#diffaw search results
Was this #ILMA also helpful in developing some important #DiffAW concepts - Airway Rescue, Hybrid Intubation, Failed AW etc.?
Great question! Somewhat simplified answer- look at the #DiffAW algorithms of the past- #ASA2003 vs #ASA2013! For us #OldGuys, like Hans & I et al, who trained #preVL- there was either DL or FOI & some SGAs, but if all else failed, SxAW! “Turn back, see how far we have come!”
Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
With sugammadex, succ should not be needed. If NMB may improve vent/intubation, use roc for a longer block. If not helpful Or unanticipated #DiffAW, then suga at high dose. Side effects and contraind for succ will likely make it obsolete #pediatricanesthesia #anesthesia
Agreed, #SGA probably only in a hypoxic pt., #DiffAW rescue or to facilitate smooth #coughfree extubation?
#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!
Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise
And we #OldDogs keep our skills up and learn new tricks too by teaching newbies & others! [#DiffAW management, like many other clinical areas, has been advanced both by research & training *learners!]
Yes! And insert a universal connector from the ETtube into the Nasal Airway to get another literal #DiffAW life-saver! #ModifiedNasalTrumpet @AirwayMxAcademy @jducanto
Many of these pts. will hypoventilate or become intermittently apneic, especially with *excessive O2 supplementation! Nasal CPAP via a Modified Nasal Trumpet, may in some pts. & situations, prevent or treat dangerous hypoxia?
#Transillumination works well and should/could be practiced #IMHO as a #DiffAW adjunct/rescue?
Or hold the flashlight against the anterior tracheal wall skin? #transillumination HT Anesthesiology 2013, Vol.118, 1059-1064. Image- anesthesiology.pubs.asahq.org/data/journals/…
Maybe a good idea, but those wings held down by the FM will cause a loss of mask seal!? #MObesity #DiffAW Personally, for #DiffBMV prefer a light #Cricoid to create an oropharyngeal seal & prevent gastric insufflation during BMV! #CricoidParadox
See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!
Thanks! Our societies @SOBA @ISPCOP_notes @ESPCOP have worked to promote safer #DiffAW management in #MObesity! #RCL from #IARS2017
Challenging case #DiffAW #CSpine with @phanmd @TOH_DoS 'Neurogenic shock in a patient with cervical myelopathy from severe cervical kyphoscoliosis' @CJA_Journal #Images link.springer.com/article/10.100…
There may be 7P’s to any #DiffAW, And the greatest of these is P3 for Position!
Agreed #MODA #MObesity + #DiffAWs make for Anatomical & Physiological challenges! @ISPCOP_notes @SOBAuk @AirwayMxAcademy
Again Brilliant! Something that has really helped when 'extubating an anticipated #DiffAW' is using #BaileysManeuver Ping @AirwayMxAcademy Here is a nice demo from @fibroanestesia
Baileys Maneuver for extubation of a potentially difficult airway! @fibroanestesia #Brilliant HT: BAILEY MANEUVER: AS YOU HAVE NEVER SEEN BEFORE youtu.be/SdYiu_mu0c0 via @YouTube
youtube.com
YouTube
BAILEY MANEUVER: AS YOU HAVE NEVER SEEN BEFORE
Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex
Soooo true! I often find myself saying “take a deep breath, NAVEEN…..” when dealing with a dangerously #DiffAW!
Anticipated #DiffAW? Maybe they need an app too? @AirwayMxAcademy
First thought? Source: drjbminterdvm. BTW, the patient is doing great.
#Transillumination works well and should/could be practiced #IMHO as a #DiffAW adjunct/rescue?
Or hold the flashlight against the anterior tracheal wall skin? #transillumination HT Anesthesiology 2013, Vol.118, 1059-1064. Image- anesthesiology.pubs.asahq.org/data/journals/…
There may be 7P’s to any #DiffAW, And the greatest of these is P3 for Position!
Agreed #MODA #MObesity + #DiffAWs make for Anatomical & Physiological challenges! @ISPCOP_notes @SOBAuk @AirwayMxAcademy
Was this #ILMA also helpful in developing some important #DiffAW concepts - Airway Rescue, Hybrid Intubation, Failed AW etc.?
Challenging case #DiffAW #CSpine with @phanmd @TOH_DoS 'Neurogenic shock in a patient with cervical myelopathy from severe cervical kyphoscoliosis' @CJA_Journal #Images link.springer.com/article/10.100…
Again Brilliant! Something that has really helped when 'extubating an anticipated #DiffAW' is using #BaileysManeuver Ping @AirwayMxAcademy Here is a nice demo from @fibroanestesia
Baileys Maneuver for extubation of a potentially difficult airway! @fibroanestesia #Brilliant HT: BAILEY MANEUVER: AS YOU HAVE NEVER SEEN BEFORE youtu.be/SdYiu_mu0c0 via @YouTube
youtube.com
YouTube
BAILEY MANEUVER: AS YOU HAVE NEVER SEEN BEFORE
#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!
