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Tracheal intubation in the emergency setting can be difficult with the fiberoptic bronchoscope due to blood, vomit, or secretions in the airway and poor patient cooperation. Because of this, patients with massive facial injury, complete upper airway obstruction, severely diminished ventilation, or profuse upper airway bleeding are poor ...
Human errors include repeated attempts at intubation during which the short-acting anesthetic may wear off but the paralyzing drug does not; esophageal intubation; inadequate drug dose; a drug given by the wrong route or a wrong drug given; drugs given in the wrong sequence; inadequate monitoring; patient abandonment; disconnections and kinks ...
Patient and doctor describing state of consciousness similar to "twilight anesthesia" Twilight anesthesia is an anesthetic technique where a mild dose of sedation is applied to induce anxiolysis (anxiety relief), hypnosis, and anterograde amnesia (inability to form new memories). The patient is not unconscious, but sedated.
In patients with known difficult airways, fiberoptic intubation can be considered. This technique involves the use of a flexible fiberoptic bronchoscope for visualization of the vocal cords. The bronchoscope can be passed directly into the trachea and the endotracheal tube can be threaded over the bronchoscope into position.
This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents .
Procedural sedation and analgesia (PSA) is a technique in which a sedating/dissociative medication is given, usually along with an analgesic medication, in order to perform non-surgical procedures on a patient. The overall goal is to induce a decreased level of consciousness while maintaining the patient's ability to breathe on their own.
[45] [46] They are also used to lessen the sympathetic stress response, cough reflex during laryngoscopy or intubation, and supplement sedation by synergistic effects. [ 47 ] [ 48 ] The dose of sedative-hypnotic agents should be reduced due to the synergistic effects when combined with adjuvant agents.
However, patients can be given sedating and paralytic drugs to minimize discomfort and help out with intubation. Pretreatment includes 100% oxygen, lidocaine, and atropine. 100% oxygen should be administered for 3 to 5 minutes. The time depends on pulse rate, pulmonary function, RBC count, and other metabolic factors. Lidocaine can be given in ...