Advanced Airway Management in the Neurologically Injured Patient

  • A. Gabrielli
  • L. J. Caruso
  • A. J. Layon
Conference paper

Abstract

A systematic approach to airway management has been shown to reduce the likelihood of an adverse outcome in the operating room [1–4]. Accordingly, in this chapter we discuss the unique challenges involved in the airway management of the neurologically injured patient and offer a strategy that may improve neurologic outcome after central nervous system (CNS) injury.

Keywords

Endotracheal Tube Vocal Cord Airway Management Laryngeal Mask Airway Difficult Airway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Caplan RA, Posner KL, Ward RJ, et al (1990) Adverse respiratory events in anesthesia–A closed claims analysis. Anesthesiology 72: 828–833PubMedCrossRefGoogle Scholar
  2. 2.
    Crosby ET, Cooper RM, Douglas MJ, et al (1998) The unanticipated difficult airway with recommendations for management. Can J Anaesth 45: 757–776PubMedCrossRefGoogle Scholar
  3. 3.
    American Society of Anesthesiologists Task Force on Management of the Difficult Airway (1993) Practice guidelines for management of the difficult airway. Anesthesiology 78: 597–602CrossRefGoogle Scholar
  4. 4.
    Benumof JL (1991) Management of the difficult adult airway–With special emphasis on awake tracheal intubation. Anesthesiology 75: 1087–1110PubMedCrossRefGoogle Scholar
  5. 5.
    Leach RM, Treacher DS (1998) ABC of oxygen. Oxygen transport - 2. Tissue hypoxia. Br Med J 317: 1370–1373Google Scholar
  6. 6.
    The Brain Trauma Foundation (2000) Resuscitation of blood pressure and oxygenation. J Neurotrauma 17: 471–478Google Scholar
  7. 7.
    Safar P (2000) On the future of reanimatology. Acad Emerg Med 7: 75–89PubMedCrossRefGoogle Scholar
  8. 8.
    Benumof JL (1999) The unanticipated difficult airway. Can J Anaesth 46: 510–515PubMedGoogle Scholar
  9. 9.
    Benumof JL (1999) The ASA difficult airway algorithm - New thoughts/considerations. Lecture 134, ASA Refresher Course Lectures. American Society of Anesthesiologists, Park RidgeGoogle Scholar
  10. 10.
    Wilson ME, Spiegelhalter D, Robertson JA, et al (1988) Predicting difficult intubation. Br J Anaesth 61: 211–216PubMedCrossRefGoogle Scholar
  11. 11.
    Mallampati SR, Gatt SP, Gugino LG, et al (1985) A clinical sign to predict difficult tracheal intubation: A prospective study. Can Anaesth Soc J 32: 429–434PubMedCrossRefGoogle Scholar
  12. 12.
    Samsoon GLT, Young JRB (1987) Difficult tracheal intubation: A retrospective study. Anaesthesia 42: 487–490PubMedCrossRefGoogle Scholar
  13. 13.
    Cormack RS, Lehane JR, Adams AP, Carli F (2000) Laryngoscopy grades and percentage glottic opening. Anaesthesia 55: 184PubMedCrossRefGoogle Scholar
  14. 14.
    LoCicero J (1989) Bronchopulmonary aspiration. Surg Clin North Am 69: 71–76PubMedGoogle Scholar
  15. 15.
    Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78: 56–62PubMedCrossRefGoogle Scholar
  16. 16.
    Benumof JL (1996) Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 84: 686–699PubMedCrossRefGoogle Scholar
  17. 17.
    Kinni ME, Stout MM (1986) Aspiration pneumonitis: Predisposing conditions and prevention. J Oral Maxillofacial Surg 44: 378–384CrossRefGoogle Scholar
  18. 18.
    Chevron V, Menard JF, Richard JC, et al (1998) Unplanned extubation: risk factors and predictive criteria for reintubation. Crit Care Med 26: 1049–1053PubMedCrossRefGoogle Scholar
  19. 19.
    Koh WY, Lew TWK, Chin NM, Wong MFM (1997) Tracheostomy in a neuro-intensive care setting: Indication and timing. Anaesth Intensive Care 25: 365–368PubMedGoogle Scholar
  20. 20.
    Benumof JL, Dagg R, Benumof R (1997) Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 87: 979–982PubMedCrossRefGoogle Scholar
  21. 21.
    Thomas DI (1999) Overcoming the beard. Anaesthesia 54: 100PubMedCrossRefGoogle Scholar
  22. 22.
    Ruben H, Knudsen EJ, Carugati G (1961) Gastric inflation in relation to airway pressure. Acta Anaesth Scand 5: 107–116PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen M (1993) Initial resuscitation of the patient with spinal cord injury. Trauma Quarterly 9: 38–43Google Scholar
  24. 24.
    Benumof JL, Cooper SD (1996) Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth, 8: 136–140PubMedCrossRefGoogle Scholar
  25. 25.
    Takahata O, Kubota M, Mamiya K, et al (1997) The efficacy of the “BURP” maneuver during a difficult laryngoscopy. Anesth Analg 84. 419–421PubMedGoogle Scholar
  26. 26.
