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  • Cited by 2
  • 2nd edition
  • Edited by Ian Calder, National Hospital for Neurology and Royal London Hospital, Adrian Pearce, Guy's and St Thomas' Hospital, London
Publisher:
Cambridge University Press
Online publication date:
January 2011
Print publication year:
2010
Online ISBN:
9780511760310

Book description

Every anaesthetist reaches the end of their career with a collection of difficult airway experiences. Managing airway challenges relies on a combination of good clinical practice, knowledge of relevant basic sciences and critical evaluation of every aspect of airway care. This new edition of Core Topics in Airway Management provides any trainee or consultant involved in airway techniques with practical, clinically relevant coverage of the core skills and knowledge required to manage airways in a wide variety of patients and clinical settings. All new procedures and equipment are reviewed, and detailed chapters advise on airway issues in a range of surgical procedures. This edition also contains a series of practical questions and answers, enabling the reader to evaluate their knowledge. Written by leading airway experts with decades of experience managing difficult airways, Core Topics in Airway Management, 2nd edition is an invaluable tool for anaesthetists, intensivists, and emergency physicians.

Reviews

Review of the first edition:‘Core Topics in Airway Management concisely covers all the basics and some of the unique areas in airway management … Key, groundbreaking, clinically relevant material is presented in a clear and succinct manner, with salient points bulleted at the end of each chapter along with further reading suggestions … In summary, Core Topics in Airway Management is exactly what it says it is, a textbook that provides succinct and useful information on airway management that is required by a wide spectrum of health care professionals, independent of the reader's medical discipline or training level. This text provides a foundation for the multispecialty approach to airway management. Readers are offered an easy to read book on airway management, containing many pearls of practical wisdom.'

Carin Hagberg Source: Anesthesia and Analgesia

'I was impressed with the review of physiology and the willingness of editors and authors to describe areas of controversy in acute airway management … an excellent introduction to a central topic in anesthesiology and acute medicine.'

Source: Doody's Notes

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Contents


Page 2 of 2


  • Chapter 22 - Bariatrics
    pp 203-208
  • View abstract

    Summary

    Blind intubation techniques remain within the CCT training syllabus in the UK and can be classified into four groups. The four groups are blind oral or nasal, retrograde, light-guided, and intubating laryngeal mask. Blind nasal intubation remains a popular and successful technique in both anaesthetised and awake patients. The term retrograde intubation is a misnomer, and it should perhaps be termed guided blind intubation or translaryngeal intubation. Retrograde techniques are relatively contraindicated when neck anatomy is unfavourable, there is infection in the neck, a bleeding diathesis or gross glottic abnormality. Light-guided intubation has been described through a supraglottic airway, and a recently developed blind intubation device (BID) incorporates a supraglottic airway with oesophageal airway component and catheter with lighted tip. Intubation through a supraglottic airway is a useful effective technique and is included in Plan B for failed direct laryngoscopy in the Difficult Airway Society guidelines.
  • Chapter 23 - Maxillofacial surgery
    pp 209-222
  • View abstract

    Summary

    Rigid indirect laryngoscopy (RIL) can overcome some of the problems inherent to direct laryngoscopy and intubation using a flexible bronchoscope, but it has its own drawbacks. There is no ideal intubation device. This chapter discusses the design and technical features of rigid indirect laryngoscopes. No classification of equipment has yet been generally accepted, and a simple scheme is discussed: optical stylets, bladed indirect laryngoscopes, and tube-guiding indirect laryngoscopes. RILs allow visually controlled TT placement and visual confirmation of the tube passing between the vocal cords. RILs eliminate the need to align the axes of the upper airway and in general require less force to achieve a good view of the laryngeal inlet compared to DL. The built-in optics and electronics usually allow viewing of the image by multiple spectators and also allow documentation of successful intubation. The market for RILs is fast-moving.
  • Chapter 24 - Dental anaesthesia
    pp 223-226
  • View abstract

    Summary

    Unrecognised misplacement of a tracheal tube may have disastrous sequelae, and is avoidable. A variety of tests has been devised to do the prompt recognition of misplacement. The characteristic flatus-like sound produced during manual ventilation of a tube placed in the oesophagus is quite different from that produced if the tube is correctly placed, but is not reproduced reliably. Successful identification of tracheal and oesophageal ventilation has been described in small sized studies. Tests to confirm tracheal intubation are listed in this chapter. None of the easily used tests is very reliable, and haemoglobin desaturation is often the reason that bronchial intubation is suspected and detected. There are no specific tests to exclude misplacement in positions such as the retropharyngeal space or intracranial space. However there will be a complete inability to ventilate the lungs, which should become apparent very quickly using the standard tests.
  • Chapter 25 - ENT surgery
    pp 227-243
  • View abstract

    Summary

    An extubation plan should always be formulated. Extubation in a deep plane of anaesthesia is an advanced technique. One-third of aspiration events occur after extubation. Every extubation technique should ensure minimal interruption in the delivery of oxygen to the patient's lungs, and should extubation fail, ventilation should be achievable with the minimal difficulty or delay. The choice of extubation position reflects a balance between the risks of vomiting post-extubation, and subsequent inhalation and soiling of the lungs, and potential respiratory embarrassment and ease of assisting ventilation. The depth of anaesthesia at the time of extubation is highly important because of the risk of life-threatening laryngospasm. Peri-extubation insertion of a laryngeal mask airway (LMA) is a useful technique for airway maintenance in the recovery period with less airway obstruction and coughing, and higher saturations than either deep or awake extubation. An airway exchange catheter (AEC) is a useful aid.
  • Chapter 26 - Airway management in cervical spine disease
    pp 244-254
  • View abstract

