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Recognition and management of the difficult airway 

Recognition and management of the difficult airway
Chapter:
Recognition and management of the difficult airway
Author(s):

Charles H. Kates

and Steven Gayer

DOI:
10.1093/med/9780199564217.003.0004
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date: 19 July 2018

Anaesthesia for oral and maxillofacial surgery presents a number of complex problems not shared with most other specialties. These procedures demand special attention in the establishment and maintenance of a patent, functional airway. Anaesthetists must conduct a meticulous evaluation of the upper respiratory tract, understand the unique nature of certain pathologies, and establish ventilatory access that does not interfere with the planned procedure. A great deal of skill in airway manipulation is requisite.

The amount of upper respiratory tract variations and issues coincident with oral surgery are too numerous to tabulate and provide comprehensive answers to, but the provider with adequate background and an armamentarium of knowledge and expertise can deal with these problems as they arise. A recurrent theme of this chapter is that the foremost challenge in the delivery of anaesthesia for oral and maxillofacial surgery relates to airway management. Our discussion is limited to means of evaluating and recognizing the difficult oral surgery patient airway, but also includes management and maintenance of that airway, such that once successfully acquired, its patency is not compromised.

The majority of the chapter's discussion applies to general anaesthesia for maxillofacial surgery in the hospital setting; however, many of the same principles and techniques are applicable to day case outpatient practice as well. The airway management of patients undergoing monitored intravenous sedation is an additional special challenge that will also be addressed.

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