Hagberg and Benumof’s Airway Management

Description

Anesthesiologists, residents, and advanced practice practitioners alike rely upon the comprehensive content of Hagberg and Benumof’s Airway Management to remain proficient in this essential area. The 4th Edition, by Drs. Carin A. Hagberg, Carlos A. Artime, and Michael F. Aziz, continues the tradition of excellence with coverage of new devices and algorithms, new research, new outcomes reporting, and much more – while retaining a concise, how-to approach; carefully chosen illustrations; and case examples and analysis throughout. Offers expert, full-color guidance on pre- and post-intubation techniques and protocols, from equipment selection through management of complications. Includes the latest ASA guidelines, as well as six all-new chapters including airway management in nonoperating room locations (NORA), airway management and outcomes reporting, and more. Features completely rewritten chapters on airway pharmacology, algorithms for management of the difficult airway, airway assessment, video-assisted laryngoscopy, and many more. Reviews new airway devices and techniques, along with indications for and confirmation of tracheal intubation. Brings you up to date with the latest devices, the DAS extubation algorithm, the Vortex approach, and emergency cricothyrotomy. Hagberg and Benumof's Airway Management......Page 2 Copyright Page......Page 4 Dedication......Page 5 Contributors......Page 6 Foreword......Page 14 Preface......Page 15 Acknowledgments......Page 16 Video Contents......Page 17 Structure......Page 18 Function......Page 19 Function......Page 20 Obstructive Sleep Apnea......Page 21 Bones of the Larynx......Page 22 Cricoid Cartilage.......Page 23 Epiglottis.......Page 24 Laryngeal Cavity......Page 25 Intrinsic Muscles of the Larynx.......Page 26 Glottic Closure and Laryngeal Spasm......Page 28 Vocal Cord Palsies......Page 29 Structure......Page 30 Blood Supply......Page 31 Forces Acting on the Airway......Page 32 Conclusion......Page 33 Selected References......Page 34 References......Page 35 Introduction......Page 37 Magnetic Resonance Imaging......Page 38 Radiologic Anatomy......Page 39 Cervical Spine Anatomy and Pathology......Page 40 Cervical Airway Anatomy and Pathology......Page 45 Radiology Overview......Page 51 Chest Anatomy and Pathology......Page 53 Development and Structure......Page 56 Imaging Anatomy and Pertinent Pathology......Page 57 Congenital Anomalies......Page 59 Trauma......Page 60 Tumors and Other Pathology......Page 61 Development and Structure......Page 62 Imaging Anatomy and Pertinent Pathology......Page 64 Macroglossia......Page 67 Tumors......Page 68 Adenoidal Hypertrophy......Page 70 Tornwaldt Cyst......Page 72 Oropharynx......Page 76 Retropharyngeal Abscess......Page 78 Tumors......Page 79 Trauma......Page 80 Structure and Function......Page 81 Imaging Anatomy and Pertinent Pathology......Page 82 Trauma......Page 84 Development and Structure......Page 85 Extrinsic Tracheal Pathology......Page 86 Intrinsic Tracheal Pathology......Page 87 Conclusion......Page 88 Clinical Pearls......Page 89 Selected References......Page 91 References......Page 92 The Ultrasound Image and How to Obtain It......Page 94 Mouth and Tongue......Page 95 Larynx......Page 97 Esophagus......Page 98 Peripheral Lung and Pleura......Page 99 Diaphragm......Page 100 Diagnosis of Obstructive Sleep Apnea......Page 101 Localization of the Trachea......Page 102 Localization of the Cricothyroid Membrane......Page 103 Confirmation of Endotracheal Tube Placement......Page 105 Confirmation of Gastric Tube Placement......Page 106 Prediction of Successful Extubation......Page 107 Special Techniques and Future Aspects......Page 109 Selected References......Page 110 References......Page 112 Ideal Gases......Page 115 Pressure, Flow, and Resistance......Page 116 Example: Transtracheal Jet Ventilation......Page 117 Laminar Flow......Page 118 Reynolds Number Calculation Example......Page 119 Flow Through an Orifice......Page 120 Pressure Differences......Page 121 Endotracheal Tube Resistance......Page 122 Work of Breathing......Page 124 Determination of Rohrer’s Constants......Page 126 Anesthesia at Moderate Altitude......Page 127 Flowmeter Calibration......Page 128 Estimation of Oxygen Consumption Rate......Page 129 Conclusion......Page 130 Selected References......Page 131 References......Page 133 Distribution of Pulmonary Perfusion......Page 135 Distribution of Ventilation......Page 137 The Ventilation-Perfusion Ratio......Page 138 Lung Volume......Page 140 Tissue (Endothelial- and Smooth Muscle–Derived) Products......Page 141 Alveolar Gases......Page 142 Neural Influences on Pulmonary Vascular Tone......Page 