecting the Right Device | 346 | ||
| Conclusion | 347 | ||
| Clinical Pearls | 347 | ||
| Selected References | 348 | ||
| References | 348.e1 | ||
| 20 Supraglottic Airway Techniques | 349 | ||
| Chapter Outline | 349 | ||
| Introduction | 349 | ||
| Cuffed Pharyngeal Sealers With Esophageal Cuff | 349 | ||
| Esophageal Tracheal Combitube | 349 | ||
| Technical Description | 350 | ||
| Indications and Advantages | 350 | ||
| Prehospital Settings | 351 | ||
| In Hospital Settings | 352 | ||
| Complications | 353 | ||
| Summary | 353 | ||
| EasyTube | 353 | ||
| Technical Description | 353 | ||
| Indications and Advantages | 354 | ||
| Manikin Studies | 354 | ||
| Clinical Studies | 354 | ||
| Complications | 355 | ||
| Summary | 355 | ||
| Laryngeal Tube | 355 | ||
| Technical Description | 355 | ||
| Indications and Advantages | 356 | ||
| Complications | 358 | ||
| Laryngeal Tube Suction | 358 | ||
| Laryngeal Tube Suction II | 358 | ||
| Laryngeal Tube Suction Disposable | 359 | ||
| Intubating Laryngeal Tube Suction Disposable—iLTS-D | 359 | ||
| Gastro Laryngeal Tube | 360 | ||
| Summary | 361 | ||
| Cuffed Pharyngeal Sealers Without Esophageal Cuff | 361 | ||
| Cobra Perilaryngeal Airway | 361 | ||
| Technical Description | 361 | ||
| Indications and Advantages | 362 | ||
| Complications | 363 | ||
| Summary | 363 | ||
| Tulip Airway Device | 363 | ||
| Technical Description | 363 | ||
| Indications and Advantages | 364 | ||
| Complications | 364 | ||
| Summary | 364 | ||
| Anatomically Preshaped Noninflatable Supraglottic Airway Device | 364 | ||
| i-gel | 364 | ||
| Technical Description | 364 | ||
| Indications and Advantages | 365 | ||
| Complications | 367 | ||
| Summary | 367 | ||
| Streamlined Liner of the Pharynx Airway | 367 | ||
| Technical Description | 367 | ||
| Indications and Advantages | 367 | ||
| Complications | 368 | ||
| Summary | 368 | ||
| Baska Mask | 368 | ||
| Technical Description | 368 | ||
| Indications and Advantages | 369 | ||
| Complications | 369 | ||
| Summary | 369 | ||
| Conclusion | 369 | ||
| Clinical Pearls | 370 | ||
| Selected References | 370 | ||
| References | 370.e1 | ||
| 21 Laryngoscopic Tracheal Intubation | 371 | ||
| Chapter Outline | 371 | ||
| Introduction | 371 | ||
| Endotracheal Intubation for Resuscitation | 371 | ||
| Endotracheal Intubation for Prehospital Care | 372 | ||
| Endotracheal Intubation for Emergency Medicine | 372 | ||
| Endotracheal Intubation for Intensive Care | 373 | ||
| Endotracheal Intubation for Anesthesia | 374 | ||
| Decisions Before Tracheal Intubation | 376 | ||
| Preparation for Laryngoscopy and Tracheal Intubation | 376 | ||
| Equipment | 376 | ||
| Laryngoscopy | 376 | ||
| Assessment | 376 | ||
| Assistance | 377 | ||
| Positioning | 377 | ||
| Preoxygenation and Perioxygenation | 378 | ||
| Medications | 379 | ||
| Morbidity, Mortality, and Tracheal Intubation | 379 | ||
| Laryngoscopy Assessment | 379 | ||
| Techniques for Laryngoscopy and Tracheal Intubation | 379 | ||
| Macintosh Laryngoscopy and Tracheal Intubation | 380 | ||
| Technique | 380 | ||
| Straight Blade Laryngoscopy | 384 | ||
| Technique | 385 | ||
| Indications | 386 | ||
| Difficulties | 386 | ||
| Nasal Intubation | 387 | ||
| Preparation | 387 | ||
| Intubation | 387 | ||
| Rapid Sequence Induction | 387 | ||
| Video-Assisted Laryngoscopy | 388 | ||
| Conclusion | 388 | ||
| Clinical Pearls | 388 | ||
| Selected References | 388 | ||
| References | 390.e1 | ||
| 22 Blind Intubation Techniques | 391 | ||
| Chapter Outline | 391 | ||
| Introduction | 391 | ||
| Digital Intubation | 392 | ||
| History | 392 | ||
| Indications | 392 | ||
| Technique | 392 | ||
| Preparation | 392 | ||
| Positioning | 393 | ||
| Procedure | 393 | ||
| Types of Techniques | 394 | ||
| Tracheal Introducer-Assisted Digital Intubation | 394 | ||
| Neonatal Digital Intubation | 394 | ||
| Combined Techniques | 394 | ||
| Clinical Utility and Case History | 395 | ||
| Limitations | 395 | ||
| Blind Nasal Intubation | 396 | ||
| History | 396 | ||
| Indications | 396 | ||
| Contraindications | 396 | ||
| Nostril Selection | 396 | ||
| Technique | 396 | ||
| Preparation | 396 | ||
| Positioning | 397 | ||
| Procedure | 397 | ||
| Light-Guided Blind Nasal Intubation | 397 | ||
| Complications | 397 | ||
| Clinical Utility | 397 | ||
| Retrograde Intubation | 397 | ||
| History | 397 | ||
| “Classic” Technique | 397 | ||
| Preparation | 397 | ||
| Positioning | 398 | ||
| Procedure | 398 | ||
| Other Techniques | 400 | ||
| Clinical Utility | 400 | ||
| Complications | 400 | ||
| Conclusion | 400 | ||
| Clinical Pearls | 400 | ||
| Selected References | 401 | ||
| References | 401.e1 | ||
| 23 Intubating Introducers and Lighted and Optical Stylets | 402 | ||
| Chapter Outline | 402 | ||
| Introduction | 402 | ||
| Intubating Introducers and Stylets | 402 | ||
| Eschmann Introducer | 402 | ||
| Other Types of Intubation Guides | 403 | ||
| Endotracheal Tube Exchangers | 404 | ||
| Stylets | 404 | ||
| Use With Video-Assisted Laryngoscopy | 405 | ||
| Complications | 405 | ||
| Clinical Utility | 405 | ||
| Lighted Stylets | 405 | ||
| Lighted Stylet Intubation: Detailed Technique | 407 | ||
| Preparation | 407 | ||
| Positioning | 407 | ||
| Control of Ambient Light | 407 | ||
| Intubation Technique | 407 | ||
| Oral Intubation | 407 | ||
| Nasal Intubation | 409 | ||
| Clinical Utility of Lighted Stylets | 410 | ||
| Use in Routine Practice | 410 | ||
| Difficult Airway | 410 | ||
| Hemodynamic Effects | 411 | ||
| Pediatric Patients | 411 | ||
| Synergy With Direct Laryngoscopy | 411 | ||
| Use With Other Airway Devices | 411 | ||
| Percutaneous Tracheotomy | 412 | ||
| Limitations | 412 | ||
| Complications | 412 | ||
| Optical Stylets | 412 | ||
| Types of Optical Stylets | 413 | ||
| Clinical Utility of Optical Stylets | 414 | ||
| Combination Techniques | 414 | ||
| Conclusion | 415 | ||
| Clinical Pearls | 415 | ||
| Selected References | 415 | ||
| References | 416.e1 | ||
