Ambulatory_Anesthesia_2013_Layout 1 6/26/13 2:21 PM Page 39
A I R W A Y
M A N A G E M E N T
are spontaneously breathing — they won't need to insert
an endotracheal tube (ET).
In contrast, during tonsillectomy-adenoidectomy, the ET
tube is the only option for maintaining respiration, because
the surgeon will be occupying the airway for the procedure. In the case of a non-superficial abdominal surgery,
such as a laparoscopic cholecystectomy, a muscle relaxant and paralytic will be necessary, which will impair natural spontaneous respiration. For any case involving general
anesthesia, which triggers a complete loss of reflexes, an
ET is required to manage the airway.
As with the type of surgery and choice of anesthesia, the
patient's physical condition and medical history can also
impact airway management options. Is the patient pediatric
or morbidly obese? What are their airway anatomies like?
Do they suffer from any potentially complicating comorbidities, such as obstructive sleep apnea? Have they presented intubation difficulties during previous surgeries? The
imaging abilities of video laryngoscopes, which provide
direct views of the glottic inlet, can help providers place
artificial airways more easily in challenging anatomies, but
they must be mindful of whether the airway will remain
open throughout the procedure.
Patients who are extremely overweight, who suffer from
obstructive sleep apnea and severe gastric reflux, might
not be able to protect their own airway when anesthetized.
They'd likely obstruct quickly without artificial means, so
anesthetists would never consider placing just an oral airway. In such situations, an ET tube is the only true option.
— Rosalind Ritchie, MD
J U LY 2013 | S U P P L E M E N T
TO
O U T PAT I E N T S U R G E R Y M A G A Z I N E
3 9
