The practice of anesthesia requires development of good decision-making processes, in addition to remembering knowledge and learning skills. This article explores the decision process that was used for a case of securing the airway in a young child with a large airway abscess. Read More …
Intubating an infant or young child with a GlideScope requires age specific blades and modified technique because the anatomy of infants and toddlers differs from adults. This article discusses the modification of technique to improve successful pediatric intubation with the GlideScope. Read More …
How to open the airway is an essential skill that every health provider should know. Of all the airway skills, it’s the easiest to master and the most likely to save lives in respiratory distress and failure. This article details recognizing airway obstruction, techniques to open the airway, and insertion of Read More …
To learn intubation in addition to learning the physical steps, you need to understand why you’re doing those steps. This article will explain how to perform the steps of intubation, as well as the rationale behind them. Links to other articles on intubation technique appear both in the body of the text as well as repeated as a list at the end. Read More …
Failure to see the cords on first pass intubation occurs about 10% of the time. This article describes the thought process behind the next steps for approaching the next intubation attempts. Read More …
My review article has just been published in Anesthesiology News: 10 Common Pediatric airway Problems — And Their Solutions. The trend to only use pediatric providers has a seriously negative unintended consequence: It deprives other providers of routinely caring for children, making them less prepared for when they do inevitably have to care for a small child. This reviews the most important pediatric airway differences. Read More …
In many ways pediatric anatomy and physiology predisposes a child to respiratory distress and respiratory failure. Inefficient mechanics of breathing is one major risk factor for infants and young children. This article discusses the ways the anatomy of a child creates inefficient mechanics of breathing and predisposes to respiratory distress and failure. Read More …
And the numbers are in, my review article for Anesthesiology News was actually THE MOST viewed article on the site for the whole year! The link for the article is included. Please feel free to share.
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Intubation with the MAC blade requires precise placement of the tip of the blade in the vallecula in order to manipulate the hyoepiglottic ligament and lift the epiglottis. This discussion uses illustration, Xray, and video to demonstrate proper intubation technique. Read More …
When first learning intubation, a beginner often concentrates on memorizing the key laryngeal anatomy. This is important of course. If you can’t recognize the vocal cords, you will not be able to successfully intubate. However, even more important to learning intubation is understanding how the larynx relates to the other structures in the head and neck. In order to intubate you must manipulate those other structures to bring the larynx into view. This post uses lateral X-rays and CT scan images to help novice intubators master the anatomical relationships they must know to intubate. Read More …
I’m excited. My latest article, titled, “10 Rules for Approaching Difficult Intubation, Always Prepare for Failure” has just been released in the journal supplement Airway Management, published by Anesthesiology News. Managing the difficult airway is one of the most challenging, risk ridden, and downright scary clinical problems in anesthesia. The article makes the Read More …
The GlideScope can be difficult to use in a patient with a small, narrow mouth. This article discusses a technique for improving successful intubation in that type of patient. Read More …
At long last, after two years of writing (and rewriting), illustrating, and filming on-line videos, I’m excited to announce the publication of my new book Pediatric Airway Management: A Step-by-Step Guide. Anyone who rarely cares for children tends to be anxious when faced with a small child’s airway. This is true even if they are comfortable with adult airway management.
My goal for this book is to demystify basic pediatric airway management. I want to give you the skills you need to recognize when a child is in trouble and act quickly to safeguard that child, including helping them breathe if necessary. My sincere wish is that this new book helps in the care of our littlest patients, no matter where they are. Read More …
When I was training, we used nitrous oxide on just about every anesthetic. It was easy to use. It was inexpensive. It didn’t tend to effect hemodynamics so it was useful in less stable patients when combined with an opioid. It helped speed induction through the second gas effect. It was not metabolized so renal and liver insufficiency were of less concern.
However, a lot more is now known about the pharmacologic disadvantages, and potential harm, of nitrous oxide in certain patients. N2O interferes with the B12/folate pathway and methylates DNA. This discussion reviews some of those patients at risk of harm from nitrous oxide exposure during anesthesia. Read More …
Learning to intubate is easier for some people than for others. Sometimes, no matter how knowledgeable you are about the theory of the technique, the novice can still struggle to bring it all together to pass the endotracheal tube. The anatomy can be confusing. Understanding how to place the laryngoscope blade and manipulate that anatomy can be challenging. And all the while you must be ever vigilant to protect those precious front teeth, avoid hypertension and tachycardia, and breathe for the patient at regular intervals. This article discusses 4 chief technical barrier to learning to intubate. Read More …
When I’m teaching airway management to my Perioperative/OR nurses, I often recount the story of management of a young child’s postoperative respiratory depression. In addition to illustrating the importance of evaluating ventilation in addition to oxygenation, this case shows how good communication makes management of a critical event more effective. Read More …
A case of “can’t intubate- can’t ventilate is discussed which illustrates the importance of always using good techniques of basic airway management. Read More …
During a recent volunteer medical mission to Honduras, we had a close call with a blood clot in the airway following nasal surgery. This article discusses that event. Read More …
As you read this I am flying to Honduras with International Relief Team on a head and neck surgery medical mission. I will attempt to post mission updates from the hospital compound, pending internet connections. Participating in a medical mission to the developing world is never easy.
Medical personnel trained in a high tech environment take for granted the complex monitoring devices, multiple choices of drugs, and plentiful support peronnel which simplify our job. When medical volunteers travel to the developing world they are often unprepared for the potential hazards produced by outdated technology, unfamiliar and sometimes poorly maintained equipment, poor sanitation, limited supplies, and a malnourished, often poorly educated population.
Let me give you an example of one rather exciting case from early in my volunteer experience in which I had to reinvent PEEP using some suction tubing and an irrigation bottle filled with water.
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I used to love the old TV show MacGyver, which featured an inventive hero who frequently had to improvise some clever device from ordinary objects in order to beat insurmountable odds and save the day. The concept was so popular that the word MacGyver became a verb. Oxford Dictionaries state that to “MacGyver” is to make or repair something “in an improvised or inventive way, making use of whatever items are at hand”.
As I have traveled the developing world on medical missions I have often had to reinvent ways to do the things I take for granted in my sophisticated operating room, such as producing PEEP from some suction tubing and a bottle of water. (see story here)
But being able to improvise is just as important in the settings of the more modern hospital. This article describes two examples of having to improvise for an anesthetic. Read More …