effective management of airway Management is the bread and butter of an analystologist, American society of anaesthesiology frequent guidelines and management algorithms
ASA Guidelines for Management of the Difficult AirwaySun Yai-Cheng
Practice Guidelines for Management of the Difficult Airway
An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway
Anesthesiology 2013; 118(2):251-270
The questions asked in the Anaesthesiology viva examination are presented in this presentation which will be useful for the post-graduates appearing for the M.D-Anaesthesia examination.
ASA Guidelines for Management of the Difficult AirwaySun Yai-Cheng
Practice Guidelines for Management of the Difficult Airway
An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway
Anesthesiology 2013; 118(2):251-270
The questions asked in the Anaesthesiology viva examination are presented in this presentation which will be useful for the post-graduates appearing for the M.D-Anaesthesia examination.
Exposure to outdoor air pollution and its effect.pptxdipakghimire77
Outdoor air pollution is a complex and pervasive environmental issue that affects millions of people worldwide. The continuous release of pollutants into the atmosphere from various sources has led to widespread exposure, contributing to a range of health problems. This comprehensive review explores the sources, composition, and health effects of outdoor air pollution, emphasizing the significance of addressing this global challenge.
Exposure to outdoor air pollution and its effect.pptxdipakghimire77
Outdoor air pollution is a complex and pervasive environmental issue that affects millions of people worldwide. The continuous release of pollutants into the atmosphere from various sources has led to widespread exposure, contributing to a range of health problems. This comprehensive review explores the sources, composition, and health effects of outdoor air pollution, emphasizing the significance of addressing this global challenge.
A Study to Assess the Level of Knowledge Regarding Airway Management Modaliti...ijtsrd
INTRODUCTION Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. Due to obstruction in the airway the life of the individual is in danger so use of airway management modalities will help to save the individual’s life. These modalities ensures an open pathway which provide breath to the lungs through the atmospheric air and mechanical support to secure life. The study was conducted to assess the level of knowledge on airway management among Nursing student. The main objectives of study were to assess the knowledge on airway management modalities and to associate the level of knowledge with selected demographic variables. A Quantitative research approach with Descriptive research design was used to evaluate the knowledge regarding airway management modalities. A sample of 60nursing students were selected by convenient sampling technique. structured questionnaire was used to obtain data from the sample . Data analysis was done by using descriptive and inferential statistics on the basis of objective of the study RESULT The result of the study shows that out of 60 samples 13 21.66 having good knowledge 45 75.3 having average knowledge and 2 3.33 having poor knowledge regarding airway management modalities. with regard to mean and standard deviation of knowledge shows 17.3 and 3.92 respectively. CONCLUSION The study concludes that, the knowledge level of students regarding airway management modalities associated airway management is average, the study suggest that proper teaching and adequate training on airway management will be helpful for the students to gain knowledge. Mr. Pradip Kumar Mishra | Mr. Raghavendran M "A Study to Assess the Level of Knowledge Regarding Airway Management Modalities among Nursing Student at Selected Nursing, College Kanpur" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45205.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/45205/a-study-to-assess-the-level-of-knowledge-regarding-airway-management-modalities-among-nursing-student-at-selected-nursing-college-kanpur/mr-pradip-kumar-mishra
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
2022 ASA Airway.ppt
1. 2022 American
Society of
Anesthesiologists
Practice
Guidelines for
Management of
the
Difficult Airway
Jeffrey L. Apfelbaum, M.D., Carin A. Hagberg, M.D.,
Richard T. Connis, Ph.D., Basem B. Abdelmalak, M.D.,
Madhulika Agarkar, M.P.H., Richard P. Dutton, M.D.,
John E. Fiadjoe, M.D., Robert Greif, M.D.,
P. Allan Klock, Jr., M.D., David Mercier, M.D.,
Sheila N. Myatra, M.D., Ellen P. O’Sullivan, M.D.,
William H. Rosenblatt, M.D.,
Massimiliano Sorbello, M.D.,
Avery Tung, M.D.
Anesthesiology 2021; XXX:00–00
2. Definition of Difficult Airway
Difficult Facemask Ventilation. It is not possible to provide adequate ventilation (e.g., confirmed by end-tidal
carbon dioxide detection), because of one or more of the following problems: inadequate mask seal, excessive
gas leak, or excessive resistance to the ingress or egress of gas.
Difficult Laryngoscopy. It is not possible to visualize any portion of the vocal cords after multiple attempts at
laryngoscopy.
Difficult Supraglottic Airway Ventilation. It is not possible to provide adequate ventilation because of one or more
of the following problems: difficult supraglottic airway placement, supraglottic airway placement requiring multiple
attempts, inadequate supraglottic airway seal, excessive gas leak, or excessive resistance to the ingress or
egress of gas.
