Outpatient Surgery Magazine

Salary Survey - January 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 82 of 110

plan B." Dr. Dutton says advanced pre-op plan- ning remains "over the horizon." A basic physical exam has been best practice for decades. "Open your mouth, stick out your tongue," he says. "We look at their neck; can they move their head around? We get the traditional Mallampati score. And if you're doing a really difficult case, you might have CT scans or MRIs to look at ahead of time to see where the airway is." But Dr. Dutton is intrigued by an emerg- ing technique called flexible nasopharyn- goscopy — "taking a very small, short fiber optic bronchoscope, sticking it in the patient's nose, and looking at the back of the throat." He says the technique is widely used by ENT sur- geons, but as it gets easier and cheaper, it's being used to resolve ques- tions about patient airways and mouth/throat anatomy. "It's easy to put it in somebody's nose, even without any anesthesia or topical or local, and take a look around," says Dr. Dutton. "Doing this pre-operatively is soon going to be a best practice for assessing the difficult airway. This direct look with a scope is far and away the best way to assess the anatomy so we can be fairly confident if we put a video laryngoscope in the patient. The real danger in intubation is when you stick the laryngoscope in and stuff isn't where it's sup- posed to be, either because it's been pushed out of the way or because there's something like a mass in the way." Flexible nasopharyngoscopy could help your providers avoid sur- prises and know that the airway is open and everything's where it's supposed to be. As they say, better to know than to assume. OSM J A N U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 8 3 • PLAN AHEAD Devising a safe plan for diffi- cult airways pre-operatively can prevent sur- prises in the OR.

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