One of the more frightening events in anesthesia is laryngospasm – the protective, reflex, spasmodic closure of the vocal cords that occurs when the vocal cords are stimulated. When laryngospasm occurs, vocal cord closure can be so forceful that it can prevent all ventilation or even the passage of the endotracheal tube. Life-threatening hypoxia can quickly follow. Other potential complications include post obstructive pulmonary edema, and possibly even cardiac arrest. This post discusses the different muscle actions that combine to make laryngospasm create dangerous airway obstruction.
The longer I do anesthesia, the more I realize that not knowing the details about the surgeries that I see every day can cause unexpected problems with the anesthesia. Removal of the hyoid as part of a thyroglossal duct cyst excision, normally innocuous, can rarely cause severe postoperative airway obstruction.
Given the difficulty of working with a volunteer team in the developing world, how do we take strangers and quickly transform them into a cohesive, well-functioning team in a difficult environment? Let’s look at some of the tools we use.
While power failures in hospitals in the United States are thankfully rare, they do happen. This discussion offers tips on dealing with power failure in the OR while working in the developing world.
The need to change a tank in the middle of the case can happen anywhere to anyone. But if you´re prepared, it will go smoothly and your patient will remain safe.
Postoperative opioid-induced respiratory depression is common and results from an imbalance in the forces of arousal vs the forces of sedation. Opioid induced respiratory depression requiring treatment can occur to any patient at any time, and under the care of any provider — from novice to experienced. You must understand the forces of sedation and arousal and be constantly vigilant to keep your patients safe.
Persistent endotracheal tube leaks may require the need to exchange the endotracheal tube in a critical patient or situation. The differential diagnosis of such leaks is discussed. In addition, a case regarding a patient biting a pinhole in the pilot tube of their endotracheal tube is presented.
The LMA provides an alternate means to ventilate a patient during surgery — without intubation and while freeing the provider’s hands from having to hold the mask. It provides a more secure airway that makes gastric distention less likely. Since its invention, the LMA has since become quite valuable as a rescue device in situations when intubation may be difficult — even for the inexperienced. Let’s talk about some tips for successful insertion.
Intubation by direct laryngoscopy depends on using the laryngoscope blade to give you a clear field of view of the larynx by shifting the tongue and other pharyngeal structures out of the way. As you might imagine, the patient’s anatomy, pathology, or position can sometimes make this visualization difficult. Laryngoscopy blades come in different shapes to help manage these various situations.
Use of a bag-valve-mask device is one of the most important skills you can master in patient care. Many of my students have a hard time ventilating with a bag-valve-mask device because they fail to get a good seal with the mask. So let’s discuss how to place the mask step-by-step.