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perform bronchoscopy and other airway procedures, pulmonary specialists must be able to adequately anesthetize the upper airway with local anesthetics, and

Airway Surgery

Collection Start/Stop ☐ Medication ☐ Position and Patient Checks ☐ Airway/Procedure Notes ☐ PACU Orders ☐ Post-op Note ☐ MGH Safety Reporting System EMERGENCY

on the procedure tab up top. 3. Scroll to the bottom and click on Floor/ICU intubation 4. Once in the record you will need to create an airway procedure

Emergency Manual ☐ Locate Code Cart ☐ Operate Defibrillator ☐ Locate Airway Cart ☐ Setup Airway Cart ☐ Locate OR Pharmacy ☐ Locate Anesthesia Workrooms ☐ How

Management Table 4. Airway Management Key features of airway assessment include preexisting airway abnormality, current airway injury (i.e., inhalation

meticulous airway management. 6. Careful preoperative planning will prevent the conversion of a partial airway obstruction into a complete airway obstruction

on Management of Difficult Airway. Anesthesiology, 118. Benumof JL. 1996. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology,

during the procedure.8,9 Healthy patients undergoing simple procedures such as screening colonoscopies or EGDs will generally tolerate these procedures well

RICU Consult The examples presented are for airway management but the pathways are the same for other procedures such as central line placement Log in as

Respiratory Muscle Function Airway patency is governed by complex interactions between neuromuscular function and inherent airway structural properties [38

6776 procedures performed in a freestanding surgical facility dedicated to ART. Of the 4199 patients who had vaginal oocyte retrieval procedures, seven

with the operator standing behind the supine patient. UPPER AIRWAY Nasopharynx The upper airway examination begins with a quick assessment of nasal and oral

breathing room air.  Some procedures may require breath holds, which may effect your choice of anesthesic.  Certain procedures may also require complete

be more important to minimize airway pressures. The following steps may be taken to optimize ventilatory settings: Airway pressure: If Pplat is above 30

after the procedure. I I Table 2. Dental Procedures for Which Endocarditis Prophylaxis Is Reasonable for Patients in Table 1 �:' dental procedures that involve

injuries from 2000 to 2012, 72 involved procedures in NORA locations compared with 1828 claims involving procedures within the OR. The NACOR dataset consisted

pre-operative critical airway, followed by an intraoperative transected airway, and finally a precarious post-operative airway that may be edematous due

surgical case. ● Perform advanced airway techniques, POCUS and TTE exams as appropriate. ● Be a resource for procedures, including invasive line and difficult

you plan to secure the airway? Airway management strategy  We use manual in-line stabilization (MILS) during all aspects of airway management for patients

sedation for neurointerventional procedures (not including AIS) a 25% incidence of respiratory complications (snoring, airway obstruction, SpO2<90% or respiratory

sedation for neurointerventional procedures (not including AIS) a 25% incidence of respiratory complications (snoring, airway obstruction, SpO2 < 90% or respiratory

travel BUNDLE bedside procedures AVOID nebs, prefer MDIs Appropriate guideline-based isolation for aerosol generating procedures including intubation/extubation

identified. During long procedures, sedation may lead to respiratory depression and obstruction. Obstruction during EP procedures may be problematic, because

moderate PEEP instead of initial recourse to PEEP titration procedures or PEEP/FiO2 tables. Plateau airway pressure (Pplat, pressure measured during an end-inspiratory

with increased atelectasis and small airway collapse, decreased lung and chest wall compliance and increased airway resistance, as well as moderate to severe

inspiratory pressure measured by the airway pressure inlet/transducer, it utilized f. MAP – Mean airway pressure measured by the airway pressure inlet/transducer

PEEPTOT or, in case of airway closure, airway opening pressure (no patient exhibited a drop in the airway pressure after airway opening pressure was overcome

continuously during each of the procedures. The higher the inflow of oxygen into the hood, or the greater the aerosolization of the procedure, the more the Buffalo

2016;63(5)B5241 9 Airway Devices Nasopharyngeal Airway Used in awake or sedated patients without definitive airway to bypass upper airway obstruction. Proper