143 Alternative (Nonalveolar) Pathways of Blood Flow Through the Lung......Page 144 Airway Resistance......Page 145 Different Regional Lung Time Constants......Page 146 Work of Breathing......Page 147 Lung Volumes and Functional Residual Capacity......Page 148 Airway Closure and Closing Capacity......Page 149 Patient With Normal Lungs.......Page 150 Relationship Between Functional Residual Capacity and Closing Capacity.......Page 151 Alveolar and Dead Space Ventilation and Alveolar Gas Tensions......Page 152 Overview......Page 153 Oxygen-Hemoglobin Dissociation Curve......Page 154 Effect of Q̇t and V̇o2 on Arterial Oxygen Content......Page 156 Fick Principle......Page 157 Pulmonary Microcirculation, Interstitial Space, and Fluid (Pulmonary Edema)......Page 158 Anesthetic Depth and Respiratory Pattern......Page 160 Special Intraoperative Conditions......Page 161 Hyperventilation......Page 162 Neuromuscular Blockade......Page 163 Supine Position, Immobility, and Excessive Intravenous Fluid Administration......Page 164 Decreased Removal of Secretions (Decreased Mucociliary Flow)......Page 165 Neuromuscular Blockade......Page 166 Involvement of Mechanisms of Hypoxemia in Specific Diseases......Page 167 Increased Carbon Dioxide Production......Page 168 Hypoxia......Page 169 Hyperoxia (Oxygen Toxicity)......Page 170 Hypocapnia......Page 171 Clinical Pearls......Page 172 Selected References......Page 173 References......Page 174 Introduction......Page 178 Routes of Drug Administration to the Airway......Page 179 Autonomic Nervous System......Page 180 Airway Reactivity and Resistance......Page 181 Local Anesthetics......Page 182 Intravenous Anesthetics......Page 183 Opioids......Page 184 Reversal Agents for Neuromuscular Blocking Drugs......Page 185 Treatment of Asthma......Page 186 Glucocorticoids......Page 187 Anticholinergic Agents......Page 188 Proactive Management—Prevention of Bronchospasm......Page 189 Reactive Management—Treatment of Bronchospasm......Page 190 Selected References......Page 191 References......Page 192 Cardiovascular Reflexes......Page 195 Intubation in Patients With Neuropathologic Disorders......Page 196 Cardiopulmonary Consequences of Positive-Pressure Ventilation......Page 197 Technical Considerations: Minimizing Stimulation of Airway Sensory Receptors......Page 198 Inhalational Anesthetics......Page 199 Intravenous Agents......Page 200 Upper Airway Resistance......Page 201 Lower Airway Resistance......Page 202 Functional Residual Capacity......Page 203 Regional and Topical Anesthesia......Page 204 Technical Considerations: Minimizing Airway Stimulation......Page 205 Choice of Neuromuscular Blocking Drug......Page 206 Clinical Pearls......Page 207 Selected References......Page 208 References......Page 209 Causes of Difficult Mask Ventilation......Page 214 Definition of Difficult Mask Ventilation......Page 215 Laryngeal Visualization......Page 216 Incidence of Difficult Laryngeal Visualization......Page 217 Difficult Video-Assisted Laryngoscopy......Page 218 Conclusion......Page 219 Selected References......Page 220 References......Page 221 History of a Difficult Airway......Page 223 Bleeding Risk......Page 224 Acromegaly......Page 225 Oral Aperture......Page 226 Dentition......Page 227 Thyromental Distance......Page 228 Neck Anatomy and Mobility......Page 229 Facial Features......Page 230 Challenges to Studying Airway Assessment......Page 231 Conclusion......Page 232 Selected References......Page 233 References......Page 235 Decision Making......Page 238 Laryngoscopy and Intubation......Page 239 Ventilation......Page 240 Tolerance of Apnea......Page 241 Integration: The Airway Approach Algorithm......Page 242 Selected References......Page 243 References......Page 244 Usefulness of Airway Algorithms......Page 246 National Anesthesia Society Guidelines......Page 247 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway......Page 248 Difficult Airway Society Guidelines for Management of Unanticipated Difficult Intubation in Adults......Page 250 Canadian Airway Focus Group Guidelines......Page 251 Chinese Society of Anesthesiology Guidelines for Management of the Difficult Airway......Page 252 The Vortex Approach to Airway Management......Page 253 Difficult Airway Scenarios—Comparison Between National Societies......Page 254 Follow-Up Care of a Patient With a Difficult Airway......Page 256 Selected References......Page 257 References......Page 258 Introduction......Page 260 The Patient Interview......Page 261 Antisialagogues......Page 262 Metoclopramide......Page 263 Precautions......Page 264 Precautions......Page 265 Droperidol......Page 266 Other Local Anesthetics......Page 267 Nebulizers......Page 268 Spray-as-You-Go......Page 