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The flexible optical bronchoscope has unparalleled utility for difficult airway management and is part of every difficult airway management algorithm. The device can facilitate intubation for patients with airway tumours and bony or soft tissue abnormalities. It provides continuous visualisation of the airway during management, can be used to deliver local anaesthetics to the airway and is relatively less traumatic compared to other devices. Mastery of the device requires significant practice and the practitioner must use the device regularly to maintain skills. Several tips for success and pitfalls to be avoided are discussed.
One of the ways of producing some structure to the way in which we think about managing normal and difficult airways is by algorithm or flow-chart. Sedation makes treatments such as endoscopies, tracheal intubation, dental treatment and minor surgical procedures more tolerable. Neuro-muscular blocking drugs (NMBS) are powerful drugs, indubitably dangerous in untrained hands. NMBDs make a vital contribution to patient safety; it is worth recalling what anaesthetic practice must have been like without them. The classic causes of acute airway obstruction include haematomas or tissue swelling after thyroid or anterior cervical spine or carotid surgery, trauma, or pharyngeal and laryngeal infections. Humans make errors, which in retrospect can seem distressingly obvious. Those involved in airway management need to appreciate that in critical situations there will not be time for detailed, analytical decision making, and be wary of fixating on issues or techniques that are not contributing to success.
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