History of major airway surgery or unusual airway anatomy (History of difficult intubation in previous anesthetic) ● Upper or lower airway tumor or obstruction

Scale 12 9 Airway Devices ASA Difficult Airway Algorithm Nasopharyngeal Airway Used in awake or sedated patients without definitive airway to bypass upper

traditionally received little knowledge of airway management. However in the Medical ICU many patients require invasive airway management and Dr ___________________________

nonsurgical airway ventilation consisting of a face mask or supraglottic airway device (e.g., laryngeal mask airway, intubating laryngeal mask airway, and laryngeal

PHYSIOLOGY Anatomy of Upper Airway and Trachea The airway can be functionally divided into upper and lower airway. The upper airway includes the nose, pharynx

Preparation Airway issues How will one-lung ventilation be tolerated? What is the likelihood of bypass or ECMO? Are there any other procedures that may require

less invasive techniques, with laparoscopic and robotic procedures supplanting many open procedures. A natural extension of this trend has been innovation

prior to extubation were excluded. Patients who had airway management for elective or emergency procedures in the operating room were not considered as ICU

Sevoflurane was used for maintenance. The airway was secured with either an endotracheal tube or laryngeal mask airway. Regional anesthesia Target nerves (sciatic

upper airway from the alveoli Mixture of anatomical and alveolar dead space Alveolar plateau CO2 concentration reaches uniform levels in the airway Height

intubation to secure the airway, using a modified rapid sequence intubation, or discontinuing the medication before elective procedures. None of these solutions

by decreasing transpulmonary blood flow (almitrine, Continuous Positive Airway Pressure (CPAP), reverse Trendelenburg positioning, fluid depletion…). Indeed

The following are general guidelines only. The patients undergoing these procedures are presenting for placement of implants for breast reconstruction/gender

consider oral airway. 2. Call for Difficult Airway cart. CANNOT Ventilate Successful Ventilation CALL FOR HELP! Place oral, nasal airway. Switch to two-handed

increases maximal oropharyngeal airway size and decreases closing pressures of the airway (indicating a more patent airway), whereas neck flexion with bite

complex, large cases with massive blood loss; two stage procedures OMFS OR 68 Great airway management cases; Nasal intubations Trauma OR 69 - 70

The following are general guidelines only. The patients undergoing these procedures are presenting for removal of breasts for reconstruction/gender affirmation

complex, large cases with massive blood loss; two stage procedures OMFS OR 68 Great airway management cases; Nasal intubations Trauma OR 69 - 70

laparoscopic procedures. METHODS: We retrospectively reviewed the electronic health records of 8567 patients who underwent major laparoscopic procedures (lasting

initial tidal volume of 12 ml per kilogram of predicted body weight and an airway pressure measured after a 0.5-second pause at the end of inspiration (plateau

peak airway pressure obtained with bag mask ventilation can easily exceed 40 cm H2O. Clinicians often do not precisely control and monitor airway pressure

landmarks and narrowing of the airway passages; collectively, these changes magnify the difficulty in intubation and airway management. Thoracic compliance

Standard procedure. Secure the ETT to the patient with obsessive compulsive intent as you will have potentially limited access to the airway throughout

prior) he had tolerated well under deep sedation with natural airway. One prior procedure was performed under general endotracheal anesthesia. He had a

Compared With a Sham Procedure in Rapid Sequence Induction of Anesthesia I nduction of anesthesia induces a loss of protective upper airway reflexes and may

for surgical airway (tracheostomy) Continued on next page DIFFICULT AIRWAY 6 If second intubation attempt fails Insert oropharyngeal airway and perform

operating rooms. Table XXX- Cardiac surgical emergency procedures as the MGH (CY 2018) Procedure Repair of aortic dissection Sternal debridement/washout/exploration

system (Figure 1): Paw ¼ P0 þ (R � flow) þ (Vt � ERS), where Paw ¼ airway pressure (at the airway opening), P0 ¼ initial alveolar pressure, R ¼ resistance to

system (Figure 1): Paw ¼ P0 þ (R � flow) þ (Vt � ERS), where Paw ¼ airway pressure (at the airway opening), P0 ¼ initial alveolar pressure, R ¼ resistance to