269 Anatomy......Page 270 Anatomy......Page 271 External Approach (Peristyloid)......Page 272 Anatomy......Page 273 Thyroid Notch.......Page 274 Internal Approach......Page 275 Technique......Page 276 Conclusion......Page 277 Selected References......Page 278 References......Page 279 Incidence......Page 283 Demographic......Page 284 Pregnancy......Page 285 Pathophysiology......Page 286 Prevention of Aspiration......Page 287 Pregnant Patients......Page 288 Preinduction Gastric Emptying......Page 289 Rapid Sequence Induction and Cricoid Pressure......Page 290 Gastroesophageal Motility......Page 291 Erythromycin......Page 292 Cimetidine.......Page 293 Proton Pump Inhibition......Page 294 Management of Pulmonary Aspiration......Page 295 Selected References......Page 296 References......Page 297 Physiologic Considerations......Page 301 Body Oxygen Stores......Page 302 Mechanism......Page 303 Efficacy of Preoxygenation......Page 304 Efficiency of Preoxygenation......Page 305 Tidal Volume Breathing......Page 306 Deep Breathing Techniques......Page 307 Noninvasive Positive-Pressure Ventilation......Page 309 THRIVE......Page 310 Breathing Systems for Preoxygenation......Page 311 Pregnancy......Page 312 Morbid Obesity......Page 313 Pediatric Patients......Page 314 Critically Ill Patients......Page 315 Selected References......Page 316 References......Page 317 Intravenous Induction Without Neuromuscular Blockade......Page 320 Rapid Sequence Induction and Intubation......Page 321 Inhalational Induction......Page 322 Selected References......Page 323 References......Page 324 Early Anatomic and Physiologic Experiments......Page 326 A New Approach in Adults......Page 327 Simple Airway Management......Page 328 Infection—A Different Airway Challenge......Page 329 Early Experience With Intubation for Anesthesia......Page 330 Wide-Bore Tracheal Tubes......Page 331 Improvements to Tracheal Tubes......Page 332 Early Laryngoscope Development......Page 333 Laryngoscopes for Anesthesia......Page 334 Development of the Laryngeal Mask Airway......Page 336 Bougies and Stylets......Page 337 Transtracheal Ventilation......Page 338 Indirect Laryngoscopes......Page 339 Difficult Airway Trolley......Page 340 Selected References......Page 341 References......Page 343 Indications......Page 347 Oxygen Delivery Systems......Page 348 Nasal Cannulas......Page 349 Simple Face Mask......Page 350 Nonrebreathing Mask......Page 351 Venturi Masks......Page 352 Humidifiers......Page 353 Complications......Page 355 Equipment......Page 356 Postural Drainage and Positional Changes......Page 357 Incentive Spirometry......Page 359 Administration......Page 360 Noninvasive Ventilation in Cardiothoracic and Upper Abdominal Surgical Patient......Page 361 Inhalation Therapy......Page 362 Aerosolized Drug Delivery Systems......Page 363 Mucokinetic Drugs......Page 364 Sympathomimetics......Page 365 Conclusion......Page 367 Selected References......Page 368 References......Page 369 Introduction......Page 372 Upper Airway Collapsibility and Obstruction......Page 373 Airway Maneuvers Applied to Bony Structures......Page 374 Validated Airway Maneuvers......Page 375 Resuscitation/Anesthesia Face Mask Design and Techniques for Use......Page 376 Oropharyngeal Airways......Page 378 Nasopharyngeal Airways......Page 380 “E-C” Grip......Page 381 Objective Markers......Page 382 Strategies to Minimize Gastric Insufflation......Page 383 Patient Factors......Page 384 Provider Factors......Page 385 Strategies for an Optimal Attempt at Face Mask Ventilation......Page 386 Controlled Ventilation by Face Mask......Page 387 Conclusion......Page 388 Selected References......Page 389 References......Page 391 Introduction......Page 394 Pragmatic Classification......Page 396 Anatomico-Mechanistic Classification......Page 397 Design Features......Page 398 Aspiration Protection......Page 399 Atraumatic Insertion......Page 400 Controlled Ventilation......Page 401 Management of the Expected Difficult Airway......Page 402 Surgery in the Prone Position......Page 403 Pregnant Patients......Page 404 Basic LMA Insertion Technique......Page 405 Insertion Techniques for the ProSeal and Supreme LMA......Page 406 Blind Technique......Page 407 Identification of Malposition......Page 409 Oropharyngeal Leak Pressure Test......Page 411 Selecting the Right Device......Page 412 Clinical Pearls......Page 413 Selected References......Page 414 References......Page 415 Esophageal Tracheal Combitube......Page 420 Indications and Advantages......Page 421 Prehospital Settings......Page 422 In Hospital Settings......Page 423 Technical Description......Page 424 Clinical Studies......Page 425 Technical Description......Page 426 Indications and Advantages......Page 