0071643192.pdf

ADVANCEDAIRWAYPROCEDURES

Used in the management of the difficult or failed airway

DIFFICULTAIRWAY

■ Difficult mask ventilation or endotracheal intubation
■ If anticipated by preintubation assessment →perform awake (no paralysis)
intubation

FAILEDAIRWAY

■ Failed intubation (“can’t intubate”) and failed BVM ventilation (“can’t
ventilate”)

Advanced airway procedures include:

■ Awake intubation
■ Supraglottic airway (eg, laryngeal mask airway)
■ Fiberoptic intubation
■ Translaryngeal jet ventilation
■ Retrograde tracheal intubation
■ Lighted stylet
■ Cricothyrotomy
■ Tracheostomy

AWAKEINTUBATION

INDICATIONS

■ Spontaneously breathing patients with an anticipated difficult airway

RESUSCITATION
TABLE 1.5. Paralytic Agents for Rapid Sequence Intubation

DRUG ONSET DURATION COMPLICATION

Depolorizing Agent

Succinylcholine 45–60 sec 5–9 min Hyperkalemia

Fasciculations

Increased ICP/IOP

Malignant hyperthermia

Prolonged action if ↓pseudo-

cholinesterase activity

Nondepolorizing Agents

Vecuronium 2–4 min 40–60 min Prolonged action in obese/

elderly/hepatorenal

dysfunction

Rocuronium 1–3 min 30–45 min Tachycardia

Pancuronium 2–5 min 40–60 min Tachycardia

Hypertension