Key messages

• A difficult intubation should always be anticipated.

• Fiber-optic techniques represent a dramatic advance in the management of such patients, and are particularly suited to the awake patient in the elective setting.

• If mask ventilation and/or laryngeal mask ventilation prove impossible and the patient still cannot be intubated, transtracheal jet ventilation can be initiated. The patient can then be either awakened, and a semi-elective tracheostomy or cricothyroidotomy performed, or intubated with a special endotracheal intubation technique.

For clinicians involved in airway management, anticipating a difficult intubation may be the first step in preventing major problems. Difficult intubation is defined as inadequate visualization of the glottis, and failed orotracheal intubation as an inability to insert a tracheal tube from the oropharynx into the trachea. Physical limitations to mask ventilation and endotracheal intubation may be accurately identified by thorough observation. All patients should be examined for orofacial anatomical features and for oral structure visibility. A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate, and the base of the uvula has been designed as a means of predicting the degree of difficulty in laryngeal exposure (Mallampati classes I, II, III). The size of the mandibular space, retrognathia, micrognathia, head-neck configuration, obesity, and the degree of neck mobilization (the ability to assume a 'sniffing' position), as well as prominent central maxillary dentition and limitation of mouth opening, are important factors determining the degree of difficulty of direct laryngoscopy.

Several procedures are available for overcoming the problems of difficult intubation. Fiber-optic techniques represent a dramatic advance in the management of these patients, and are particularly suited to the awake patient in the elective setting. They can also be useful in selected emergency situations. When a difficult intubation is suspected, the patient should be informed about the procedures to be used and brief and reassuring explanations should be given. If the patient agrees to co-operate, premedication is adapted to produce a conscious but relaxed patient. Atropine sulfate is given intramuscularly to decrease nasopharyngeal secretions. Prerequisites for performing a difficult intubation are shown in Table 1..

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Healthy Fat Loss For A Longer Life

Healthy Fat Loss For A Longer Life

What will this book do for me? A growing number of books for laymen on the subject of health have appeared in the past decade. Never before has there been such widespread popular interest in medical science. Learn more within this guide today and download your copy now.

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