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5 results

  • Chapter 11 - Respiratory Compromise in Moderate and Deep Sedation

  • Edited by Richard D. Urman, Ohio State University, Alan David Kaye, Louisiana State University School of Medicine
  • Book:
    Moderate and Deep Sedation in Clinical Practice
    Published online:
    12 December 2024
    Print publication:
    19 December 2024, pp 143-151

  • Summary

    Sedation and anesthesia are common triggers of respiratory compromise, which often manifests as depression of respiratory drive, airway occlusion, and resultant hypoxemia and hypercarbia. The respiratory compromise cascade (Figure 11.1) can be understood as a set of states through which a patient moves from respiratory insufficiency toward respiratory failure and, ultimately, respiratory arrest. While the movement of a patient through the cascade is not linear, the effect of increasing momentum with progression to each phase occurs. Therefore, the later the patient is recognized in the cascade, the more serious the interventions to restore normal gas exchange become.

  • Chapter 20 - Anesthesia for Zenker's diverticulectomy

  • from Section 3 - Anesthesia for head and neck surgery
  • Edited by Basem Abdelmalak, John Doyle
  • Book:
    Anesthesia for Otolaryngologic Surgery
    Published online:
    05 November 2012
    Print publication:
    18 October 2012, pp 195-202

  • Summary

    The location of Zenker's diverticulum along with the inherent risks of aspiration at any given stage of surgery (pre-, intra- or postoperative periods) adds an element of unique difficulty in the anesthetic approach to these patients. This chapter explores the anesthetic considerations for this unique procedure. The surgical procedure is generally curative and a majority of the patients live symptom-free for the rest of their lifetime. A main concern during the induction period is to safely secure the airway without increasing the risk of aspiration. While regurgitation and aspiration may occur during induction of anesthesia and during intubation, they might still happen even after successful uneventful intubation. Pertinent perioperative evaluation should include detailed cardiovascular and nutritional status evaluation and optimization. Perforation of Zenker's diverticulum may occur during a difficult intubation, or during blind placement of a nasogastric tube.