The Airway Manual: Practical Approach to Airway Management

Description:

The book provides up-to-date and easy to understand information on airway management with special emphasis on practical management along with required theory background and key points. It covers all aspects of airway management including education, training, audit, controversies, recent advances, case discussion, etc. The book covers all the techniques of airway management like the use of videolaryngoscopy, fibre-optic intubation, and retrograde intubation. Further, the book includes a chapter on airway management during transmittable infectious diseases, such as COVID-19. The book also includes separate chapters on the available guidelines; discussion of interesting cases; neonatal airway; and out of hospital airway management. The book is written by experienced authors keeping in mind the unique problems and situations related to this specialized and vital area of patient management. It presents summary and key points in each chapter. Overall, this book provides practical, specialty oriented and patient centered approach to airway management.

 The book is a useful resource for postgraduate students, residents and fellows in anesthesia, emergency medicine, critical care medicine. It is also relevant for anesthesiologists, intensivists, emergency physicians and internal medicine physicians.

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About the Editors

Raveendra Shankaranarayana Ubaradka, MD, DNB is currently working as consultant anesthesiologist at Jerudong Park Medical Centre and Maxillofacial, Plastic and Reconstructive Surgery Center in Brunei Darussalam. Dr Raveendra was involved in conducting numerous training programs and workshops related to airway management including fiberoptic airway management in many places across the country. He has contributed a chapter on pediatric difficult airway to a pediatric anesthesia manual. Dr. Raveendra is recognized for the contribution in maxillofacial anesthesia where difficult airway is frequent. He was the founder secretary of All India Difficult Airway Association (AIDAA) and was a part of the guidelines group of AIDAA which published the first Indian guidelines related to difficult airway management in 2016. He has delivered many guest lectures related to airway management in various scientific meetings and conferences including 21st ASEAN Congress of Anesthesiologists (ACA) held in Brunei in 2019.

Nishkarsh Gupta, MBBS, MD, DNB, PGCCHM, MNAMS is working as additional professor in the Department of Onco-anesthesiology and Palliative Medicine at the All India Institute of Medical Sciences (AIIMS), New Delhi. He has been a keen researcher with more than 180 publications to his name. He has written 30 book chapters. He has been the pioneer in the field of difficult airway in onco-anesthesia. He has been an invited faculty for more than 100 conferences. He has conducted many airway workshops across India. He is on the editorial board of several journals. He is the editor of the South Asian adaptation of two of the most widely popular books in anesthesia Clinical Anesthesia by Barash and Understanding Anesthesia Equipment by Dorsch & Dorsch.

Prasanna Udupi Bidkar, MBBS, MD, DNB, DM is Professor and head of the Division of Neuroanesthesiology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry. He is well known in the field of neuroanesthesiology and neurocritical care in India. He is an expert in the field of airway management in neurosurgery and onco-anesthesia. He has many publications in reputed international journals. He has written several chapters in various books and edited a book “Acute Neuro Care”. He is the current treasurer of two national Indian societies (Indian Society of Neuroanesthesiology and Critical Care, and the Neurocritical Care Society of India). He has served in different capacities at various conferences and has been an invited faculty for more than 120 conferences. He is associate editor of Journal of Anaesthesiology and Clinical Pharmacology. He is editorial board member of many reputed anesthesiology journals.

Debendra Kumar Tripathy, DNB, MNAMS is working as professor and ex-vice dean (innovation) at All India Institute of Medical Sciences (AIIMS), Rishikesh, India. He has been pioneering in the field of ultrasound of the airway in India. He has conducted more than ten workshops in USG in airway and delivered more than 100 lectures all over the country, and has many innovations to his credit. He has many publications and was the organizing secretary of many anesthesiology conferences in India.

Anju Gupta, MD, DNB, MNAMS, PGCCHM, IDRA is working as an assistant professor in the Department of Anesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi. She completed her MD from Lady Hardinge Medical College, New Delhi, and now has over 15 years of experience in anesthesia and has been faculty at various national and international platforms. She is an avid researcher and has more than 130 publications in reputed national and international journals and over 25 book chapters to her credit. She has won several prestigious awards and is on the editorial board of several journals. She is the international executive committee member at ESRA. She is the editor of the South Asian adaptation of two of the most widely popular books in anesthesia Clinical Anesthesia by Barash and Understanding Anesthesia Equipment by Dorsch & Dorsch.

Table of contents:

Contents
Editors and Contributors
About the Editors
Contributors
Part I: General
1: History and Milestones of Airway Management
1 Introduction
2 Era Before Endotracheal Intubation
3 Endotracheal Intubation: Techniques and Devices
3.1 Endotracheal Tubes and Intubation
3.2 Laryngoscopes and Laryngoscopy
4 Supraglottic Airway Devices, Video Laryngoscopes, and Flexible Endoscopes
4.1 Supraglottic Airway Devices
4.2 Video Laryngoscopes
4.3 Flexible Video Endoscopes
5 Isolation of Lungs
6 Risk of Aspiration and Prevention
7 Airway Management and Resuscitation
8 Monitoring and Diagnostic Tools, Drugs
9 Surgical and Emergency Airway Techniques and Devices
10 Academics of Airway Management
11 Interesting Incidents and Events
References
2: Anatomy and Physiology of the Airway Applied Aspects
1 Introduction
2 Airway Anatomy and Anesthetic Implications
2.1 Nose
2.2 Oral Cavity
2.3 Pharynx
2.4 Larynx
2.4.1 Anatomy of the Larynx and Its Anesthetic Implications
2.5 Trachea
2.5.1 Anatomy of the Trachea and Its Anesthetic Implications
2.5.2 Anatomy Below the Carina and Its Applied Aspects
2.5.3 Congenital Anomalies of the Tracheobronchial Tree
3 Physiology of the Lower Airway and its Applied Aspects
4 Special Situations
4.1 Pregnancy
4.2 Airway Anatomy and Tracheostomy
4.3 Pediatric Airway
4.3.1 Pediatric Airway Anatomy and Its Anesthetic Implications
