I am hungry for your participation and contributions. I am specially seeking the wisdom of our Pediatric colleagues regarding this eternal question/debate/feud of whether pediatric patients should get cuffed vs. uncuffed ETT’s.
Once again let us discuss the issue of SGA use and aspiration
As discussed here before, we are fairly conservative with regards to SGA use and surgery for a variety of reasons, but mainly due to fear of the risk of aspiration of gastric contents. At the VA for example who does not report that has GERD? The question is do we really know if an SGA is contraindicated in such patients and also do we really know whether they should be used in certain surgical procedures such as laparoscopic surgery? The article I am posting today deals with some of these issues. Look forward to your comments.
RSA… I do not know if I like this one
Several posts in this site have dealt with controversies surrounding RSI. There are many unsolved issues (cric vs. no cric, ventilate vs. not ventilate, to use N.M relaxants outside the O.R vs. not use them, etc…) the truth is that more questions than answers exist. But how about this new concept coined in 2007 by E.D’s and paramedics during rescue operations. I hope to hear your comments (any comments).
To further add to the complexity of airway management in OB patients
The difficulties, morbidity and mortality associated with airway management and obstetrics, lead to a culture shift, and regional anesthesia and specifically neuro-axial blocks are very often used to provide anesthesia in this patient population. This brings an interesting question.How to maintain skills, gain experience and train residents in the dying art of GA in obstetrics? How to assure greater success rates and safety in those rare GA cases? Read on
D.A. Algorithm @ UF. Survey 10-09
Survey attitude towards the ASA D.A algorithm @UF (Actually realistically the response was not that great, so in truth I could have taken the “UF” out)
The LMA “classic” is it a secure airway
I read this somewhat interesting letter to the editor in the latest issue of Acta Anaesthesiologica Scandinavica, and it caught my attention. I believe this has to do with the fact that in airway management topics, there are more “factoids” than actual “facts”. Believe it or not I posted this question to some of the most prestigious minds in the airway related community, and most sidestepped an answer. And so my question goes for you: Is the LMA classic a secure airway? If “yes”, only for certain procedures, or only for certain patients? And if “No” is it because it does not a gastric aspiration port? Which then leads to the next obligatory question: Are the ProSeal and/or Supreme LMA’s, secure airways?
Controlled RSI in Peds?
It would be very interesting to hear comments from our fellow members of the Peds. group regarding this never ending controversy of RSI. Does this simulation study give us the answer?
RSI…How
In 1951 Morton and Wylie described the technique of rapid IV administration of a barbiturate and a muscle relaxant almost simultaneously followed by intubation with a cuffed endotracheal tube “to prevent regurgitation or vomiting of gastric contents”. Later in 1971 Stept and Safar reported a fifteen-step technique to prevent “regurgitation, vomiting and aspiration during Induction of anesthesia and resuscitation” and use the term “rapid sequence induction” still in vogue today. A lot has been written on the subject and considerable controversy persists: a)is it effective or not? b)should crycoid pressure be used and if so, how should it be performed? c)Should BMV be withheld or not.?
I expect a lot of controversy and participation (do not make me think this is wishful thinking) .
But the patient has GERD… Can and should you even consider a SGA?
If you have followed the blog, perhaps you have read the articles that deal with the issues of GERD and airway instrumentation. This article deals with this issue again. I suspect that it will lead to controversy… bring it on!
Expanding Role and importance of SGA’s (LMA in particular) for Airway Management
As discussed with some of you, we live, work and train at a place that is ultra conservative in the use of SGA’s for airway management. In the “real world” the role of SGA’s and the LMA is different and expanding. We have to learn from these people and their experiences. Be open minded. Look forward to your comments.
My Profile
Currently a Clinical Associate Professor of Anesthesiology at the University of Florida, he has been a member of UF anesthesia since 1994; did his residency then fellowship in Cardiothoracic anesthesia, and then has been a staff member ever since. Currently also he is the Director of the Master of Education Fellowship from the C.O.M. Interests include: 1-Airway related topics 2-Education about Airway management 3- Resident training in Airway management 4-Non-Anesthesia providers airway training and education.