| 24 Video-Assisted Laryngoscopy | 417 | ||
| Chapter Outline | 417 | ||
| Introduction | 417 | ||
| Brief History | 417 | ||
| Image Recording | 417 | ||
| Clinical Scenarios | 418 | ||
| Undifferentiated Airway | 418 | ||
| Novice Provider | 418 | ||
| Predicted Difficult Intubation | 418 | ||
| Unanticipated Difficult Intubation | 419 | ||
| Video-Assisted Laryngoscopy for Awake Airway Management | 419 | ||
| Video-Assisted Laryngoscopy Outside of the Operating Room | 419 | ||
| Difficulty or Failure With Video-Assisted Laryngoscopy | 419 | ||
| Suspension Pressure During Video-Assisted Laryngoscopy | 420 | ||
| Video-Assisted Laryngoscopy for the Immobilized Cervical Spine | 420 | ||
| Cervical Spine Motion During Video-Assisted Laryngoscopy | 420 | ||
| Combination Techniques With Video-Assisted Laryngoscopy | 422 | ||
| Injury Associated With Video-Assisted Laryngoscopy | 422 | ||
| Comparison of Video-Assisted Laryngoscopy Devices | 422 | ||
| Device Considerations | 422 | ||
| Macintosh Blade Designs | 423 | ||
| Storz C-MAC/DCI | 423 | ||
| McGrath MAC | 423 | ||
| GlideScope Direct | 424 | ||
| Acute-Angle Blade Designs | 424 | ||
| GlideScope | 424 | ||
| McGrath Series 5 | 425 | ||
| C-MAC D-Blade | 425 | ||
| King Vision | 425 | ||
| Channeled Devices | 426 | ||
| Airtraq | 426 | ||
| Pentax AWS | 426 | ||
| Future Directions With Video-Assisted Laryngoscopy | 427 | ||
| Conclusion | 427 | ||
| Clinical Pearls | 427 | ||
| Selected References | 427 | ||
| References | 427.e1 | ||
| 25 Flexible Scope Intubation Techniques | 428 | ||
| Chapter Outline | 428 | ||
| Introduction | 429 | ||
| How They Work, How to Choose, and What to Do With Them | 430 | ||
| Flexible Intubation Scope Design | 431 | ||
| Flexible Intubation Scope Cleaning | 432 | ||
| Deciding on Disposables or Partially Disposables | 432 | ||
| Partial Disposable—Endosheath on a Nondisposable Flexible Fiberoptic Scope | 434 | ||
| Fully Disposable—Nonfiberoptic Flexible Intubation Scope | 434 | ||
| Rationale for Flexible Scope Intubation | 434 | ||
| Criteria for Use | 435 | ||
| Contraindications | 435 | ||
| Equipment | 435 | ||
| Fiberoptic and Nonfiberoptic Flexible Intubation Scope Inner Workings | 435 | ||
| Flexible Intubation Scope Cart | 435 | ||
| Ancillary Equipment | 436 | ||
| Bronchoscopy Swivel Adapters and Endoscopy Masks | 436 | ||
| Intubating Oral Airways | 437 | ||
| Unexpected Adaptations of Short, Soft Nasopharyngeal Airways | 437 | ||
| Endotracheal Tubes: What Is Best? | 437 | ||
| Flexible Scope Intubation in Adults | 438 | ||
| Preparing for Oral Flexible Scope Intubation in Awake Patients | 438 | ||
| Equipment, Monitoring, and Drug Availability | 439 | ||
| Psychological Preparation | 439 | ||
| Pharmacologic Therapy: Rationale | 439 | ||
| Respiratory Monitoring Methods | 439 | ||
| Sedation and Analgesia | 439 | ||
| Local Anesthesia Rationale and Preparation | 440 | ||
| Innervation of the Orotracheal Airway | 440 | ||
| Local Orotracheal Anesthesia Techniques | 441 | ||
| Intraoral Local Anesthesia | 441 | ||
| External Approach to Superior Laryngeal Nerve Block | 441 | ||
| Transtracheal Block | 442 | ||
| Aerosol/Nebulized Method | 443 | ||
| “Spray as You Go” Technique | 443 | ||
| Local Anesthetic Drug Choices | 443 | ||
| Orotracheal Flexible Scope Intubation Technique | 444 | ||
| Practical Application of Orotracheal Flexible Scope Intubation Technique | 444 | ||
| Three Successive Directions for Flexible Intubation Scope Guidance | 445 | ||
| Preparing for Nasotracheal Flexible Scope Intubation Technique in Awake Patients | 447 | ||
| Innervation of the Nasopharyngeal Airway | 447 | ||
| Local Nasopharyngeal Anesthetic Techniques | 447 | ||
| Vasoconstrictors and Local Anesthetic Drug Choices | 448 | ||
| Nasotracheal Flexible Scope Intubation Technique | 448 | ||
| Oral or Nasal Flexible Scope Intubation in Asleep Patients | 448 | ||
| During Routine General Anesthesia | 448 | ||
| During General Anesthesia With Rapid Sequence Induction | 449 | ||
| Flexible Scope Intubation in Unconscious, Unanesthetized Patients | 449 | ||
| Combination Techniques: Devices Combined With Flexible Intubation Scopes | 449 | ||
| Superficial Devices | 450 | ||
| Endoscopy Masks | 450 | ||
| Bronchoscopy Swivel Adapters | 450 | ||
| Short, Soft Nasopharyngeal Airways | 450 | ||
| Supraglottic Airways | 450 | ||
| Supraglottic Airways and Multiple Endotracheal Tube Techniques | 451 | ||
| Supraglottic Airways and Aintree Catheters | 451 | ||
| Supraglottic Airways and Guidewires | 451 | ||
| Intubating Supraglottic Airways | 452 | ||
| Rigid Laryngoscopes | 452 | ||
| Unsoiled Airway Conditions | 452 | ||
| Soiled Airway Conditions | 453 | ||
| Video Laryngoscopes and Optical Laryngoscopes | 453 | ||
| Nonchanneled Devices | 454 | ||
| Channeled Devices | 454 | ||
| Special Flexible Intubation Scope Uses | 455 | ||
| Facilitating Endotracheal Tube Exchange | 455 | ||
| Intubation in the Presence of Preexisting Combitube or Rüsch EasyTube | 456 | ||
| Troubleshooting Blind Nasotracheal Intubation | 456 | ||
| Use Similar to a Lighted Stylet | 456 | ||
| One-Lung Isolation Assistance | 456 | ||
| Troubleshooting Double-Lumen Tubes | 456 | ||
| Troubleshooting Bronchial Blockers | 456 | ||
| Facilitating Retrograde Intubation | 457 | ||
| Flexible Scope Oxygen Insufflation (Rarely Recommended)—Supplements Preferred | 457 | ||
| Flexible Scope Intubation in Infants and Children | 457 | ||
| Preparing for Oral Flexible Scope Intubation in Awake Pediatric Patients | 458 | ||
| Equipment and Monitoring | 458 | ||
| Psychological Preparation | 458 | ||
| Pharmacologic Therapy: Rationale | 458 | ||
| Highlighting Differences in Pediatric Airway Anatomy | 458 | ||
| Local Orotracheal Anesthesia Techniques | 458 | ||
| Local Anesthetic Drug Choices | 459 | ||
| Positioning Infants and Small Children | 459 | ||
| Endotracheal Tubes: Cuffed Versus Uncuffed | 459 | ||
| Orotracheal Flexible Scope Intubation Technique | 459 | ||