4.3.2 Pediatric Airway Physiology and Its Anesthetic Implications
5 Conclusion
References
3: Preoperative Airway Assessment
1 Introduction
2 Normal, Compromised, and Obstructed Airway
3 Definitions of Difficult Airway
3.1 Difficult Mask Ventilation
3.2 Difficult Supraglottic Airway Device Placement
3.3 Difficult Laryngoscopy
3.4 Difficult Tracheal Intubation and Difficult Transtracheal Surgical Airway
3.5 Difficult Surgical Airway
4 Airway Assessment Tools
4.1 History, Congenital Anomalies, and Comorbidity
4.2 Clinical Examination
5 Airway Assessment Tests
5.1 Mallampati Test
5.2 Inter-incisor Gap (IIG)
5.3 Upper Lip Bite Test
5.4 Calder’s Jaw Protrusion Test
5.5 Thyromental Distance (TMD)/Patil’s Test
5.6 Thyromental Height Test (TMHT)
5.7 Sternomental Distance (SMD)/Savva Test
5.8 Delilkan’s Test
5.9 Wilson’s Score
5.10 El-Ganzouri Risk Index/Simplified Airway Risk Index (SARI)
6 Laryngoscopic View Grading
6.1 Cormack and Lehane (C&L) Grading
6.2 POGO (Percentage of Glottic Opening) Score
6.3 Freemantle Score
6.4 The Intubation Difficulty Scale (IDS)
7 Radiological Evaluation of Airway
7.1 X-ray
7.2 Computerized Tomography (CT)
7.3 Ultrasonography
8 Preoperative Endoscopic Airway Examination (PEAE)
9 Three-Column Model for Airway Assessment
10 Commonly Used Mnemonics for Prediction of Difficult Airway
11 Infraglottic Airway Assessment
12 Conclusion
References
4: Imaging of the Airway
1 Introduction
2 Imaging Tools
3 X-Ray
3.1 Radiograph of the Cervical Spine
3.2 Uses of X-ray in Airway Management
4 Computerized Tomography
4.1 Basic Principles
4.2 Different CT Modalities
4.3 Advantages of CT
4.4 Clinical Application of CT of Airway
4.5 Printing in 3D
5 Magnetic Resonance Imaging
5.1 Basic Principles
5.2 Difference Between MRI and CT
6 Virtual Imaging
6.1 Basic Principle
6.2 Clinical Application
6.2.1 Preoperative Preparation
6.2.2 Evaluation After Surgery
7 Ultrasound
7.1 Description of Basics and Terminologies
7.2 Normal Sono-anatomy of Airway
7.2.1 Position of Patient
7.2.2 Systematic Scanning of Airway
7.2.3 Sonographic Attributes of Airway Structures
7.2.4 Role of USG in Dynamic Airway Scanning
7.3 Applications in Airway Management
7.3.1 Upper Airway Ultrasound Can Be Used for the Evaluation of [26–43] 7.3.2 Difficult Airway Predictors
7.3.3 Estimation of Tube Size
7.3.4 Role in Endotracheal Intubation
7.3.5 Role in Perioperative Airway Management
7.3.6 Other Applications Related to Airway Management
References
Part II: Equipment
5: Masks and Airways
1 Introduction
1.1 Advantages of Mask Ventilation
1.2 Disadvantages of Mask Ventilation
1.3 Equipment Required
2 Types of Facemasks
2.1 Black Rubber Face Mask
2.2 Transparent Plastic Face Mask
2.3 Silicone Face Mask
2.4 Disposable Face Masks
2.5 Dental Masks
2.6 Endoscopy Mask
2.7 Patil-Syracuse Mask
2.8 Rendell-Baker-Soucek (RBS) Mask
2.9 Scented Masks
3 Parts of a Facemask
3.1 Body
3.2 Edge (Aka: Seal or Cushion)
3.3 Connector (Aka: Orifice, Collar, Mount)
3.4 Mask Straps
3.5 Dead Space
4 Procedure
4.1 Maneuvers to Improve Mask Ventilation
5 Special Situations
5.1 Bearded Patient
5.2 Edentulous Patient
5.3 Tracheostomy Stoma
6 Complications of Mask Ventilation
7 Airways
7.1 Introduction
7.2 Oropharyngeal Airway (OPA)
7.2.1 About the Equipment
7.2.2 Parts of an Oropharyngeal Airway (Fig. 5.9)
7.2.3 Procedure
7.2.4 Complications
7.2.5 Specific Types of OPA
Guedel Airway
Berman Airway
Patil-Syracuse Endoscopic Airway
William’s Airway Intubator
Ovassapian Airway
COPA
7.3 Nasopharyngeal Airways
7.3.1 The Equipment
7.3.2 Parts of a Nasopharyngeal Airway (Fig. 5.11)
7.3.3 Procedure
7.3.4 Complications
7.3.5 Specific Types of NPA
Linder NPA
Cuffed NPA
Binasal Airway
Wei Nasal Jet Tube (Fig. 5.13)
8 Conclusion
References
6: Supraglottic Airway Devices
1 Introduction
2 History
2.1 Design Changes in LMA
3 Classification of SGAD
4 LMA® Classic™ Airway
4.1 Insertion Techniques
5 Description of LMA Variants
5.1 Insertion Techniques of ProSeal LMA
5.2 Position Evaluation
5.3 LMA® Supreme™ Airway
5.4 Intubating LMA
5.4.1 Techniques of ILMA Insertion
Clinical Utility
6 I-GEL
6.1 Salient Features
6.2 Clinical Utility
6.3 Technique for Inserting I Gel
7 Streamlined Liner of the Pharynx Airway (SLIPA)
7.1 Salient Features
7.2 Clinical Utility
8 Baska Mask
8.1 Salient Features
8.2 Insertion Technique
8.3 Clinical Utility
9 Laryngeal Tube
9.1 Salient Features
9.2 Insertion Technique
9.3 Laryngeal Tube Suction II
9.4 Laryngeal Tube Suction
9.5 Laryngeal Tube Suction Disposable
9.6 Intubating Laryngeal Tube Suction Disposable (iLTS-D)
9.6.1 Clinical Utility
10 Air Q
10.1 Salient Features
10.2 Clinical Utility
11 Ambu Aura I
11.1 Salient Features
11.2 Clinical Utility
12 Combitube
12.1 Salient Features
12.2 Clinical Utility
13 Tulip Airway
13.1 Salient Features
13.2 Clinical Utility
14 Removal of SGADs
15 Contraindications to SGAD
15.1 Adverse Effects
15.2 Complications
15.3 Cleaning of Supraglottic Airway Devices
15.4 Sterilisation of Supraglottic Airway Devices
16 Conclusion
References
7: Endotracheal Tubes
1 Introduction
2 Description of Endotracheal Tube
3 Modifications of Endotracheal Tube
4 Special Endotracheal Tubes
4.1 Cole’s Tube
4.2 Oxford Tube
4.3 Armoured Tube
4.4 RAE Tubes
4.5 Microlaryngeal Tube (MLT)
4.6 Laser Shield Tubes
4.7 Parker Tip Tube
4.8 Microcuff Tube
4.9 Wei Jet Nasal Tube
4.10 Laryngectomy Tube
4.11 Endotracheal Tube with Subglottic Secretion Drainage
5 Summary
References
8: Direct Laryngoscopes
1 Introduction
2 Brief History
3 Design and Components of Laryngoscope
3.1 Handle
3.2 Blade
3.2.1 Macintosh Blade
3.2.2 Left-Handed Macintosh Blade
3.2.3 Polio Blade
3.2.4 Improved Vision Macintosh Blade
3.2.5 Fink Blade
3.2.6 Bizzarri-Giuffrida Blade
3.2.7 Belscope Blade
3.2.8 McCoy Blade
3.2.9 Flexiblade
3.2.10 Straight Blades
3.2.11 Miller Blade
3.2.12 Cardiff Blade
3.2.13 Oxford Infant Blade
3.2.14 Other Modifications of Blade (Historical Importance)
3.3 Curved Vs. Straight Blade in Paediatric Patients
3.4 Single-Use Laryngoscope Blades
References
9: Video Laryngoscopes
1 Introduction
2 Brief History
3 Direct Vs. Indirect Laryngoscopy
3.1 Characteristics of an Ideal VL
3.2 Classification
3.2.1 Nonchanneled/Macintosh Blade Design
Coopdech C-Scope: Daiken Medical, Osaka, Japan
Storz V-MAC (DCI) and C-MAC
Technique
McGrath MAC VL Medtronic, Minneapolis, MN, USA
Technique
3.3 Video Laryngoscopes with Angulated Blades
3.3.1 Glidescope (Verathon, Bothell, WA, USA)
Technique
3.3.2 McGrath Series 5 (Aircraft Medical, Edinburgh, UK)
Technique
3.3.3 Storz C-MAC D-Blade
4 Video Laryngoscopes with a Tube Channel
4.1 Pentax Airway Scope 100 (Pentax AWS 100, Pentax Corporation, Tokyo, Japan)
4.2 Airtraq Optical Laryngoscope
4.2.1 Technique
4.3 Res-Q-Scope II
5 Current Evidence on the Use of VL
5.1 Predicted Difficult Intubation
5.2 Novice Provider
5.3 Unanticipated Difficult Intubation
5.4 Video-Assisted Laryngoscopy Outside of the Operating Room
