الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
It is not without significance that the ”A” in ABC (airway, breathing, circulation) comes first. It is of critical importance that the clinicians are well educated as possible in the evaluation and management of this subject. Difficulty in managing the airway is the single most important cause of major anesthesia-related morbidity and mortality. Successful management of a difficult airway begins with recognizing the potential problem so all patients should be examined well.
If there is a good possibility that intu¬bation and/or ventilation by mask will be difficult, thus the airway should be secured while the patient is still awake. In order for an awake intubation to be successful, it is absolutely essential that the patient be properly pre¬pared. Otherwise, the anesthesiologist will simply fulfill a self-defeating prophecy. Once the patient is properly pre¬pared, it is likely that anyone of a number of intubation techniques will be successful. If the patient is already anesthetized and/or paralyzed and intubation is found to be difficult, many repeated attempts at intubation should be avoided because progressive development of laryngeal edema and hemorrhage will develop and the ability to ventilate the lungs via mask consequently may be lost.
After several attempts of intubation it may be best to awaken the patient. a semielective tracheostomy is done, or proceed with the case using mask ventilation. In the event that the ability to ventilate via mask is lost and the patient’s lungs still cannot be ventilated, TTJV should be instituted immediately or LMA insertion is done. Tracheal extubation of a patient with a dif¬ficult airway over a jet stylet permits a controlled, gradual, and reversible (in that ventilation and reintubation is pos¬sible at any time) withdrawal from the airway. Significant advances in the management of the difficult airway have occurred in recent years.
Fiberoptic intubation is an underutilized technique for placement of endotracheal tubes.it has been reserved as a last resort for placement of the endotracheal tube .Carefull preparation of the patient and attension to details can enable rapid visualization of the vocal cords and intubation.It is like any new technique needing practice.
The fiberoptic bronchoscope offers an effective, safe, and easy approach in patients who are difficult to intubate with conventional techniques especially whenever movement of the head and neck is limited, the opening of the mouth is restricted, and when the access to the anterior neck is not possible.
Fiberoptic intubation is tolerated well by awake patients under topical anaesthesia, less stressful, and is associated with lesser degrees of hypertension and tachycardia. The cardiovascular response to fiberoptic intubation under general anaesthesia has not been shown to be more favorable compared with rigid . laryngoscopy.
Fiberoptic intubation can be carried out with the patient in the supine, sitting, lateral, or even prone position. .
The fiberoptic bronchoscope can be used in combination with other techniques used for difficult airway management
Failure of fiberoptic intubation may result from Lack of training and experience, Presence of secretions and blood, Distorted airway anatomy, Limited space between the epiglottis and the posterior pharyngeal wall, Inadequate topical anaesthesia, Inability to advance the ET and Inability to remove the FB.
The disadvantages of the fiberoptic bronchoscope include its high cost and its size that limit its practical availability in everyplace in a hospital, and its need to be cleaned, disinfected, and sterilized, but the major barrier to its use is the lack of training and experience that can be overcomed by using the art of fiberoptic airway management routinely in anaesthesia training programs and attending hands-on workshops.
There are also another indications for FFB including diagnostic evaluation of the airway ,bronchi and lungs and therapeutic evaluation as removal of foreign body or retained secretions.
The rigid fiberoptic bronchoscope can also be used for intubation of difficult airway , another diagnostic and therapeutic indications but under general anaesthesia not local anaesthesia as FFB.
Anaesthesiology residents must receive instruction in this technique. Skill acquisition is achieved through reading, lectures, workshop, mannequin or model practice and in patients with normal airway anatomy , ultimately in patients with abnormal airway.