427 Laryngeal Tube Suction II......Page 429 Intubating Laryngeal Tube Suction Disposable—iLTS-D......Page 430 Gastro Laryngeal Tube......Page 431 Technical Description......Page 432 Indications and Advantages......Page 433 Technical Description......Page 434 Technical Description......Page 435 Indications and Advantages......Page 436 Indications and Advantages......Page 438 Technical Description......Page 439 Conclusion......Page 440 Selected References......Page 441 References......Page 442 Endotracheal Intubation for Resuscitation......Page 447 Endotracheal Intubation for Emergency Medicine......Page 448 Endotracheal Intubation for Intensive Care......Page 449 Endotracheal Intubation for Anesthesia......Page 450 Assessment......Page 452 Positioning......Page 453 Preoxygenation and Perioxygenation......Page 454 Techniques for Laryngoscopy and Tracheal Intubation......Page 455 Technique......Page 456 Straight Blade Laryngoscopy......Page 460 Technique......Page 461 Difficulties......Page 462 Rapid Sequence Induction......Page 463 Selected References......Page 464 References......Page 467 Introduction......Page 471 Preparation......Page 472 Procedure......Page 473 Combined Techniques......Page 474 Limitations......Page 475 Preparation......Page 476 Preparation......Page 477 Procedure......Page 478 Clinical Pearls......Page 480 Selected References......Page 481 References......Page 482 Eschmann Introducer......Page 484 Other Types of Intubation Guides......Page 485 Stylets......Page 486 Lighted Stylets......Page 487 Oral Intubation......Page 489 Nasal Intubation......Page 491 Difficult Airway......Page 492 Use With Other Airway Devices......Page 493 Optical Stylets......Page 494 Types of Optical Stylets......Page 495 Combination Techniques......Page 496 Selected References......Page 497 References......Page 499 Image Recording......Page 503 Predicted Difficult Intubation......Page 504 Difficulty or Failure With Video-Assisted Laryngoscopy......Page 505 Cervical Spine Motion During Video-Assisted Laryngoscopy......Page 506 Device Considerations......Page 508 McGrath MAC......Page 509 GlideScope......Page 510 King Vision......Page 511 Pentax AWS......Page 512 Selected References......Page 513 References......Page 514 Chapter Outline......Page 516 Introduction......Page 517 How They Work, How to Choose, and What to Do With Them......Page 518 Flexible Intubation Scope Design......Page 519 Deciding on Disposables or Partially Disposables......Page 520 Rationale for Flexible Scope Intubation......Page 522 Flexible Intubation Scope Cart......Page 523 Bronchoscopy Swivel Adapters and Endoscopy Masks......Page 524 Endotracheal Tubes: What Is Best?......Page 525 Preparing for Oral Flexible Scope Intubation in Awake Patients......Page 526 Sedation and Analgesia......Page 527 Innervation of the Orotracheal Airway......Page 528 External Approach to Superior Laryngeal Nerve Block......Page 529 Transtracheal Block......Page 530 Local Anesthetic Drug Choices......Page 531 Practical Application of Orotracheal Flexible Scope Intubation Technique......Page 532 Three Successive Directions for Flexible Intubation Scope Guidance......Page 533 Local Nasopharyngeal Anesthetic Techniques......Page 535 During Routine General Anesthesia......Page 536 Combination Techniques: Devices Combined With Flexible Intubation Scopes......Page 537 Supraglottic Airways......Page 538 Supraglottic Airways and Guidewires......Page 539 Unsoiled Airway Conditions......Page 540 Video Laryngoscopes and Optical Laryngoscopes......Page 541 Channeled Devices......Page 542 Facilitating Endotracheal Tube Exchange......Page 543 Troubleshooting Bronchial Blockers......Page 544 Flexible Scope Intubation in Infants and Children......Page 545 Local Orotracheal Anesthesia Techniques......Page 546 Two-Stage Flexible Scope Intubation Technique......Page 547 Faster Learning Curve—Faster Time to Intubate Very Difficult Airways......Page 548 Minimal Cervical Spine Motion......Page 549 Complications......Page 550 Practicing Tips for Novices, Intermediates, or Experts......Page 551 Try Purely Computer-Based Bronchoscopy Simulators......Page 552 How About Low-Fidelity Training Models?......Page 553 Make a Free Model in 5 Minutes......Page 554 Practice Troubleshooting High Airway Pressures, Low Saturations, Uncertain Endotracheal or Supraglottic Airway Positions, or One-Lung Isolation......Page 555 Skill Retention Tips......Page 556 Clinical Pearls......Page 557 Selected References......Page 558 References......Page 559 Physiology......Page 565 Relative Indications......Page 566 Disadvantages......Page 567 Placement of the Double-Lumen Tube......Page 568 Malpositioning and Complications......Page 570 