Airway management for induction of general anesthesia
- Lauren Berkow, MD
Lauren Berkow, MD
- Associate Professor of Anesthesiology
- University of Florida College of Medicine
Airway management is a crucial skill for the clinical anesthesiologist. It is an integral part of general anesthesia, allowing ventilation and oxygenation as well as a mode for anesthetic gas delivery. Major complications of airway management in the operating room are very rare but may be life threatening.
This topic will discuss the formulation of an airway management strategy for general anesthesia, including plans for the use of mask ventilation, use of supraglottic airway devices (SGA), endotracheal intubation, and the selection of medications for induction of general anesthesia. Techniques and devices for airway management, rapid sequence induction intubation, and management of the difficult airway are discussed separately. (See "Management of the difficult airway for general anesthesia" and "Rapid sequence induction and intubation (RSII) for anesthesia" and "The difficult airway in adults" and "Rapid sequence intubation for adults outside the operating room" and "Direct laryngoscopy and endotracheal intubation in adults" and "Flexible scope intubation for anesthesia".)
All patients undergoing general anesthesia should have a complete history and anesthesia-directed physical examination. One goal of this evaluation is to predict the degree of difficulty with mask ventilation and endotracheal intubation using standard devices. The plan for airway management follows from this prediction, since in many cases induction of anesthesia will result in airway obstruction and at least temporarily make the patient apneic. In addition, factors that predispose the patient to aspiration during anesthesia should be identified.
Airway history — For patients who report problems with anesthesia in the past, every effort should be made to obtain and review prior anesthesia records for details of airway management.
A number of disease states, both congenital and acquired, have been associated with difficult airway management (table 1). In addition, pulmonary problems such as asthma, recent upper respiratory infection, pneumonia, bronchitis, or presence of chronic obstructive pulmonary disease (COPD) may impact oxygenation and ventilation during induction .
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- AIRWAY ASSESSMENT
- Airway history
- Airway examination
- Advanced methods of airway assessment
- PREDICTION OF THE DIFFICULT AIRWAY
- Difficult mask ventilation
- Difficult supraglottic airway device use
- Difficult intubation
- Obesity as a risk factor
- CREATION OF A STRATEGY FOR AIRWAY MANAGEMENT
- General approach
- Choice of airway device
- - Airway device options
- - Supraglottic airway versus endotracheal tube
- Choice of intubation technique
- Choice of medications for induction and intubation
- - Intravenous induction
- - Inhalation induction
- SECURING THE AIRWAY
- Preparation for induction of anesthesia
- - Patient positioning
- - Preoxygenation
- Mask ventilation
- Administration of neuromuscular blocking agents
- Airway placement
- Confirmation of airway placement
- SUMMARY AND RECOMMENDATIONS