Airway Basics: Functional Airway Management

2019 ◽  
Author(s):  
Gilbert S Tang
Keyword(s):  
Oral Cavity ◽  
Upper Airway ◽  
Stomach Contents ◽  
Lower Airway ◽  
Lymphoid Tissues ◽  
Pediatric Airway ◽  
Endotracheal Tubes ◽  
Advanced Airway ◽  
Cord Injury ◽  
Airway Devices

The anesthesiologist maintains patency of the airway through the use of various airway techniques, from simple maneuvers such as jaw thrust and chin lift, to the insertion of oropharyngeal or nasopharyngeal airways, to the placement of advanced airway devices such as supraglottic airways and endotracheal tubes. Understanding the structure, function and anatomic relationships of the airway provides the foundation to evaluate the patient and determine a safe plan for airway management.The nose and mouth are the beginning point of the airway, which can be divided into the upper airway consisting of nasal cavity, nasopharynx, oral cavity, oropharynx, hypopharynx and larynx, and the lower airway consisting of the trachea, bronchi and subdivisions of the bronchi. The airway is the conduit from which air flows to and from the alveoli, where oxygenation and ventilation occurs. It plays important functions in trapping airborne contaminants, producing mucus and secretions, permitting olfactory and general sensation, warming and humidifying the air, providing immunologic defense from infection through lymphoid tissues, allowing a mechanism for vocalization, creating a functional separation between the swallowing and breathing, and protecting from aspiration of oral and stomach contents. This review contains 2 tables and 34 references. Key words: airway, intubation, pharynx, larynx, kiesselbach’s plexus, vocal cord injury, swallow, cough, laryngospasm, bronchospasm, obstruction, aspiration, pediatric airway

Airway Basics: Functional Airway Management

2019 ◽  
Author(s):  
Gilbert S Tang
Keyword(s):  
Oral Cavity ◽  
Upper Airway ◽  
Stomach Contents ◽  
Lower Airway ◽  
Lymphoid Tissues ◽  
Pediatric Airway ◽  
Endotracheal Tubes ◽  
Advanced Airway ◽  
Cord Injury ◽  
Airway Devices

The anesthesiologist maintains patency of the airway through the use of various airway techniques, from simple maneuvers such as jaw thrust and chin lift, to the insertion of oropharyngeal or nasopharyngeal airways, to the placement of advanced airway devices such as supraglottic airways and endotracheal tubes. Understanding the structure, function and anatomic relationships of the airway provides the foundation to evaluate the patient and determine a safe plan for airway management.The nose and mouth are the beginning point of the airway, which can be divided into the upper airway consisting of nasal cavity, nasopharynx, oral cavity, oropharynx, hypopharynx and larynx, and the lower airway consisting of the trachea, bronchi and subdivisions of the bronchi. The airway is the conduit from which air flows to and from the alveoli, where oxygenation and ventilation occurs. It plays important functions in trapping airborne contaminants, producing mucus and secretions, permitting olfactory and general sensation, warming and humidifying the air, providing immunologic defense from infection through lymphoid tissues, allowing a mechanism for vocalization, creating a functional separation between the swallowing and breathing, and protecting from aspiration of oral and stomach contents. This review contains 2 tables and 34 references. Key words: airway, intubation, pharynx, larynx, kiesselbach’s plexus, vocal cord injury, swallow, cough, laryngospasm, bronchospasm, obstruction, aspiration, pediatric airway

scholarly journals Changes in the Upper and Lower Pharyngeal Airway Spaces Associated with Rapid Maxillary Expansion

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Fitin Aloufi ◽  
Charles B. Preston ◽  
Khalid H. Zawawi
Keyword(s):  
Orthodontic Treatment ◽  
Upper Airway ◽  
Rapid Maxillary Expansion ◽  
Lower Airway ◽  
Control Group ◽  
Maxillary Expansion ◽  
Pharyngeal Airway ◽  
Significant Difference ◽  
And Gender ◽  
Maxillary Constriction

Objectives. The primary objectives of this retrospective study were first to compare the upper and lower pharyngeal airway spaces between orthodontic patients with and without maxillary constriction and second to evaluate the effect of rapid maxillary expansion (RME) on these airway spaces. A secondary objective was to compare the mode of breathing between groups. Materials and Methods. The experimental (RME) group consisted of 30 patients (mean age, years, 16 boys and 14 girls) with maxillary constriction who were treated with hyrax-type RME. The control group comprised the records of age- and gender matched patients (mean age, years, 16 boys and 14 girls) with no maxillary constriction but requiring nonextraction comprehensive orthodontic treatment. Cephalometric measurements in the sagittal dimension of upper and lower airway spaces for the initial and final records were recorded. Mode of breathing and length of treatment were also compared. Results. The sagittal dimension of the upper airway increased significantly in the RME group ( mm) compared to the control group ( mm), . However, there was no significant difference in the lower pharyngeal airway measurement between the RME group () and the control group (), . There was no significant difference with respect to mode of breathing between the two groups (). Conclusion. Rapid maxillary expansion (RME) during orthodontic treatment may have a positive effect on the upper pharyngeal airway, with no significant change on the lower pharyngeal airway.