__________________ is currently the senior editor for the of the M GH handbook Clinical Procedures of the Massachusetts General Hospital – 8th Edition. Dr. __________________

associated with upper airway obstruction (due to myxedematous tissue), which may predispose patients to difficulty in maintaining a patent airway. Our patient's

modes of ventilation, which include PC-IMV, airway pressure release ventilation (APRV), biphasic positive airway pressure, PSV, and pressure-regulated VC

congestive heart failure, aspiration, ineffective cough with airway secretion build-up, or upper airway obstruction. Other reasons for reintubation include the

chest wounds Obstetric–gynecologic procedures Cesarean delivery Laparoscopic procedures, Rubin insufflation procedures, vacuum abortion Urology Urology–prostatectomy

measurement of CO2 at the airway opening, generally displayed as PCO2. Colorimetric, qualitative capnometers can be placed directly in the airway to confirm endotracheal

have developed an algorithm for management of airway hemorrhage (Figure XXX). Prior to weaning the airway (ETT) is visually inspected while the lungs are

having airway pressures of >20 cmH2O receiving both RBC and FFP, and lowest in patients ventilated with tidal volume of ≤7 mL/kg PBW and having airway pressures

anesthesia, supraglottic airways, positive pressure ventilation, duration of surgery greater than two hours, or difficult airway; and device factors such

Q. 7). 5. Airway Management and Ventilation A simplified airway algorithm is shown in Fig. 2. ­First-responders without advanced airway experience must

(red lines). (A) “Bag squeezing” using the airway pressure-limiting valve of the anesthesia machine. The airway pressure is difficult to control, possibly

�Combined procedures that significantly lengthen duration of surgery or add significant blood loss (e.g., CABG-carotid, other vascular procedures). Although

Given the evidence of increased lung compliance, early airway closure, extensive peripheral airway dysfunction, and maldistribution of ventilation in smokers

a low risk of nosocomial superinfection, reflecting reduced exposure to procedures associated with such infections.10 It has been progressively used worldwide

of postoperative analgesia. For procedures associated with moderate levels of postoperative pain (laparoscopic procedures), a dose of 10 mg before surgical

requires proper qualifications to perform invasive procedures. Invasive bedside medical procedures are associated with greater risks for serious errors

transcatheter procedures and assessments of cardiac structure and function that will influence cardiac surgery. Although guidance of procedures may require

7 Airway Exam – Good Candidates Lateral walls stable 800-051-001, Rev C © Inspire Medical Systems, Inc. All Rights Reserved 8 Advanced Airway Assessment

Laryngeal Mask Airway for Tracheal Surgery In 1993, I introduced the use of the Laryngeal Mask Airway as a minimallyinvasive tool for airway management and

been a 15-fold increase in spine procedures between 2000 and 2007 alone; among this growth, primary lumbar fusion procedures had the largest increase compared

Chlorhexidine is used commonly as a disinfectant before surgery or invasive procedures, including central line placement. Allergy to chlorhexidine is usually

swab from the upper airway does not rule out SARS-CoV-2 infection and repeated sampling from multiple sites, including the lower airway, will increase diagnostic

protocol, p = 0.53 Wilcoxon rank test) were not significantly different. Airway driving pressure (plateau pressure - positive end-expiratory pressure) and

noninvasive variable positive airway pressure (most commonly “bilevel”) devices consisting of a higher inspiratory positive airway pressure and a lower expiratory

abdominal, intra-abdominal, and orthopedic (limb and spine) procedures.2 Patients undergoing procedures with expected mild levels of pain, such as tonsillectomy

0.05 mg/kg cisatracurium. ‖ Thoracic and abdominal procedures (referent) versus all other procedures. # Normal weight (BMI less than 25 kg/m2) is referent

Deliberate Practice Can Be Used to Improve the Performance of Technical Procedures The theoretical framework of deliberate practice has been applied to a

to secure the tubing to the face Have emergency airway equipment readily available (nasal/oral airways, mask, LMA) Four infusions on pump: remifentanil

cardiac surgery should be scrutinized for evidence of adverse events or airway management difficulties. In addition to antianginal, antihypertensive, diuretic

