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Part 4. Managing Anesthesia Care
Section B. Managing the Airway
Chapter 35. Airway Management
P. Allan Klock, Jr., MD, and Andranik Ovassapian, MD
1. Tracheal intubation can be accomplished using a direct visual (rigid laryngoscopy), indirect visual (fiberoptic laryngoscopy), guided blind (laryngeal mask airway, retrograde, lightwand), or a complete blind (blind nasal) technique. Each technique has its preferred indication and risks and benefits.
2. Airway management without tracheal intubation is becoming more popular with the introduction of the laryngeal mask airway.
3. General anesthesia and muscle relaxants are used to facilitate tracheal intubation. A rapid-acting muscle relaxant is used during rapid sequence induction and intubation.
4. Soft-tissue upper airway obstruction is common after induction of anesthesia. Oropharyngeal airway insertion and application of jaw thrust often are successful for overcoming soft-tissue airway obstruction.
5. Securing the airway under topical anesthesia with or without sedation (an "awake intubation") provides the optimal approach for patients with severely compromised or difficult airways.
6. Awake intubation should be encouraged, taught, and practiced regularly so that anesthesiologists are comfortable and skilled with the elements of this technique.
7. The availability of a difficult airway cart should be assured for every anesthetizing..."
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