Prehospital airway management on rescue helicopters in the United Kingdom.

Adequate equipment is one prerequisite for advanced, out of hospital, airway management. There are no data on current availability of airway equipment on UK rescue helicopters. An internet search revealed all UK rescue helicopters, and a questionnaire was sent to the bases asking for available airway management items. We identified 27 helicopter bases and 26 (96%) sent the questionnaire back. Twenty-four bases (92%) had at least one supraglottic airway device; 16 (62%) helicopters had material for establishing a surgical airway (e.g. a cricothyroidotomy set); 88% of the helicopters had CO(2) detection; 25 (96%) helicopters carried automatic ventilators; among these, four (15%) had sophisticated ventilators and seven (27%) helicopters carried special face masks suitable for non-invasive ventilation. We found a wide variation in the advanced airway management equipment that was carried routinely on air ambulances. Current guidelines for airway management are not met by all UK air ambulances.

Airway management in the outpatient setting: new devices and techniques.

PURPOSE OF REVIEW: There are an ever-increasing number of supraglottic airway devices available on the market, many being suitable for ambulatory surgery and the specific demands it creates. These include constraints of time, high turnover and the need for early and effective discharge. This article hopes to highlight the potential benefits of the current devices available. RECENT FINDINGS: Laryngeal masks are still undoubtedly the most popular supraglottic devices available but there are an increasing number of other airways on offer. Advantages of these include higher seal pressures, ease of insertion and the ability to drain gastric fluids. SUMMARY: Some of the unique advantages offered by certain devices lend themselves well to anaesthesia in ambulatory surgery. The laryngeal mask airway has a proven track record but newer airway devices are becoming more popular and may offer advantages. Further research is needed in this fast-moving field to assess these benefits, especially in specific cohorts of patients (such as the obese), who are appearing with increasing regularity on outpatient surgery lists.

Availability of difficult airway equipment to rural anaesthetists in Queensland, Australia.

INTRODUCTION: Since 1990 several airway devices have become available to assist in difficult intubation. Multiple surveys have assessed difficult airway equipment availability in international anaesthetic departments and emergency departments. The practice of GP anaesthetists is unique in both its multidisciplinary nature and geographical isolation. OBJECTIVES: General practitioners performing general anaesthesia in rural and remote Queensland, Australia were surveyed to assess their access to difficult airway equipment and whether this was related to the remoteness of their location or attendance at continuing professional development activities. DESIGN: survey. SETTING: proceduralists performing general anaesthesia in hospitals categorised as Rural, Remote and Metropolitan Area (RRMA) classification 4 to 7 inclusive were surveyed. OUTCOME MEASURE: data collected included demographic information, availability of airway management equipment, and attendance at continuing professional development activities. The received data was entered into a Microsoft Excel spreadsheet and analysed in Statistical Package for Social Sciences (SPSS Inc; Chicago, IL, USA) using the frequencies and crosstabs functions. The Fisher's exact test was used. A p-value of less than 0.10 was considered noteworthy and a p-value of less than 0.05 was considered to be significant. A statistical comparison was made between the known demographics of the target population and the survey responders. The known demographics were derived from the Health Workforce Queensland database and included age, gender, practice location and practitioner type. RESULTS: Seventy-nine surveys were distributed and 35 returned (response rate 44%). This represented 21 hospitals. There was no statistical difference between the target population and the survey responders in terms of age and gender. There was no statistical difference in terms of practice location, although the small percentage responding from RRMA 6 was notable. There was a statistically significant difference between the groups in terms of practitioner type. Hospital-based practitioners were relatively under-represented in the responder group. Eighty-two per cent of practitioners felt they had access to appropriate equipment and this was not significantly related the remoteness of their location. There was wide variation in available equipment. Simple adjuncts such as the bougie and stylet were not universally available but cricothyroidotomy sets were more common. Practitioners in the more remote locations were less likely to have attended an educational activity such as conference, workshop or skills laboratory (p=0.05). CONCLUSIONS: We suggest standardisation of difficult airway equipment for rural practitioners. This could be supported by increased availability of airway management workshops in remote areas. Such an intervention would be in line with other initiatives to standardise medical equipment in rural and remote Queensland hospitals. Familiarity with infrequently used equipment may assist practitioners and their locums. Standardisation of equipment and practice is a recognised method of improving patient safety.

Tracheal intubation, tracheal tubes and laryngeal mask airways.

