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114 ● AnesthesiA student survivAl Guide Figure 9.7 Laryngoscopes: Macintosh and Miller blades (Photo courtesy J. Ehrenfeld). ● ● ● patients with severe, positional gastroesophageal reflux disease diabetics (decreased gastric emptying) or obese patients patients with neurological impairment In order to decrease the interval between when a patient is awake with intact laryngeal muscles protecting their airway from aspiration and when the endotracheal tube is in place guarding against aspiration, a rapid sequence induction (RSI) may be performed. An RSI differs from a standard induction after the induction of general anesthesia in three ways: 1. During an RSI, face mask ventilation is not used to ventilate the patient. This is to avoid distension of the stomach that can occur with face mask ventilation. 2. Cricoid pressure is maintained from before the time the patient receives induction agents until the endotracheal tube placement in the trachea is
AirwAy evAluAtion And MAnAGeMent ● 115 confirmed. The cricoid cartilage is the only tracheal cartilage that surrounds the entire trachea. Applying pressure to the anterior aspect of the cricoid cartilage occludes the esophagus by closing its lumen between the posterior aspect of the cricoid cartilage and the anterior aspect of the body of the cervical vertebrae. 3. Succinylcholine is classically used as the muscle relaxant of choice to facilitate intubation due to its short onset time. Rocuronium is another choice for patients who might have detrimental side effects from succinylcholine use (e.g. burn and spinal cord injury patients). Fiber-optic Intubation Endotracheal intubation can be accomplished via fiber-optic guidance. This is accomplished by passing the distal end of a bronchoscope through the glottis and then sliding an endotracheal tube off of the scope into the trachea under direct vision. Fiber-optic intubation can be accomplished in awake as well as anesthetized patients. Awake patients only tolerate the procedure with sufficient local anesthesia delivered to their airway beforehand via topicalization and/or nerve blockade. Sedation may be given to awake patients having fiber-optic intubation. Patients with anticipated difficult airways are often intubated using an awake fiber-optic technique. Video Assisted Endotracheal Intubation (Glidescope, C-Trach) Recently, there have been several airway management tools introduced that combine traditional laryngoscopy with fiber-optic technology such as the Glidescope or C-Trach. One of the benefits of these instruments is that they may allow intubation under conditions such as limited mouth opening that might have been impossible with direct laryngoscopy. Evaluation and Management of the Difficult Airway The ASA Difficult Airway Algorithm is a step-wise approach to managing a challenging airway (also see, Appendix A, ASA Difficult Airway Algorithm). The algorithm is designed to present a rational approach to utilizing a number of different management techniques for securing the airway. These include various types of equipment such as the intubating LMA, Lightwand, Combitube, and fiber-optic laryngoscope. Ultimately, if noninvasive attempts at airway management fail, options include waking the patient up or performing a cricothyroidotomy or a tracheostomy.
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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Page 116 and 117: The Preoperative Patient Evaluation
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Page 126 and 127: Therapy-based indications radiation
Page 128 and 129: Table 8.5 Formulation an anesthetic
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Anesthetic techniques: GenerAl, sed
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Table 12.6 (continued) Anesthetic t
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Anesthetic techniques: GenerAl, sed
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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