Difficult or Failed Tracheal Intubation. Tracheal intubation requires multiple attempts or tracheal intubation fails
after multiple attempts.
Difficult or Failed Tracheal Extubation. The loss of airway patency and adequate ventilation after removal of a
tracheal tube or supraglottic airway from a patient with a known or suspected difficult airway (i.e., an “at risk”
extubation).
Difficult or Failed Invasive Airway. Anatomic features or abnormalities reducing or preventing the likelihood of
successfully placing an airway into the trachea through the front of the neck.
Inadequate Ventilation. Indicators of inadequate ventilation include absent or inadequate exhaled carbon dioxide,
absent or inadequate chest movement, absent or inadequate breath sounds, auscultatory signs of severe
obstruction, cyanosis, gastric air entry or dilatation, decreasing or inadequate oxygen saturation, absent or
inadequate exhaled gas flow as measured by spirometry, anatomic lung abnormalities as detected by lung
ultrasound, and hemodynamic changes associated with hypoxemia or hypercarbia (e.g., hypertension,
tachycardia, bradycardia, arrhythmia). Additional clinical symptoms may include changed mental status or
somnolence.
3. Purposes of the Guidelines
The purposes of these guidelines are to guide the
management of patients with difficult airways, optimize first
attempt success of airway management, improve patient
safety during airway management, and minimize/avoid
adverse events. The principal adverse outcomes associated
with the difficult airway include (but are not limited to) death,
brain injury, cardiopulmonary arrest, airway trauma, and
damage to the teeth.
4. Application
These guidelines are intended for use by anesthesiologists and all other
individuals who perform anesthesia care or airway management. The
guidelines are intended to apply to all airway management and
anesthetic care delivered in inpatient (e.g., perioperative, nonoperating
room, emergency department, and critical care settings) and ambulatory
settings (e.g., ambulatory surgery centers and office-based surgery and
procedure centers performing invasive airway procedures).
Excluded are prehospital settings and individuals who do not deliver
anesthetic care or perform airway management.
These guidelines are also intended to serve as a resource for other
physicians and patient care personnel who are involved in the care of
difficult airway patients, including those involved in local policy
development.
5. Process and Evaluation of Evidence
These updated guidelines were developed by means of a six-step process.
First, consensus was reached on the criteria for evidence.
Second, a comprehensive literature search was conducted by an independent librarian to
identify citations relevant to the evidence criteria.
Third, original published articles from peer-reviewed journals relevant to difficult airway
management were evaluated and added to literature included in the previous update.
Fourth, consultants who had expertise or interest in difficult airway management and who
practiced or worked in various settings (e.g., private and academic practice) were asked
to participate in opinion surveys addressing the appropriateness, completeness, and
feasibility
of implementation of the draft recommendations and to review and comment on a draft of
the guidelines.
Fifth, additional opinions were solicited from random samples of active members of the
ASA and participating organizations.
Sixth, all available information was used to build consensus to finalize the Guidelines.
6. Inclusion Criteria for literature acceptance included randomized controlled trials, prospective
nonrandomized comparative studies (e.g., quasiexperimental, cohort), retrospective comparative
studies (e.g., case control), observational studies (e.g., correlational or descriptive statistics), and case
reports or case series from peer-reviewed journals.
Exclusion criteria included:
(1) patients or practitioners described in the study who were specifically excluded or not
identified by evidence criteria in the evidence model;
(2) interventions not identified or specifically excluded in the evidence model;
(3) studies with insufficient or no outcome data or reported outcomes not relevant to the
evidence model;
(4) articles with no original data, including review articles, descriptive letters, or editorials;
(5) systematic reviews, secondary data, meta-analysis,∥ or other articles with no original data;
(6) abstracts, letters, or articles not published in a peer-reviewed journal;
(7) studies outside of designated search dates;
(8) duplicate data presented in a different reviewed article; or
(9) retracted publications.
7. Evaluation of the Airway
Airway evaluation topics include
(1) risk assessment to predict a difficult airway or risk of aspiration, and
(2) Airway examination (bedside and advanced).
Risk assessment includes evaluation of information obtained from a patient’s
history or medical records, including demographic information, clinical conditions,
diagnostic tests, and patient/family interviews or questionnaires.
Airway examination is intended to identify the presence of upper airway
pathologies or anatomical anomalies. Issues addressed in these guidelines
include:
(1) measurement of facial and jaw features,
(2) anatomical measurements and landmarks,
(3) Imaging with ultrasound or virtual laryngoscopy/bronchoscopy,
(4) three-dimensional printing, and
(5) bedside endoscopy.
8. Patient demographic and personal characteristics
evaluated for difficult airway risk prediction included age, sex, body
mass index, weight, and height.
Clinical characteristics assessed included
a history of difficult intubation, distorted airway anatomy, snoring, obstructive sleep
apnea, diabetes mellitus, or findings from diagnostic tests (e.g., radiography,
computed tomography), patient interviews, and questionnaires.