Great question! Somewhat simplified answer- look at the #DiffAW algorithms of the past- #ASA2003 vs #ASA2013! For us #OldGuys, like Hans & I et al, who trained #preVL- there was either DL or FOI & some SGAs, but if all else failed, SxAW! “Turn back, see how far we have come!”
Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
Soooo true! I often find myself saying “take a deep breath, NAVEEN…..” when dealing with a dangerously #DiffAW!
Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise
Maybe a good idea, but those wings held down by the FM will cause a loss of mask seal!? #MObesity #DiffAW Personally, for #DiffBMV prefer a light #Cricoid to create an oropharyngeal seal & prevent gastric insufflation during BMV! #CricoidParadox
See effect of CP in sealing the Oropharynx- Invaluable during diff.BMV aka the Cricoid Paradox!
And we #OldDogs keep our skills up and learn new tricks too by teaching newbies & others! [#DiffAW management, like many other clinical areas, has been advanced both by research & training *learners!]
Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex
I also think that preoperative #DiffAW prediction has an important role in #clinicalretrospect, especially when faced with unanticipated difficulty #LookBack #PredictPlanPrepare
#PlanA is mostly propofol+fent+Roc, then BMV followed by MacDL + Preloaded Bougie👊👏! That's for every-day, fasted- elective & not #DiffAW🙏👊!
@QueensPeriopMed Thanks for the VP invite! Looking forward to presenting June 13th Grand Rounds on #ObesityAnesthesia Sharing @OttawaHospital @OttAnesthesia experience with #MObesity #DiffAW Ping @queensu
All ^^^BMIs not same! @SOBAuk Highlights the need to distinguish central vs peripheral obesity for #MObesity #DiffAW prediction, see their excellent single sheet. @AirwayMxAcademy @ISPCOP_notes @dasairway #GAMC18
A lot of tips & tricks by @AirwayMxAcademy & Co. (Free to download @iTunes) In an #DiffAW that cannot be topicalized, would use #Dexmed (Or Remi+PPF) Maybe go thru a #SplitNasalAW with #ModNasalTrumpet to maintain conduit and control (sim below)
Any mention of the #ObAirway becoming like the #MObesity #DiffAW? Once again, P3 #Position is so very important!
Looks like a #MObesity #DifficultAirway setup? The 7P's of #MODA, but #TheGreatest of these is #Position! @AirwayMxAcademy
Still believe these are invaluable summaries of what is being done in 2021?! Looking back, 2003 vs 2013 ASA #DiffAW Algorithms, nice to see how the practice has evolved- from the original 4 questions & SGA rescue, to 6 questions & VL, and now this circular approach?
Please ask @mmargarson how #Age influences #DiffAW in #MObesity more than BMI? "Physiology trumps Anatomy" Age+BMI>100 (#NaveensFormula) is #Huge predictor of #MODA @AirwayMxAcademy @ISPCOP_notes #GAMC18
While 'Asleep & Paralyzed' vs 'Awake & Breathing' may have been at opposite ends of the classic #DiffAW spectrum, this discussion seems to make them look less further away than that.
ThankU, And I yours! EM/ED/ER pts., acuity, etiology & urgency etc. are often very different from #Anesthesia #Periops, so whether it is #DiffAW or #AcutePain, I respect your perspective, experience and practice! #Respect
Exactly, some experts believe in a Roc:Suggam ratio?🤔 But till they decide, I prefer 1x 200mg ‘small’ vials for ‘routine’ reversal in the drug cart and use 2 or 3x 500mg ‘big’ vials for ‘rapid’ reversal from the #DiffAW cart! @GongGasGirl #AdjBW #NMBreversal #Suggamadex
Should I call ENT first? Or Should I ask them to bring the patient to the Operating Room? Maybe I should I bring my #DiffAW cart? Where are my Drugs, who is my Backup? #EquipmentExperienceExpertise
Excellent! Three big #controversies in #MObesity #DiffAW are related to #AWRescue- SGAs, ATI & eFONA are all #VDifficult! #BetterAvoidedthanTreated Any #tipsNtricks appreciated! @ISPCOP_notes #MODA
Agree fully with NMB for tracheal intubation, but am quite sure that Sux is not ideal to achieve this, esp. in elective-fasted pts. #MObesity! [Thanks for the engaging #DiffAW discussion, happy to hear how differently the same #MODA problems are approached]
And we #OldDogs keep our skills up and learn new tricks too by teaching newbies & others! [#DiffAW management, like many other clinical areas, has been advanced both by research & training *learners!]
And when faced with 'unpredicted' #DiffAW always look back to see what was missed! #WorkForSuccess Or maybe load the data on The Airway Triage App? @AirwayMxAcademy @french9a vimeo.com/247634208
Thanks! Our societies @SOBA @ISPCOP_notes @ESPCOP have worked to promote safer #DiffAW management in #MObesity! #RCL from #IARS2017
Agreed! #HateBlind VL has changed #DiffAW so much, but rare occasions require calling up some old #Crazy skills! *Blind Nasal *Retrograde etc. #CantLoseWhatUNeverHad #ABBForever
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