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S U P P L E M E N T T O O U T P AT 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 | J U LY 2 0 1 4
A I R W A Y M A N A G E M E N T
Intubation traumas are usually mild, with cut or
bruised lips following sore throats as the most
prevalent. How common are such incidents over-
all? Estimates vary widely, from as low as 17% to
as high as 50%. One reason: If you ask post-op
patients how they feel, they often say their knees
or bellies hurt, but they don't mention that their
throats are sore, unless you ask.
But more severe traumas, such as mucosal tears or dislocation of the arytenoid, while
rare, aren't nonexistent. The same with dental damage, one of the more common catalysts
causing patients to come looking for compensation. (Most practitioners tell them: Go to the
dentist and send me the bill. Implants are expensive, but less expensive than legal hassles.)
Experienced providers know which patients are more vulnerable: Those with prominent
teeth; with thick, short necks; and the grossly obese. When you anticipate a difficult air-
way, there are ways to make it easier, such as using video laryngoscopes. The disposable
costs are considerable, so they're not practical for every patient, but they're also wonderful
for getting yourself out of an unexpected jam. Fortunately, there just isn't the need with
most patients.
The trauma rate is higher with women, because most have smaller tracheas. When you
use a smaller tube, the size of the cuff relative to the airway tends to be bigger. You can
use high-volume, low-pressure cuffs, but they, too, add considerable expense.
Diligence pays. Spend time in your ORs, watching to see how carefully your anesthesia
providers secure airways. Are they gentle? Are they skilled with laryngoscopes? Do they
use lubricating jelly on LMAs so they slide in more gently? In short, are they treating each
patient the way you'd like to be treated?
— Robin J. Elwood, MD, FAAP
Dr. Elwood (
rob in-elwood@ouhsc.ed u
) is the vice chairman for clinical affairs and a
professor in the anesthesia department at the University of Oklahoma in Norman, Okla.
SUCCESSFUL STARTS
Pain-Free Airway Access
EASY DOES IT LMAs should be well
lubricated, so they slide in easily.
Pamela
Bevelhymer,
RN,
BSN
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