TY - CHAP M1 - Book, Section TI - Procedures A1 - Gadsden, Jeff A1 - Jones, Dean L. PY - 2011 T2 - Anesthesiology Oral Board Flash Cards AB - Table Graphic Jump Location|Download (.pdf)|PrintConsiderationsProcedures—direct laryngoscopy, fiberoptic bronchoscopy, rigid bronchoscopy, foreign body removal, laser surgery, airway stents, or airway traumaRequires close communication between surgeon and anesthetistIf respiratory distress—surgical airwayHigh prevalence of cigarette smoking (COPD, airway tumors)Options for ventilation: Spontaneous ventilation + local anesthesia/sedation—limited procedures that patients can tolerateSpontaneous ventilation + GA—for upper airway endoscopyPositive pressure ventilation (with small ETT) + GA—obscures surgical view but allows for standard equipmentJet ventilation + GA—unobstructed view but risk barotraumaLasers—risk of airway fire. Use minimal inspired oxygen concentration to maintain oxygenation and use specialized laser airway endotracheal tubesTIVA useful to maintain anesthesia and/or reduce pollutionHistoryLocation, size, and symptoms of airway abnormality (dyspnea, hoarseness, dysarthria, aspiration, coughing)Tumors—medications, radiation, surgery?Foreign body? Often pediatric patientsComorbid cardiopulmonary diseaseOther—cigarette smoking, alcohol usePhysical ExamVital signsAirway exam—stridor? Neck ROM, MP scoreFeatures of difficult mask ventilation—obesity, beard, or no teethCardiopulmonary examLab Tests/ImagingAirway—imaging, bronchoscopy results, fiberoptic assessmentConsultsConflict(s)Weigh pros and cons of various ventilation modes for given patient and surgical requirementsOptimizePositioning—protect neck, teeth, eyesAnesthesia—often TIVA—ensure adequate IV accessOptionsMAC/local anesthesiaGeneral anesthesia—spontaneous ventilation, jet ventilation, or with ETT or LMA as requiredPreop:PremedBloodICU/stepdown bedRoom Setup (Special Drugs/Monitors)Consider arterial line for hemodynamic monitoring or blood gases as requiredInductionDepending on assessment: surgical airwayAFOIinduce but maintain spontaneous ventilationinduce, muscle relaxants, and PPVMaintenanceTIVA or balanced technique ± muscle relaxantsShort-acting agents often preferredDexamethasone 10 mg IV—to reduce airway edemaLaser surgery—protective eye equipment for patient and staffEmergenceAssess airway—edema or bleeding may limit ability to extubateDisposition/PainAssess re: airway edema, obstructionStridor: nebulized epinephrine, helioxEmergency airway equipment available SN - 2161-5683 PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=55892976 ER -