Some early work identified two types of receptor in the larynx: one a slowly adapting receptor and the second a rapidly adapting receptor thought to be especially sensitive to chemical stimulants. Anaesthetic agents may sensitise the receptors, explaining why some inhaled and intravenous agents may easily precipitate laryngeal spasm. Prior to the administration of lidocaine airway irritation caused not only the cough reflex, but also other respiratory reflexes such as expiration, apnoea and spasmodic panting.
It should be noted that the initial application of local anaesthetic agents to the airway may be associated with laryngospasm. It is now thought that the pharyngeal dilators, in addition to the diaphragm, comprise the efferent output of the respiratory centre. Tonic contraction is required to keep the tongue forward and maintain airway patency.
Summary Cross-infection may occur through reusable airway devices.
Guide Core Topics in Airway Management (Cambridge Medicine (Hardcover))
The infective agent for transmissable spongiform encephalopathies TSE transmission is an abnormal prion protein. No prion-specific nucleic acid is involved in disease transmission, and abnormal prion-protein infectivity is not controlled by standard decontamination procedures of standard autoclaving or cold chemical sterilisation. There are three possible options for airway equipment, single use equipment, steam sterilisation or cold chemical sterilisation. Single use equipment eliminates the risk of cross-infection between patients through the airway device and is the preferred option.
Repeated cycles of heat sterilisation will produce loss of transmitted light in rigid laryngoscope bundles. Cold chemical sterilisation is appropriate for devices which are not single use and are thermally sensitive. Automated disinfectors should be used for fibrescopes. Summary One of the ways of producing some structure to the way in which we think about managing normal and difficult airways is by algorithm or flow-chart. Sedation makes treatments such as endoscopies, tracheal intubation, dental treatment and minor surgical procedures more tolerable.
Neuro-muscular blocking drugs NMBS are powerful drugs, indubitably dangerous in untrained hands. NMBDs make a vital contribution to patient safety; it is worth recalling what anaesthetic practice must have been like without them. The classic causes of acute airway obstruction include haematomas or tissue swelling after thyroid or anterior cervical spine or carotid surgery, trauma, or pharyngeal and laryngeal infections. Humans make errors, which in retrospect can seem distressingly obvious.
Those involved in airway management need to appreciate that in critical situations there will not be time for detailed, analytical decision making, and be wary of fixating on issues or techniques that are not contributing to success. Summary This chapter discusses difficult airway, causes of difficulty, patient factors, and types of difficulties. One of the principal difficulties in predicting airway problems under anaesthesia is that in most unexpected cases there are no symptoms.
The symptoms associated with obstructed sleep apnoea OSA syndrome should be sought in suspected cases. Anaesthetists should be aware of the symptomatology and signs of impending airway obstruction. The chapter briefs about special investigations such as 'Quick look' laryngoscopy, ultrasound and radiology. Sleep apnoea patients in particular may well be at greater risk in the postoperative period than at induction, whilst some types of surgery are notorious for engendering airway difficulty post-operatively; facio-maxillary and anterior cervical surgery are examples.
Rheumatoid and acromegalic diseases of the larynx are particularly prone to post-extubation obstruction, so that the smallest possible size of tracheal tube should be used. This chapter deals with the pathophysiology of the condition and its presenting features, investigations and treatment.
Tonsillar hypertrophy should be recorded because this may be the underlying problem, and usually is so in children presenting with OSA. Although avoidance of sedative and opioid drugs during the peri-operative period is the recommended practice, sedatives and opioids have been used freely in conjunction with CPAP therapy without complication in the post-operative period. Post operative management involves nocturnal oxygen supply for at least one more night after opioid therapy has stopped.
Summary Facemask anaesthesia may be suitable for airway maintenance for short anaesthetic procedures. Many anaesthesia facemasks are delivered with a multipronged o-ring around the collar of the connector. Maintenance of the patient's airway may be facilitated by use of an oropharyngeal or nasopharyngeal airway.
Supraglottic airway devices SADs have several roles including anaesthesia, airway rescue after failed intubation or out of hospital use during cardiopulmonary resuscitation and as conduits to assist tracheal intubation. There are several classifications of SADs with most based on device anatomy and positioning. First generation SADs e. SADs are established methods for management of the difficult airway.
Summary This chapter concentrates on characteristics of the cuffed tube. With a cuffed tube, it is important that the insertion depth is sufficient to avoid inflating the cuff within the larynx itself. Cuffed tubes are generally used in adult practice to seal the airway to protect it from soiling from above and to prevent gas leaks. Three factors contribute to the extent of cuff induced tracheal damage: cuff characteristics, cuff pressure regulation, and cuff inflation technique and medium.
Tracheal tubes are attached to the breathing system via tapered male to female 15 mm International Organization for Standardization ISO connectors. Tracheostomy tubes with a 15 mm ISO connector can be connected directly to a breathing circuit. Tube characteristics may influence the risk of ventilator-associated pneumonia VAP.
The chapter also reviews special tubes such as laser tubes, microlaryngoscopy tubes, and tubes for paediatric practice.
Summary Iatrogenic airway injury is mostly caused by laryngoscopy, visualisation of the laryngeal inlet, the placement of a tracheal tube and long-term intubation. Damage to teeth during laryngoscopy is the commonest cause of civil action against anaesthetists. Iatrogenic laryngeal trauma occurs mostly in patients undergoing routine, non-difficult, short-term tracheal intubation.
Tracheal intubation-related neuropraxia of the lingual, hypoglossal, and laryngeal nerves have been described.
The listing you're looking for has ended. View original item. Sell one like this. We found something similar. About this product. Stock photo. Brand new: lowest price The lowest-priced, brand-new, unused, unopened, undamaged item in its original packaging where packaging is applicable. It focuses not only on reading and writing, but also on other modes of communication, including oral, visual, audio, gestural and spatial. Using real-world examples and illustrations, Literacies features the experiences of both teachers and students.
Read full description. See details and exclusions. Con-ding the textbook are chapters dedicated to specialations, such as the pediatric airway and the airway in obstet-al patients, and problem areas including aspiration and thet airway. Within each chapter is a well-organized framework that fa-tates the understanding and learning of the reader. Complementing the text areltiple tables, graphs, and illustrations.
Core Topics in Airway Management
The main strength of the book is that the authors do notrely provide the facts of a subject, but they also discuss theterial as if they were having a discussion. The editors remarkt an uneasy combination of science and art in airway man-ment exists. Throughout the book, this theme is repeated. Theysician, nurse, or technologist whose job it is to control theway must be able to adapt to each situation.
This idea is mostarly observed in the discussions on intubation and extuba-n, where the variability of patients dictates the health-carefessionals plan and management on an individual basis. From a surgeons point of view, this book has a lot of value. Later in the text, specific chapters reflect special situa-ns and circumstances that will be encountered in every sur-ns career. The chapter on airway management in the inten-e care unit is one of these essential chapters.
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In addition, theiration and lost airway chapters discuss those events thatfortunately occur, although hopefully not often, andmust bederstood andmanaged successfully to prevent disastrous out-es from occurring. Itthe first step in every resuscitative effort, and therefore, itnot be overlooked.