Measurement of facial and jaw features included mouth opening, the ability to
prognath, head and neck mobility, prominent upper incisors, presence of a beard,
and an upper lip bite test.
Anatomical measures included Mallampati and modified Mallampati scores,
thyromental distance, sternomental distance, interincisor distance, neck
circumference, ratio of neck circumference to thyromental distance, ratio of height to
thyromental distance, hyomental distance, and hyomental distance ratio.
Measurements obtained from ultrasound included skin-to-hyoid distance, tongue
volume, and distance from skin to epiglottis.
9. Recommendations for Evaluation of the Airway
• Before the initiation of anesthetic care or airway management, ensure that an airway risk assessment is
performed by the person(s) responsible for airway management whenever feasible to identify patient,
medical, surgical, environmental, and anesthetic factors (e.g., risk of aspiration) that may indicate the
potential for a difficult airway.
◦ When available in the patient’s medical records, evaluate demographic information, clinical conditions,
diagnostic test findings, patient/family interviews, and questionnaire responses.
◦ Assess multiple demographic and clinical characteristics to determine a patient’s potential for a difficult
airway or aspiration.
• Before the initiation of anesthetic care or airway management, conduct an airway physical examination to
further identify physical characteristics that may indicate the potential for a difficult airway.
◦ The physical examination may include assessment of facial features‡‡ and assessment of anatomical
measurements and landmarks.
◦ Additional evaluation to characterize the likelihood or nature of the anticipated airway difficulty may
include bedside endoscopy, virtual laryngoscopy/bronchoscopy, or three-dimensional printing.
• Assess multiple airway features to determine a patient’s potential for a difficult airway or aspiration.
10. Preparation for Difficult Airway Management
Topics related to interventions intended to prepare for difficult airway management include
(1) the availability of equipment for airway management (e.g., items for anesthetizing locations, portable storage
unit, cart, or trolley for difficult airway management);
(2) informing the patient with a known or suspected difficult airway;
(3) preoxygenation;
(4) patient positioning;
(5) sedative administration;
(6) local anesthesia;
(7) supplemental oxygen during difficult airway management;
(8) patient monitoring; and
(9) human factors
11. Recommendations for Preparation for Difficult Airway
Management
• Ensure that airway management equipment is available in the room.
• Ensure that a portable storage unit that contains specialized equipment for difficult airway
management is immediately available.
• If a difficult airway is known or suspected:
◦ Ensure that a skilled individual is present or immediately available to assist with airway
management when feasible.
◦ Inform the patient or responsible person of the special risks and procedures pertaining to
management of the difficult airway.
◦ Properly position the patient, administer supplemental oxygen before initiating management of
the difficult airway, and continue to deliver supplemental oxygen whenever feasible throughout
the process of difficult airway management, including extubation.
• Ensure that, at a minimum, monitoring according to the ASA Standards for Basic Anesthesia
Monitoring are followed
immediately before, during, and after airway management of all patients.
12. Anticipated Difficult Airway Management
Airway management of an anticipated difficult airway consists of interventions addressing
awake tracheal intubation, anesthetized tracheal intubation, or both awake and anesthetized
intubation.
Recommendations for Anticipated Difficult Airway Management
• Have a preformulated strategy for management of the anticipated difficult airway.
◦ This strategy will depend, in part, on the anticipated surgery, the condition of the patient,
patient cooperation/
consent, the age of the patient, and the skills and preferences of the anesthesiologist.
◦ Identify a strategy for: (1) awake intubation, (2) the patient who can be adequately ventilated
but is difficult
to intubate, (3) the patient who cannot be ventilated or intubated, and (4) difficulty with
emergency invasive airway rescue.
13. ◦ When appropriate, perform awake intubation if the patient is suspected to be a difficult intubation and one
or more of the following apply: (1) difficult ventilation (face mask/supraglottic airway), (2) increased risk of
aspiration, (3) the patient is likely incapable of tolerating a brief apneic episode, or (4) there is expected difficulty with
emergency invasive airway rescue
The uncooperative or pediatric patient may restrict the options for difficult airway management, particularly options that involve
awake intubation. Airway management in the uncooperative or pediatric patient may require an approach (e.g., intubation
attempts after induction of general anesthesia) that might not be regarded as a primary approach in a cooperative patient.
◦ Proceed with airway management after induction of general anesthesia when the benefits are judged to
outweigh the risks.
◦ For either awake or anesthetized intubation, airway maneuver(s) may be attempted to facilitate intubation.
◦ Before attempting intubation of the anticipated difficult airway, determine the benefit of a noninvasive versus invasive approach
to airway management.
▪ If a noninvasive approach is selected, identify a preferred sequence of noninvasive devices to use for airway management.
• If difficulty is encountered with individual techniques, combination techniques may be performed.
