Airwaymanagement

BACKGROUND: In case of distorted airway anatomy, awake intubation with a flexible bronchoscope can be extremely difficult or even impossible. To facilitate this demanding procedure, an infrared flashing light source can be placed on the patient's neck superficial to the cricothyroid membrane. The light travels through the skin and tissue to the trachea, from where it can be registered by the advancing bronchoscope in the pharynx and seen as flashing white light on the monitor. We hypothesised that the application of this technique would allow more proximal and easier identification of the correct pathway to the trachea in patients with severe airway pathology...

The safe sedation of children for procedures requires a systematic approach abstract that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airwaymanagement to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of appropriately trained staff to bothcarry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equippedand staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions...

Airway management in the prehospital setting is a particular challenge. Even with numerous alternative devices, endotracheal intubation still represents the gold standard. Limited knowledge and experience of the user in addition to a critical patient's condition, special environmental conditions and limited material resources at the out of hospital emergency, are major causes of an increased incidence of difficult airways in the preclinical setting. For the management of the difficult airway emergency physicians can use alternatives to tracheal intubation such as extraglottic airway devices, videolaryngoscopy and cricothyroidotomy...

The standards of treatment of patients suffering cardiac arrest is defined by international guidelines for cardiopulmonary resuscitation, that are updated every five years. Scientific knowledge is continuously increasing and recent studies should be considered and discussed to improve the results of daily emergency care. There are some leading topics of the ongoing discussion concerning airwaymanagement, mechanical ventilation, mechanical cpr-devices and extracorporal life support. The strategies of postresuscitation care are also in the focus of interest...

Endotracheal intubation remains the "goldstandard" in airway management. If with use of conventional techniques intubation of the patient fails, or if an anticipated difficult airway is present, video-assisted techniques may help to increase intubation success. Video-assisted techniques give the possibility to indirectly visualise the laryngeal structures with fibreoptical or camerachip-technique, and to display the videopicture on an external or integrated monitor. For the anticipated difficult airway, awake flexible fibreoptical intubation still is the first choice...