What's so hard about establishing an airway?

[OrbitalOverload]

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Please excuse the attention-grabbing title of this thread.

I'm an MS1 without a solid appreciation for the challenges that anesthesiologists face in the OR. In specific, I shadowed a surgical operation today and observed that the anesthesia team had a really difficult time getting in the airway. (Note: it was a pediatric patient).

I was hoping someone might explain that challenges of establishing an airway in general and in pediatric patients in specific. I have a basic appreciation of anatomy and physiology.

Thanks

 

[pgg]

Attached is a chapter from Principles of Airway Management. Google returns the PDF as a top result for "evaluation of the airway" search; it appears Springer has made it available as a free download. Boxes 2.1 and 2.2 are good answers to your general question of what makes an airway easy or hard.

 

[deleted171991]

Attached is a chapter from Principles of Airway Management. Google returns the PDF as a top result for "evaluation of the airway" search; it appears Springer has made it available as a free download. Boxes 2.1 and 2.2 are good answers to your general question of what makes an airway easy or hard.

tl;dr Airway management is tough because difficult airways are not 100% predictable. And if you find yourself unable to both intubate and ventilate an apneic paralyzed patient... you might have just another minute or two to fix it before the patient gets anoxic brain injury.

What you saw today, @OrbitalOverload, is actually very unusual. Pediatric airways are famous for being easy (or at least easy to predict).

 

[OrbitalOverload]

Thank you both for the helpful reply

 

[Noyac]

Actually I think they were pulling the old tried and true tactic of making it look like what we do is difficult in front of someone that is new to the scene. It's a common tactic we pull from time to time just in case the new guy in the OR thinks anesthesia is easy.

 

[Chloroform4Life]

Please excuse the attention-grabbing title of this thread.

I'm an MS1 without a solid appreciation for the challenges that anesthesiologists face in the OR. In specific, I shadowed a surgical operation today and observed that the anesthesia team had a really difficult time getting in the airway. (Note: it was a pediatric patient).

I was hoping someone might explain that challenges of establishing an airway in general and in pediatric patients in specific. I have a basic appreciation of anatomy and physiology.

Thanks

Who on the anesthesia team attempted the airway first? CRNA? Resident? Anesthesiologist? How was the airway finally secured?

I would say 95% of airways i encounter are easy, 4% somewhat difficult, 1% really difficult. If planned correctly, even the really difficult airways can be somewhat easy. Very rare to encounter an unexpected difficult airway that can't be managed with a glidescope these days.

 

[deleted171991]

Very rare to encounter an unexpected difficult airway that can't be managed with a glidescope these days.

And that's one reason why physician anesthesiologists will go the way of the dinosaurs (in the next 25-50 years). 😉

Before all the videolaryngoscopes, it was downright stressful to learn to intubate. Now it's done by midlevels, and I don't mean CRNAs.

 

[pgg]

Good anesthesia is like good refereeing, if you're doing it well, it looks like you're doing nothing at all.

Beware of the anesthesiologist who's constantly saving the day in dramatic fashion. If he was half as good as he looks to casual observers, he'd never have gotten himself in all those holes he had to dig out of in the first place.

The ones I've looked up to over the years are the ones I've seen handle gnarly **** while the surgeon was occupied and the circ RN was Facebooking Farmville or whatever, and neither one noticed.

 

[Planktonmd]

Actually I think they were pulling the old tried and true tactic of making it look like what we do is difficult in front of someone that is new to the scene. It's a common tactic we pull from time to time just in case the new guy in the OR thinks anesthesia is easy.

Oh man... why did you tell him the secret???

 

[caligas]

And that's one reason why physician anesthesiologists will go the way of the dinosaurs (in the next 25-50 years). 😉

Before all the videolaryngoscopes, it was downright stressful to learn to intubate. Now it's done by midlevels, and I don't mean CRNAs.

"I'm an anesthesiologist"

"A physician anesthesiologist?"

Insert Colonol Jessep impression: "Is there any other kind?

 

[deleted87051]

There's only 2 holes. You have a 50-50 shot. Unless you make your own hole😉

 

[Mman]

I would say 95% of airways i encounter are easy, 4% somewhat difficult, 1% really difficult. If planned correctly, even the really difficult airways can be somewhat easy. Very rare to encounter an unexpected difficult airway that can't be managed with a glidescope these days.

I would roughly agree with those percentages. I find myself needing to do an awake FOI maybe 1/1000-1/5000 cases or so. The rest can be managed asleep with some combination of laryngscope, LMA, and/or glidescope.