Airway Management in ICU Settings

Maintenance of patent airway, adequate ventilation, and pulmonary gas exchange is very important in critically ill patients. Airway management in intensive care patients differs significantly from routine surgical procedures in the operating room. The airway competence in intensive care unit (ICU) should be coping with the rapidly evolving advances in airway management. Therefore, efforts should be focused on the three pillars of airway master: airway providers as intensivists or critical care physicians, equipment, and operational plans. Not all institutions can afford all airway equipment in the market; however, they should make sure that critical care providers have a full access to the available tools and they are comfortable using it. Educational sessions and refresher courses should be tailored to meet the competence level of the ICU providers and equipment availability. Operational plan includes developing institutional airway protocols and implementing difficult airway guidelines. The protocols should consider different staffing models of ICU and make sure all the time at least one member of the team with the highest experience in airway should be always available. The aim of writing this chapter is to enable the intensivist to optimize their use of airway equipment and managing high‐risk patients in ICU

Pain Management for Pregnant Women in the Opioid Crisis Era

Acute and chronic pain management during pregnancy, after delivery and even during lactation are challenging even for experienced physicians. This chapter intends to cover pregnancy-induced physiological changes in relation to pain conditions. It also covers the most common pain disorders in pregnancy and provides a comprehensive summary of the pharmacological and non-pharmacological options for pain management in pregnancy. Additionally, pain management in context of opioid abuse will also be covered, as high prevalence of opioid prescription is linked to the very poor maternal and fetal outcomes. The possibility of maternal opioid abuse and fetal opioid withdrawal should be known to all physicians, given its rising trends. Multimodal protocols and opioid sparing strategies are highly essential for safe pain management during pregnancy and have been discussed. This chapter is intended to be a fast and detailed review for residents, pain fellows, and physicians who seek pain control in pregnant women

Management of Acute Pain in Obese Patients with Sleep Apnea

Perioperative pain management for obese patients is daily challenges for anesthesiologists especially if complex comorbidities such as Obstructive Sleep Apnea and cardiovascular disease coexist. Limitations to effective pain management in this group are multifactorial, that includes technical difficulty with regional techniques, limited expertise, unavailability of standardized guidelines and lack of familiarity with recent multimodal analgesic regimens. Opioid-related complications such as narcotic-induced ventilatory depression in these group of patients poses another critical concern for both trainees and the experienced anesthesiologists. This chapter is intended for residents, fellows, as well as senior perioperative physicians, and will explore various regional and pharmacological options for acute pain management in this special population based on recent advances and available evidence

Airway Management in Full Stomach Conditions

Pulmonary aspiration in the perioperative period is one of the well-known complications under anesthesia and procedural sedation. A full stomach condition either due to non-adherence to fasting guidelines or due to various other factors that delay gastric emptying are the most common causes. Following aspiration, a patient may develop a wide spectrum of clinical sequelae. The key factors in preventing aspiration include proper pre-operative assessment, appropriate premedication and operating room preparations. Rapid sequence induction and intubation is the recommended technique for securing the airway in cases of full stomach. Management of aspiration depends on the nature of the aspirate. Pre-operative fasting guidelines have been established by various medical societies which may be modified in special circumstances of high risk of aspiration. Prediction of difficult airway in certain cases of full stomach necessitates clinical expertise in airway management

Experimental effect of different dilutions of blood with human plasma protein fraction and large dose factor one on blood coagulation and chemistry in vitro

Background and Aims: Human plasma protein fraction 5% (PPF5%) is an albumin-based colloid used to expand the plasma volume during volume deficiency. The current basic medical experimental study assessed in vitro coagulation of PPF5% solution and its effects on blood coagulation and chemistry. Methods: The study involved 20 volunteers, and each volunteer donated 20-50 ml of fresh blood. Three dilutions of blood with PPF5% dilutions were prepared (30, 50, and 70%). The fibrinogen dose required to correct coagulation in the 50% diluted samples was assessed (two doses used). The thromboelastogram (TEG) measured the haemostatic parameters (fibrinogen level, initiation of coagulation [R time], kinetics [K], acceleration of coagulation [α angle], maximum amplitude [MA] and coagulation index [CI]), and the ABL gas analyser measured the blood chemistry changes. Results: All dilutions showed significant TEG and blood chemistry changes when compared to controls. The two doses of fibrinogen corrected the clot formation speed with no significant difference in speed between the two doses. Acidosis measured by the strong ion gap (SID) and pH were significant for all dilutions when compared with the baseline. The 30% dilution remained within the lower normal acceptable value while 50% dilution was beyond the critical normal values. Conclusion: In vitro PPF5% to replace blood loss up to 50% dilution did not have significant coagulation and blood chemistry effects while coagulopathy should be expected in extreme dilutions (70%). Fibrinogen in a dose equivalent to 4 gm/70 kg adult improved clot strength at 50% dilution. Wolters Kluwer Medknow Publications</p