| Two-Stage Flexible Scope Intubation Technique | 459 | ||
| Nasotracheal Flexible Scope Intubation Technique | 460 | ||
| Oral or Nasal Flexible Scope Intubation in Asleep Pediatric Patients | 460 | ||
| Patients Under Routine General Anesthesia | 460 | ||
| General Anesthesia Using Short, Soft Nasopharyngeal Airways | 460 | ||
| Advantages of Flexible Intubation Scopes | 460 | ||
| Confirmation Accuracy of the Location of Respiratory Tract Intubation | 460 | ||
| Faster Learning Curve—Faster Time to Intubate Very Difficult Airways | 460 | ||
| Less Patient Trauma or Side Effects | 461 | ||
| Minimal Cervical Spine Motion | 461 | ||
| More Diagnostic Capabilities | 462 | ||
| More Therapeutic Capabilities | 462 | ||
| Disadvantages of Flexible Intubation Scopes: Are They Significant? | 462 | ||
| Unsuccessful Intubation | 462 | ||
| Worsening Respiratory Tract Obstruction | 462 | ||
| Fragility and Expense | 462 | ||
| Space Logistics for Storage and Use | 462 | ||
| Time to Intubation | 462 | ||
| Complications | 462 | ||
| Preventing and Overcoming Flexible Intubation Scope Failure | 463 | ||
| Conquering Inexperience | 463 | ||
| Preventing Insufficient Preparation | 463 | ||
| Maximizing Assistance | 463 | ||
| Thinking Outside the Box and Improving Adaptability | 463 | ||
| Rescuing Insufficient Local Anesthesia | 463 | ||
| Combination Subsets of Plans A, B, and C | 463 | ||
| Dodging Discordance Diameters | 463 | ||
| Practicing Tips for Novices, Intermediates, or Experts | 463 | ||
| A Spectrum of Games, the Web, and Workshops for Learning | 464 | ||
| A Gamut of Free to Intricately Designed Dexterity Practice | 464 | ||
| Manikin Heads and Full Bodies | 464 | ||
| Dexterity Models and Sophisticated Simulators | 464 | ||
| Experience High-Fidelity Inanimate Airway Models | 464 | ||
| Try Purely Computer-Based Bronchoscopy Simulators | 464 | ||
| How About Low-Fidelity Training Models? | 465 | ||
| Make a Free Model in 5 Minutes | 466 | ||
| The Living Human Experience: The Best Care | 467 | ||
| Examination Experience With Already Intubated Healthy Patients | 467 | ||
| Asleep Patients Using Endoscopy Mask or Swivel Adapters | 467 | ||
| Practice Troubleshooting High Airway Pressures, Low Saturations, Uncertain Endotracheal or Supraglottic Airway Positions, or One-Lung Isolation | 467 | ||
| Choose Handling Routine General Anesthesia and Intubation | 468 | ||
| Move on to Awake Flexible Scope Intubation Experiences | 468 | ||
| Generous Instructor Teaching and Learning Experience: Does It Help? | 468 | ||
| Instruction | 468 | ||
| Assessing Knowledge, Planning, and Technical Proficiency | 468 | ||
| Tips on Using Flexible Intubation Scopes in Any Clinical Setting | 468 | ||
| Skill Retention Tips | 468 | ||
| Conclusion | 469 | ||
| Clinical Pearls | 469 | ||
| Acknowledgment | 470 | ||
| Selected References | 470 | ||
| References | 470.e1 | ||
| 26 Separation of the Two Lungs | 471 | ||
| Chapter Outline | 471 | ||
| Introduction | 471 | ||
| Physiology | 471 | ||
| Indications for Lung Separation | 472 | ||
| Absolute Indications | 472 | ||
| Relative Indications | 472 | ||
| Techniques | 473 | ||
| Double-Lumen Tubes | 473 | ||
| Anatomy | 473 | ||
| Advantages | 473 | ||
| Disadvantages | 473 | ||
| Selection | 474 | ||
| Right-Sided Versus Left-Sided Double-Lumen Tubes | 474 | ||
| Double-Lumen Tube Size | 474 | ||
| Positioning | 474 | ||
| Placement of the Double-Lumen Tube | 474 | ||
| Confirmation of Proper Placement | 476 | ||
| Malpositioning and Complications | 476 | ||
| Exchanging the Double-Lumen Tube for a Single-Lumen Tube | 479 | ||
| Procedure | 479 | ||
| Airway Exchange Catheters | 479 | ||
| Contraindications | 479 | ||
| Single-Lumen Tubes | 480 | ||
| Indications | 480 | ||
| Difficult Airways | 480 | ||
| Segmental Lobe Isolation | 480 | ||
| Disadvantages | 480 | ||
| Lung Deflation | 480 | ||
| Secretion Removal | 480 | ||
| Bronchial Mucosal Damage | 480 | ||
| Treatment of Desaturation | 481 | ||
| Univent Tubes | 481 | ||
| Anatomy | 481 | ||
| Positioning | 481 | ||
| Endobronchial Blockers | 483 | ||
| Indications | 483 | ||
| Coaxial Stand-Alone Endotracheal Blockers | 483 | ||
| Arndt Endobronchial Blocker | 483 | ||
| Cohen Flexitip Endobronchial Blocker | 484 | ||
| Uniblocker | 485 | ||
| EZ-Blocker | 485 | ||
| Fogarty Catheters | 486 | ||
| Para-Axial Endotracheal Blockers | 486 | ||
| Pediatric Lung Isolation | 487 | ||
| Ventilation-Perfusion During Thoracic Surgery | 487 | ||
| Indications and Techniques for Single-Lung Ventilation in Infants and Children | 488 | ||
| Single-Lumen Tube | 488 | ||
| Balloon-Tipped Bronchial Blockers | 488 | ||
| Univent Tube | 489 | ||
| Double-Lumen Tubes | 489 | ||
| Conclusion | 489 | ||
| Clinical Pearls | 489 | ||
| Selected References | 490 | ||
| References | 490.e1 | ||
| 27 Percutaneous Emergency Airway Access | 491 | ||
| Chapter Outline | 491 | ||
| Introduction | 492 | ||
| Definitions and Classifications | 492 | ||
| Cricothyrotomy and Percutaneous Dilational Cricothyrotomy | 492 | ||
| Tracheostomy and Percutaneous Dilational Tracheostomy | 493 | ||
| Open Tracheostomy | 493 | ||
| Percutaneous Tracheostomy | 493 | ||
| Transtracheal Jet Ventilation | 494 | ||
| Role of the Anesthesiologist, Emergency Medicine Physician, and Otolaryngologist | 494 | ||
| Anatomy and Physiology | 495 | ||
| Indications and Contraindications | 495 | ||
| Cricothyrotomy | 495 | ||
| Percutaneous Dilational Tracheostomy | 497 | ||
| Transtracheal Jet Ventilation | 497 | ||
| Rescue Oxygenation in a Cannot Intubate/Cannot Oxygenate Situation | 497 | ||
| Airway Rescue in Complete Upper Airway Obstruction | 498 | ||
| Supplemental Oxygenation During Difficult Tracheal Intubation | 498 | ||
| Ventilation During Upper Airway Surgery | 498 | ||
| Percutaneous Dilational Cricothyrotomy | 498 | ||
| Principles and Planning | 498 | ||
| Specific Cricothyrotomy Sets | 499 | ||
| Melker Emergency Cricothyrotomy Catheter Set | 499 | ||
| Arndt Emergency Cricothyrotomy Catheter Set | 500 | ||
