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Complications of managing the airway

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The inability to secure the airway, with consequent failure of oxygenation and ventilation, is a life-threatening complication. Failure of oxygenation leads to hypoxia followed by brain damage, cardiovascular dysfunction, and finally death. Time is a very crucial factor in this context. Complications vary widely in severity; while some are dramatic and immediately life-threatening (unrecognized esophageal intubation), others can be severe and long-lasting (nerve injuries) or mild and short-lived (sore throat). To minimize injury to the patient, the anesthesiologist should examine the patient's airway carefully, identify any potential problems, devise a plan that involves the least risk for injury, and have a back-up plan immediately available. Each anesthesiology department should establish guidelines/algorithms specific to their institution. Unfortunately, a reliable test for detecting all patients at risk does not exist.

Section snippets

Mask ventilation

The maximum risk of airway problems presents during the ‘cannot intubate, cannot ventilate’ situation.2, 3 Difficult mask ventilation is an underestimated aspect of the difficult airway. The ability to ventilate and oxygenate the patient sufficiently using a mask is essential. Face masks should be completely free of residual cleansing agents, as these can cause serious mucosal, skin or eye injury (conjunctivitis, burning, irritation) and tongue swelling (allergic glossitis).

While applying a

Endotracheal intubation

The main injury associated with use of laryngoscopes is damage to the teeth. Laryngoscopy usually requires deep anesthesia because it causes stimulation of physiological reflexes, and adverse respiratory, cardiovascular and neurological effects are possible (Table 2). Patients with a history of hypertension, pregnancy-induced hypertension and ischemic heart disease are at additional risk. Deep anesthesia, application of topical anesthetics, drug prevention of the sympathoadrenal response using

Complications with infraglottic procedures

Infraglottic airway access is the last step in the ASA airway management algorithm.14 In cases in which endotracheal intubation is impossible and the patient's condition deteriorates into a ‘cannot ventilate, cannot intubate’ situation, lifesaving steps must be immediately undertaken. Despite possible (and severe) complications, there are no contraindications for infraglottic procedures in these critical situations. The most severe complication is failure to establish an airway before brain

Responses to intubation

The larynx has the greatest afferent nerve supply of the airway. Airway reflexes require suppression for stress-free airway management, especially for endotracheal intubation. Intensive autonomic responses may occur during placement, maintenance and removal of all airway devices.

Complications with extubation

Primary and secondary responses to extubation are possible. The primary effects include local and systemic responses. The same responses that follow intubation may be observed at extubation. During intubation the patient is more protected by anesthesia induction than during extubation, therefore the cardiovascular responses may be even more exaggerated. The most serious complication after extubation is the occurrence of acute airway obstruction. Decrease in consciousness, central respiratory

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