Contraindications......Page 573 Bronchial Mucosal Damage......Page 574 Positioning......Page 575 Arndt Endobronchial Blocker......Page 577 Cohen Flexitip Endobronchial Blocker......Page 578 EZ-Blocker......Page 579 Para-Axial Endotracheal Blockers......Page 580 Ventilation-Perfusion During Thoracic Surgery......Page 581 Balloon-Tipped Bronchial Blockers......Page 582 Clinical Pearls......Page 583 Selected References......Page 584 References......Page 585 Chapter Outline......Page 587 Cricothyrotomy and Percutaneous Dilational Cricothyrotomy......Page 588 Percutaneous Tracheostomy......Page 589 Role of the Anesthesiologist, Emergency Medicine Physician, and Otolaryngologist......Page 590 Cricothyrotomy......Page 591 Rescue Oxygenation in a Cannot Intubate/Cannot Oxygenate Situation......Page 593 Principles and Planning......Page 594 Melker Emergency Cricothyrotomy Catheter Set......Page 595 Over-the-Needle Catheter Versus Introducer Needle......Page 596 Principles and Planning......Page 598 Seldinger Guidewire and Single-Dilator Kits......Page 599 Portex ULTRAperc Single-Stage Dilator......Page 601 Portex Griggs Percutaneous Dilation Tracheostomy Kit......Page 603 Translaryngeal Tracheostomy Kit......Page 604 Principles and Planning......Page 606 Insertion Techniques......Page 607 Cricothyrotomy......Page 608 Transtracheal Jet Ventilation......Page 609 Infection Sites......Page 610 Swallowing and Communication Difficulty......Page 611 Selected References......Page 612 References......Page 613 Instrumentation......Page 617 Preoperative Considerations......Page 619 Anesthesia for Bronchoscopy......Page 620 Surgical Technique......Page 621 Complications......Page 622 Foreign Body Removal......Page 623 Selected References......Page 624 References......Page 625 General Principles......Page 626 Definitions of the Surgical Airway......Page 627 Vascular Structures......Page 628 Anatomic Variations......Page 629 Indications and Contraindications......Page 630 Landmarks......Page 631 Traditional Surgical Cricothyrotomy: The “No-Drop” Technique......Page 632 Rapid Four-Step Technique......Page 636 Percutaneous Cricothyrotomy Techniques......Page 637 Training Issues......Page 638 Hemorrhage......Page 639 Selected References......Page 640 References......Page 641 Introduction......Page 643 Endotracheal Tube Visualization......Page 644 Secondary Endotracheal Detection Techniques......Page 645 Carbon Dioxide in Exhaled Gases......Page 646 Esophageal Detector Device......Page 647 Ultrasonography......Page 648 Techniques to Determine Endotracheal Tube Insertion Depth......Page 649 Positioning Under Direct Visualization......Page 650 Chest Radiography......Page 651 Clinical Pearls......Page 652 Selected References......Page 653 References......Page 654 Different Types of Emergency Medical Service Systems and Providers......Page 657 Cardiac Arrest......Page 658 Noninvasive Positive Pressure Ventilation......Page 659 Intubation of the Nonsupine Patient......Page 660 Entrapped Patients......Page 661 Medication-Facilitated Airway Management......Page 662 Airway Management for Out-of-Hospital Cardiac Arrest......Page 663 Cricothyrotomy......Page 664 Awake Techniques......Page 665 Selected References......Page 666 References......Page 667 Basic Life Support and Cardiopulmonary Resuscitation Guidelines......Page 669 Rescue Breathing......Page 672 Advanced Airway Management During Cardiopulmonary Resuscitation......Page 674 Oxylator......Page 675 Challenges of Airway Management During Cardiopulmonary Resuscitation......Page 676 Supraglottic Airway Devices Versus Endotracheal Intubation as an Advanced Airway Technique......Page 677 Clinical Pearls......Page 678 Selected References......Page 680 References......Page 681 Triage Techniques......Page 683 Mass Trauma......Page 684 Epidemic Versus Pandemic......Page 686 Radiation Exposure......Page 688 Airway Management in Austere Environments......Page 689 Personal Protective Equipment......Page 690 Selected References......Page 691 References......Page 693 Introduction......Page 694 Indications for Airway Management......Page 695 Prevention of Aspiration......Page 697 Neuromuscular Blocking Agents......Page 698 Choice of Technique and the Difficult Airway......Page 699 Dealing With the Field-Placed Airway......Page 701 Damage Control Radiology and Airway Management......Page 702 Penetrating Neck Trauma......Page 703 Maxillofacial Trauma......Page 705 Cervical Spine Injury......Page 706 Traumatic Brain Injury......Page 707 Thoracic Injury......Page 708 Selected References......Page 709 References......Page 710 Phases of Burn Injury......Page 714 Pharmacologic Considerations in Burn Patients......Page 715 Airway Management During the Acute Phase