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Podcast Episode 1 (Introduction)

By •• Posted in Lectures, Podcast

This is the introductory lecture to the Advance Airway Rotation and it contains the Pre and Post Test Quiz. Please Submit your answers via e-mail.

Click the link below to view the video.

Read the rest of this entry »


Airway Blog 2.0

By •• Posted in Uncategorized

After a long hiatus I am back…. interesting things are happening as always in the “airway world” but more importantly with me and new ideas and skills I have been working on regarding educational technology. Today after many hours of work and trial and error ( more error than I am willing to disclose) I bring back my blog but with a twist: Anesthesia residents in the Airway rotation will interact with me in the usual fashion as well with the aid of technological aids such as Tweeter feeds and Podcasts via iTunes. Naturally the continuity and success or lack of it, will depend on the amount of feedback and how much residents engage in this social collaborative endeavor.


Are we ignoring this important issue? Will this change our practices in the future?

By •• Posted in Devices, SGA

In an upcoming issue of Acta Anaesthesiologica Scandinavica the following article will appear ( I am including the abstract). I must confess this concern about SGA’s -that perhaps should be extended to all of them- had not been on my radar screen for quite a while. Any comments?

“Exposure to anaesthetic trace gases during general anaesthesia: CobraPLA vs. LMA classic

Department of Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria, Department of Anaesthesiology, University of Regensburg, Regensburg, Germany and Department of Internal Medicine I, Medical University of Vienna,Austria.

Background: To prospectively investigate the performance,sealing capacity and operating room (OR) staff exposure to waste anaesthetic gases during the use of the Cobra perilaryngeal airway (CobraPLA) compared with the laryngeal mask airway classic (LMA). Methods: Sixty patients were randomly assigned to the CobraPLA or the LMA group. Insertion time, number ofinsertion attempts and airway leak pressures were assessed after induction of anaesthesia. Occupational exposure to nitrous oxide (N2O) and Sevoflurane (SEV) was measured at the anaesthetists’ breathing zone and the patients’ mouth using a photoacoustic infrared spectrometer. Results: N2O waste gas concentrations differed significantly in the anaesthetist’s breathing zone (11.7-7.2 p.p.m. in CobraPLA vs. 4.1  4.3 p.p.m. in LMA,P50.03), whereas no difference could be shown in SEV concentrations. Correct CobraPLA positioning was possible in 28 out of 30 patients (more than one attempt necessary in five patients). Correct positioning of the LMA classic was possible in all 30 patients (more than one attempt in three patients). Peak airway pressure was higher in the CobraPLA group (16  3 vs. 14  2 cmH2O, P50.01). The average leak pressure of the CobraPLA was (24 +/- 4 cmH2O), compared with (20 +/-  4 cmH2O) of the LMA classic (Po0.001; all values means  SD). Conclusion: Despite higher airway seal pressures, the CobraPLA caused higher intraoperative N2O trace concentrations in the anaesthetists’ breathing zone. Accepted for publication 11 November 2009 The Acta Anaesthesiologica Scandinavica Foundation”


Requiem for the reusable Eschman Bougie?

By •• Posted in Devices, Techniques

At the end of every year a tradition from the networks and news organizations is to show us whom among celebrities and famous people died during the year. I must admit I do not pay close attention to it and rather think of whom or what  I would add to the list. This year something stood out for me. With new regulations at VA hospitals we are no longer allowed to re-use certain pieces of equipment and they are mandating instead the use of disposables. This means I had to forcefully retire a dear friend and ally of many battles (that saved me countless times) and that I used to carry with me in my pocket every day: the reusable Eschman bougie. I am still in mourning. I still think this was not a wise move. Read these articles and tell me what you think.

Frova vs Eshman vs Portex

Portex Single use


Randomized controlled studies in airway topics… how common are they?

Despite some considering the airway as “the cornerstone of anesthesia” if one looks closely, the amount of RCS on the subject, actually are very, very rare. Doing studies on the airway is perhaps inherently difficult because the stakes of things going the wrong way are basically too high. The majority of the literature or information we have on the subject is anecdotal, or retrospective, but RCS are a dime a dozen. Take a look at this letter criticizing  some researches for what they did in their research (I am including the original article as well) and tell me what you think. I look forward for a lively discussion.

Can J AnesthJ Can Anesth 2009 Adnet

Manual In-line stabilization


Can’t intubate, can’t ventilate… are you and your institution ready?

By •• Posted in Education, Techniques

Take a look at this interesting article from the U.K. They identified a problem and saw an opportunity to improve. Imagine if you will this study was done in Gainesville; wherever you worked today,last week, last month, do you know the location of the D.A cart? Do people that would be in charge of assisting you in case of a problem know the location and contents of this cart? If you choose jet ventilation as an alternative therapeutic option, do you know how to connect the O2 outlet in the anesthesia machine?

EJA 2009


Interesting and Timely topic

The judge gave the verdict of… guilty. We are not currently doing this and I somewhat agree with the author. It would be interesting to see if you think we should and the issue of how, naturally comes to mind.

Look forward to your comments.

Glidescope letter


Handling the patient with potential or with known cervical spine issues

The issue of elective/urgent/emergency airway management of patients with cervical spine issues is always a challenge and often comes out during oral boards questions. The bad thing is that there are multiple theories, methods, controversies and dangers etc… associated with this issue (reason why they love to ask these kind of questions)…..and those remain; the good thing is that we have made some progress and there are fortunately newer alternative methods available to handle the airway that are being used more commonly. The present post (requested by Adam Fier) is designed to give you some recent articles to show some relatively new alternatives of handling the airway in patients with or potential cervical spine conditions. I look forward to your comments.

Airtraq vs. CTrach

EMS and VL

Glidescope and Cervical Collar

Mac vs Airtraq


To “cuff or not to cuff”?… much ink has been used to attempt to answer this question

By •• Posted in Education, Pediatric

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.

Peds Cuff vs. Uncuffed ETT’s

cuff vs no cuff


Once again let us discuss the issue of SGA use and aspiration

By •• Posted in SGA

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.

sga and aspiration