| Pertrach | 500 | ||
| QuickTrach | 500 | ||
| Portex Cricothyroidotomy Kit | 500 | ||
| Special Considerations | 500 | ||
| Skin Incision Before Needle Insertion | 500 | ||
| Vertical Versus Horizontal Incision | 500 | ||
| Over-the-Needle Catheter Versus Introducer Needle | 500 | ||
| Percutaneous Dilational Tracheostomy | 502 | ||
| Principles and Planning | 502 | ||
| Insertion Techniques | 503 | ||
| Seldinger Guidewire and Single-Dilator Kits | 503 | ||
| Ciaglia Blue Rhino G2 Advanced Percutaneous Tracheostomy Kit | 505 | ||
| Portex ULTRAperc Single-Stage Dilator | 505 | ||
| Dolphin BT Ciaglia Balloon-Assisted Tracheostomy Introducer | 507 | ||
| Portex Griggs Percutaneous Dilation Tracheostomy Kit | 507 | ||
| PercuTwist | 508 | ||
| Translaryngeal Tracheostomy Kit | 508 | ||
| Controversies | 510 | ||
| Use of Bronchoscopy and Ultrasonography | 510 | ||
| Patient’s Habitus | 510 | ||
| Transtracheal Jet Ventilation | 510 | ||
| Principles and Planning | 510 | ||
| Equipment | 511 | ||
| Insertion Techniques | 511 | ||
| Postoperative Considerations | 512 | ||
| 5 Difficult Airway Situations | 551 | ||
| 31 Prehospital Airway Management | 552 | ||
| Chapter Outline | 552 | ||
| Overview of the Prehospital Care Environment and Structure | 552 | ||
| Different Types of Emergency Medical Service Systems and Providers | 552 | ||
| Unique Considerations | 553 | ||
| Airway Management Issues by Specific Setting | 553 | ||
| Ground Versus Air/Critical Care Transport | 553 | ||
| Urban Setting | 553 | ||
| Austere Environment | 553 | ||
| Airway Management Issues by Specific Clinical Condition | 553 | ||
| Cardiac Arrest | 553 | ||
| Trauma | 554 | ||
| Specific Airway Techniques in the Prehospital Environment | 554 | ||
| Bag-Mask Ventilation | 554 | ||
| Noninvasive Positive Pressure Ventilation | 554 | ||
| Endotracheal Intubation | 555 | ||
| Intubation of the Supine Patient | 555 | ||
| Intubation of the Nonsupine Patient | 555 | ||
| Entrapped Patients | 556 | ||
| Controversies in Prehospital Airway Management | 557 | ||
| Blind Nasotracheal Intubation | 557 | ||
| Medication-Facilitated Airway Management | 557 | ||
| Rapid Sequence Intubation | 558 | ||
| Rapid Sequence Airway | 558 | ||
| Sedation-Facilitated Intubation | 558 | ||
| Airway Management for Out-of-Hospital Cardiac Arrest | 558 | ||
| Pediatric Intubation | 559 | ||
| Video-Assisted Laryngoscopy | 559 | ||
| Cricothyrotomy | 559 | ||
| Paramedic Education and Training | 560 | ||
| Initial Intubation Training | 560 | ||
| Skill Retention | 560 | ||
| Quality Assurance and Improvement | 560 | ||
| Future Directions | 560 | ||
| Approaching the Airway as Continuum of Care | 560 | ||
| Awake Techniques | 560 | ||
| Flexible Endoscopic Techniques | 561 | ||
| Telebation | 561 | ||
| Conclusion | 561 | ||
| Clinical Pearls | 561 | ||
| Selected References | 561 | ||
| References | 561.e1 | ||
| 32 Cardiopulmonary Resuscitation and Airway Management | 562 | ||
| Chapter Outline | 562 | ||
| Introduction | 562 | ||
| Basic Life Support and Cardiopulmonary Resuscitation Guidelines | 562 | ||
| Initial Airway Management During Cardiopulmonary Resuscitation | 565 | ||
| Rescue Breathing | 565 | ||
| Airway Adjuncts | 567 | ||
| Advanced Airway Management During Cardiopulmonary Resuscitation | 567 | ||
| Confirmation of Endotracheal Tube Placement During Cardiopulmonary Resuscitation | 568 | ||
| Use of Cricoid Pressure During Cardiopulmonary Resuscitation | 568 | ||
| Supraglottic Airway Devices | 568 | ||
| Role of Advanced Airway Devices | 568 | ||
| Alternative Methods of Oxygen Delivery During Cardiopulmonary Resuscitation | 568 | ||
| Oxylator | 568 | ||
| ResQPOD | 569 | ||
| Passive Oxygen Insufflation | 569 | ||
| Challenges of Airway Management During Cardiopulmonary Resuscitation | 569 | ||
| Access to the Airway | 570 | ||
| Cervical Spine Injury | 570 | ||
| Equipment Challenges | 570 | ||
| Controversies | 570 | ||
| Role of Hyperventilation | 570 | ||
| When to Secure the Airway | 570 | ||
| Supraglottic Airway Devices Versus Endotracheal Intubation as an Advanced Airway Technique | 570 | ||
| Pediatric Basic Life Support and Resuscitation | 571 | ||
| Neonatal Basic Life Support and Resuscitation | 571 | ||
| Conclusion | 571 | ||
| Clinical Pearls | 571 | ||
| Selected References | 573 | ||
| References | 573.e1 | ||
| 33 Austere Environment and Disaster Preparedness | 574 | ||
| Chapter Outline | 574 | ||
| Introduction | 574 | ||
| Epidemiology: Natural Versus Man-Made Disasters | 574 | ||
| Triage Techniques | 574 | ||
| Mass Trauma | 575 | ||
| Operating Room Checklist for Mass Casualty | 577 | ||
| Biological Threats | 577 | ||
| Epidemic Versus Pandemic | 577 | ||
| Chemical Threats | 579 | ||
| Radiation Exposure | 579 | ||
| Airway Management in Austere Environments | 580 | ||
| Surge Management | 581 | ||
| Personal Protective Equipment | 581 | ||
| Infrastructure Resiliency | 582 | ||
| Simulation and Training | 582 | ||
| Conclusion | 582 | ||
| Clinical Pearls | 582 | ||
| Selected References | 582 | ||
| References | 583.e1 | ||
| 34 Airway Management in the Trauma Patient | 584 | ||
| Chapter Outline | 584 | ||
| Introduction | 584 | ||
| General Considerations | 585 | ||
| Challenges in the Emergency Department or Trauma Resuscitation Unit | 585 | ||
| Indications for Airway Management | 585 | ||
| Principles of Airway Management in the Trauma Patient | 587 | ||
| Prevention of Aspiration | 587 | ||
| Pharmacologic Considerations | 588 | ||
| Induction Agents | 588 | ||
| Neuromuscular Blocking Agents | 588 | ||
| Other Pharmacologic Agents | 589 | ||
| Choice of Technique and the Difficult Airway | 589 | ||
| Management of the Combative Patient | 591 | ||
| Dealing With the Field-Placed Airway | 591 | ||
| Damage Control Radiology and Airway Management | 592 | ||
| Specific Clinical Considerations in Trauma | 593 | ||
| Direct Airway Trauma | 593 | ||
| Penetrating Neck Trauma | 593 | ||
