TY  - CHAP
M1  - Book, Section
TI  - Chapter 36. Airway Management
A1  - Klock, Allan P.
A1  - Hernandez, Michael
A1  - Seraphin, Sally
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Tracheal  intubation  can  be  accomplished  using  several  techniques,  including  direct  visual  (rigid)  laryngoscopy,  video  laryngoscopy,  indirect  visual  (fiberoptic)  laryngoscopy,  guided  blind  (retrograde),  and  complete  blind  (eg,  intubation  through  supraglottic  airway  [SGA]  or  blind  nasal)  intubation.  Each  technique  has  its  preferred  indication,  risks,  and  benefits.Soft  tissue  upper  airway  obstruction  is  common  after  induction  of  anesthesia.  Insertion  of  an  oropharyngeal  airway  or  an  SGA  or  application  of  a  jaw  thrust  often  is  successful  for  overcoming  soft  tissue  airway  obstruction.General  anesthesia  and  muscle  relaxants  facilitate  tracheal  intubation.  A  rapid-acting  muscle  relaxant  is  used  during  rapid-sequence  induction  and  intubation.During  general  anesthesia,  airway  management  without  tracheal  intubation  has  become  well-accepted  common  practice  since  the  introduction  of  SGA  devices.  As  with  any  technique,  it  is  incumbent  upon  the  physician  to  determine  what  technique  is  most  appropriate  given  the  clinical  scenario.Securing  the  airway  under  topical  anesthesia  with  or  without  sedation  (an  "awake  intubation")  provides  the  optimal  approach  for  a  patient  with  a  severely  compromised  or  difficult  airway.Awake  intubation  should  be  encouraged,  taught,  and  practiced  regularly  to  help  maintain  comfort  and  skill  with  the  technique.The  availability  of  a  difficult  airway  cart  should  be  assured  for  every  anesthetizing  location.Many  major  anesthetic  complications  are  frequently  associated  with  airway  mismanagement,  including  inadequate  ventilation  or  oxygenation  and  unrecognized  esophageal  intubation.Laryngospasm  is  common  with  airway  stimulation  during  light  anesthesia.  Stridor  indicates  partial  blockade  of  the  airway.  Lack  of  stridor  may  indicate  complete  closure  of  the  larynx  with  no  air  exchange.For  patients  in  whom  the  upper  airway  is  obstructed,  establishing  emergency  ventilation  with  a  supraglottic  device  (eg,  laryngeal  mask  airway),  esophageal  device  (eg,  Combitube),  cricothyrotomy,  or  transtracheal  jet  ventilation  is  a  must  and  should  be  applied  as  soon  as  possible  to  prevent  brain  injury  and  death.Trauma  to  laryngeal  structures  can  leave  patients  with  vocal  cord  paralysis  and  serious  voice  dysfunction.Many  airway  disasters  have  been  reported  after  patient  extubation.  A  well-planned  and  prepared  extubation  is  a  must  for  high-risk  patients  to  minimize  airway-related  complications.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/17
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56633341
ER  -