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  • Image not available.Improper face mask technique can result in continued deflation of the anesthesia reservoir bag when the adjustable pressure-limiting valve is closed, usually indicating a substantial leak around the mask. In contrast, the generation of high breathing-circuit pressures with minimal chest movement and breath sounds implies an obstructed airway.
  • Image not available.The laryngeal mask airway partially protects the larynx from pharyngeal secretions (but not gastric regurgitation), and it should remain in place until the patient has regained airway reflexes.
  • Image not available.After insertion of a tracheal tube (TT), the cuff is inflated with the least amount of air necessary to create a seal during positive-pressure ventilation to minimize the pressure transmitted to the tracheal mucosa.
  • Image not available.Although the persistent detection of CO2 by a capnograph is the best confirmation of tracheal placement of a TT, it cannot exclude bronchial intubation. The earliest manifestation of bronchial intubation is an increase in peak inspiratory pressure.
  • Image not available.After intubation the cuff of a TT should not be felt above the level of the cricoid cartilage, because a prolonged intralaryngeal location may result in postoperative hoarseness and increases the risk of accidental extubation.
  • Image not available.Preventing unintentional esophageal intubation depends on direct visualization of the tip of the TT passing through the vocal cords, careful auscultation for the presence of bilateral breath sounds and the absence of gastric gurgling, analysis of exhaled gas for the presence of CO2 (the most reliable method), chest radiography, or use of fiberoptic bronchoscopy.
  • Image not available.Clues to the diagnosis of bronchial intubation include unilateral breath sounds, unexpected hypoxia with pulse oximetry (unreliable with high inspired oxygen concentrations), inability to palpate the TT cuff in the sternal notch during cuff inflation, and decreased breathing-bag compliance (high peak inspiratory pressures).
  • Image not available.The large negative intrathoracic pressures generated by a struggling patient in laryngospasm can result in the development of negative-pressure pulmonary edema even in healthy young adults.

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Expert airway management is an essential skill for an anesthesiologist. This chapter reviews the anatomy of the upper respiratory tract, describes the necessary equipment, presents techniques, and discusses complications of laryngoscopy, intubation, and extubation. Patient safety depends on a thorough understanding of each of these topics.

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Other than rendering a patient insensible to pain, no characteristic better defines an anesthesiologist than the ability to “manage” an airway and a patient’s breathing. Successful intubation, ventilation, cricothyrotomy, and regional anesthesia of the larynx require detailed knowledge of airway anatomy. There are two openings to the human airway: the nose, which leads to the nasopharynx (pars nasalis), and the mouth, which leads to the oropharynx (pars oralis). These passages are separated anteriorly by the palate, but they join posteriorly in the pharynx (Figure 5–1). The pharynx is a U-shaped fibromuscular structure that extends from the base of the skull to the cricoid cartilage at the entrance to the esophagus. It opens anteriorly into the nasal cavity, the mouth, the larynx, and the nasopharynx, oropharynx, and laryngopharynx (pars laryngea), respectively. The nasopharynx ...

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