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C H A L L E N G I N G
I N T U B A T I O N S
ESSENTIAL TOOLS
Airway Access Aids
W
hen standard intubation attempts fail, the next best option in most
cases is mask ventilation, says anesthesiologist Ashish Sinha, MD,
PhD, DABA, vice chairman of clinical research at Drexel University
College of Medicine in Philadelphia, Pa.
If that doesn't work, he says, grab a laryngeal mask airway. "Placing an LMA in
the airway, getting the patient to take a few breaths to move oxygen in and out,
lets you relax, take your time and approach the airway again," he explains.
But if an LMA can't be used because of the type of case — thyroid surgery, for
example — opt for blind or fiber-optic nasal intubation or video-assisted laryngoscopy. Video laryngoscopes are a safe, easy fallback when all else fails, says
Dr. Sinha.
Why is the popularity of video laryngoscopy increasing among providers? Dr.
Sinha explains that during standard intubation, you're trying to align the oral, laryngeal and phalangeal axes, and you can't see the vocal cords if you're unable to
align them in a straight line. When working with a video
laryngoscope that lets you see "around the corner" of the
airway, you don't have to align the axes for a direct view of
the glottis.
"Some providers call that cheating," says Dr. Sinha.
"So what? Video laryngoscopes not only make intubation
possible, they make it easier. Why make intubation hard-
er than it needs to be?"
— Daniel Cook
D E C E M B E R 2012 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E
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