Effects of pharyngeal lubrication on the opening of obstructed upper airway

1992 ◽  
Vol 72 (6) ◽  
pp. 2311-2316 ◽  
Author(s):  
H. Miki ◽  
W. Hida ◽  
Y. Kikuchi ◽  
T. Chonan ◽  
M. Satoh ◽  
...  
Keyword(s):  
Hypoglossal Nerve ◽  
Muscle Tone ◽  
Upper Airway ◽  
Intraluminal Pressure ◽  
Lower Airway ◽  
Before And After ◽  
Airway Opening ◽  
Cervical Trachea ◽  
Artificial Surfactant ◽  
Stimulation Of

We examined the effect of electrical stimulation of the hypoglossal nerve and pharyngeal lubrication with artificial surfactant (Surfactant T-A) on the opening of obstructed upper airway in nine anesthetized supine dogs. The upper airway was isolated from the lower airway by transecting the cervical trachea. Upper airway obstruction was induced by applying constant negative pressures (5, 10, 20, and 30 cmH2O) on the rostral cut end of the trachea. Peripheral cut ends of the hypoglossal nerves were electrically stimulated by square-wave pulses at various frequencies from 10 to 30 Hz (0.2-ms duration, 5–7 V), and the critical stimulating frequency necessary for opening the obstructed upper airway was measured at each driving pressure before and after pharyngeal lubrication with artificial surfactant. The critical stimulation frequency for upper airway opening significantly increased as upper airway pressure became more negative and significantly decreased with lubrication of the upper airway. These findings suggest that greater muscle tone of the genioglossus is needed to open the occluded upper airway with larger negative intraluminal pressure and that lubrication of the pharyngeal mucosa with artificial surfactant facilitates reopening of the upper airway.

scholarly journals Comparison of the Proseal, Supreme, and I-Gel SAD in Gynecological Laparoscopic Surgeries

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sanli Mukadder ◽  
Begec Zekine ◽  
Kayhan Gulay Erdogan ◽  
Ozgul Ulku ◽  
Ucar Muharrem ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Supraglottic Airway ◽  
Lower Airway ◽  
Trendelenburg Position ◽  
Ph Values ◽  
Oropharyngeal Leak Pressure ◽  
Supraglottic Airway Devices ◽  
Pharyngeal Region ◽  
Airway Devices ◽  
Time Ease

We compared proseal, supreme, and i-gel supraglottic airway devices in terms of oropharyngeal leak pressures and airway morbidities in gynecological laparoscopic surgeries. One hundred and five patients undergoing elective surgery were subjected to general anesthesia after which they were randomly distributed into three groups. Although the oropharyngeal leak pressure was lower in the i-gel group initially (mean ± standard deviation; 23.9 ± 2.4, 24.9 ± 2.9, and 20.9 ± 3.5, resp.), it was higher than the proseal group and supreme group at 30 min of surgery after the trendelenburg position (25.0 ± 2.3, 25.0 ± 1.9, and 28.3 ± 2.3, resp.) and at the 60 min of surgery (24.2 ± 2.1, 24.8 ± 2.2, and 29.5 ± 1.1, resp.). The time to apply the supraglottic airway devices was shorter in the i-gel group (12.2 (1.2), 12.9 (1.0), and 6.7 (1.2), resp.,P=0.001). There was no difference between the groups in terms of their fiber optic imaging levels. pH was measured at the anterior and posterior surfaces of the pharyngeal region after the supraglottic airway devices were removed; the lowest pH values were 5 in all groups. We concluded that initial oropharyngeal leak pressures obtained by i-gel were lower than proseal and supreme, but increased oropharyngeal leak pressures over time, ease of placement, and lower airway morbidity are favorable for i-gel.

The Pediatric Airway

2018 ◽  
pp. 34-40
Author(s):  
Lowell Clark ◽  
Stephen Tomek
Keyword(s):  
Soft Tissue ◽  
Clinical Application ◽  
Deep Sedation ◽  
Upper Airway ◽  
Procedural Sedation ◽  
Pediatric Airway ◽  
Airway Patency ◽  
Anatomy And Physiology ◽  
Airway Function ◽  
Specific Responsibility

The practice of procedural sedation involves the use of medications that alter upper airway function and patency because of myoneural suppression of anatomic airway elements. It is the specific responsibility of the sedationist to ensure upper airway patency during conditions induced by pharmaceuticals in which the airway is almost certain to be threatened, if not totally obstructed. Soft tissue collapse during inspiration is modeled by the Starling resistor. Airway protective reflexes may be profoundly disturbed during deep sedation. The sedationist’s knowledge of the anatomy and physiology of the upper airway and proficiency in clinical application of airway supportive principles are essential.