5.5 Video-Assisted Laryngoscopy for the Immobilized Cervical Spine
6 Conclusions
References
10: Flexible Video Endoscopes
1 Introduction
2 History
3 Basics and Physics
4 Classification and Terminology
4.1 The Flexible Fiberoptic Endoscope
4.2 Flexible Video Endoscopes
5 Components of Flexible Fiberoptic Endoscopes (FEs)
5.1 Control Body (Fig. 10.8)
5.2 Insertion Cord
5.3 Bending Section\Distal Tip
5.4 Light Guide Connector and Cord
5.5 Plumbing System or Working Channel
5.6 Dimensions of Flexible Endoscopes
6 Movements of Flexible Endoscopes
6.1 Anterior–Posterior Movement of Tip (Fig. 10.9)
6.2 Side to Side Movement of Tip
6.3 Straight Line Movement of Tip
7 Cleaning, Disinfection, and Sterilization
8 Recent Advances
8.1 Ultrathin Endoscopes
8.2 Auto Endoscopic Reprocessor (AER) (Fig. 10.10)
8.3 Disposable Flexible Endoscopes
8.3.1 Sheathed Fiberoptic Bronchoscope
8.3.2 Single Use Flexible Video Endoscopes
9 Conclusion
References
11: Airway Adjuncts
1 Introduction
2 Tracheal Tube Introducers
2.1 Eschmann Introducer (EI) (Smiths Medical, UK)
2.1.1 Technique of Use
2.2 Frova Intubating Introducer (Cook Inc., Bloomington, IN)
2.3 Muallem Endotracheal Tube Stylet (METTS) (Muallem ET Tube Stylet, VBM Medizintechnik GmbH, Sulz a. N, Germany)
2.4 Muallem Endotracheal Tube Introducer (METTI) [24] (Muallem ET Tube Introducer, VBM Medizintechnik GmbH, Sulz a. N, Germany)
2.5 Endotracheal Introducer (EI) (Sun Med, Largo, FL)
2.6 Schroeder Directional Stylet (Parker Medical, Englewood, CO)
2.7 Introes Pocket Bougie
2.8 Total Control Introducer (TCI)
3 Airway Exchange Catheter
3.1 Cook Airway Exchange Catheter (Cook Critical Care, Bloomington, Indiana, USA)
3.2 Cook Airway Exchange Catheter: Extra Firm with Soft Tip
3.2.1 Aintree Intubation Catheter (Cook Critical Care, Bloomington, IN, USA)
3.3 Sheridan Tracheal Tube Exchanger (Sheriden Catheter Corp., Oregon, NY)
4 Stylets
4.1 Simple Stylet
4.2 Optical Stylets
4.3 Trachlight (Laerdal Medical Corp., Wappingers Falls, NY)
4.3.1 Technique
4.3.2 Patient Position
4.3.3 Orotracheal Intubation
4.3.4 Nasotracheal Intubation
4.3.5 Role in Difficult Airway
4.3.6 Fiberoptic and Video Intubating Stylet
4.4 Shikani Optical Stylet (Clarus Medical, Minneapolis, MN)
4.4.1 Procedure
4.5 Clarus Video System (Clarus Medical, Minneapolis, MN)
4.6 Levitan Fiberoptic Stylet (Clarus Medical, Minneapolis, MN)
4.7 Bonfils Retromolar Intubation Fiberscope (Karl Storz GmbH, Tuttlingen, Germany)
4.7.1 Preparation and Intubation Technique
5 Conclusion
References
12: Lung Isolation Devices
1 Introduction
2 Double-Lumen Tubes (DLTs)
2.1 Types of Double-Lumen Tubes (Table 12.1)
2.2 Size Selection
3 Univent Tube
4 Bronchial Blockers (BBs)
4.1 Arndt Endobronchial Blocker [6–8] 4.2 Cohen Tip-Deflecting Bronchial Blocker [7–9] 4.3 Uniblocker [10] 4.4 EZ Blocker [11, 12] 5 Embolectomy Catheter
6 Adjuvants to the Primary Devices for Lung Isolation
7 Conclusion
References
13: Difficult Airway Cart
1 Introduction
2 Concept and Need for Difficult Airway Cart
2.1 Drawers
3 Modifications and Customization of DAT
4 Optimal Utilization Is the Key
5 Conclusion
References
Part III: Practice
14: Principles of Airway Management
1 Introduction
2 Rationale for Understanding the Principles
3 Basic Facts: Universally Applicable in all Circumstances
4 Airway Management from Anaesthesia Perspective
4.1 General Aspects
4.2 Oxygenation and Airway Management
4.3 Normal Airway and Elective Surgery
4.4 Normal Airway: Emergency Surgery
4.5 Anticipated Difficult Airway: Elective Surgery
4.6 Anticipated Difficult Airway: Emergency Surgery
4.7 Unanticipated Difficult Airway: Elective Surgery/Procedures
4.8 Unanticipated Difficult Airway: Emergency Surgery/Procedures
4.9 Other Issues
References
15: Overview of Airway Techniques and Decision Making
1 Introduction
2 Terminologies
2.1 Strategy
2.2 Plan
3 Normal Versus Difficult Airway
4 Airway Management in Non-anesthetizing Locations
5 Strategies for Oxygenation
5.1 Methods of Oxygenation During Airway Management
6 Strategies for Definitive Airway
6.1 Endotracheal Intubation
6.2 Indications for Use of Intubation Aids
6.3 Possible Scenarios of Failed Intubation
6.4 Options and Management Applicable to All Scenarios of Failed Intubation
6.5 Hybrid Techniques of Intubation
6.6 Supraglottic Airway Device
6.7 Invasive Airway Management
6.7.1 Tracheostomy
6.7.2 Cricothyrotomy and Transtracheal Jet Ventilation
6.8 Cardiopulmonary Bypass (CPB) and Extracorporeal Membrane Oxygenation (ECMO)
7 Decision Making
8 Conclusion
References
16: Oxygenation During Airway Management
1 Introduction
2 Physiology of Oxygenation
3 Hypoxia During Airway Management: Mechanisms and Risk Factors
4 Preoxygenation Techniques
5 Apnoeic Oxygenation (ApOx)
5.1 High Flow Oxygen Therapy
5.2 Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)
5.3 Supraglottic Oxygenation
5.4 Nasal and Buccal Oxygenation
5.5 Transtracheal Oxygenation
6 Preoxygenation at Special Circumstances
6.1 Morbidly Obese
6.2 Pregnancy
6.3 Paediatrics
6.4 Geriatrics
6.5 ICU
6.6 Emergency Department
7 Potential Risks of Preoxygenation
7.1 Absorption Atelectasis
7.2 Delayed Recognition of Oesophageal Intubation
8 Conclusion
References
17: Airway Management Guidelines: An Overview
1 Introduction
2 Vortex Approach (VA)
3 Transition in Airway Management
4 Various Guidelines
4.1 Unanticipated Difficult Airway (UADA) in Adults
4.1.1 DAS Guidelines for Adult Unanticipated Difficult Airway
4.1.2 AIDAA Guidelines for Adult Unanticipated Difficult Airway
4.1.3 Canadian Airway Focus Group Guidelines for Unanticipated Difficult Airway
4.2 Guidelines for Anticipated Difficult Airway Management in Adults
4.2.1 ASA Guidelines for Difficult Airway Management in Adults
4.2.2 DAS Guidelines for Awake Tracheal Intubation
4.3 Airway Guidelines in Obstetrics
4.3.1 DAS Guidelines for Obstetrics
4.3.2 The AIDAA Obstetric Airway Guidelines
4.4 Airway Guidelines for the Management of Pediatric Difficult Airway
4.4.1 Difficult Airway Society/Association of Pediatric Anesthetist’s (DAS/APA) Guidelines
4.4.2 AIDAA Pediatric Airway Guidelines for Children Between 1 and 12 Years (Fig. 17.18)
4.5 Airway Guidelines for Critically Ill Patients
4.5.1 DAS Airway Guidelines for Critically Ill Adults
4.5.2 AIDAA Guidelines for Airway Management in Critically Ill Adults
4.6 Extubation Guidelines
4.6.1 DAS Extubation Guidelines
4.6.2 AIDAA Guidelines for Extubation
4.7 Airway Guidelines for Managing COVID-19 Patients
4.7.1 DAS Guidelines for Airway Management in COVID-19 Patients (March 2020) [98] Key Features
4.7.2 AIDAA Airway Algorithm for COVID-19 Patients-May 2020 [101] References
Part IV: Techniques
18: Mask Ventilation: A Neglected Art
1 Introduction
2 Indications, Contraindications, Advantages, and Disadvantages [1–3] 3 Equipment for Mask Ventilation [1, 2] 3.1 Face Mask: Description and Components
