Basics of Airway Management—Part II (Tips and Tidbits)
Catherine Marcucci MD
Nabil M. Elkassabany MD
Airway management is both a science and an art, and the wise anesthesia provider will make himself a lifelong student. An informal review of the peer-reviewed anesthesia literature shows that there are at least 25 new manuscripts, case reports, and letters on airway management each month. Similarly, even the “old” drugs in airway management are under ongoing evaluation—the literature for the first months of 2007 contains dozens of reports on the use of succinylcholine, a drug that has been in clinical use for about 60 years. The authors feel strongly that there is also ample opportunity to learn from the spoken tradition as well.
Try to become expert in each new airway device and technique as it comes out, but remember that the most valuable airway techniques are sometimes the simplest and most basic—a nasal trumpet, a headstrap, or even a jaw thrust. It is best to become proficient with a new airway device on patients with a normal airway before trying to use the new airway device on a complicated patient or in an emergency situation.
Control your airway situation by controlling your airway drugs. One of the authors saw a case of significant bradycardia probably caused by repeated doses of succinylcholine given to facilitate intubation. The clinical situation then focused on dealing with the bradycardia rather than securing the airway.
One of the most valuable drugs in airway management is oxygen (the authors had a professor of anesthesia who used to say to put the patient on oxygen first and then think). If difficulty is suspected, have the patient breathe 100% oxygen for 5 minutes. Remember that oxygen utilization by the (nonpregnant) human adult is approximately 3 mL/kg/min. If you have fully denitrogenated the lungs, the chances of having “the oxygen out last the succinylcholine” are increased.
When you are just learning airway skills, try to do as many mask cases as possible. The successful mask airway is the foundation on which all airway management is based.Related posts:
Never Neglect the Basics of Airway Management
Always Troubleshoot An Increase in Peak Airway Pressure
Do Not Start the Airway Management of a Ludwig Angina Patient Until Personnel and Equipment for a Definitive (Surgical) Airway Are Assembled
Do Not Use the Subclavian Vein for Central Access of Any Type in a Patient Planned for Dialysis
Consider the Use of Tris-Hydroxymethyl Aminomethane (THAM) to Treat Refractory or Life-Threatening Metabolic Acidosis
Be Aware of the Drugs that Require Slow Intravenous Administration
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