• Be aware of the passage of time, the number of attempts, and oxygen saturation.
• Provide and test mask ventilation after each attempt, when feasible.
• Limit the number of attempts at tracheal intubation or supraglottic airway placement to avoid potential injury and complications.
▪ If an elective invasive approach to the airway is selected, identify a preferred intervention.
• Ensure that an invasive airway is performed by an individual trained in invasive airway techniques, whenever possible.
• If the selected approach fails or is not feasible, identify an alternative invasive intervention.
◦ Initiate ECMO when/if appropriate and available
14. Unanticipated and Emergency Difficult
Airway Management
Airway management of an unanticipated or emergency
difficult airway consists of interventions addressing
(1)Calling for help,
(2) optimization of oxygenation,
(3) use of a cognitive aid,
(4) noninvasive airway management devices,
(5) combination techniques,
(6) invasive airway management interventions, and
(7) ECMO.
15. Recommendations for Unanticipated and Emergency Difficult Airway Management
• Call for help.
• Optimize oxygenation.
• When appropriate, refer to an algorithm and/or cognitive aid.
• Upon encountering an unanticipated difficult airway:
◦ Determine the benefit of waking and/or restoring spontaneous breathing.
◦ Determine the benefit of a noninvasive versus invasive approach to airway management.
◦ If a noninvasive approach is selected, identify a preferred sequence of noninvasive devices to use for airway
management.
▪ If difficulty is encountered with individual techniques, combination techniques may be performed.
▪ Be aware of the passage of time, the number of attempts, and oxygen saturation.
▪ Provide and test mask ventilation after each attempt, when feasible. ▪ Limit the number of attempts at tracheal
intubation or supraglottic airway placement to avoid potential injury and complications.
• If an invasive approach to the airway is necessary (i.e., cannot intubate, cannot ventilate), identify a referred
intervention
◦ Ensure that an invasive airway is performed by an individual trained in invasive airway techniques, whenever
possible.
◦ Ensure that an invasive airway is performed as rapidly as possible.
◦ If the selected invasive approach fails or is not feasible, identify an alternative invasive intervention.
▪ Initiate ECMO when/if appropriate and available.
16. Extubation of the Difficult Airway
An extubation strategy includes interventions that may be used to facilitate airway
management associated with extubation of a difficult airway.
Extubation intervention topics addressed by these guidelines include:
(1)Assessment of patient readiness for extubation,
(2) the presence of a skilled individual to assist with extubation,
(3) selection of an appropriate time and location for extubation,
(4) Planning for possible reintubation,
(5) elective tracheostomy,
(6) awake extubation or supraglottic airway removal,
(7) supplemental oxygen throughout the extubation process, and
(8) extubation with an airway exchange catheter or supraglottic airway.
The task force regards the concept of an extubation strategy as a logical extension of the
intubation
strategy.
17. Recommendations for Extubation of the Difficult Airway
• Have a preformulated strategy for extubation and subsequent airway management.
◦ This strategy will depend, in part, on the surgery/procedure, other perioperative
circumstances, the condition of the patient, and the skills and preferences of the clinician.
• Assess patient readiness for extubation.
• Ensure that a skilled individual is present to assist with extubation when feasible.
• Select an appropriate time and location for extubation when possible.
• Assess the relative clinical merits and feasibility of the short-term use of an airway
exchange catheter and/or supraglottic airway that can serve as a guide for expedited
reintubation.
◦ Minimize the use of an airway exchange catheter with pediatric patients.
• Before attempting extubation, evaluate the risks and benefits of elective surgical
tracheostomy.
• Evaluate the risks and benefits of awake extubation versus extubation before the return
to consciousness.
• When feasible, use supplemental oxygen throughout the extubation process.
• Assess the clinical factors that may produce an adverse impact on ventilation after the
patient has been extubated.
18. Follow-up Care
Follow-up care includes the topics of:
(1)Postextubation care (i.e., steroids, racemic epinephrine),
(2) Postextubation counseling (i.e., informing and advising
the patient or responsible individual of the occurrence and
potential complications associated with a difficult airway),
(3) Documentation of difficult airway and management in the
medical record and to the patient, and
(4) registration with a difficult airway notification service.
19. Recommendations for Follow-up Care.
• Use postextubation steroids and/or racemic epinephrine when appropriate.
• Inform the patient or a responsible person of the airway difficulty that was
encountered to provide the patient (or responsible person) with a role in
guiding and facilitating the delivery of future care.
◦ The information conveyed may include (but is not limited to) the presence
of a difficult airway, the apparent reasons for difficulty, how the intubation was
accomplished, and the implications for future care.
• Document the presence and nature of the airway difficulty in the medical
record to guide and facilitate the delivery of future care.
• Instruct the patient to register with an emergency notification service when
appropriate and feasible.