الفهرس 
Upper Airway AnatomyOnly 14 pages are availabe for public view
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Abstract
Adequate preoperative airway planning, including specific techniques and equipment tailored to each specific patient, can play an important role in decreasing the risks associated with difficult airway management. A thorough review of the patient’s medical history, comorbid conditions, and prior anesthetics is imperative for creating an airway-management plan. Specific airway assessment tools, especially when used in combination, can help in predicting difficult airway anatomy. In addition, especially in nonemergent situations, the use of imaging studies such as endoscopy and bedside ultrasound may improve the efficacy of existing prediction tools (Caplan et al., 1990).Numerous difficult-airway prediction tools exist, but providers must appreciate their limitations in predicting this rare outcome. Given these limitations, adequate preparation with functional equipment and alternative plans must accompany airway assessment for individual patients. Additionally, because of the unusual factors associated with these cases, airway scenarios outside the operating rooms must be given special attention. Perioperative providers from multiple disciplines should be involved in early identification and referral of patients with difficult airway history or signs (Ramachandran et al., 2013).
While preparations for airway control are made, basic maneuvers are implemented: preoxygenation techniques, including relief of airway obstruction by chin lift and jaw thrust, and insertion of a nasal airway or an oral airway. Bag mask ventilation with the use of an oropharyngeal or nasopharyngeal airway can be a difficult skill to master, best performed by two individuals with a more efficient mask seal and jaw thrust, but it can easily inflate the stomach. The second component of optimal mask ventilation is the use of large oral or nasal pharyngeal airways. Finally, ventilation pressure-controlled mask ventilation reduced the inspiratory peak flow rates and airway pressures in comparison with the manual circle system with bag-valve-mask ventilation devices, providing additional patient safety by decreasing the risk of regurgitation and subsequent pulmonary aspiration (Von Goedecke et al., 2004).
The tools and techniques that are available to anesthesia providers in the ambulatory setting have improved considerably during the past 10 years. To fully use these gains, clinicians must understand the risks and benefits and appropriate clinical settings for each technique and device. Patients are presenting for ambulatory procedures with increasing comorbidities and risk factors for difficult airway management. To mitigate this risk, it is important to develop an airway strategy that includes addressing difficult mask ventilation, intubation, and SGA use. In doing so, the specialty of anesthesiology can improve on its strong record of providing excellent patient safety and care (Anderson & Klock, 2014).
As novel and innovative as these airway management and rescue devices are, one must remember that their role always must be as part of an emergency airway algorithm that is a stepwise progression that goes logically and rapidly through decision points. SGAs have a proven role in airway rescue in unanticipated respiratory issues. However, there is no single fail-safe technology in airway management that can overcome every problem. There is no doubt that the devices are only as good as the clinical judgment of the provider and his or her training and experience. The introduction of any critical airway rescue device must be rehearsed and practiced to assure that the device will, in fact, make the difference in patient safety and outcome (Rosenberg et al., 2014).
Implementation of the guidelines does not obviate the need for planning at a local level. To achieve and maintain competence with devices such as videolaryngoscopes and second-generation SADs and drugs such as sugammadex, they need to be available for regular use, and local training will be necessary. New airway devices will continue to be developed and introduced into clinical practice; their place in these guidelines will need to be evaluated (Frerk et al., 2015).