What combination of quantitative and qualitative data is used by advanced practitioners to decide readiness for airway manipulation? Do you think describing this process may help trainees improve airway management skills?
Aside from the traditional lash reflex test I will test the patient's jaw tightness before attempting an airway manipulation. Patients reach readiness for airway manipulation at different rates and with varying dosages of medications depending on, metabolic rate, cardiac function, volume status and nutritional state. So 20 seconds either way can have a big effect. If you do not have adequate hypnotic and neuromuscular junctions blockade levels at the time of airway manipulation this can cause brochospasm, laryngospasm and damage to the oropharynx.
I think the best way to predict the accurate deep of anaesthesia is using the EEG tracing, but if you look only at overal number (bispectral index), there is substantial delay in change of this number after getting the anaesthesia deeper. You can combine it with relaxometry because even having enough deep of anaesthesia I saw reflexes after manipulation with the air-ways. Personaly, I like remifentanyl - using it you can nicely steer the level of analgesia during intubation and then during following ,,valley,, phase of surgical preparation till the incision.
I agree with Jessica. I would like to add that repetition is the key to learning the nuances related to induction of anesthesia and airway manipulation readiness.
Regards,
Christopher
Airway manipulation and for that matter, laryngoscopy and tracheal intubation should be conducted when the patient is deeply anesthetized ( preferably a BIS score of 40-60)and having adequate muscle relaxation with a TOF of zero. Apart from the eye lash reflex, I personally have witnessed that Syringe drop technique also has a good correlation with the BIS and the eye lash reflex.
To Dr.Khan: Can you explain what me is the ,,Syringe drop technique,,? Thanks
The patient is asked to hold a 50 ml syringe with his thumb and indexe finger and the induction of anesthesia is initiated. Once the sringe drops, it tells us that the patient is fully unconcious foloowing which a muscle relaxant is hiven and once there are no twitches on the TOF , intubation is executed. This is the syringe drop technique and it correlates with eyelash reflex that we use customarily.
Dear Dr Milan, I hope I have explained it in toto.
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