Topical Anesthetics to support Intubation

Local Anesthesia for Awake Intubation

Topical anesthetic products can play a pivotal role in the comfort and safety of patients in the operating room. When used in conjunction with awake intubation, for example, and delivered with skill and care, these agents can lessen or even eliminate the need for sedation, thereby greatly improving patient cooperation during surgical procedures…..

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Aspiration in Obstetric Anesthesia


You might have read the previous post on Airway management in obstetric anesthesia.

this post is an extension to the previous one.

  • Pulmonary aspiration is defined as the inhalation of foreign material below the level of the vocal cords and into the lower respiratory tract
  • Pulmonary aspiration is the commonest cause of death in association with complications of airway management.
  • Pregnant women are at increased risk of aspiration due to a number of factors including delayed gastric emptying.
  • The factors increasing the risk of aspiration associated with pregnancy include the gravid uterus, progesterone-mediated lower oesophageal sphincter relaxation, lower gastric pH and delayed gastric empting during labour.
  • Aspiration pneumonitis is called Mendelson’s syndrome in pregnancy and can have deleterious effects secondary to lower pH of gastric contents.
  • Recent policies now recommend a light diet in established labour. It is not clear whether the change to policy on oral intake will impact on the frequency of maternal aspiration.

Here is an online video of approx 50 min which discusses the problem of aspiration in a pregnant patient.

Also added two presentations on aspiration pneumonitis .These are not from Obstetric anesthesia point of view per se but are still a good read.

Video on Aspiration in Obstetric Anesthesia

Two Presentations on Aspiration Pneumonitis from Medicine Perspective….

Aspiration Pneumonia

Regardless of the type of aspiration material, there is an acute inflammation in the lung characterised by neutrophil infiltration, alveolar haemorrhage, intra-alveolar and interstitial oedema, and impairment of alveolar fluid clearance. This is followed by a repair process characterised by scavenging of alveolar detritus by macrophages and proliferation of type II alveolar epithelial cells.

Aspiration Pneumonia medicine

Also look at our Obstetric Anesthesia section to read more articles on the subject.

We have a dedicated Airway management section . Also look for articles of your interest.

Difficult Airway Management Part -2 Guidelines

Part two of our feature on difficult airway management . Here i am posting guidelines from ASA, and a few more. Do post your comments in the section below.


A presentation on recognizing difficult airway

A Presentation on Airway anatomy and Management

Airway Management in intensive care Unit


A Chapter on Anticipated Difficult Airway

I found this chapter on slideshare, I didn’t upload it. If there is any copyright infringement, please report and i will remove it


 Contents of Difficult Airway Trolley

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An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach™)


More Algorithms on difficult airway management

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Difficult Airway Management – Part 1- Presentations

Difficult airway

is defined as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation of the upper airway, difficulty with tracheal intubation, or both.

It can be further described as follows

1. Difficult face mask ventilation:

(a) It is not possible for the anesthesiologist to provide adequate face mask ventilation due to one or more of the following problems: inadequate mask seal, excessive gas leak, or excessive resistance to the ingress or egress of gas.

(b) Signs of inadequate face mask ventilation include (but are not limited to) absent or inadequate chest movement, absent or inadequate breath sounds, auscultatory signs of severe obstruction, cyanosis, gastric air entry or dilatation, decreasing or inadequate oxygen saturation (SpO2), absent or inadequate exhaled carbon dioxide, absent or inadequate spirometric measures of exhaled gas flow, and hemodynamic changes associated with hypoxemia or hypercarbia (e.g., hypertension, tachycardia, arrhythmia).

2. Difficult laryngoscopy:

(a) It is not possible to visualize any portion of the vocal cords after multiple attempts at conventional laryngoscopy.

3. Difficult tracheal intubation:

(a) Tracheal intubation requires multiple attempts, in the presence or absence of tracheal pathology.

4. Failed intubation:

(a) Placement of the endotracheal tube fails after multiple intubation attempts.

I have found a lot of resources on internet regarding the topic. I am sharing a few of them here….


A powerpoint presentation on the topic


Another PPT



And Another



Yet Another

I will post part two tomorrow with downloadable PDF guidelines from ASA and other societies. If you want to be informed of new articles via email, please subscribe through the box on the right.

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 Read More Articles on Difficult Airway Here…..


Tracheotomy refers to the surgical opening of the trachea while tracheostomy refers to the creation of a
stoma at the skin surface, which leads to the trachea.

The history of surgical access to the airway is largely one of condemnation. This technique of slashing
the throat to save a life was known as semi-slaughter. However, once the technique was perfected as a
last  resort  in  largely  hopeless  cases  of  diphtheria,  the  opportunities  it  offered  for  medical  heroism
ensured its place in the surgical armamentarium, such that Fabricius could write in the 17th century,
“This operation redounds to the honor of the physician and places him on a footing with the Gods”.
Tracheostomy was performed in ancient Egypt and is one of the oldest surgical procedures. 1  Chevalier
Jackson described the principles of tracheostomy at the beginning of the 20 th  century. 2

Tracheostomies  may  be  temporary  or  permanent.  A  temporary  tracheostomy  may  be  used  as  a
permanent  tracheostomy  however  there  will  still  be  a  communication  between  the  pharynx  and  the
lower airway via the larynx.

Given below are some powerpoint presentations on tracheostomy. some of them i found on internet and a few i uploaded myself.

Do share them for benefit of community

Tracheostomy Overview


Tracheostomy Presentation for PG students

Percutaneous Tracheostomy


Care of  Tracheostomy

Tracheostomy PDF

ISA Kakinada