Barry C. Simon, MD


How to handle the difficult airway, part 2

July 01, 2005

Abstract: The laryngeal mask airway (LMA) and intubating LMA are valuable alternatives in patients in whom intubation has failed and who need oxygenation and ventilation immediately. The dual-lumen, dual-cuffed airway tube is effective in a variety of settings and can tolerate ventilation at pressures as high as 50 cm H2O; it is contraindicated in awake patients who have intact airway reflexes, caustic ingestions, and upper airway obstruction from a foreign body or pathology. Surgical airways are lifesaving techniques when intubation is unsuccessful or impossible through the mouth or nose. It may be particularly appropriate in patients with laryngeal or facial trauma, upper airway obstruction, or oropharyngeal injury. When patients aged 12 years and older cannot be ventilated by mask or intubated with traditional methods, surgical or needle cricothyrotomy is the procedure of choice. (J Respir Dis. 2005;26(7):298-302)

How to handle the difficult airway, part 1

June 01, 2005

Abstract: A number of scoring systems can be used to help predict difficult intubations. The Mallampati system, for example, can be useful in assessing patients before elective surgery, but it is less practical in emergent situations. Clinical features that suggest a potentially problematic airway include relatively long upper incisors, prominent overbite, narrow palate, edematous mandibular space, thick neck, and limited flexion of the neck. The most effective and rapid way of securing definitive airway management remains direct laryngoscopy with placement of an endotracheal tube (ETT). The ETT/stylet assembly of the light wand is best used when the patient can be successfully ventilated with a bag-valve mask device between intubation attempts. One of the most critical components of airway management is confirming that the ETT has been successfully placed in the trachea. (J Respir Dis. 2005;26(6):268-276)