Tracheal intubation is used when a clear airway is difficult to achieve with a face mask or laryngeal mask, or if there is a risk of dislodgement of other forms of airway control. Tracheal intubation is considered to be an important part of patient management when a major intraoperative complication develops (for example anaphylaxis, massive haemorrhage or malignant hyperpyrexia).

Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

The effect of nitrous oxide on laryngeal mask cuff pressure.

During general anesthesia with the laryngeal mask airway (LMA), a significant increase in cuff pressure due to diffusion of nitrous oxide through the cuff wall occurs. This descriptive clinical study was conducted in a university teaching hospital ambulatory surgical center with 100 patients (ASA physical status, I-III; age, 5 months to 76 years; weight, 5.8-146.3 kg) undergoing general anesthesia with an LMA. The airway pressure at which the LMA seal was broken (leak pressure) was determined immediately after the insertion of the LMA. The LMA leak pressure was determined by closing the circuit pop-off valve and recording with a stethoscope at the neck the pressure at which the gas was first heard to escape around the LMA. The LMA cuff pressure was determined by connecting the check valve of the LMA pilot balloon to a sphygmomanometer. The mean LMA cuff pressure increased 16 +/- 8.2 mm Hg (1- to 30-minute group), 38.11 +/- 15.87 mm Hg (31- to 60-minute group), 39.53 +/- 16.9 mm Hg (61- to 90-minute group), 42.63 +/- 20.36 mm Hg (91- to 120-minute group), and 44.25 +/- 14.03 mm Hg (120- to 350-minute group). This study demonstrated that there was a gradual increase in the cuff pressure well over a 3-hour period during nitrous oxide and oxygen anesthesia.

Devices for difficult airway management in academic emergency departments: results of a national survey.

STUDY OBJECTIVE: We conducted a national survey of emergency medicine residency program directors to determine which alternative devices were available in their emergency departments for difficult airway management. We also assessed the residency directors' experience in use of these devices. METHODS: After approval was received from the institutional review board at our institution, residency directors were contacted by mail, fax, or phone in October 1997. Alternative intubation devices were defined as devices that do not involve use of a laryngoscope and direct visualization for tracheal tube placement. Alternative ventilation devices were defined as those that do not use a face mask for ventilation. We asked whether the following alternative intubation devices were stocked in their department: a flexible fiberoptic bronchoscope, a rigid fiberoptic device (ie, Bullard, Wu-Scope), a lighted stylet, or a retrograde intubation kit. We also asked about the following alternative ventilation devices: a transtracheal jet ventilation system with a 50-psi oxygen source and control valve, the esophageal tracheal twin-lumen airway device (Combitube), or the laryngeal mask airway. Residency directors were also questioned about their duration of practice, intubation experience, and use of these devices. RESULTS: We obtained information from 95 of 118 (81%) programs. Of 95 programs, 61 (64%) had a fiberoptic bronchoscope, 43 (45%) a retrograde intubation kit, 33 (35%) a lighted stylet, and 6 (.06%) a rigid fiberoptic device. Forty-seven (49%) of the programs reported 2 or more devices, and 20 (21%) reported having no alternative intubation devices. Of 95 programs, 64 (67%) had a transtracheal jet ventilation system, 25 (26%) had the Combitube, and 25 (26%) had the laryngeal mask airway. Thirty-one (33%) programs had at least 2 alternative ventilation devices, and 20 (21%) had none. Ten (11%) programs had no alternative intubating or ventilation devices. Additional information on duration of practice, intubation experience, and actual use of alternative devices was obtained from 83 of the 95 (87%) emergency medicine residency directors contacted. Forty-one (49%) reported never having used an alternative device for intubation. The most commonly used alternative intubation device was the flexible fiberoptic bronchoscope (37%), and the mean number of times any alternative device was used was 7. CONCLUSION: The availability of devices for difficult airway management varies tremendously across emergency medicine residency programs. Only half of residency program directors had any experience with these devices, and among those that reported any experience, they are used rarely.

Máscara laríngea / The laringeal mask

Se describe la construcción de la máscara y su mecanismo de acción. Se precisa el procedimiento, sus indicaciones y la técnica de inserción. Se mencionan las contraindicaciones y las precauciones durante el funcionamiento. Se enumeran las ventajas y desventajas

Máscara laríngea / The laringeal mask

Se describe la construcción de la máscara y su mecanismo de acción. Se precisa el procedimiento, sus indicaciones y la técnica de inserción. Se mencionan las contraindicaciones y las precauciones durante el funcionamiento. Se enumeran las ventajas y desventajas (AU)