| Blunt Neck Trauma | 595 | ||
| Maxillofacial Trauma | 595 | ||
| Cervical Spine Injury | 596 | ||
| Traumatic Brain Injury | 597 | ||
| Intraocular Injury | 598 | ||
| Thoracic Injury | 598 | ||
| Conclusion | 599 | ||
| Clinical Pearls | 599 | ||
| Selected References | 599 | ||
| References | 599.e1 | ||
| 35 Airway Management in Burn Patients | 600 | ||
| Chapter Outline | 600 | ||
| Introduction | 600 | ||
| Burn Injury and the Airway | 600 | ||
| Phases of Burn Injury | 600 | ||
| Carbon Monoxide and Cyanide Toxicity | 601 | ||
| Specific Airway Management Considerations in Burn Patients | 601 | ||
| Pharmacologic Considerations in Burn Patients | 601 | ||
| Airway Management During the Acute Phase of Burn Injury | 602 | ||
| Airway Management During the Subacute Phase of Burn Injury | 603 | ||
| Airway Management During the Chronic Phase of Burn Injury | 604 | ||
| Tracheal Extubation in Burn Patients | 606 | ||
| Airway Management of Pediatric Burn Patients | 606 | ||
| Conclusion | 607 | ||
| Clinical Pearls | 607 | ||
| Selected References | 607 | ||
| References | 607.e1 | ||
| 36 Airway Management in Pediatric Patients | 608 | ||
| Chapter Outline | 608 | ||
| Introduction | 609 | ||
| Anatomy of the Pediatric Airway | 609 | ||
| Larynx | 609 | ||
| Epiglottis | 609 | ||
| Subglottis | 609 | ||
| Evaluation of the Pediatric Airway | 609 | ||
| Diagnostic Evaluation | 610 | ||
| Classification of the Difficult Pediatric Airway | 610 | ||
| Pediatric Airway Equipment | 610 | ||
| Face Mask | 610 | ||
| Oropharyngeal Airway | 611 | ||
| Nasopharyngeal Airway | 611 | ||
| Endotracheal Tube | 611 | ||
| Endotracheal Tube Exchangers | 612 | ||
| Laryngoscopes | 612 | ||
| Straight Versus Curved Blades | 612 | ||
| Oxyscope | 612 | ||
| Anterior Commissure Laryngoscope | 612 | ||
| Video Laryngoscopes | 612 | ||
| Stylets | 613 | ||
| Lighted Stylets | 613 | ||
| Optical Stylets | 613 | ||
| Video-Optical Intubation Stylet | 614 | ||
| Supraglottic Airway Devices | 614 | ||
| Laryngeal Mask Airway Family | 614 | ||
| Air-Q Intubating Laryngeal Airway | 614 | ||
| Rigid Ventilating Bronchoscope | 615 | ||
| Induction Technique | 615 | ||
| Airway Management Techniques | 616 | ||
| Techniques for Ventilation | 616 | ||
| Techniques for Intubation | 616 | ||
| Direct Laryngoscopy | 616 | ||
| Fiberoptic Laryngoscopy | 616 | ||
| Retrograde Intubation | 617 | ||
| Emergency Access | 618 | ||
| Other Intubation Techniques | 618 | ||
| Complications of Airway Management | 618 | ||
| Airway Diseases and Implications | 618 | ||
| Head Anomalies | 618 | ||
| Airway Implications | 618 | ||
| Specific Anomalies | 619 | ||
| Encephalocele | 619 | ||
| Hydrocephalus | 619 | ||
| Mucopolysaccharidoses | 619 | ||
| Facial Anomalies: Maxillary and Mandibular Disease | 619 | ||
| Tumors | 620 | ||
| Cystic Hygroma | 620 | ||
| Neck Teratoma | 620 | ||
| Cherubism | 620 | ||
| Congenital Hypoplasia | 620 | ||
| Acrocephalosyndactyly | 620 | ||
| Apert Syndrome. | 621 | ||
| Crouzon Syndrome. | 621 | ||
| Pfeiffer Syndrome (Type I). | 621 | ||
| Acrocephalopolysyndactyly | 621 | ||
| Carpenter Syndrome (Type II). | 621 | ||
| Mandibular Hypoplasia | 622 | ||
| Pierre Robin Syndrome. | 622 | ||
| Treacher Collins Syndrome. | 622 | ||
| Goldenhar Syndrome/Hemifacial Microsomia. | 623 | ||
| Nager Syndrome. | 623 | ||
| Smith-Lemli-Opitz Syndrome | 623 | ||
| Cornelia de Lange (Cryptophthalmos) Syndrome | 623 | ||
| Hallermann-Streiff Syndrome | 624 | ||
| Turner Syndrome | 624 | ||
| Inflammatory Disease | 624 | ||
| Juvenile Rheumatoid Arthritis (Still Disease) | 624 | ||
| Mouth and Tongue Anomalies | 624 | ||
| Microstomia | 624 | ||
| Congenital Microstomia | 624 | ||
| Freeman-Sheldon Syndrome. | 624 | ||
| Hallermann-Streiff Syndrome. | 624 | ||
| Airway Implications. | 624 | ||
| Acquired Microstomia | 624 | ||
| Epidermolysis Bullosa Hereditaria Dystrophica. | 624 | ||
| Burns From Lye Ingestion. | 625 | ||
| Diseases of the Tongue | 625 | ||
| Congenital Disease | 625 | ||
| Hemangioma. | 625 | ||
| Lymphangioma. | 625 | ||
| Traumatic Injury | 625 | ||
| Lymphatic or Venous Obstruction. | 625 | ||
| Metabolic Disorders | 625 | ||
| Glycogen Storage Diseases. | 625 | ||
| Lipid Storage Diseases. | 625 | ||
| Neurofibromatosis. | 626 | ||
| Tongue Tumors | 626 | ||
| Lingual Tonsil Hypertrophy. | 626 | ||
| Nasal and Palatal Anomalies | 626 | ||
| Choanal Atresia | 626 | ||
| Nasal Masses | 627 | ||
| Palatal Anomalies | 627 | ||
| Adenotonsillar Disease | 628 | ||
| Obstructive Sleep Apnea | 628 | ||
| Definition | 628 | ||
| Prevalence of Snoring | 628 | ||
| Pathophysiology and Clinical Picture | 629 | ||
| Laboratory Evaluation | 629 | ||
| Retropharyngeal and Parapharyngeal Abscesses | 631 | ||
| Pharyngeal Bullae or Scarring | 632 | ||
| Dystrophic Epidermolysis Bullosa | 632 | ||
| Epidermolysis Bullosa Simplex | 632 | ||
| Junctional Epidermolysis Bullosa | 632 | ||
| Laryngeal Anomalies | 633 | ||
| Laryngomalacia | 633 | ||
| Epiglottitis | 633 | ||
| Congenital Glottic Lesions | 634 | ||
| Recurrent Respiratory Papillomatosis | 634 | ||
| Laryngeal Granulomas | 634 | ||
| Congenital and Acquired Subglottic Disease | 634 | ||
| Subglottic Stenosis | 634 | ||
| 6 Postintubation Procedures | 781 | ||
| 45 Endotracheal Tube and Respiratory Care | 782 | ||
| Chapter Outline | 782 | ||
| Introduction | 782 | ||
| Properties of the Endotracheal Tube | 783 | ||
| Anatomy of the Endotracheal Tube | 783 | ||
| Development and Properties of the Endotracheal Tube | 784 | ||
| Physiologic Effects of Endotracheal Tube Placement | 784 | ||
| Complications of Endotracheal Tube Placement | 785 | ||
| Endotracheal Tubes and Other Airway Adjuncts | 785 | ||
| Choice of Endotracheal Tube Size | 785 | ||
| Small Tubes and Airway Resistance | 785 | ||
| Large Tubes and Trauma | 786 | ||
| Potentially Beneficial Alternatives to the Standard Endotracheal Tube | 786 | ||
| Preformed and Reinforced Tubes | 786 | ||
| Laser Tubes | 786 | ||