3.2 Special Masks
4 Techniques of Mask Ventilation [1–4] 4.1 Relevant Anatomy
4.2 Seal First Versus Maneuver First
4.3 Positioning
4.4 Grips
4.5 Ventilation Technique
5 Difficult Mask Ventilation
5.1 Risk Factors of Difficult BMV
5.2 Mechanisms of Difficulty in Mask Ventilation
5.3 Ventilation in Broncho Cutaneous and Bronchopleural Fistula
6 Complications of Mask Ventilation
7 Use of Ultrasound
8 Conclusion
References
19: Supraglottic Airway Devices: Clinical Applications
1 Introduction
2 Primary Airway Device During Routine Anaesthesia
3 Condiut for Intubation in Difficult Airway
3.1 Supraglottic Airway Devices for Blind Tracheal Intubation
3.2 Supraglottic Tracheal Intubation Using Fibreoptic-Guided Airway Devices
4 Rescue Device in Difficult Airway
4.1 Rescue Airway: Difficult Intubation, Failed Intubation, Cannot Intubate, and Cannot Ventilate
5 Ventilatory Assist Devices for Elective/Emergency Front of Neck Access
6 Extubation Assist Device
7 Supraglottic Airway Devices in the Pre-hospital Airway Management
8 SGAD and Special Patient Groups
8.1 Patients with Gastroesophageal Reflux Disease (GERD)
8.2 Paediatric Patients
8.3 Obese Patients
8.4 Prone Positioning
9 Contraindications for Use of SGADs
10 Conclusions
References
20: Endotracheal Intubation: Direct and Video Laryngoscope Guided Techniques
1 Introduction
2 Brief History
3 Functional Anatomy of the Airway
4 Indications
4.1 Endotracheal Intubation for Anaesthesia
4.2 Endotracheal Intubation for Prehospital Care
4.3 Endotracheal Intubation for Resuscitation
5 Preparation for Laryngoscopy and Intubation
5.1 Equipment
5.2 Airway Assessment
5.3 Personnel and Assistance
5.4 Positioning
5.5 Preoxygenation-Peri Oxygenation: Apnoeic Oxygenation
5.6 Medications
6 Techniques of Laryngoscopy and Intubation
6.1 Video Assisted Laryngoscopy (VAL)
7 Nasal Intubation
8 Laryngoscopy Assessment
9 Failed Intubation
10 Confirmation of Endotracheal Tube Position
10.1 Auscultatory Methods
10.2 Tactile Method
10.3 Visual Method
10.4 Pulse Oximetry
10.5 Fibreoptic Methods
10.6 Chest Radiograph
10.7 Carbon Dioxide Detection
10.8 Suction Devices
10.9 Sonomatic Confirmation of Tracheal Intubation (SCOTI) Device
10.10 Impedance Method
10.11 Ultrasonic Methods
11 Endotracheal Cuff Pressure Monitoring
12 Post-intubation Care
13 Conclusion
References
21: Flexible Video Endoscopic Guided Airway Management: Principles and Practice
1 Introduction
2 Principles of Flexible Endoscopic Guided Airway Techniques
3 Advantages and Disadvantages of Flexible Endoscopic Guided Techniques (Table 21.1)
4 Indications and Contraindications for Flexible Video Endoscopic Techniques (Table 21.2)
5 Patient Preparation
5.1 Counselling
5.2 Consent
5.3 Drugs (Table 21.3)
5.4 Choice of Anaesthesia
6 Preparation of Flexible Video Endoscope
7 Techniques-Overview
7.1 Patient vs. Performer Positions
7.2 Direct and Indirect Techniques
8 Preparation for Endotracheal Intubation, Oral, and Nasal (Table 21.5)
8.1 Airway Anaesthesia
9 Nasotracheal Intubation
9.1 Standard Technique
9.1.1 Awake Tracheal Intubation (ATI)
9.2 “Tube-First” Technique
9.3 Endoscope and Endotracheal Tube Through Different Nostrils
9.4 Laryngoscope/Video Laryngoscope Assisted Nasotracheal/Orotracheal Fibreoptic Intubation (Fig. 21.10)
10 Oral Intubation
10.1 Indirect Techniques
11 Flexible Endoscope Assisted Retrograde Intubation
12 Other Applications Related to Endotracheal Intubation
12.1 Confirmation of ETT Placement and Position
12.2 Change from Nasal to Oral Route (Fig. 21.14)
12.3 Change from Oral to Nasal Route (Fig. 21.15)
12.4 Diagnosis/Evaluation of Intraoperative Airway Problems
12.5 Extubation
13 Applications Related to Lung Isolation Devices
14 Assessment of Positioning of Supraglottic Airway (Table 21.6)
15 Evaluation of Postoperative Airway Problems
16 Role In ICU
17 Trouble Shooting
17.1 Technical and Equipment Related
17.2 Difficulty in Negotiating the Nasopharynx
17.3 Bleeding from the Nasopharynx
17.4 Difficulty in Identifying Glottic Structure
17.5 Difficulty in Negotiation Through the Glottic Opening
17.6 Difficulty in Visualization of Trachea and Carina
17.7 Difficulty in Railroading the Endotracheal Tube
17.8 Not Able to Withdraw the Endoscope After Intubation
18 Complications of Fibreoptic Bronchoscopic Guided Techniques
19 Disinfection and Sterilization
20 Conclusion
References
22: Unconventional Intubation Techniques
1 Introduction
2 Retrograde Intubation
2.1 Historical Perspective
2.2 Definition and Types
2.3 Principle
2.4 Advantages of Retrograde Intubation Over Other Intubation Techniques (Table 22.1)
2.5 Indications and Contraindications
2.6 Equipment and Preparation
2.7 Classic Technique and Modifications (Fig. 22.1)
2.8 Modified Technique Using Commercial Retrograde Intubation Set
2.9 Ultrasound Guided Technique
2.10 Fiberoptic Bronchoscope Aided Retrograde Intubation
2.11 Videolaryngoscope Assisted Retrograde Intubation
2.12 Retrograde Intubation with Light Guidance
2.13 Supraglottic Airway Device Assisted Retrograde Intubation
2.14 Complications of RI
2.15 Pit Falls and Best Practices (Lessons from Past to Present)
2.16 Troubleshooting During Retrograde Intubation
2.16.1 The Guidewire Is not Going in and not Emerging Inside Oral Cavity?
2.16.2 Which Guidewire Should Be Used for Retrieving by Bronchoscope?
2.16.3 Endotracheal Tube Is Passed, but Capnography Trace Is not Obtained?
3 Blind Nasal Intubation
3.1 Technique of BNI
3.1.1 Techniques to Minimize Trauma During Blind Nasal Intubation
3.2 Indications and Contraindications
3.3 Complications
4 Digital Tracheal Intubation
4.1 Historical Perspective
4.2 Technique
4.3 Indications and Contraindications
4.4 Complications