Anaesthetic equipment

2019 ◽  
pp. 71-100
Author(s):  
Richard Craig
Keyword(s):  
Near Infrared ◽  
Supraglottic Airway ◽  
Endotracheal Tubes ◽  
Practical Advice ◽  
Anaesthetic Equipment ◽  
Supraglottic Airway Devices ◽  
Perioperative Monitoring ◽  
Airway Equipment ◽  
Bis Monitor ◽  
Airway Devices

This chapter presents anaesthetic equipment used in paediatric anaesthesia. Airway equipment is described in detail with specific examples. This includes a description of the variety of supraglottic airway devices, endotracheal tubes, laryngoscopes for direct and indirect visualization of the larynx, breathing systems, ventilators, and modes of ventilation. Equipment for perioperative monitoring of the paediatric patient is reviewed. Practical advice regarding monitoring neonates and small babies is given particular attention. The use of the bispectral index (BIS) monitor and near-infrared spectroscopy (NIRS) are discussed. New advances in pulse oximetry that enable better monitoring with low perfusion states and motion are included.

Endotracheal saline and suction catheters: sources of lower airway contamination

1994 ◽  
Vol 3 (6) ◽  
pp. 444-447 ◽  
Author(s):  
DA Hagler ◽  
GA Traver
Keyword(s):  
Critical Care ◽  
Normal Saline ◽  
Catheter Insertion ◽  
Lower Airway ◽  
Suction Catheter ◽  
Endotracheal Suctioning ◽  
Saline Irrigation ◽  
Endotracheal Tubes ◽  
Viable Bacteria ◽  
Saline Instillation

BACKGROUND. Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients. OBJECTIVE. To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes. METHODS. Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis. RESULTS. Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies. CONCLUSIONS. The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.

scholarly journals Characterization of Persistent Uncontrolled Asthma Symptoms in Community Members Exposed to World Trade Center Dust and Fumes

2020 ◽  
Vol 17 (18) ◽  
pp. 6645
Author(s):  
Joan Reibman ◽  
Caralee Caplan-Shaw ◽  
Yinxiang Wu ◽  
Mengling Liu ◽  
Milan R. Amin ◽  
...  
Keyword(s):  
World Trade ◽  
World Trade Center ◽  
Asthma Management ◽  
Upper Airway ◽  
Dust Exposure ◽  
Lower Airway ◽  
High Dose ◽  
Community Members ◽  
Asthma Control Test ◽  
Trade Center

The destruction of the World Trade Center (WTC) towers on the 11th of September, 2001 released a vast amount of aerosolized dust and smoke resulting in acute and chronic exposures to community members as well as responders. The WTC Environmental Health Center (WTC EHC) is a surveillance and treatment program for a diverse population of community members, including local residents and local workers with WTC dust exposure. Many of these patients have reported persistent lower respiratory symptoms (LRS) despite treatment for presumed asthma. Our goal was to identify conditions associated with persistent uncontrolled LRS despite standard asthma management. We recruited 60 patients who were uncontrolled at enrollment and, after a three-month run-in period on high-dose inhaled corticosteroid and long acting bronchodilator, reassessed their status as Uncontrolled or Controlled based on a score from the Asthma Control Test (ACT). Despite this treatment, only 11 participants (18%) gained Controlled status as defined by the ACT. We compared conditions associated with Uncontrolled and Controlled status. Those with Uncontrolled symptoms had higher rates of upper airway symptoms. Many patients had persistent bronchial hyper-reactivity (BHR) and upper airway hyper-reactivity as measured by paradoxical vocal fold movement (PVFM). We found a significant increasing trend in the percentage of Controlled with respect to the presence of BHR and PVFM. We were unable to identify significant differences in lung function or inflammatory markers in this small group. Our findings suggest persistent upper and lower airway hyper-reactivity that may respond to standard asthma treatment, whereas others with persistent LRS necessitate additional diagnostic evaluation, including a focus on the upper airway.

Modulation of the extrinsic tongue muscle activity in response to bronchopulmonary C-fiber activation following midcervical contusion in the rat

2020 ◽  
Vol 128 (5) ◽  
pp. 1130-1145
Author(s):  
Hsiao-Sen Chang ◽  
Kun-Ze Lee
Keyword(s):  
Spinal Cord ◽  
Muscle Activity ◽  
Cervical Spinal Cord ◽  
Upper Airway ◽  
Airway Patency ◽  
Tongue Muscle ◽  
Cord Injury ◽  
Burst Amplitude ◽  
C Fiber ◽  
Spinal Cord Contusion

Tongue muscle activity plays an important role in the regulation of upper airway patency. This study aimed to investigate the respiratory activity of the extrinsic tongue muscle in response to capsaicin-induced bronchopulmonary C-fiber activation following cervical spinal cord contusion. Midcervical spinal-contused animals exhibited a greater baseline preinspiratory burst amplitude of the extrinsic tongue muscle and were resistant to inhaled capsaicin-induced reduction of respiratory tongue muscle activity at the acute injured stage. However, inhalation of capsaicin caused a more severe attenuation of preinspiratory activity of the extrinsic tongue muscle at the chronic injured stage. These results suggest that the upper airway may be predisposed to collapse in response to bronchopulmonary C-fiber activation following chronic cervical spinal cord injury.

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