| Subglottic Suctioning “Evac” Endotracheal Tubes | 787 | ||
| Double-Lumen Endotracheal Tubes | 787 | ||
| Supraglottic Airways | 788 | ||
| Proper Safeguarding of the Airway | 788 | ||
| Airway Evaluation: Predicting the Difficult Airway | 788 | ||
| Identifying Proper Position of the Endotracheal Tube | 789 | ||
| Detection of Esophageal Intubation | 789 | ||
| Confirmation of Appropriate Depth of Insertion | 790 | ||
| Cuff Pressure Monitoring | 791 | ||
| Evaluation of a Cuff Leak | 791 | ||
| Documentation of Placement | 792 | ||
| Stabilization of the Endotracheal Tube | 792 | ||
| Taping | 792 | ||
| Commercially Available Devices | 794 | ||
| Stapling for Facial Burns | 795 | ||
| Rapid Response Cart for Airway Emergencies | 795 | ||
| Maintenance of the Endotracheal Tube | 795 | ||
| Heat and Humidity of Inspired Gas | 796 | ||
| Suctioning | 796 | ||
| Subglottic Care | 797 | ||
| Bronchoscopy | 797 | ||
| Biofilm Management | 797 | ||
| Respiratory Therapies for the Intubated Patient | 798 | ||
| Secretion Clearance and Control Therapies | 798 | ||
| Mucolytic Agents | 798 | ||
| Chest Physiotherapy | 798 | ||
| Percussion and Postural Drainage | 798 | ||
| Positive End-Expiratory Pressure Therapy | 799 | ||
| Intrapulmonary Percussive Ventilation | 799 | ||
| High-Frequency Chest Wall Compression | 799 | ||
| Overcoming Work of Breathing Imposed by Endotracheal Tubes, Tracheostomy Tubes, and Ventilator Circuits | 799 | ||
| Pressure Support | 799 | ||
| Continuous Positive Airway Pressure | 799 | ||
| Automatic Tube Compensation | 800 | ||
| Pharmacologic Treatments | 800 | ||
| Inhalation Drug Delivery | 800 | ||
| Nebulizers | 800 | ||
| Metered-Dose Inhalers | 800 | ||
| Inhaled Bronchodilators | 800 | ||
| Anticholinergics | 801 | ||
| Corticosteroids | 801 | ||
| Inhaled Antibiotics | 801 | ||
| Miscellaneous Adjuncts for Bronchospasm | 801 | ||
| Positioning of the Patient | 801 | ||
| Conclusion | 802 | ||
| Clinical Pearls | 802 | ||
| Selected References | 802 | ||
| References | 803.e1 | ||
| 46 Mechanical Ventilation | 804 | ||
| Chapter Outline | 804 | ||
| Introduction | 804 | ||
| Initiation of Mechanical Ventilation | 805 | ||
| Noninvasive Ventilation | 805 | ||
| Invasive Mechanical Ventilation | 806 | ||
| Characteristics of Mechanical Ventilation | 806 | ||
| Tidal Volume | 807 | ||
| Respiratory Rate | 807 | ||
| Positive End-Expiratory Pressure | 807 | ||
| Fraction of Inspired Oxygen | 808 | ||
| Peak Pressure | 808 | ||
| Plateau Pressure | 808 | ||
| Trigger Sensitivity | 809 | ||
| Flow Rate | 809 | ||
| Flow Pattern | 809 | ||
| Common Modes of Mechanical Ventilation | 809 | ||
| Assist-Control Ventilation | 809 | ||
| Synchronized Intermittent Mandatory Ventilation | 811 | ||
| Pressure-Support Ventilation | 811 | ||
| Pressure-Regulated Volume Control | 811 | ||
| Uncommon Modes of Ventilation | 812 | ||
| Inverse-Ratio Ventilation | 812 | ||
| Airway Pressure Release Ventilation | 812 | ||
| High-Frequency Ventilation | 812 | ||
| Proportional Assist Ventilation | 813 | ||
| Volume Guarantee Ventilation | 813 | ||
| Acute Respiratory Distress Syndrome Management of Acute Respiratory Distress Syndrome | 813 | ||
| Weaning From Mechanical Ventilation | 814 | ||
| Complications of Mechanical Ventilation | 815 | ||
| Mechanical Complications | 815 | ||
| Auto-Positive End-Expiratory Pressure | 817 | ||
| Consequences of Auto-Positive End-Expiratory Pressure | 818 | ||
| Infectious Complications | 818 | ||
| Conclusion | 819 | ||
| Clinical Pearls | 820 | ||
| Selected References | 820 | ||
| References | 820.e1 | ||
| 47 Monitoring the Airway and Pulmonary Function | 821 | ||
| Chapter Outline | 821 | ||
| Introduction | 821 | ||
| Monitoring the Airway | 821 | ||
| Monitoring the Native (Nonintubated) Airway | 822 | ||
| Monitoring the Airway During Tracheal Instrumentation | 823 | ||
| Monitoring the Airway in the Mechanically Ventilated Patient | 825 | ||
| Monitoring the Airway After Tracheal Extubation | 825 | ||
| Monitoring the Airway in the Patient With a Tracheostomy | 826 | ||
| Monitoring Respiratory Function | 827 | ||
| Clinical Assessment | 827 | ||
| Imaging | 827 | ||
| Assessment of Gas Exchange | 828 | ||
| Blood Gas Monitoring | 828 | ||
| Noninvasive Monitoring | 829 | ||
| Pulse Oximetry | 829 | ||
| Capnography | 836 | ||
| Monitoring Pulmonary Function During Mechanical Ventilatory Support | 837 | ||
| Assessment of Ventilation | 837 | ||
| Assessment of Tidal Volume and Airflow | 838 | ||
| Assessment of Work of Breathing | 839 | ||
| Ventilatory Waveform Analysis | 839 | ||
| Airway Resistance and Lung-Thorax Compliance | 840 | ||
| Intrinsic Positive End-Expiratory Pressure | 840 | ||
| Special Considerations During Noninvasive Ventilation | 841 | ||
| Assessment During Weaning From Mechanical Ventilatory Support | 841 | ||
| Indices to Predict Weaning From Mechanical Ventilator Support | 842 | ||
| Breathing Pattern Analysis | 842 | ||
| Airway Occlusion Pressure | 842 | ||
| Assessment of Respiratory Function With Spontaneously Initiated Modes of Mechanical Ventilation | 842 | ||
| Conclusion | 843 | ||
| Clinical Pearls | 843 | ||
| Selected References | 843 | ||
| References | 843.e1 | ||
| 48 Extubation and Reintubation of the Difficult Airway | 844 | ||
| Chapter Outline | 844 | ||
| Introduction | 845 | ||
| Extubation Failures and Challenges | 845 | ||
| Extubation Risk Stratification | 845 | ||
| Rates, Causes, and Complications of Routine Extubation Failure | 845 | ||
| Hypoventilation Syndromes | 846 | ||
| Hypoxemic Respiratory Failure | 846 | ||
| Inability to Protect the Airway | 846 | ||
| Failure of Pulmonary Toilet | 846 | ||
| Airway Obstruction | 847 | ||
| Laryngeal Edema | 847 | ||
| Laryngospasm | 847 | ||
| Macroglossia | 848 | ||
| Laryngeal or Tracheal Injury | 848 | ||
| Postobstructive Pulmonary Edema | 849 | ||
| Inadvertent Extubations | 849 | ||
| Tracheal Tube Entrapment | 849 | ||
| Hypertension and Tachycardia | 849 | ||