LMA (GA) vs nasopharyngeal airway (MAC) vs no airway instrumentation (MAC) GA vs MAC for the pre-awake phase Differ in airway management, ventilation mode

needed throughout stages of surgery - Airway exam: assess for neck flexion/extension, other features of difficult airway. Review records of prior anesthetics

Carts: o o o o Airway Cart - Red cart in back next to code cart (Blades, ETT, Cric kit, etc) Line cart - Blue cart in back with airway cart Code Cart-

Postoperative Critical Care of the Adult Cardiac Surgical Patient: Part II: Procedure-Specific Considerations, Management of Complications, and Quality Improvement

reduced rates of myocardial infarction, stroke, and revascularisation procedures.10,11,13,14 (CABG) which resulted in lower perioperative glucose concentrations

than around the frame on the OR table 2) Place all necessary airway equipment for procedure under the hood (don’t forget eye ovals) 3) Attach the smoke

mechanics during the procedure of prone positioning in ARDS patients. This information is important in order to interpret changes in airway pressure that may

of Anesthesiologists Difficult Airway Algorithm. In 2002 I initiated the practice of teaching surgical residents airway management at Mclean in the diverse

Chlorhexidine is used commonly as a disinfectant prior to surgery or invasive procedures, including central line placement. Allergy to chlorhexidne is usually

fiberoptic bronchoscopic guidance can also facilitate intubation in patients with airway pathology. Retrograde fiberoptic intubation (RFI) is described sparingly

31861 Preoperative Evaluation • • • • • • • • • Airway assessment- alert attending of difficult airways Asthma, hypertension, GERD, bleeding disorders,

jelly, Ovasappian airway, gauze. Have all the appropriate resuscitation drugs and equipment ready. 7. Monitor patient throughout the procedure. Oral awake intubation

patients at end expiration (identified with an airway pressure signal) but were not adjusted for airway pressure.15 Measured intravascular pressure (mm

Filters ▪ HMEF on airway, gas sampling on machine side • Second filter on the expiratory limb if possible (required if no filter on airway) o Active humidifiers

whenever positioning and procedure permits Patients with late effect burns to neck and face should be considered a difficult airway due to restricted head

continued when the procedure is low-risk pain procedures. However, antiplatelet therapy is discontinued when medium- and high-risk procedures are planned. The

Sedation Management  Anesthetic Course: o Respiratory Status: Vent settings o Airway Concerns o Hemodynamic Stability o Medications: Last Paralytic & Reversal/

Pediatric Regional Anesthesia Network documented no LAST episodes in 14,917 procedures,42 although its most recent analysis of over 100,000 regional anesthetics

exposure to general anesthesia of duration similar to typical surgical procedures (roughly 2 hours). Cognitive testing includes the Postoperative Quality

coma suggests eclampsia. e. Respiratory - upper airway and laryngeal edema predispose to a difficult airway. Pulmonary edema occurs due to the elevations

NPO but has a raging URI with post nasal drip. What is your plan for his airway and why? 3. You are taking care of a 10-year old girl who fractured her

cooled by ambient air; similarly, probes inserted too far may approach the airway and be cooled by ventilation gases. We thus determined the range of nasopharyngeal

undesirable anesthesia side effects in their children undergoing surgical procedures. Paediatr Anaesth. 2007;17:1035–42. 6. Rashiq S, Bray P. Relative value

during video-assisted thoracic procedures for improved pain control [Intravenous lidocaine infusion during VATS procedures reduces postoperative analgesic

resection in a total of 47 patients (20.5%) [15 ]. & AIRWAY MANAGEMENT As discussed previously, airway management may be particularly challenging in patients

care were similar for both groups. The experimental and control group procedures are detailed in the protocol and the manual of operations (Supplements

Diagnostic and interventional cardiac procedures, including electrophysiology procedures 1. �Perform procedure in a hospital with cardiologists, anesthesiologists

after extubation. Weaning guidelines suggest performing the test positive airway pressure) [1, 26]. In this regard, the T-tube strategy is the more realistic

after extubation. Weaning guidelines suggest performing the test positive airway pressure) [1, 26]. In this regard, the T-tube strategy is the more realistic