5 Complications
References
23: Airway Management in Thoracic Surgery
1 Introduction
2 Indications
3 Physiology of OLV
4 Lung Isolation Methods and Selection of Devices, Techniques
4.1 Double Lumen Tubes
4.1.1 DLT Placement Techniques
4.1.2 Technique for Left-sided DLT
4.1.3 Technique for Right-sided DLT
4.1.4 Confirmation of Successful DLT Position
4.1.5 Complications of DLT Placement
4.2 Univent Tubes
4.2.1 Placement of Univent Tube
4.3 Bronchial blockers
4.3.1 Placement of Bronchial Blockers (BBs) for Lung Isolation
4.3.2 Complications Related to Bronchial Blockers Placement
4.4 Single Endobronchial Lumen Tubes
5 Extubation of a DLT
6 Change of DLT to Single Lumen Tube and Vice Versa: When and How?
7 Lung Isolation in Special Situations
7.1 Difficult Airway
7.1.1 Primary Goal in Difficult Airway: Secure the Airway Safely
7.1.2 Alternate Ways for Lung Isolation in Difficult Airways
7.2 Lung Isolation in Patients with Tracheostomy
7.3 Lung Isolation in Distorted Anatomy of Lower Airway
7.4 Lung Isolation in Patients with Aspiration Risk
8 Ventilation Strategies
8.1 Hypoxemia During OLV: Predictors
8.2 Management of Hypoxia
8.3 Other Maneuvers
8.3.1 Continuous Positive Airway Pressure (CPAP)
8.3.2 Pharmacological Management: Nitric Oxide (NO)
8.3.3 Re-expansion of the Non-ventilated Lung
9 Choice of Anesthesia
10 Use of Extra Corporeal Membrane Oxygenation (ECMO) and Ipsilateral (Operative) Lung Ventilation
11 Summary and Conclusions
References
24: Airway Anesthesia
1 Introduction
2 Indications, Contraindications, and Advantages
3 Drugs
3.1 Local Anesthetic Drugs
3.2 Adjuvants Used During Airway Anesthesia
4 Equipment
4.1 Drug Delivery Devices
4.2 Monitors
4.3 Yankauer Suction Device
4.4 Airway cart
5 Preparation of the Patient
5.1 General Preparation
5.2 Psychological Preparation
6 Various Methods of Providing Airway Anesthesia
7 Anesthesia of Nasal Cavity and Nasopharynx
8 Anesthesia of Mouth, Oropharynx, and Base of the Tongue
9 Anesthesia of the Hypopharynx, Larynx, and Trachea
10 Recent Developments
10.1 Airway Anesthesia During COVID-19
10.2 Use of Ultrasound in Airway Anesthesia
10.2.1 Ultrasound Guided Superior Laryngeal Nerve Block
10.2.2 Ultrasound Guided Transtracheal Nerve Block
11 Complications of Airway Anesthesia
References
25: Front of Neck Access Procedures
1 Introduction
2 Failed Intubation-Ventilation-Oxygenation: Evolution of a Crisis
3 Rescue Technique-Which One to Choose?
4 Classification of Rescue Techniques
5 Indications and Contraindications for Front of Neck Access
6 Cricothyrotomy
6.1 Anatomy and Identification of Cricothyroid Membrane
6.2 Common Steps of FONA
6.3 Surgical Cricothyrotomy
6.3.1 Scalpel Cricothyrotomy (Stab, Twist, Bougie, Tube Technique)
6.3.2 Classical/No Drop Technique Cricothyrotomy
6.3.3 Rapid Four-Step Technique
6.3.4 Portex® Cricothyrotomy Kit
6.3.5 Pulmodyne Control-Cric™ System
6.4 Percutaneous Dilatational Cricothyrotomy
6.4.1 Percutaneous Dilatational Cricothyrotomy Sets Using the Seldinger Technique
6.4.2 Melker Percutaneous Dilatational Cricothyrotomy Set
6.4.3 Portex Mini-Trach II Set
6.4.4 Direct Catheter-Over-Needle Techniques
7 Needle Cricothyrotomy
8 Complications of Cricothyrotomy
9 Problems Associated with Ventilation via a Narrow Bore Cannula
9.1 Basic Considerations Before Initiating Ventilation via Narrow Bore Cannula
9.2 Improvised/Self-assembled Devices
9.3 Commercial Devices
9.4 Complications of Needle Percutaneous Transtracheal Ventilation
10 Management of the Patient After eFONA
11 Surgical Tracheostomy
11.1 Applied Anatomy and Steps of Surgical Tracheostomy
11.2 Percutaneous Dilatational Tracheostomy
11.2.1 Percutaneous Dilatational Tracheostomy Protocol
11.2.2 Advantages of Percutaneous Dilatational Tracheostomy
11.3 Post-tracheostomy Care
11.4 Complications of Tracheostomy
12 Human Factors in eFONA
13 Conclusion
References
26: Extubation
1 Introduction
2 Clinical Classification
3 Readiness for Extubation
4 Process of Extubation
4.1 Extubation Response
5 Plan for Extubation
5.1 Routine Extubation
5.2 Deep Extubation
5.3 Extubation of a Difficult Airway
5.4 Extubation in Head and Neck Surgery
5.5 Extubation in Skull Base Surgery
5.6 Extubation in Obese Patients
5.7 Extubation in Paediatric Patient
6 Position for Extubation
7 Adjuncts to Extubation
8 Post-Extubation Monitoring
8.1 Complications
8.2 Extubation Failure
8.3 Desaturation After Extubation
8.4 Accidental Extubation
9 Conclusion
References
Part V: Specialty
27: Airway Management in Paediatric Anaesthesia
1 Introduction
2 The Paediatric Airway and Anaesthetic Implications
2.1 Anatomical Considerations
2.2 Physiological Considerations
3 Paediatric Airway Assessment
3.1 Components of Airway Assessment (Fig. 27.1)
3.2 History
3.3 Anatomy
3.3.1 Anthropometry
3.3.2 Altered Anatomy (From Above to Below)
3.3.3 Airway Scores
3.3.4 Modified Mallampati Score [8] 3.4 Assessment of Physiology Component
3.4.1 Paediatric Difficult Intubation Registry [10] 4 Anaesthesia for Airway Management: Inhalational (Table 27.2 and Fig. 27.3) vs. Intravenous Induction (Table 27.3)
4.1 Comparison Between Total Intravenous Anaesthesia (TIVA) and Inhalational Anaesthesia
4.2 Rapid Sequence Induction in Paediatric Anaesthesia
5 Airway Management in Paediatric Patients
5.1 Mask Ventilation (Fig. 27.4a, b)
5.2 Tracheal Intubation: Direct Laryngoscopy
5.3 Cuffed Endotracheal Tubes
5.4 Video Laryngoscopy
5.5 Fibre-Optic Intubation (or Flexible Video Endoscopic Guided Airway Management) (Fig. 27.9)
5.5.1 Route of Fibre-Optic Intubation
5.5.2 Fibre-Optic Intubation Through a Supraglottic Airway Device (SAD)
Railroading the Tube Over the Bronchoscope
Blind Nasal Intubation (Fig. 27.10)
