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A I R W A Y
M A N A G E M E N T
SETTING A STRATEGY
Choose the Safe and Effective Choice
Rosalind Ritchie, MD
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SEEKING THE SHOT Regional anesthesia allows spontaneous breathing
without the need for artificial airways.
W
hat type of surgery is the patient scheduled to
undergo? More specifically, where is the surgical
site? This consideration goes hand in hand with
which anesthetic technique will likely be used. And both of these
factors will consequently determine the airway methods at an
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anesthesia provider's disposal.
Let's look at a few scenarios. Suppose surgery is planned on a
patient's extremity: an anterior cruciate ligament repair, for example. The anatomy of this surgical site gives providers the latitude
to employ local anesthesia, regional anesthesia via neuraxial
blockade or a peripheral nerve block. This awake sedation infiltrates the area at issue or numbs the limb and nothing but the
limb, leaving breathing operational.
Plus, because the surgeon won't be working around the head
and neck or in the airway, the patient's head won't be turned
away from the anesthesia workspace. In this situation, providers
might be able to use a natural airway, a nasal cannula and medication for pain control. Even if they opt for an artificial airway —
a laryngeal mask airway (LMA) can be placed in patients who
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O U T PAT I E N T S U R G E R Y M A G A Z I N E | J U LY 2013
