Mendonca, C. (2019) Advancing technology in airway management. PhD thesis, University of Warwick.

Preview

PDF WRAP_Theses_Mendonca_2019_Redacted.pdf - Submitted Version - Requires a PDF viewer. Download (1802Kb) | Preview

Request Changes to record.

Abstract

This thesis presents work from seven papers on airway management. The key principle explored is safely delivering oxygen to the lungs in an anaesthetised patient. Modern technology, particularly using a miniature video camera to visualise the anatomy of the airway, has revolutionised airway management. A thorough airway assessment, anticipation of difficulty, preparedness to manage an unanticipated difficulty are all essential components of safe airway management. The Difficult Airway Society (DAS) 2015 guidelines provide a strategy to manage unanticipated difficulties with airway management. An early recognition of difficulties, communication with team members and the use of advanced techniques are emphasised in the guidelines.

Facemask ventilation is an integral skill and an essential fall-back technique for maintaining oxygenation when a supraglottic airway device or tracheal intubation fails. My paper on facemask ventilation showed that neuromuscular blockade improves facemask ventilation and, therefore, oxygen delivery prior to a tracheal intubation attempt. The DAS 2015 guidelines recognise the importance of optimum head and neck position in achieving high success rate at first attempt of laryngoscopy. My paper reassures that both the “sniffing” and neutral positions are acceptable whilst using videolaryngoscopes for tracheal intubation. In an anticipated difficulty, awake tracheal intubation enhances patient safety and I have demonstrated that videolaryngoscopes have a comparable success rate and patient acceptance to that of flexible fibrescope.

When attempts to deliver oxygen by facemask, a supraglottic airway device and tracheal intubation have failed, a ‘can’t intubate can’t oxygenate’ situation arises. This requires emergency front of neck access to deliver oxygen to the lungs. As this is a very stressful situation, regular training using simulation is essential for all anaesthetists, surgeons, operating theatre teams and physicians involved in airway management. My three papers on emergency front of neck access emphasise the role of structured training in a simulated operating theatre environment.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RC Internal medicine R Medicine > RF Otorhinolaryngology
Library of Congress Subject Headings (LCSH):	Airway (Medicine), Artificial respiration, Breathing apparatus, Anesthesiology, Trachea -- Intubation
Official Date:	April 2019
Dates:	Date Event April 2019 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Sponsors:	Perkins, Gavin D.
Format of File:	pdf
Extent:	1 volume (various pagings) : illustrations, charts
Language:	eng

Request changes or add full text files to a record

Repository staff actions (login required)

View Item

Downloads