Shared Airway: Techniques, Anesthesia Considerations, and Implications

Woerner, Jennifer E.; Meram, Andrew T.; Armuth, Spencer

doi:10.1007/978-3-319-96125-5_5

Cited by 2 publications

(13 citation statements)

References 29 publications

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“…MAC is defined as administration of local anesthesia along with sedation and analgesia, titrating to a level of sedation that preserves spontaneous breathing and airway reflexes 10,23 . Providers administering MAC must be able to convert to GA and perform intubation if necessary 10 .…”

Section: Introductionmentioning

confidence: 99%

“…The provider alters sedation levels based on clinical and physiologic changes throughout the surgery 5 . While continuous monitoring is required in GA and MAC, meticulous monitoring using pulse oximetry, telemetry, and capnography is especially crucial during MAC, as patients under MAC have been found to experience levels of sedation consistent with the depth of GA 10,11,23,24 . Complications associated with MAC include those related to oversedation and decreased control over the patient's airway, as well as electrocautery‐induced surgical fires in an open oxygen delivery system and accidental systemic toxicity from large amounts of local anesthesia 10,23–26 .…”

Section: Introductionmentioning

confidence: 99%

“…Because the airway is not secured in MAC, laryngospasm is significantly more dangerous in MAC as opposed to GA and can lead to hypoxia, bradycardia, pulmonary edema, cardiac arrest, and death 10 . While respiratory complications occur in both GA and MAC, aspiration events are more common with MAC 10 …”

Section: Introductionmentioning

confidence: 99%

“…5 While continuous monitoring is required in GA and MAC, meticulous monitoring using pulse oximetry, telemetry, and capnography is especially crucial during MAC, as patients under MAC have been found to experience levels of sedation consistent with the depth of GA. 10,11,23,24 Complications associated with MAC include those related to oversedation and decreased control over the patient's airway, as well as electrocautery-induced surgical fires in an open oxygen delivery system and accidental systemic toxicity from large amounts of local anesthesia. 10,[23][24][25][26] Complications associated with oversedation from MAC include hypotension, tachycardia, airway obstruction, and cardiopulmonary depression and/or failure. 10 Because the airway is not secured in MAC, laryngospasm is significantly more dangerous in MAC as opposed to GA and can lead to hypoxia, bradycardia, pulmonary edema, cardiac arrest, and death.…”

mentioning

confidence: 99%

“…10,[23][24][25][26] Complications associated with oversedation from MAC include hypotension, tachycardia, airway obstruction, and cardiopulmonary depression and/or failure. 10 Because the airway is not secured in MAC, laryngospasm is significantly more dangerous in MAC as opposed to GA and can lead to hypoxia, bradycardia, pulmonary edema, cardiac arrest, and death. 10 While respiratory complications occur in both GA and MAC, aspiration events are more common with MAC.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Increasing rates of general anesthesia use in lumpectomy procedures: A 15‐year trends analysis

Rubenstein

Tadros

Slutsky

et al. 2023

Journal of Surgical Oncology

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Background Anesthesia methods in oncologic breast surgery have evolved with less invasive practices. The aims of this study were primarily to examine trends in anesthesia type used during lumpectomy. Methods We analyzed lumpectomy procedures from 2005 to 2019 using the NSQIP database. Upon defining the nadir in general anesthesia (GA) and peak in monitored anesthesia care (MAC) use as 2007, we compared patient characteristics and complications in the 2007 versus 2019 GA and MAC cohorts. Multivariable logistic regression was used to examine associations with receipt of GA. Results Of 253 545 lumpectomy patients, 191 773 (75.6%) received GA and 61 772 (24.4%) received MAC. From 2005 to 2019, GA rates increased from 66.7% to 82.5%, while MAC rates decreased from 33.3% to 17.5%. More GA patients were obese and American Society of Anesthesiologists class 3. Over time, age and body mass index (BMI) increased in both GA and MAC cohorts. Odds of receiving GA increased over time, and predictors included concurrent axillary lymph node dissection (p < 0.0001) or sentinel lymph node biopsy (p < 0.0001). Conclusions We demonstrate increasing use of GA over time for lumpectomy, which may be related to aging lumpectomy patient population with higher BMIs. We also find a strong association between use of GA and concurrent lymph node procedures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Increasing rates of general anesthesia use in lumpectomy procedures: A 15‐year trends analysis

Rubenstein

Tadros

Slutsky

et al. 2023

Journal of Surgical Oncology

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Shared Airway for Tracheal Resection and Anastomosis in a Patient with Severe Subglottic Stenosis after Intra-cardiac Repair for Tetralogy of Fallot

Anandan,

Das

2023

JCCC

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Subglottic stenosis is a condition causing narrowing of the trachea, which can occur rarely secondary to trauma, infection, tumors, inflammatory, and iatrogenic causes. In our case, the child developed subglottic stenosis post-cardiac surgery after being mechanically ventilated in the postoperative period. The causes for subglottic stenosis may be some trauma in the presence of coagulation abnormalities in cyanotic heart diseases such as TOF, the ischemia to the subglottic tissue by reduced perfusion during cardiopulmonary bypass, and/or the trauma caused by crying and fighting of the child while being with the endotracheal tube. Anesthetic management of the surgery is challenging for the anesthesiologist due to the shared airway by the surgeon and the anesthesiologist. The inability to effectively ventilate the patient after induction of general anesthesia will result in catastrophic complications. Subglottic stenosis requires careful planning and execution along with proper communication between the team.

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Shared Airway: Techniques, Anesthesia Considerations, and Implications

Cited by 2 publications

References 29 publications

Increasing rates of general anesthesia use in lumpectomy procedures: A 15‐year trends analysis

Increasing rates of general anesthesia use in lumpectomy procedures: A 15‐year trends analysis

Shared Airway for Tracheal Resection and Anastomosis in a Patient with Severe Subglottic Stenosis after Intra-cardiac Repair for Tetralogy of Fallot

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