| Intracranial Hypertension | 849 | ||
| Intraocular Pressure | 849 | ||
| Coughing | 850 | ||
| Higher Risk Extubations | 850 | ||
| Clinical Settings of Complications | 850 | ||
| Perioperative Settings | 850 | ||
| Laryngoscopic Surgery | 850 | ||
| Thyroid Surgery | 850 | ||
| Carotid Artery Surgery | 852 | ||
| Cervical Spine Surgery | 852 | ||
| Maxillofacial Surgery and Trauma | 853 | ||
| Thermal Airway Injury | 854 | ||
| Deep Neck Infections | 854 | ||
| Posterior Fossa Surgery | 854 | ||
| Stereotactic Surgery and Cervical Immobilization | 854 | ||
| Tracheal Resections | 855 | ||
| Palatoplasty | 855 | ||
| Preexisting Medical Conditions | 855 | ||
| Obesity, Morbid Obesity, and Obstructive Sleep Apnea Syndrome | 855 | ||
| Paradoxical Vocal Cord Motion | 855 | ||
| Parkinson Disease and Multiple System Atrophy | 856 | ||
| Rheumatoid Arthritis | 857 | ||
| Tracheomalacia | 857 | ||
| Laryngeal Incompetence | 858 | ||
| Pulmonary Aspiration of Gastric Contents | 858 | ||
| Factors Affecting Intubation and Extubation | 858 | ||
| Known Difficult Airway | 858 | ||
| Limited Access | 858 | ||
| Higher Risk Cases | 858 | ||
| Extubation Strategies | 859 | ||
| Deep Versus Awake Extubation | 859 | ||
| Extubation With a Laryngeal Mask or Other Supraglottic Airway | 859 | ||
| Extubation or Reintubation With a Flexible Bronchoscope or Laryngoscope | 860 | ||
| Use of a Gum Elastic Bougie or Mizus Endotracheal Tube Replacement Obturator | 860 | ||
| Use of Jet Stylets | 860 | ||
| Use of Commercial Tube Exchangers | 860 | ||
| Tracheal Tube Exchangers | 861 | ||
| Cook Airway Exchange Catheters | 861 | ||
| Arndt Airway Exchange Catheter | 862 | ||
| Staged Extubation Set | 862 | ||
| Endotracheal Ventilation Catheter | 862 | ||
| Techniques for Airway Exchange | 863 | ||
| Exchange of Double-Lumen Tubes | 863 | ||
| Visually Assisted Tube Exchange | 864 | ||
| Conversion from Nasal to Oral Intubation | 864 | ||
| Conversion from Oral to Nasal Intubation | 864 | ||
| Conversion from Supraglottic Airways to Endotracheal Tubes | 865 | ||
| Changing Tracheostomy Tubes | 865 | ||
| Insufflation and Jet Ventilation Through Stylets | 865 | ||
| Communication | 866 | ||
| Conclusion | 866 | ||
| Clinical Pearls | 866 | ||
| Selected References | 867 | ||
| References | 867.e1 | ||
| 49 Complications of Managing the Airway | 868 | ||
| Chapter Outline | 868 | ||
| Complications in Managing Patients With Difficult Airways | 868 | ||
| History of the Patient and Examination | 869 | ||
| Omission, Commission, and Communication | 870 | ||
| Planning and Scheduling | 870 | ||
| Complications With Mask Ventilation | 870 | ||
| The Sterilization Process | 870 | ||
| Mechanical Difficulties | 870 | ||
| Prolonged Mask Ventilation | 871 | ||
| Complications With Supraglottic Airways | 871 | ||
| Laryngeal Mask Airway | 871 | ||
| Esophageal-Tracheal Combitube and EasyTube | 872 | ||
| Other Supraglottic Airway Devices | 872 | ||
| Complications With Intubation | 872 | ||
| Endotracheal Intubation | 872 | ||
| Anatomic Requirements | 872 | ||
| Laryngoscope Modifications and Rigid Optical Instruments | 873 | ||
| Difficult Intubation | 873 | ||
| Traumatic Intubation | 873 | ||
| Lip Injury | 874 | ||
| Dental Injury | 874 | ||
| Tongue Injury | 874 | ||
| Injury to the Uvula | 874 | ||
| Pharyngeal Mucosal Injury | 874 | ||
| Laryngeal Trauma and Injury to the Vocal Cords | 875 | ||
| Tracheobronchial Injury | 876 | ||
| Barotrauma | 877 | ||
| Nerve Injuries | 877 | ||
| Spinal Cord and Vertebral Column Injury | 877 | ||
| Eye Injuries | 877 | ||
| Temporomandibular Joint Injuries | 878 | ||
| Nasotracheal Passage | 878 | ||
| Cranial Intubation | 878 | ||
| Nasal Injury | 878 | ||
| Foreign Bodies | 879 | ||
| Esophageal Intubation | 879 | ||
| Endotracheal Tube Placement | 879 | ||
| Esophageal Perforation and Retropharyngeal Abscess | 879 | ||
| Bronchial Intubation | 879 | ||
| Use of an Endotracheal Tube | 879 | ||
| Use of a Double-Lumen Tube | 880 | ||
| Maintenance of the Endotracheal Tube | 880 | ||
| Airway Obstruction | 880 | ||
| Disconnection and Dislodgment | 880 | ||
| Circuit Leaks | 881 | ||
| Laser Fires | 881 | ||
| Special Techniques | 881 | ||
| Flexible Scope Intubation | 881 | ||
| Lighted Stylets | 881 | ||
| Submandibular and Submental Approach for Tracheal Intubation | 882 | ||
| Complications With Infraglottic Procedures | 882 | ||
| Translaryngeal Airway | 882 | ||
| Retrograde Wire Intubation | 882 | ||
| Cricothyrotomy | 882 | ||
| Transtracheal Airway | 882 | ||
| Transtracheal Jet Ventilation | 882 | ||
| Percutaneous Dilatational Tracheostomy | 883 | ||
| Formal Tracheostomy | 883 | ||
| Physiologic Responses | 883 | ||
| Hemodynamic Changes | 883 | ||
| Laryngospasm | 884 | ||
| Bronchospasm | 885 | ||
| Coughing and Bucking | 885 | ||
| Vomiting, Regurgitation, and Aspiration | 885 | ||
| Intraocular Pressure Changes | 885 | ||
| Intracranial Pressure Changes | 885 | ||
| Latex Allergy | 885 | ||
| Complications With Extubation | 886 | ||
| Hemodynamic Changes | 886 | ||
| Laryngospasm | 886 | ||
| Laryngeal Edema | 887 | ||
| Laryngotracheal Trauma | 887 | ||
| Bronchospasm | 887 | ||
| Negative-Pressure Pulmonary Edema | 887 | ||
| Aspiration | 887 | ||
| Airway Compression | 887 | ||
| Difficult Extubation | 888 | ||
| Accidental Extubation | 888 | ||
| Conclusion | 888 | ||
| Clinical Pearls | 888 | ||
| Selected References | 888 | ||
| References | 889.e1 | ||
| 7 Societal Considerations | 890 | ||
| 50 Airway Management Education | 891 | ||
| Chapter Outline | 891 | ||
| Introduction | 891 | ||
| Clinical Teaching | 892 | ||
| The Features of a Good Clinical Teacher | 892 | ||
| Creating a Learning Experience | 893 | ||
| Miller Learning Pyramid | 893 | ||
| Developing Expertise in Airway Management | 894 | ||
| Competency-Based Medical Education Curriculum | 894 | ||
| Airway Education Backed Up by Practice Guidelines, Algorithms, and Cognitive Aids | 895 | ||
| Mastery Learning | 895 | ||