GA, no other anesthetics were listed. a private practice setting (all procedures were performed by experienced anesthesiologists), Gambling et al24 found

SPU Pediatric/Adult Airway Adapter SPU Neonatal/Pediatric Airway Adapter B–2 www.zoll.com 9650-0912-01 Rev. N Reusable Adult Airway Adapter Reusable

clinician can directly measure the pressure from the ventilator at the airway opening (airway pressure [Paw]) and reference it to body surface pressure (Pbs)

Unintended carotid artery puncture leading to hematoma formation and potential airway compromise is the most common major complication of internal jugular vein

whole respiratory cycle (40, 41) (Figure 3). Airway resistance and expiratory flow limitation Small airway (< 2mm in diameter) resistance plays a minimal

NIV can be delivered using continuous positive airway pressure (CPAP) or using bi-level positive airway pressure with pressure-support (PS). Whatever the

not record maximal inspiratory pressures or respiratory mechanics; maximal airway pressures also require adequate volitional effort and respiratory mechanics

device (endotracheal tube or laryngeal mask). Anesthesia administration and airway management were delivered as per the anesthesiologist’s usual practice and

used in accordance with the airway algorithm in the respective country of application or the official specifications for airway management. La utilización

that protect the airway. Several approaches to reduce the occurrence of delirium were instituted as part of standard operating procedures for patients in

of 0.5 (D) administration of oxygen 50% with 5 cmH2O continuous positive airway pressure (E) observation, with no action at present 14. In patients with

studies concerning eight conditions and procedures.3 This review led to the conclusion that for a wide variety of procedures, higher volume (by either the hospital

hypertension and reduced cerebral perfusion. It is essential to ensure a patent airway and adequate oxygenation and ventilation. Patients who regain consciousness

consent was obtained from participants or their authorised surrogates. Procedures Patients were randomly assigned in a 1:1 manner to management with paired

once considered the most formidable of the whole organ transplantation procedures and the least likely to be practical, has become the flagship of new principles

obtained research ethics board approval before commencing recruitment. Procedures During the period from recruitment to 1 day be­fore surgery, participants

death,7,8 and each institution should have its own relevant policies and procedures that are in accordance with local laws.9 The Ad Hoc Committee of the Harvard

CRITICAL CARE PERSPECTIVE Definitions of Physiological Abbreviations ∆Paw: airway driving pressure Cstat,rs: static compliance of the respiratory system ECCO2R:

CRITICAL CARE PERSPECTIVE Definitions of Physiological Abbreviations ∆Paw: airway driving pressure Cstat,rs: static compliance of the respiratory system ECCO2R:

advances are focused on the use of samples easily available by noninvasive procedures and representing as best as possible the lung environment © Annals of

advances are focused on the use of samples easily available by noninvasive procedures and representing as best as possible the lung environment © Annals of

oropharynx. Intubation endoscopes are designed for transient use in invasive procedures through a body orifice. NOTE: 6JG�HNGZKDNG�KPVWDCVKQP�GPFQUEQRG� ����

dedicated to feedback. Trainees are provided with a list of commonly performed procedures for which they are expected to demonstrate competence such as endotracheal

should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining

recruitment and retention of lung units while limiting tidal volumes and airway pressure; and avoiding fluid overload. Re-recruitment is particularly important

two were enriched with Bacteroides sp (OTU0014). Pink boxes indicate upper airway associated taxa, while brown boxes indicate gut-associated taxa. (B) Bacterial

maintained at 35 to 45 mmHg by adjusting the ventilation rate and maximum airway pressure. Patients were sent to the postanesthetic care unit or intensive

of symptoms. In terms of safety, efforts should focus on protection of the airway and prevention of aspiration, maintenance of hydration and nutrition, prevention

severity using an appropriate pain measurement tool and indicated diagnostic procedures. Early identification of patients with potential cancer pain should be

Coma Scale score �8 need to be intubated and ventilated to protect their airway prior to scanning. In this particular circumstance, hyperventilation may