6 Extubation
7 Supraglottic Airway Devices (SADs)
7.1 Supraglottic Airway Devices in Children (Fig. 27.12)
7.2 SAD and Difficult Airway
7.3 Common Misconceptions About LMA Use in Children
7.3.1 Air-Q
8 Algorithms for Unanticipated Difficult Airway in Children
8.1 Oxygenation
8.2 Tracheal Intubation
8.3 Rescue
8.3.1 Cannot Intubate, Cannot Oxygenate (CICO/CICV)
9 Airway Management of Children in the Intensive Care Unit
9.1 Differences of Airway Management in the OT Setup and ICU Setup
10 Airway Management Surveys
11 Paediatric Airway Training
12 Conclusions
References
28: Airway Management in Obstetrics
1 Introduction
2 Changes in Airway Anatomy and Physiology (Table 28.2, Fig. 28.1)
2.1 Anatomical Changes
2.2 Physiological Changes
2.3 Impact of the Changes in Anatomy and Physiology
3 Airway Assessment
3.1 Assessment in Emergency Procedures
4 Planning and Preparation
4.1 Preparation
4.2 Preoperative Fasting and Pharmacologic Aspiration Prophylaxis
4.3 Patient Positioning
4.4 Preoxygenation
5 Induction of Anesthesia
6 Management of Difficult Obstetric Airway (Fig. 28.5)
6.1 Role of Guidelines
6.2 Anticipated Difficult Airway
6.3 Unanticipated Difficult Intubation
6.4 Failed Intubation
6.5 Complete Ventilation Failure
7 Role of Supraglottic Airway Device (SAD)
8 Role of Video Laryngoscopy (VL) [40, 45] 9 Surgical Airway
10 Extubation and Postoperative Care
11 Effect on Neonatal Outcome
12 Role of Human Factors
13 Ultrasonography in Obstetric Airway
14 Simulation in Obstetric Airway
15 Airway Management of the Obstetric Patient for Non-Obstetric Surgical Procedure
16 Conclusion
References
29: Airway Management in Trauma
1 Introduction
2 Unique Aspects and Challenges of Airway Management in Trauma
3 Initial Clinical Evaluation
3.1 General Examination
3.2 Anatomical Integrity of Airway (Fig. 29.2)
3.3 Predictors of Difficult Airway
3.4 Physiologically Difficult Airway
4 Approach to the Airway Management (Fig. 29.8)
4.1 Identification of Impending or Actual Airway Obstruction
4.2 Basic Airway Techniques
4.2.1 Head Tilt, Chin Lift, and Jaw Thrust Maneuver
4.2.2 Oropharyngeal Airway (OPA) and Nasopharyngeal Airway (NPA) (Fig. 29.3)
4.3 Definitive Airway Strategy
4.4 Indications of Intubation
4.5 Confirmation of Tracheal Placement of Endotracheal Tube
5 Drug-Assisted Intubation/Modified Rapid Sequence Intubation (Fig. 29.5)
6 Delayed Sequence Intubation
7 Role of Supraglottic Airway Devices (Fig. 29.6)
8 Surgical Airway
9 Role of Apneic Oxygenation
10 Special Trauma Scenarios
10.1 Cervical Spine Injury and Impact on Airway Management
10.2 Traumatized Airway
10.2.1 Clinical Presentation
10.2.2 Approach to the Patient with Airway Injury
10.2.3 Management of Airway Injuries
11 Conclusion
References
30: Airway Management in Obesity
1 Introduction
2 Anatomy and Physiology of Airway in Obesity
3 Pharmacology Related to Airway Management
4 Airway Assessment
5 Airway Management Strategies
5.1 Positioning
5.2 Preoxygenation
5.2.1 Methods of Preoxygenation
5.3 Face Mask Ventilation and Supraglottic Airway Devices
5.4 Intubation Techniques
5.5 Cannot Intubate, Cannot Ventilate Situation (CICV)
6 Post-Anesthetic Airway Complications
7 Conclusion
References
31: Airway Management in Maxillofacial Surgery
1 Introduction
2 Unique Aspects of Maxillofacial Surgery: Airway Perspective
3 Overview of Procedures
4 Assessment
5 Preparation and Planning
5.1 Patient
5.2 Equipment
5.3 Teamwork
6 Overview of Airway Techniques (Fig. 31.1)
6.1 Mask Ventilation
6.2 Endotracheal Intubation
6.3 Postintubation Management
6.4 Extubation
6.5 Role of Surgical Airway
7 Facial Esthetic Surgeries
7.1 Specific Perioperative Considerations (Fig. 31.4)
8 Maxillofacial Trauma
9 Pediatric Maxillofacial Procedures
9.1 General Considerations in Pediatric Maxillofacial Patients
9.2 Glossopexy
9.3 Cleft Lip and Palate Repair and Alveolar Grafting
9.3.1 Assessment
9.4 Airway Management in Cleft Surgery
9.4.1 Preparation
9.4.2 Induction
9.4.3 Laryngoscopy and Intubation
9.4.4 Extubation and Postextubation Care
10 Maxillofacial Oncosurgery
10.1 Assessment
10.2 Decision Making
10.3 Airway Management
10.4 Postoperative Care
11 Craniofacial Procedures in Children
11.1 Anatomy and Terminologies
11.2 Clinical Features
11.3 Surgical Procedures
11.4 Assessment, Preparation, and Planning
11.5 Airway Management
11.6 Extubation and Postoperative Care
12 Conclusion
References
32: Airway Management in Neuroanesthesia
1 Airway Management in Neurosurgical Patients
1.1 Introduction
1.2 Airway Management and Intracranial Dynamics
1.3 Other Airway Issues in Neurosurgical Patients
1.4 Airway Management of a Neurosurgical Patient During Extubation
1.5 Strategies of Airway Assessment and Management in the Neurosurgical Patient
1.6 Airway Management in Patients Undergoing Craniotomy
1.6.1 Airway Evaluation
1.6.2 Drugs During Airway Management
1.6.3 Airway Issues and Management During Awake Craniotomy (AC)
1.6.4 Intubation Strategies for Craniotomy
1.6.5 Peri-operative Airway Complications During Neurosurgery
1.6.6 Extubation Strategies for Craniotomy
1.7 Airway Management in Patients with Traumatic Brain Injury
1.7.1 Indications for Artificial Airway
1.7.2 Concerns During Airway Management
1.7.3 Considerations During Airway Management
1.7.4 Suggested Airway Management (Modified Rapid Sequence Intubation)
1.7.5 Extubation Strategies
1.8 Airway Management in Patients with Cervical Spine Injury
1.8.1 Concerns and Considerations
1.8.2 Evaluation of CSI and Airway
1.8.3 Intubation Strategies
1.8.4 Extubation Strategies
1.9 Airway Management in Patients with Chronic Cervical Spine Disease
1.9.1 Concerns During Airway Management
1.9.2 Airway Management Strategy
1.10 Airway Management in Patients with Acromegaly
1.10.1 Airway Concerns
1.10.2 Intubation Strategies
1.10.3 Extubation Prerequisites
1.10.4 Extubation Strategies
1.11 Airway Management in Patients with Halo-frame or Stereotactic Frame
1.12 Airway Management in Paediatric Neurosurgery
1.12.1 Considerations
1.12.2 Airway Evaluation
1.12.3 Airway Strategies
1.12.4 Encephalocele
1.12.5 Hydrocephalus
1.12.6 Cranio-facial Anomalies
1.12.7 Intubation Strategies
1.12.8 Extubation Strategies
2 Airway Management in Abnormal Positions During Neurosurgery
2.1 Introduction
2.2 Airway Management in the Lateral Position
2.2.1 Encephalocoele
2.2.2 Meningomyelocele
2.2.3 Macrocephaly
2.3 Airway Management in Prone Position
2.4 Airway Management in Sitting Position
3 Conclusions
References
33: Airway Management in Upper Gastrointestinal Endoscopy
1 Introduction
2 Classification of the Upper GI Endoscopic Procedures