    Dogra S, Falconer R, Latto IP (1990) Successful difficult intubation: Tracheal tube placement over a gum-elastic bougie. Anaesthesia 45: 774–776Google Scholar
  27. 27.
    Cooper SD (1996) The evolution of upper airway retraction: New and old laryngoscopy blades. In: Benumof JL (ed) Airway Management: Principles and Practice. Mosby-Yearbook, St. Louis, pp:374–411Google Scholar
  28. 28.
    Schwartz DE, Matthay MA, Cohen NH (1995) Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 83: 431–432CrossRefGoogle Scholar
  29. 29.
    Verghese C, Brimacombe JR (1996) Survey of laryngeal mask airway usage in 11910 patients: Safety and efficacy for conventional and non-conventional usage. Anesth Analg 82: 129–133Google Scholar
  30. 30.
    Pennant JH, Walker MB (1992) Comparison of the endotracheal tube and the laryngeal mask in airway management by paramedical personnel. Anesth Analg 74. 531–534PubMedCrossRefGoogle Scholar
  31. 31.
    Mahiou P, Narchi P, Beyrac P, et al (1992) Is laryngeal mask easy to use in case of difficult intubation? Anesthesiology 77: 1228A (abst)CrossRefGoogle Scholar
  32. 32.
    Akbar AN, Muzi M, Lopatka CW, et al (1996) Neurocirculatory responses to intubation with either an endotracheal tube or a laryngeal mask airway in humans. J Clin Anesth 8: 194–197PubMedCrossRefGoogle Scholar
  33. 33.
    Rabey PG, Murphy PJ, Langton JA, et al (1992) Effect of laryngeal mask airway on lower oesophageal sphincter pressure in patients during general anaesthesia. Br J Anaesth 69: 346–348PubMedCrossRefGoogle Scholar
  34. 34.
    Brimacombe JR, Berry AM (1997) Cricoid pressure. Can J Anaesth 44: 414–425PubMedCrossRefGoogle Scholar
  35. 35.
    Klein H, Williamson M, Sue-Ling HM, et al (1997) Esophageal rupture associated with the Combitube. Anesth Analg 85: 937–939PubMedGoogle Scholar
  36. 36.
    Vézina D, Lessard MR, Bussières J, et al (1998) Complications associated with the use of the esophageal-tracheal Combitube®. Can J Anaesth 45: 76–80PubMedCrossRefGoogle Scholar
  37. 37.
    Atherton GL, Johnson JC (1993) Ability of paramedics to use the Combitube® in prehospital cardiac arrest. Ann Emerg Med 22: 1263–1268PubMedCrossRefGoogle Scholar
  38. 38.
    Frass M, Frenzer R, Zdrahal F, et al (1987) The esophageal tracheal Combitube®–Preliminary results with a new airway for CPR. Ann Emerg Med 16: 768–772PubMedCrossRefGoogle Scholar
  39. 39.
    Staudinger T, Brugger S, Watschinger B, et al (1993) Emergency intubation with the Combitube®–Comparison with the endotracheal airway. Ann Emerg Med 22: 1573–1575PubMedCrossRefGoogle Scholar
  40. 40.
    Wagner A, Roeggla M, Roeggla G, et al (1995) Emergency intubation with the Combitube in a case of severe facial burn (correspondence). Am J Emerg Med 13: 681–683PubMedCrossRefGoogle Scholar
  41. 41.
    Klauser R, Roeggla G, Pidlich J, et al (1992) Massive upper airway bleeding after thrombolytic therapy–Successful airway management with the Combitube®. Ann Emerg Med 21: 431–433PubMedCrossRefGoogle Scholar
  42. 42.
    Mercer M (2000) Respiratory failure after tracheal extubation in a patient with halo frame cervical spine immobilization. Rescue therapy using the Combitube airway. Br J Anaesth 86: 886–891CrossRefGoogle Scholar
  43. 43.
    Caparosa RJ, Zavatsky AR (1957) Practical aspects of the cricothyroid space. Laryngoscope 67: 577–591PubMedCrossRefGoogle Scholar
  44. 44.
    Zaleski L, Abello D, Gould MI (1993) The esophageal detector device: Does it work? Anesthesiology 79: 244–247PubMedCrossRefGoogle Scholar
  45. 45.
    Kasper CL, Deem S (1998) The self-inflating bulb to detect esophageal intubation during emergency airway management. Anesthesiology 88: 898–902PubMedCrossRefGoogle Scholar
  46. 46.
    Cardoso MMSC, Banner MJ, Melker RJ, et al (1998) Portable devices used to detect endotracheal intubation during emergency situations: A review. Crit Care Med 26: 957–964PubMedCrossRefGoogle Scholar
  47. 47.
    Benumof JL (1996) Airway Management - Principles and Practice. Mosby Yearbook, St. Louis, p 129Google Scholar
  48. 48.
    Gabrielli A, Layon AJ (2002) Management of the difficult airway. In: Kirby RR, Gravenstein N, Lobato EB, Gravenstein JS (eds) Clinical Anesthesia Practice, edn 2. WB Saunders, Philadelphia, pp 1010–1022Google Scholar
  49. 49.
    Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anesthesia 39: 1105–1111CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • A. Gabrielli
  • L. J. Caruso
  • A. J. Layon

There are no affiliations available

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