Tag Archives: airway

Lectures, Video laryngoscopy

DAS 2021 – Awake Video Laryngoscopy

Selected references can be accessed online via the links here. If you are unable to access a reference, or wish to download a larger set for furhter reading, please click the link for the archive at the bottom.

If you’re struggling access the articles above or would like an EndNote library and further references, you can access a share folder here.

A brief video describing a challenging case managed with awake VL using the CMAC Video Stylet is shown below. (Video prepared for the 2021 Virtual Guy’s Airway Management Course)

Guidelines, Intubation, Physiology, Video laryngoscopy

COVID Airways Podcast on Critical Care Scenarios

I was honoured to be invited back on the Critical Care Scenarios (@icuscenarios) podcast, to chat this time about airway management in COVID-19, but also talking about how it’s helping to focus improving our emergency airway management in general. Check it out at this link:

http://icuscenarios.com/episode-37-airway-management-for-covid-19/

Endoscopy, Equipment, Simulation

Nairobi Airway Course 2017: Photos

Some photos of the action at the Nairobi Surgical Skills Centre this week. Many thanks to the local faculty from the University of Nairobi and other institutions, the companies that supported use of the facilities and equipment, and the enthusiastic delegates!



Resources and notes from the course are available on the course page here. 

Administrivia

Airway Abbreviations

Herewith a collaborative effort from the airway Twitterati to establish a list of common airway abbreviations:

  • AFOI  –  Awake fibre-optic (or flexible optic) intubation
  • ApOX  –  Apnoeic Oxygenation
  • BB  –  Bronchial blocker
  • BVM  –  Bag/Valve/Mask device (see BVMR)
  • BVMR  –  Bag/Valve/Mask/Reservoir device (see BVM)
  • CICO  –  Can’t intubate, can’t oxygenate  (see CICV)
  • CICV  –  Can’t intubate, can’t ventilation (CICO now in use)
  • CL  –  Cormack-Lehane grade
  • DL  –  Direct laryngoscopy
  • DLT  –  Double-lumen endobronchial tube
  • DSI  –  Delayed sequence induction
  • ESA  –  Emegency Surgical Airway (see FONA)
  • ETI  –  Endotracheal intubation
  • ETT  –  Endotracheal tube
  • EtCO2  –  End-tital carbon dioxide
  • EXIT  –  EX-utero Intrapartum Treatment
  • FB  –  Foreign body
  • FETO  –  Fetal Endoscopic Tracheal Occlusion (or Fetoscopic EndoTracheal Occlusion)
  • FiO2  –  Fraction of inspired oxygen
  • FOI  –  Fibre-optic intubation
  • FONA  –  Front-of-neck access (see ESA)
  • LA  –  Local anaesthetic
  • LMA  –  Laryngeal Mask Airway (trade name, see SGA etc)
  • MAD  –  Mucosal Atomisation Device
  • MP  –  Mallampati grade
  • NPA  –  Nasopharyngeal airway
  • NODESAT – Nasal Oxygenation During Efforts at Secuing A Tube
  • OPA  –  Oropharyngeal airway
  • PLA  –  Perilayngeal airway
  • RSI  –  Rapid sequence induction
  • SAD  –  Supraglottic airway device (see SGA, EGA, XGA)
  • SGA  –  Supraglottic airway (see SAD, EGA, XGA)
  • THRIVE  –  Transnasal, Humidified, Rapid-Insufflatory Ventilatory Exchange
  • VL  –  Video layngoscopy
  • XGA  –  Extraglottic airway (see EGA, SAD, SGA)

Contributions/comments?  DM @openaiwayorg or @rosshofmeyr

Thanks to @AirwayMxAcademy for initiating the idea!

Lecture Notes

FCA2 Airway Update Dec’16

A short presentation on a selection of airway  themes and some of the papers from 2016 for our FCA Part 2 candidates.  Definitely not intended to be a systematic or exhaustive review!  Click the image to download a PDF of the slides, or the link below for the resources.

2016 Airway Update Resources

You can watch a 9-minute video of the slides and attendant video clips below.  Please note that this is not narrated.

AirwayHowTo, Endoscopy, Flexible scopes, Intubation

Basic fibreoptic/flexible scope skills video

Video

Another quick training video, on the basic techniques of driving a flexible scope (fibreoptic or video) for intubation.  This was made specifically as a primer for people in our own department taking part in a training study, but hopefully it is useful to a larger audience!

