Management of the anticipated and unanticipated difficult airway in anesthesia outside the operating room. 2013

Arne Neyrinck
Division of Anesthesiology and Algology, KU Leuven, Belgium. arne.neyrinck@uzleuven.be

OBJECTIVE The number of diagnostic and interventional procedures outside the operating room has dramatically increased over the last years. However, providing well tolerated anesthesia with the same standard of care in these locations is often challenging to the anesthesiologist. The remote locations include different organizational aspects and hazards. Airway management in general is still confronted with scenarios of difficult intubation and ventilation and often leads to significant morbidity and mortality. Continuous awareness of the potential complications is urged when providing anesthesia for remote procedures. RESULTS Recent studies have poorly addressed the issue of airway management by trained anesthesiologists outside the operating room. The majority of evidence is provided in the field of emergency medicine and intensive care settings. However, when dealing with difficult airway management in the remote setting, careful assessment and preparation is even more important than in the operating room. New evidence concerning prediction of ventilation and intubation must be incorporated in algorithms of airway management. Different anesthetic regimens using remifentanil and avoiding the use of neuromuscular blockers have to be carefully considered since they might change the scenario of intubation conditions. The new era of video laryngoscopes offers important potential to increase the tools for airway management. These new devices have the perfect design to be incorporated in remote settings. However, studies mainly focus on the emergency department and ICU. Also, there is currently a lack of consensus among professionals about their use and the large number of different devices seems to avoid careful comparisons. CONCLUSIONS Airway management outside the operating room is challenging and needs the implementation of algorithms including the new airway devices. The recent update of the practice guidelines about difficult airway management of the American Society of Anesthesiologists remains the standard reference guide.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000758 Anesthesia A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures.
D014741 Video Recording The storing or preserving of video signals to be played back later via a transmitter or receiver. Audiovisual Recording,Videorecording,Audiovisual Recordings,Recording, Audiovisual,Recording, Video,Recordings, Audiovisual,Recordings, Video,Video Recordings,Videorecordings
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice
D058109 Airway Management Evaluation, planning, and use of a range of procedures and airway devices for the maintenance or restoration of a patient's ventilation. Airway Control,Control, Airway,Management, Airway
D020704 Laryngoscopes Endoscopes for examining the interior of the larynx. Laryngoscope

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