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experienced repeated oxygen desaturations in the range of 87–94%, which were detected by a finger pulse oximetry probe. He responded on each occasion to verbal calls for breaths, which corrected the hypoxemia. However, the corrections were transient and he continued to repeatedly experience hypoxemia. On visual inspection of the oropharynx, a lesion was discovered attached to the uvula ( Figure 3 ). The pedunculated nature of the lesion allowed it to extend and partially obstruct the airway, analogous to a bungee cord. The lesion was immediately excised without

A century ago, in 1920, Magill and Rowbotham 1 pioneered the concept of nasotracheal intubation (NTI). By blindly inserting a red rubber oral tube with a lateral bevel through the nostril and using Magill forceps to direct the tube into the trachea, they provided a ground-breaking airway management solution for many surgical interventions requiring concurrent access to the oral and maxillofacial complex. NTI is a safe technique in skilled hands; however, the passage of a bevelled endotracheal tube (ETT) through the nasopharynx may

Anatomic and functional changes after oral surgery often cause difficulties with airway management because of maxillofacial deformation, mandibular defect, and trismus. The cuffed oropharyngeal airway (COPA; Mallinckrodt Medical, Athlone, Ireland; Figure 1 A), a modification of the Guedel oropharyngeal airway 1 , 2 with an asymmetrical cuff, fits the peripheral pharyngeal tissue for a proper seal. The COPA is one of the airway devices that can be inserted through the mouth under spontaneous respiration ( Figure 1 B). This report deals with

This article reviews the evolution and use of advanced airway devices, specifically supraglottic airways (SGAs), with the emphasis on the laryngeal mask airway (LMA), as the next intervention in difficult airway and ventilation management after bag-mask ventilation has been attempted. Management of the unexpected difficult airway during deep sedation and general anesthesia remains the most important aspect in avoiding mortality and morbidity because of the severe consequences of inadequate ventilation and oxygenation, especially in out

A thorough and focused assessment of the airway prior to the planned administration of moderate sedation or deep sedation/general anesthesia (GA) is of vital importance. Over the years, studies of closed claims have focused on the association of respiratory and airway issues with mortality and severe morbidity in hospital and off-site locations. 1 – 3 The Closed Claims Project of the American Society of Anesthesiologist (ASA) evaluated adverse anesthetic outcomes obtained from the closed claim files of 35 U.S. liability insurance companies

Nasal or oral fiberoptic intubations are often perceived to be the safest options to manage a challenging airway. Patients undergoing intraoral, oropharyngeal, maxillary, mandibular, and dental procedures or reconstructions are usually intubated nasally to facilitate surgical exposure. 1 Nasotracheal intubation can be achieved by various methods, including direct laryngoscopy with or without McGill forceps, video laryngoscopy, and awake or asleep flexible fiberoptic bronchoscopy; however, when attempting to intubate a difficult airway, a

, comprising 31% of all hospital day surgeries within this age group. 5 The gold standard for airway management is endotracheal intubation, 6 a vital component of GA since the late 1800s that provides a secure patent airway, eases ventilation, and protects against laryngospasm and aspiration. 7 However, intubation may be associated with complications including failure of placement, trauma to the oral or nasal anatomy, bronchospasm, obstruction, aspiration, epistaxis, postoperative sore throat, and damage to the laryngeal tissues. 8 , 9 Therefore, anesthesia

Dental treatment for spontaneously ventilating patients using total intravenous anesthesia to provide deep sedation/nonintubated general anesthesia (DS/GA) often requires concurrent use of airway adjuncts to maintain airway patency. A nasopharyngeal airway (NPA) is often the preferred airway adjunct in nonintubated DS/GA dental cases because the Guedel oropharyngeal airway (OPA) or the flexible laryngeal mask airway may impede intraoral access. However, in patients who have findings of obesity; mandibular retrognathia or hypoplasia