3 Pre-anaesthetic Evaluation
3.1 ASA Physical Status
3.2 Airway Assessment
3.3 Preoperative Fasting Guidelines
4 Anaesthetic Techniques
4.1 Monitoring of Respiration
4.2 Pulse Oximetry
4.3 End Tidal Carbon Dioxide (ETCO2)
4.4 Impedance Pneumography
4.5 Acoustic Respiratory Monitoring
4.6 Oxygen Reserve Index
5 Patient Positioning
5.1 Lateral Position
5.2 Prone Position
5.3 Supine Position
6 Effect of Sedation Upper Airway Physiology
7 Manoeuvres and Equipment for Airway Patency and Oxygenation
7.1 Preoxygenation and Apnoeic Oxygenation
7.2 Airway Opening Manoeuvres
7.3 Dual End Tidal CO2 Nasal Oxygen Cannula
7.4 Procedural Oxygen Mask
7.5 Endoscopy Mask
7.6 DEAS Endoscopy Mask
7.7 Nasopharyngeal Airway
7.8 LMA Gastro Airway
7.9 Bite Blocks
8 Conclusion
References
34: Airway Management in Airway Emergency
1 Introduction
2 Aetiology and Mechanisms
3 Common Principles of Management
3.1 Anticipation and Early Recognition
3.2 Clinical Features of Actual or Impending Airway Emergencies [12, 13] 3.3 Plan
3.3.1 Plan for Oxygenation
3.4 Definitive Airway Access
3.4.1 Supraglottic Airway Devices (SADs)
3.4.2 Endotracheal Intubation
4 Specific Airway Emergencies
4.1 Airway Obstruction (AO)
4.1.1 Aetiology and Pathophysiology of Airway Obstruction
4.2 Assessment
4.3 Plan and Preparation
4.4 Management
4.4.1 Oxygenation and Airway Patency
4.4.2 Definitive Airway and Rescue Techniques
Endotracheal Intubation
4.5 Airway bleeding
4.6 Airway Fire
4.6.1 Management
4.6.2 Prevention
4.7 Intraoperative Loss of Airway
4.8 Post Extubation Loss of Airway
4.9 Unusual Situations
5 Summary
References
35: Airway Management in Intensive Care Unit
1 Introduction
2 Unique Aspects of Airway Management in Intensive Care Unit
3 Challenges for Airway Management (Table 35.1)
3.1 Patient Factors
3.2 Devices: Availability and Challenges
3.3 Drugs
3.4 Logistics and Timing
3.5 Personnel
4 Indications for Airway Management (Table 35.2)
5 Preprocedure Assessment
6 Preparation and Planning
6.1 Optimization of Comorbid Conditions
6.2 Aspiration Prevention
6.3 Positioning
6.4 Preoxygenation and Management of Difficult Oxygenation
6.5 Pharmacological Agents for Intubation
7 Laryngoscopy and Intubation (Fig. 35.1)
7.1 Steps Recommended After a Failed First Intubation Attempt
7.2 Video Laryngoscope
7.3 Confirmation of Intubation
7.4 Complications of Endotracheal Intubation in ICU [34] 7.5 Endotracheal Tube Care
8 Supraglottic Airway Devices in ICU
9 Surgical Airway
9.1 Tracheostomy
9.1.1 Early (Within 7 Days) Vs. Late Tracheostomy
9.2 Tracheostomy Care
10 Quality Enhancement Program: Training, Teaching, Bundles, Algorithms
References
36: Airway Management in Prehospital Care
1 Introduction
2 Airway Management in Prehospital Situations: Overview
2.1 Airway Assessment and Recognizing Need for Airway Management
2.2 Identification of Difficult Airway in Prehospital Setting
2.3 Selection of Appropriate Airway Strategy
2.4 Airway Manoeuvres
2.5 Airway Adjuncts
2.6 Bag-Mask ventilation
2.7 Supraglottic Airway Devices
2.7.1 Laryngeal Mask Airway and Other SGADs
2.7.2 Laryngeal Tube
2.7.3 Combitube
2.7.4 Clinical Relevance
2.8 Endotracheal Intubation
2.8.1 Inverse Intubation
2.8.2 Clinical Relevance
2.8.3 Postintubation Care
3 Out-of-Hospital Cardiac Arrest
4 Prehospital Medical Team: Composition and Importance
5 Conclusion
References
37: Airway Management in Emergency Department
1 Introduction
2 Challenges in Emergency Airway Management
3 Airway Management in ED
3.1 Assessment
3.2 Indications for Securing an Emergency Advanced Airway
3.3 Planning Preparation for Management of Airway
3.4 Preoxygenation and Apneic Oxygenation: Prevention of Desaturation
3.4.1 Apneic Oxygenation
3.5 Basic Maneuvers, Airway Aids, and Mask Ventilation
3.6 Endotracheal Intubation
3.6.1 Video Laryngoscopy for Intubation
3.6.2 Flexible Video Endoscopy (FVE) Guided Intubation
3.7 Intubation Through Supraglottic Airway Device (SGAD)
3.8 Modified Rapid Sequence Intubation
3.8.1 Intubation with a Delayed Sequence Intubation
3.9 Surgical Airway
4 Role of Noninvasive Ventilation
5 Drugs for Airway Management
5.1 Premedication
5.2 Sedatives and Induction Agents
5.3 Neuromuscular Blockade (NMB)
6 Special Circumstances
6.1 Cardiac Arrest
6.2 Elevated Intracranial Pressure
6.3 Bleeding from Upper Gastrointestinal System
6.4 Cardiac Tamponade
6.5 Obesity
6.6 Pregnancy
6.7 Children
7 Role of Ultrasound
8 Crash Airways
9 Conclusion
References
38: Airway Management in ENT Procedures
1 Introduction
2 Anesthetic Concerns for Oro-Pharyngeal, Laryngeal, and Tracheal Surgeries
3 Preoperative Considerations
4 Intra-oral Surgeries
4.1 Adeno-Tonsillectomy
4.1.1 Pre-operative Considerations
4.1.2 Anesthetic Management
4.2 Post-tonsillectomy Bleeding
4.3 Tonsillar Carcinoma
4.4 Vallecular Cyst
4.4.1 Laryngospasm
5 Surgeries in Neck
5.1 Thyroidectomy
5.1.1 Preoperative Considerations
5.1.2 Anesthetic Management
5.1.3 Post-operative Care
5.2 Laryngeal Surgery
5.2.1 Preoperative Considerations
5.2.2 Anesthetic Technique
5.2.3 Closed Anesthetic Technique (With Cuffed ETT)
5.2.4 Open Anesthetic Technique (Without Cuffed ETT)
5.2.5 Jet Ventilation
5.3 Microlaryngeal Surgeries
5.4 Recurrent Laryngeal Papillomatosis
5.5 Intubation Granuloma
6 Tracheostomy for Stridor
7 Laryngectomy
8 Laser Airway Surgeries
8.1 Preparation for Laser Surgeries
8.2 Management of Airway Fire
9 Ludwig’s Angina
10 Retropharyngeal Abscess
11 Foreign Body Aspiration
11.1 Assessment
11.2 Pre-anesthetic Concerns
11.3 Imaging
11.4 Pre-anesthetic Preparation
11.4.1 Spontaneous vs. Controlled Ventilation
11.5 Jet Ventilation
12 Tracheal Reconstruction Surgeries
12.1 Pre-anesthetic Evaluation
12.2 Induction
12.3 Maintenance of Anesthesia
13 Nasal Surgeries
14 Ear Surgery
15 Summary
References
39: Airway Management in Neonates
1 Introduction
2 Developmental Airway Anatomy
2.1 Skull
2.2 Face
2.3 Larynx
2.4 Neck
3 Developmental Airway Physiology
3.1 Preferential Nasal Breathing
3.2 Airway Protective Mechanisms
3.3 Minute Ventilation, FRC, and Closing Capacity
3.4 Airway Resistance and Work of Breathing
4 Preoperative Airway Evaluation
4.1 History
4.2 Physical Examination
4.3 Preoperative Preparation
5 Airway Management Techniques
5.1 Mask Ventilation
5.2 Supraglottic Airway Devices
5.2.1 Indications for SAD
Procedure of Insertion
Demerits
5.3 Endotracheal Intubation
5.3.1 Indications
5.3.2 Cuffed Versus Uncuffed Endotracheal Tubes
Microcuff Tubes
5.4 Direct Laryngoscopy
5.5 Videolaryngoscopy
5.6 Flexible Videoendoscopy
5.6.1 Technical Differences in Neonates
6 Extubation and Postoperative Care
6.1 Extubation