| A Staged Approach to Developing Airway Expertise | 895 | ||
| Residency and Fellowship Training | 895 | ||
| Airway Fellowships | 895 | ||
| Senior Practitioners | 896 | ||
| Procedural Skill Education | 896 | ||
| Airway Equipment | 896 | ||
| Airway Workshops | 896 | ||
| Choosing the Right Training Method | 897 | ||
| Simulation-Based Medical Education | 897 | ||
| Simulator Fidelity | 898 | ||
| Simulation for Assessment | 898 | ||
| Preprocedural Warm-up | 898 | ||
| Translational Outcomes | 898 | ||
| Other Sources of Airway Management Education | 898 | ||
| Airway Societies | 898 | ||
| E-Learning | 899 | ||
| Social Media Medical Education | 899 | ||
| Assessment, Feedback, and Debriefing | 899 | ||
| Under- and Postgraduate Airway Management Education | 901 | ||
| Teaching Airway Teachers | 901 | ||
| Skills Training: Hands-on and Didactic Teaching | 901 | ||
| Distant Learning | 901 | ||
| Human Factors and Leadership Education | 901 | ||
| Research for Airway Management Education | 902 | ||
| Conclusion | 902 | ||
| Clinical Pearls | 902 | ||
| Selected References | 903 | ||
| References | 904.e1 | ||
| 51 Dissemination of Critical Airway Information | 905 | ||
| Chapter Outline | 905 | ||
| Introduction | 905 | ||
| Difficult Airway/Intubation: A Multifaceted Problem | 905 | ||
| Identification of Patients | 905 | ||
| Multidisciplinary Practice Guidelines and Difficult Airway/Intubation Algorithms and Recommendations for Dissemination and Documentation | 906 | ||
| Consequences of Difficult Airway Management | 906 | ||
| Difficult Airway/Intubation: Dissemination and Documentation of Critical Information | 906 | ||
| Documentation in Medical/Anesthesia Records | 906 | ||
| Verbal Dissemination of Information | 907 | ||
| Dissemination of Information via Letters | 907 | ||
| Difficult Airway Registries/Databases | 907 | ||
| Documentation and Dissemination via Electronic Health Records | 907 | ||
| Epidemiologic and Etiologic Difficult Airway Databases | 908 | ||
| MedicAlert Foundation Difficult Airway/Intubation Registry | 908 | ||
| Conclusion | 909 | ||
| Clinical Pearls | 909 | ||
| Selected References | 910 | ||
| References | 910.e1 | ||
| 52 Airway Research | 911 | ||
| Chapter Outline | 911 | ||
| Introduction | 911 | ||
| Systematic Reviews, Meta-Analysis, Randomized Controlled Trials | 911 | ||
| Literature Review | 913 | ||
| Conventional Databases | 913 | ||
| Open-Access Journals | 913 | ||
| Medical Subject Headings | 913 | ||
| Observational Studies | 913 | ||
| Ideal Trial | 914 | ||
| Pitfalls With Airway Research | 914 | ||
| Airway Research Questions or Answers | 915 | ||
| Studies in Airway Assessment | 916 | ||
| Facilitating Airway Research | 916 | ||
| Role of Manikins in Airway Research | 916 | ||
| Surrogates of Effective Airway Management | 917 | ||
| Understanding and Training of the Investigator | 917 | ||
| Comparing Different Laryngoscopes | 917 | ||
| Reliance on Only One Feature | 917 | ||
| Guidelines for Airway Management | 918 | ||
| Emergency Front of Neck Access/Emergency Invasive Airway Access | 918 | ||
| The Role of Audits, Surveys of Practice, and Case Reports | 918 | ||
| Audits | 918 | ||
| Surveys | 919 | ||
| Case Reports | 919 | ||
| Conclusion | 919 | ||
| Clinical Pearls | 919 | ||
| Selected References | 919 | ||
| References | 920.e1 | ||
| 53 Airway Management and Outcomes Reporting | 921 | ||
| Chapter Outline | 921 | ||
| Introduction | 921 | ||
| Documentation of Airway Management Outcomes | 921 | ||
| Quality Improvement in Anesthesia | 922 | ||
| Collecting Data | 922 | ||
| Systematic Analysis and Reporting | 922 | ||
| Change Management | 922 | ||
| Anesthesia Information Management Systems | 923 | ||
| Overview | 923 | ||
| Build and Scripting | 923 | ||
| User Interface | 923 | ||
| Airway Management Outcomes Reported in the Literature | 923 | ||
| Patient Characteristics | 923 | ||
| Setting | 924 | ||
| Physiologic Changes | 924 | ||
| Induction and Neuromuscular Blocking Agents | 924 | ||
| Primary Airway Device | 924 | ||
| Procedural Outcomes | 925 | ||
| Emergency Surgical Airway | 925 | ||
| Mortality | 926 | ||
| Team Structure | 926 | ||
| Quality Assessment | 926 | ||
| Levels of Outcome Reporting | 926 | ||
| Concept of Difficult Airway Management | 927 | ||
| Future of Airway Management Measurement | 927 | ||
| Conclusion | 931 | ||
| Clinical Pearls | 932 | ||
| Selected References | 932 | ||
| References | 932.e1 | ||
| 54 Role of the Airway Community | 933 | ||
| Chapter Outline | 933 | ||
| Introduction | 933 | ||
| Individual Societies | 933 | ||
| Society for Airway Management | 933 | ||
| Difficult Airway Society | 933 | ||
| European Airway Management Society | 933 | ||
| Other Airway Societies | 933 | ||
| Common Goals of Airway Societies | 934 | ||
| Membership | 934 | ||
| Annual Meetings | 935 | ||
| General Format | 935 | ||
| World Airway Management Meeting (WAMM) | 935 | ||
| Expert Opinions | 935 | ||
| Publications by Societies | 935 | ||
| Impact on Patient Care: Patient Safety | 935 | ||
| General | 935 | ||
| Adults | 936 | ||
| Children | 936 | ||
| Social Media and Airway Management | 936 | ||
| Future Directions | 936 | ||
| Conclusion | 936 | ||
| Clinical Pearls | 936 | ||
| Selected References | 937 | ||
| Appendix A Supplement to Chapter 51 | 938 | ||
| Appendix B Supplement to Chapter 51 | 940 | ||
| Additional National Difficult Airway/Intubation Registry Enrollment Forms Can Be Obtained by: | 944 | ||
| For Additional Information Regarding the National Difficult Airway/Intubation Registry: | 944 | ||
| Index | 945 | ||
| A | 945 | ||
| B | 948 | ||
| C | 949 | ||
| D | 951 | ||
| E | 952 | ||
| F | 954 | ||
| G | 955 | ||
| H | 955 | ||
| I | 956 | ||
| J | 958 | ||
| K | 958 | ||
| L | 958 | ||
| M | 959 | ||
| N | 961 | ||
| O | 963 | ||
| P | 964 | ||
| Q | 967 | ||
| R | 967 | ||
| S | 969 | ||
| T | 970 | ||
| U | 971 | ||
| V | 972 | ||
| W | 973 | ||
| X | 973 | ||
| Z | 973 | ||
| Inside Back Cover | ibc1 |