of Burn Injury......Page 716 Airway Management During the Subacute Phase of Burn Injury......Page 717 Airway Management During the Chronic Phase of Burn Injury......Page 718 Airway Management of Pediatric Burn Patients......Page 720 Selected References......Page 721 References......Page 722 Chapter Outline......Page 723 Evaluation of the Pediatric Airway......Page 724 Face Mask......Page 725 Endotracheal Tube......Page 726 Video Laryngoscopes......Page 727 Optical Stylets......Page 728 Air-Q Intubating Laryngeal Airway......Page 729 Induction Technique......Page 730 Fiberoptic Laryngoscopy......Page 731 Retrograde Intubation......Page 732 Airway Implications......Page 733 Facial Anomalies: Maxillary and Mandibular Disease......Page 734 Acrocephalosyndactyly......Page 735 Carpenter Syndrome (Type II).......Page 736 Treacher Collins Syndrome.......Page 737 Cornelia de Lange (Cryptophthalmos) Syndrome......Page 738 Epidermolysis Bullosa Hereditaria Dystrophica.......Page 739 Lipid Storage Diseases.......Page 740 Choanal Atresia......Page 741 Palatal Anomalies......Page 742 Prevalence of Snoring......Page 743 Laboratory Evaluation......Page 744 Retropharyngeal and Parapharyngeal Abscesses......Page 746 Junctional Epidermolysis Bullosa......Page 747 Epiglottitis......Page 748 Subglottic Stenosis......Page 749 Mediastinal Masses......Page 750 Foreign Body Aspiration......Page 751 Congenital Cervical Spine Instability......Page 752 Extubation of the Difficult Airway......Page 753 Selected References......Page 754 References......Page 755 Definitions and Concerns......Page 764 Incidence of Difficult or Failed Intubation and Cannot Intubate/Cannot Oxygenate in Obstetrics......Page 765 U.S.A. Data......Page 766 UK Data......Page 767 Trends in Obstetric Anesthesia......Page 768 Obesity......Page 769 Multivariate Predictors......Page 770 Meta-analysis of Bedside Screening Test Performance......Page 771 Management of the Difficult Airway in Obstetric Patients......Page 772 Airway Management Is Not Necessary: Neuraxial Techniques. Predicted Difficult Airway—Operative Delivery: Category II Fetal Heart Rate Tracing......Page 773 Master Algorithm. Management Strategies of Obstetric General Anesthesia Following Difficult or Failed Tracheal Intubation......Page 774 Aspiration Prophylaxis.......Page 776 Positioning.......Page 777 Preoxygenation and Apneic Oxygenation.......Page 778 Cricoid Pressure.......Page 779 External Laryngeal Manipulation.......Page 780 Use of Appropriate Devices During Difficult Laryngoscopy/Difficult Tracheal Intubation—Eschmann Introducer, Optic Stylet, Video Laryngoscope.......Page 781 Supraglottic Airway Device Selection and Placement.......Page 782 Supreme LMA.......Page 783 Decision to Intubate Through the Supraglottic Airway/Laryngeal Mask Airway.......Page 784 Incidence of Front-of-Neck Access Leading to Cricothyrotomy in Obstetric Patients.......Page 785 Scalpel Cricothyrotomy.......Page 786 Surgical Scalpel Cricothyrotomy Versus Needle Cricothyrotomy.......Page 788 Strategies to Avoid Postoperative Catastrophes......Page 789 Conclusion......Page 790 Selected References......Page 791 References......Page 792 Introduction and General Considerations......Page 797 Physical Examination......Page 799 Endoscopy and Imaging Studies......Page 800 Role of Operative Laryngoscopy and Rigid Bronchoscopy......Page 801 Role of Fiberoptic Intubation and Optical Stylets......Page 802 Role of the Supraglottic Airways and the Supraglottic Airway-Endotracheal Tube Exchange......Page 804 Surgical Airway as a Primary Approach to Tracheal Intubation and Airway Rescue......Page 806 Tracheal Extubation in Head and Neck Surgery......Page 808 Use of the Supraglottic Airways as the Primary Ventilatory Devices in Elective Head and Neck Surgery......Page 809 Partially Obstructed Airway......Page 810 Spontaneous Ventilation......Page 814 Apneic Intermittent Ventilation......Page 815 Oxygen Concentration.......Page 816 Transtracheal Jet Ventilation......Page 817 Conclusion......Page 818 Clinical Pearls......Page 819 Selected References......Page 820 References......Page 821 Introduction......Page 826 Physics......Page 827 Laser-Tissue Interaction......Page 828 Carbon Dioxide Laser......Page 829 Flexible-Fiber Carbon Dioxide Laser......Page 830 Eye Damage......Page 831 Laser Plume......Page 832 Airway Laser Hazards......Page 833 Preventing Airway Fires......Page 835 Special Endotracheal Tubes for Laser Airway Surgery......Page 836 Effect of Anesthetic Gases on Endotracheal Tube Flammability......Page 837 American Society of Anesthesiologists Practice Advisory for the Prevention and Management of Operating Room Fires......Page 838 Management of an Airway Fire......Page 