Please put your comments and (hopefully constructive) critique below.   As always, you’re welcome to use with attribution!

The permanent page for this video can be found here.

AirwayHowTo, Equipment, Video laryngoscopy

Why is my C-MAC Pocket Monitor not working (again)?

Video

Despite making a previous post and video to explain the way to make sure the device switches on, I regularly get told that the Pocket Monitor (PM) for our C-MAC video laryngoscope is not working/charging/switching on. This is in fact a design feature to prevent accidental activation or discharge. Watch here to find out more:

Thanks to the lovely Sam Adams for playing along…good career in acting if anaesthesia were to ever become boring!

Algorithms, Guidelines, Obstetric

OAA/DAS Guidelines for Difficult & Failed Intubation in Obstetrics!

Hot of the press – the Obstetric Anaesthetists’ Association and Difficult Airway Society have released their combined guidelines on difficult and failed intubation in obstetrics, which are freely available from Anaesthesia online.

The guidelines are presented as a ‘Master Algorithm’ and several sub-algorithms to deal with specific aspects of obstetric airway management, and a guide to making the decision to awake the patient or continue with surgical delivery after an airway event:

Decision guide for awakening or proceeding with surgery, from the guidelines.
Decision guide for awakening or proceeding with surgery, from the guidelines.

Some thoughts (COI – the author did provide feedback on the draft algorithms):

  • Stressing good positioning for airway management is absolutely critical in this population, and especially in practice environments where patients tend to have a high BMI (a common situation in our South African setting).  The guidelines include ramping and the ear-to-sternal-notch (E2SN) position.
  • The inclusion of cricoid pressure will inevitably spark the usual debate, but it is this author’s contention that this is likely an appropriate use until more evidence to the contrary emerges.  The guidance to consider CP reduction or release in the event of difficulty is apt.
  • The inclusion of gentle face-mask assisted ventilation during RSI is a welcome inclusion.  Will we see NPO2 or HFNC included in later editions as more outcomes evidence emerges?
  • Advocating the use of VL in obstetrics certainly sounds like a good idea, but is not attainable for most of the developing world.  This is a huge area for growth/research – the development of low-cost VL solutions.

This is a great step forward in promoting safe airway management and guiding training in a particularly dangerous corner of our practice.

For some more thoughts and images, here is a Prezi on the subject presented at the SASA Difficult Airway workshop in 2014:

Airway Assessment, Algorithms

Difficult Face Mask Ventilation – ATOTW 321

The newest edition of the Anaesthesia Tutorial of the Week (ATOTW #321) covers the much underestimated but critically important topic of predicting and managing difficulty in face mask ventilation.  Irish anaesthetists Jonathan Holland and Will Donaldson have created a useful resource for anyone studying or performing airway management, or refreshing for exam purposes.

ATOTW is a free resource created and hosted by the World Federation of Societies of Anaesthesiologists.  You can sign up to receive the weekly mails here, and download this edition on mask ventilation here:

ATOTW 321 – Difficult Mask Ventilation

The authors discuss the predictors of difficult mask ventilation and report/propose another two mnemonics, to add to the existing stable (MOANS, BONES, etc):

Two mnemonics for prediction of difficult face mask ventilation
Two mnemonics for prediction of difficult face mask ventilation.  Source: ATOTW 321

I’ve always used MOANS for mask factors (like I use LEMON for laryngoscopy), but all these mnemonics cover the same ground.  MOANS, for instance, stands for

  • M   Mask seal factors, like beards, NGTs, odd shaped faces
  • O   Obesity and causes of Obstruction, like tumours/angioedema
  • A   Age extremes (the elderly and very young)
  • N   No teeth (or nasty dentition)
  • S   Snoring and Stiff lungs (the latter being issues like inhalation burns and acute bronchospasm, where the higher pressures required increase the risk of gastric insufflation and Splinting of the diaphragm)

As you can see, they are all much the same, although there are a few things that are not covered by every algorithm.  The purist would point out that obesity is defined as a BMI of >30 kg/m2, not 26 as stated in the table.

Difficult_Mask_Algorithm
Hollan & Donaldson’s flowchart for management of difficult face mask ventilation. Source: ATOTW 321

The authors then present a useful flowchart for addressing unexpected difficulty, which is quite sensible.  It is much in line with the DAS guidelines and other algorithms for general airway difficulty, and useful for instruction.  Of course, in a dire emergency, using a cognitive aid such as the Vortex would be  effective.