6.2 Postoperative Mechanical Ventilation
7 Complications
7.1 Airway Injuries
7.2 Postintubation Croup
7.3 Laryngospasm
7.3.1 Management
8 Difficult Airway Management in Neonates
9 Conclusion
References
40: Airway Management in Infectious Diseases
1 Introduction
2 Types of Diseases We Have Witnessed
3 What Are We Aware of Till Now?
4 Risk to Healthcare Workers (HCWs)
4.1 Intrinsic Risk Factors (Patient and Procedure Related)
4.2 Individual Risk Factors (of HCWs)
5 Management of AGPs During Transmittable Respiratory Infections
5.1 Preoperative Assessment of Airway
5.2 Adequate PPE
6 Intraoperative Management
6.1 Patient Preparation
6.2 Specific Preparation for AGP
7 Anesthesia and Surgery Associated Modifications
7.1 OT Air Conditioning System Modifications
7.2 Conversion to Negative Pressure System on Emergency Basis
7.3 OT Area Modifications
7.4 Anesthesia Technique
7.4.1 Preoxygenation
7.4.2 Induction and Avoidance of Coughing
7.4.3 Intubation Equipment and Prevention of Aerosols [27, 28] 7.4.4 Additional Barriers to Prevent Aerosol Exposure During Intubation [27, 30–33] 8 Difficult Airway Management
8.1 Anticipated Difficult Airway Management
8.2 Unanticipated Difficult Airway Management [27] 8.3 Special Considerations
9 Intubation in ICU: How Is It Different from OT?
10 Extubation of the Airway
10.1 Do’s and Don’t s for Safe Extubation
11 Transportation to ICU
12 Summary
References
Part VI: Others
41: Complications of Airway Management
1 Introduction
2 Hypoxia
2.1 Risk Factors
2.2 Management and Prevention of Hypoxia
3 Aspiration
3.1 Risk Factors
3.2 Methods to Prevent Pulmonary Aspiration
3.2.1 Aspiration Prophylaxis
3.2.2 Rapid Sequence Induction (RSI) and Intubation
Modification of RSI (mRSI)
Controversies
3.3 Management of Pulmonary Aspiration During Airway Manipulation
4 Prolonged ICU Stay
5 Death
6 Trauma to the Airway
6.1 Soft Tissue Injury
6.2 Dental Injury
6.3 Injury to the Eye
7 Postoperative Sore Throat
8 Laryngospasm
9 Bronchospasm
10 Laryngeal Edema
11 Vocal Cord Paralysis
11.1 Prevention
11.2 Management
12 Aphonia
13 Laryngotracheal Stenosis
14 Other Rare Complications of the Larynx and Trachea
14.1 Tracheomalacia
14.2 Tracheoinnominate Artery Fistula
14.3 Tracheoesophageal Fistula
15 Systemic Manifestations of Airway Management
16 Complications with the Use of Videolaryngoscopes
17 Complications Associated with the Use of Fiberoptic Endoscopes
18 Complications with the Use of SAD
19 Role of Human Factors in Airway Complications
20 Prevention of Airway Complications
21 Conclusion
References
42: Controversies in Airway Management
1 Introduction
2 Difficult Mask Ventilation: To Paralyze or not
2.1 Current Evidence
3 Sellick Manoeuvre or Cricoid Pressure
3.1 Guidelines
3.2 Conclusion
4 Succinylcholine
4.1 Conclusion
5 Controversies Related to Supraglottic Airway Devices
5.1 Supraglottic Airway Device as a Definitive Airway Device in Difficult Airway
5.2 Supraglottic Airway in Obese Patients
5.3 Role of Supraglottic Airway in Laparoscopic Surgery
5.4 Role of Supraglottic Airway in Caesarean Delivery
5.5 Role of Supraglottic Airway in Prone Position
6 Is There an Ideal Videolaryngoscope?
7 Deep vs. Awake Extubation
8 Conclusion
References
43: Airway Management in Low Resource Settings
1 Introduction
2 Resources and the Impact on Safety
2.1 Airway Equipment and Medication Challenges
2.2 Challenges in Postoperative Care
2.3 Safety Culture
3 Assessment and Preparation
4 Airway Management
4.1 Oxygenation Techniques
4.2 Induction of Anesthesia and Neuromuscular Blockade
4.3 Mask Ventilation
4.4 Laryngoscopy and Tracheal Intubation
4.5 Supraglottic Airway Devices
4.6 Extubation and Postoperative Care
5 Applicability of Various Algorithms
6 Follow-Up Care
7 Role of Innovative Practices
8 Airway Management in Rural Surgical Camps
9 Training and Development
10 Conclusions
References
44: Recent Advances in Airway Management
1 Airway Management and Voice Changes
1.1 Introduction
1.2 Biomechanics of Voice [3] 1.2.1 Pulmonary System
1.2.2 Central Nervous System
1.3 Risk Factors
1.3.1 Patient Related Risk Factors
1.3.2 Anesthesia Related Factors: Drugs and Techniques (Table 44.2)
1.3.3 Surgical Risk Factors
1.4 Clinical Presentation
1.5 Diagnosis
1.6 Management
1.7 Airway Management in Voice Dependent Professionals
1.7.1 Role of Laryngeal Mask Airway (LMA) in Voice Dependent Professionals
1.8 Safety Checklist
2 Tubeless Anesthesia in Airway Management
2.1 Introduction
2.2 Indications and Clinical Applications [20] 2.3 High Pressure Source Ventilation (HPSV) or Jet Ventilation (JV)
2.3.1 Supraglottic HPSV
2.3.2 Trans Glottic HPSV
2.3.3 Transtracheal HPSV
2.4 Supraglottic Jet Oxygenation and Ventilation (SJOV)
2.4.1 Scope of SJOV
2.4.2 Mechanism of Action of SJOV (Fig. 44.4)
2.4.3 Practical Applications of SJOV
Procedural Sedation
Flexible Fiberoptic Intubation (FFOI)
Intubation
Rescue Device
Airway Patency
2.4.4 Complications
2.5 Apneic Oxygenation
2.5.1 Methods of Delivering AO
2.5.2 Physiology of AO: The “Aventilatory Mass Flow” Theory [33] (Fig. 44.5)
2.5.3 Applications of AO
2.6 Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)
2.6.1 Physiology of THRIVE: (Fig. 44.6)
2.7 Conduct of Anesthesia While Providing TA
2.8 Guide to Selection of Various Tubeless Techniques for Different Clinical Situations
2.9 Conclusion
3 Anesthesia for Airway Surgery
3.1 Introduction
3.2 Preoperative Preparation
3.2.1 Patient Assessment and Optimization
3.2.2 Preoperative Investigations
3.2.3 Equipment and Facilities
3.3 Principles of Anesthetic Management
3.3.1 Approach to Airway
3.3.2 Airway Anesthesia
3.3.3 Anesthetic Induction and Maintenance
3.3.4 Extubation and Postanesthesia Care
Airway Management in Various Laryngotracheal Surgeries
4 Laser Surgery
4.1 Introduction
4.2 Preparation
4.2.1 Equipment
4.2.2 Safety of Theater Personnel
4.2.3 Measures for Patient Protection (Fig. 44.8)
4.3 Techniques of Airway Management
References
45: Simulation-Based Airway Training
1 Introduction
2 The Need for Simulation-Based Airway Training
3 Benefits of Simulation in Airway Training
4 Effectiveness of Simulation
5 Types of Simulators
5.1 High-Fidelity Simulators for Airway Training
6 Simulation Center and Equipment
7 Training Techniques
7.1 Identify Target Trainees
7.2 Identify Training Skill
7.3 Technical Skill
7.4 Non-technical Skill
7.5 Set Goals and Objectives
7.6 Scenario Development
7.7 Briefing
7.8 De-briefing
7.9 Outcome Assessment
8 Limitations and Challenges
9 Recent Advances
9.1 Augmented Reality Simulator
9.2 Virtual Reality Simulator
9.3 Haptic Simulation
10 Conclusion
References