839 Airway Pathology......Page 840 Preoperative Evaluation......Page 841 General Anesthesia......Page 842 Spontaneous Ventilation and Insufflation Techniques......Page 844 Jet Ventilation Techniques......Page 845 Low-Frequency Jet Ventilation......Page 846 Combined Frequency Jet Ventilation......Page 847 Rigid Ventilating Bronchoscopy......Page 848 Clinical Pearls......Page 849 Selected References......Page 850 References......Page 851 Intracranial Dynamics and the Airway......Page 854 Patient for Craniotomy......Page 855 Head-Injured Patient......Page 857 Computed Tomography......Page 858 Awake Intubation.......Page 859 Alternative Strategies.......Page 860 Rheumatoid Arthritis......Page 861 Patient in a Halo Frame or Stereotactic Headframe......Page 862 Patient for Awake Craniotomy or Embolization Procedures......Page 863 Patient With Acromegaly......Page 864 After Cervical Spine Surgery......Page 866 Conclusion......Page 867 Selected References......Page 868 References......Page 869 Pharyngeal Muscle Activity and Airway Patency......Page 873 Sleep Pattern, Airway Obstruction, and Arousal......Page 874 Polysomnography......Page 875 Effects of Anesthesia and Surgery on Postoperative Sleep......Page 876 Preinduction Considerations......Page 877 Awake Endotracheal Intubation......Page 878 Mechanical Ventilation......Page 879 Conclusion......Page 880 Selected References......Page 881 References......Page 882 Patient......Page 885 Factors of Concern for Surgical Procedures Under Regional Anesthesia......Page 886 Environment......Page 887 Side Effects and Complications of Regional Anesthesia......Page 888 Airway Management Strategies......Page 889 Selected References......Page 890 References......Page 891 Nonoperating Room Anesthesia Locations and Procedures......Page 892 Physical Plant......Page 893 Equipment......Page 894 Positioning......Page 895 Magnetic Resonance Imaging Scan......Page 896 High Reliability Organizations......Page 897 Selected References......Page 898 References......Page 899 Defining the Problem......Page 901 Why Is Intensive Care Unit Airway Management so Hazardous?......Page 902 Noninvasive Positive-Pressure Ventilation in Chronic Obstructive Pulmonary Disease, Pneumonia, and Neuromuscular Disease......Page 903 Assessment......Page 904 Use of Neuromuscular Blockade......Page 905 Apneic Period: Apneic Oxygenation Using Nasal Cannula......Page 907 Neuromuscular Blockade in Failed Intubation......Page 908 Laryngoscopy......Page 909 Failed Initial Intubation Plan......Page 910 Human Factors......Page 911 Airway Care in the Mechanically Ventilated Patient......Page 912 Intubated Patient: Airway Red Flags......Page 913 Selection of the Airway Exchange Conduit......Page 914 Tracheostomy Complications......Page 915 General Remarks......Page 918 Acute Epiglottis......Page 920 Extubation in the Intensive Care Unit......Page 921 Assessment......Page 922 Classifying Risk and Extubation......Page 924 Laryngotracheal Stenosis......Page 925 Other Lesions......Page 926 Selected References......Page 927 References......Page 928 Introduction......Page 939 Anatomy of the Endotracheal Tube......Page 940 Physiologic Effects of Endotracheal Tube Placement......Page 941 Small Tubes and Airway Resistance......Page 942 Laser Tubes......Page 943 Double-Lumen Endotracheal Tubes......Page 944 Airway Evaluation: Predicting the Difficult Airway......Page 945 Detection of Esophageal Intubation......Page 946 Confirmation of Appropriate Depth of Insertion......Page 947 Evaluation of a Cuff Leak......Page 948 Taping......Page 949 Commercially Available Devices......Page 951 Maintenance of the Endotracheal Tube......Page 952 Suctioning......Page 953 Biofilm Management......Page 954 Percussion and Postural Drainage......Page 955 Continuous Positive Airway Pressure......Page 956 Inhaled Bronchodilators......Page 957 Positioning of the Patient......Page 958 Selected References......Page 959 References......Page 961 Introduction......Page 966 Noninvasive Ventilation......Page 967 Characteristics of Mechanical Ventilation......Page 968 Positive End-Expiratory Pressure......Page 969 Plateau Pressure......Page 970 Assist-Control Ventilation......Page 971 Pressure-Regulated Volume Control......Page 973 High-Frequency Ventilation......Page 974 Acute Respiratory Distress Syndrome Management of Acute Respiratory Distress Syndrome......Page 975 Weaning From Mechanical Ventilation......Page 976 Mechanical Complications......Page 977 Auto-Positive End-Expiratory Pressure......Page 979 Infectious Complications......Page 980 Conclusion......Page 981 Selected References......Page 982 References......Page 983 Monitoring the Airway......Page 987 Monitoring the Native (Nonintubated) Airway......Page 988 Monitoring the Airway During Tracheal Instrumentation......Page 989 Monitoring the Airway After Tracheal Extubation......Page 991 Monitoring the Airway in the Patient With a Tracheostomy......Page 992 Imaging......Page 993 Blood Gas Monitoring......Page 994 Pulse Oximetry......Page 995 Capnography......Page 1002 Assessment of Ventilation......Page 1003 Assessment of Tidal Volume and Airflow......Page 1004 Ventilatory Waveform Analysis......Page 1005 Intrinsic Positive End-Expiratory Pressure......Page 1006 Assessment During Weaning From Mechanical Ventilatory Support......Page 1007 Assessment of Respiratory Function With Spontaneously Initiated Modes of Mechanical Ventilation......Page 1008 Selected References......Page 1009 References......Page 1010 Chapter Outline......Page 1016 Rates, Causes, and Complications of Routine Extubation Failure......Page 1017 Failure of Pulmonary Toilet......Page 1018 Laryngospasm......Page 1019 Laryngeal or Tracheal Injury......Page 1020 Intraocular Pressure......Page 1021 Thyroid Surgery......Page 1022 Cervical Spine Surgery......Page 1024 Maxillofacial Surgery and Trauma......Page 1025 Stereotactic Surgery and Cervical Immobilization......Page 1026 Paradoxical Vocal Cord Motion......Page 1027 Parkinson Disease and Multiple System Atrophy......Page 1028 Tracheomalacia......Page 1029 Higher Risk Cases......Page 1030 Extubation With a Laryngeal Mask or Other Supraglottic Airway......Page 1031 Use of Commercial Tube Exchangers......Page 1032 Cook Airway Exchange Catheters......Page 1033 Endotracheal Ventilation Catheter......Page 1034 Exchange of Double-Lumen Tubes......Page 1035 Conversion from Oral to Nasal Intubation......Page 1036 Insufflation and Jet Ventilation Through Stylets......Page 1037 Clinical Pearls......Page 1038 Selected References......Page 1039 References......Page 1040 Complications in Managing Patients With Difficult Airways......Page 1047 History of the Patient and Examination......Page 1048 Mechanical Difficulties......Page 1049 Laryngeal Mask Airway......Page 1050 Anatomic Requirements......Page 1051 Traumatic Intubation......Page 1052 Pharyngeal Mucosal Injury......Page 1053 Laryngeal Trauma and Injury to the Vocal Cords......Page 1054 Tracheobronchial Injury......Page 1055 Eye Injuries......Page 1056 Nasal Injury......Page 1057 Use of an Endotracheal Tube......Page 1058 Disconnection and Dislodgment......Page 1059 Lighted Stylets......Page 1060 Transtracheal Jet Ventilation......Page 1061 Hemodynamic Changes......Page 1062 Laryngospasm......Page 1063 Latex Allergy......Page 1064 Laryngospasm......Page 1065 Airway Compression......Page 1066 Selected References......Page 1067 References......Page 1069 Introduction......Page 1078 The Features of a Good Clinical Teacher......Page 1079 Miller Learning Pyramid......Page 1080 Competency-Based Medical Education Curriculum......Page 1081 Airway Fellowships......Page 1082 Airway Workshops......Page 1083 Simulation-Based Medical Education......Page 1084 Airway Societies......Page 1085 Assessment, Feedback, and Debriefing......Page 1086 Human Factors and Leadership Education......Page 1088 Clinical Pearls......Page 1089 Selected References......Page 1090 References......Page 1092 Identification of Patients......Page 1095 Documentation in Medical/Anesthesia Records......Page 1096 Documentation and Dissemination via Electronic Health Records......Page 1097 MedicAlert Foundation Difficult Airway/Intubation Registry......Page 1098 Clinical Pearls......Page 1099 Selected References......Page 1100 References......Page 1101 Systematic Reviews, Meta-Analysis, Randomized Controlled Trials......Page 1102 Observational Studies......Page 1104 Pitfalls With Airway Research......Page 1105 Airway Research Questions or Answers......Page 1106 Role of Manikins in Airway Research......Page 1107 Reliance on Only One Feature......Page 1108 Audits......Page 1109 Selected References......Page 1110 References......Page 1112 Documentation of Airway Management Outcomes......Page 1115 Change Management......Page 1116 Patient Characteristics......Page 1117 Primary Airway Device......Page 1118 Emergency Surgical Airway......Page 1119 Levels of Outcome Reporting......Page 1120 Future of Airway Management Measurement......Page 1121 Conclusion......Page 1125 Selected References......Page 1126 References......Page 1127 Other Airway Societies......Page 1129 Membership......Page 1130 General......Page 1131 Clinical Pearls......Page 1132 Selected References......Page 1133 Appendix A Supplement to Chapter 51......Page 1134 Appendix B Supplement to Chapter 51......Page 1136 For Additional Information Regarding the National Difficult Airway/Intubation Registry:......Page 1140