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Facemask anaesthesia may be suitable for airway maintenance for short anaesthetic procedures. Many anaesthesia facemasks are delivered with a multipronged o-ring around the collar of the connector. Maintenance of the patient's airway may be facilitated by use of an oropharyngeal or nasopharyngeal airway. Supraglottic airway devices (SADs) have several roles including anaesthesia, airway rescue after failed intubation or out of hospital use during cardiopulmonary resuscitation and as conduits to assist tracheal intubation. There are several classifications of SADs with most based on device anatomy and positioning. First generation SADs (e.g., classic laryngeal mask airway (cLMA)) are simply airway tubes, with no specific design features to improve safety (or ventilation efficacy). Second generation SADs include proseal laryngeal mask airway, the laryngeal tube suction II, LMA Supreme, streamlined liner of the pharynx airway (SLIPA) and combitube and easytubes. SADs are established methods for management of the difficult airway.
This chapter discusses the fundamental thermodynamic concepts such as laminar flow and turbulent flow. Flow tends to be turbulent in upper airway obstruction, so gas density is influential. The functional anatomy of the upper airway can be reduced to a consideration of a collapsible segment (the pharynx) between two rigid segments (the nasopharynx and the trachea). This system behaves as a Starling resistor and airflow can become limited or completely abolished during spontaneous (negative intrathoracic pressure) breathing. Maintenance of pharyngeal airway patency is a complex neuromuscular phenomenon. In airway obstruction at the pharyngeal level, inspiratory flow may not be increased by increased inspiratory effort, but can be increased by positive pressure applied above the obstruction. The chapter describes the physics and function of a device which permitted ventilation of patients during bronchoscopy. There are a number of misconceptions regarding the operating principles of the Sanders injector.
Patients with chronic graft versus host disease (cGVHD) experience a variety of health needs that result directly from the physical, functional, and psychosocial effects of the disease, are produced as side effects of immunosuppressive treatments, or derive from the late treatment effects of high-dose therapy and hematopoietic stem cell transplantation (HSCT). The achieving optimal outcomes for patients with cGVHD requires the coordinated efforts of an interdisciplinary team delivering a comprehensive range of clinical services in both community-based and specialty care settings. The services must be designed to promptly detect, effectively mitigate, and, where possible, prevent these sequelae. This chapter focuses on the principles of interdisciplinary practice in the care of patients with cGVHD. The chapter examines seven fundamental elements for successful interdisciplinary practice in cGVHD. These elements address (1) the composition, functioning, leadership, and coordination of the team, (2) the organizational service delivery model, (3) communication and collaboration, (4) eliminating barriers to access to needed services, (5) the development of standards of care, standard operating procedures, and evidence-based guidelines, (6) involvement of patient and family, and (7) coordination and continuity of care between specialty care centers and community. Case vignettes illustrate the application of the principles of interdisciplinary care and analyze the features of interdisciplinary team functioning that contribute to optimal clinical outcomes in HSCT survivors with cGVHD and the family members and communities who are caring for them.
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