    Summary

    The pulmonary aspiration of gastric contents can cause a pneumonitis with bronchospasm and pulmonary oedema if acidic liquid is inhaled, or less often airway obstruction or massive atelectasis if particulate matter is inhaled. Cricoid pressure can cause problems with the airway. It is important that cricoid pressure is released or adjusted to become Optimal External Laryngeal Pressure (OELP) if intubation is difficult as this may improve the view at laryngoscopy. The three-finger technique to apply cricoid pressure described by Sellick is actually almost impossible to apply when the patient's head is resting on a pillow. The incidence of regurgitation is not known following intravenous induction of anaesthesia with muscle relaxants, without cricoid pressure applied in patients at high risk. During a rapid sequence induction, intubation has failed after two unsuccessful attempts at laryngoscopy both using the gum elastic bougie.
  • Chapter 27 - Thoracic anaesthesia
    pp 255-261
  • View abstract

    Summary

    Loss of the airway is quite apparent once oxygen saturations begin to fall but identifying it before this happens gives more time for a definitive diagnosis to be made and for the correct course of action to be implemented. It is obviously preferable to maintain ventilation throughout a general anaesthetic rather than have to rescue a lost airway. An emergency situation only exists when all three routine methods of oxygenation (facemask, laryngeal mask and tracheal intubation) have failed. The cricothyroid membrane is the preferred site for emergency access to the trachea for oxygenation. There are three types of cricothyroidotomy: small cannula devices, large bore cannula devices, and surgical cricothyroidotomy. Accepting the diagnosis of a lost airway is a difficult mental process. The only thing that distinguishes the lost airway from other cases is that the anaesthetist's usual armamentarium of techniques does not restore ventilation.
  • Chapter 28 - Airway management in the ICU
    pp 262-273
  • View abstract

    Summary

    Airway management is more difficult and stressful in obstetrics, and the consequences of difficulty are more serious than in many other areas. Most problems involve general anaesthesia although airway management may be required in regional anaesthesia. One advantage of regional anaesthesia, if not the main one, is the avoidance in most cases of the need for airway support. Apart from the possible contribution of reduced training in airway management and obstetric general anaesthesia, another factor that might lead to a higher reported incidence is that trainees are now taught to declare failure earlier rather than persist with attempts to intubate. The value of a drill in the management of difficult/failed intubation has long been recognised and a modern, simplified version is offered. Care must also be taken with tracheal extubation, especially if there is a risk of laryngeal oedema, perhaps exacerbated by intubation, for example in pre-eclampsia.
  • Chapter 30 - Ethical issues arising in airway management
    pp 287-292
  • View abstract

    Summary

    Airway-related problems are the most common critical incidents in paediatric anaesthesia and are four times more common in infants than in older children. This chapter discusses anatomical and physiological differences in the paediatric airway. Straight laryngoscope blades are useful in infants up to about the age of 3 to 6 months. In contrast to the tracheal tube (TT), paediatric laryngeal mask airways (LMAs) are sized according to patient weight. There are a number of syndromes and pathologies that are known to be associated with difficult airway management. There are a number of causes, both congenital and acquired, of airway obstruction in the child. The general principles of airway management are the same regardless of underlying cause, however, there are two scenarios that deserve special attention: inhalation of a foreign body, and acute epiglottitis. Rapid sequence induction is not a standard in paediatric practice.
  • Chapter 31 - Legal and regulatory aspects of airway management
    pp 293-298
  • View abstract

    Summary

    Airway anatomy and physiology are altered in obesity, and an understanding of these changes is key to appropriate airway management. Longitudinal studies of pulmonary function have shown reduction in pulmonary tests with obesity. The functional residual capacity (FRC) is reduced by the conduct of general anaesthesia. In the obese, the resting metabolic rate, oxygen consumption and also carbon dioxide production are all increased, compounding the reduction in FRC. In addition to acting as an oxygen store, FRC is important in splinting small airways. Respiratory mechanics are affected even in moderate obesity. Prediction of difficulty: Mallampati score and neck circumference are better predictors than body mass index (BMI) and a history of obstructive sleep apnoea (OSA), but their predictive value is not strong. Difficult mask ventilation and difficult intubation are uncommon. Awake intubation is worthwhile if difficulty is expected, because of the rapid desaturation problem.
  • Chapter 32 - Sample structured oral examination questions
    pp 299-311
  • View abstract

    Summary

    This chapter discusses the airway assessment specific to maxillofacial work and airway management in dento-alveolar surgery, upper airway tumours (intraoral), orthognathic surgery, maxillofacial trauma and infections. Minor surgery involving the teeth and teeth bearing portions of the jaws is known collectively as dento-alveolar surgery and is the most common form of maxillofacial surgery. One of the most challenging groups of patients with maxillofacial surgery is those returning to theatre after head and neck reconstruction. Orthognathic surgery is carried out to correct growth deformity or secondary to trauma. Intra-operative inter-maxillary fixation (IMF) means that nasal intubation is mandatory. Surgical damage to the tracheal tube can occasionally occur intra-operatively. The majority of maxillofacial trauma occurs in young males. Inter-personal violence accounts for a progressively larger proportion of maxillofacial trauma. Laryngotracheal injury occurs in around 1:5000 of maxillofacial trauma cases, but can be life-threatening.

Page 2 of 2


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