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Essentials of Airway Management, Oxygenation, and Ventilation: Part 1: Basic Equipment and Devices
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
Article Category: Other
Volume/Issue: Volume 61: Issue 2
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.2.78
Page Range: 78 – 83

plumbing: (psi × F) / L/min = time remaining in minutes. 1 For example, if a flow of 15 L/min is required from an E-cylinder containing 500 psi, the time remaining would be only 10 minutes. A full tank would provide approximately 44 minutes. DEVICES FOR SUPPLEMENTAL OXYGENATION Nasal cannulas, nasal hoods, various mask designs, and certain resuscitation bags may be used to provide supplemental oxygen for the spontaneously breathing patient ( Figure 2 ). The nasal cannula is ideal for administering supplemental oxygen to sedated patients as

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Figure 6; Suggested minimum devices required for oxygenation and ventilation.
Daniel E. Becker and
Daniel A. Haas
Figure 6
Figure 6

Suggested minimum devices required for oxygenation and ventilation.

Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways
M. B RosenbergDMD,
J. C PheroDMD, and
D. E BeckerDDS
Article Category: Other
Volume/Issue: Volume 61: Issue 3
Online Publication Date: Jan 01, 2014
DOI: 10.2344/0003-3006-61.3.113
Page Range: 113 – 118

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

Figure 2.; Devices for oxygenation and ventilation. (Compilation from personal slides and slides modified from the American Heart Association.)
Daniel E. Becker and
Daniel A. Haas
Figure 2.
Figure 2.

Devices for oxygenation and ventilation. (Compilation from personal slides and slides modified from the American Heart Association.)

Figure 1.  ; Oxygen regulators and cylinder content. Oxygen regulators have various designs but all have the illustrated components. Cylinders have a valve stem at their top that is turned on to release oxygen to the regulator. Cylinders vary in volume of oxygen, but their pressure is identical. A conversion factor can be used to estimate the time remaining in a cylinder at various flow rates. (See text.)
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
<bold>Figure 1. </bold>
Figure 1. 

Oxygen regulators and cylinder content. Oxygen regulators have various designs but all have the illustrated components. Cylinders have a valve stem at their top that is turned on to release oxygen to the regulator. Cylinders vary in volume of oxygen, but their pressure is identical. A conversion factor can be used to estimate the time remaining in a cylinder at various flow rates. (See text.)

Figure 2.  ; Devices for oxygen supplementation.
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
<bold>Figure 2. </bold>
Figure 2. 

Devices for oxygen supplementation.

Figure 3.  ; Bag-valve-mask with reservoir. Top left: Tubing is connected to an oxygen source with 15 L/min supplied to the device and entering the reservoir bag while the ventilation bag is compressed. When the ventilation bag is released, it expands and oxygen within the reservoir is sucked into the ventilation bag filling it with oxygen for the next compression. In some models the reservoir bag is replaced with tubing that functions similarly. Ventilation bag sizes vary from approximately 250 mL for neonates to approximately 500 mL for children and approximately 1500 mL for adults. Top right: It is recommended that bag-valve-mask (BVM) resuscitation bags are equipped with manometers that monitor ventilation pressure. Bottom left and right: One- and two-person BVM ventilations illustrate the proper mask seal using the so-called C-E technique. The mask is sealed with the thumb and first finger forming a “C” configuration over the mask, and the remaining fingers (“E”) are placed under the mandible enhancing the seal and pulling the head into a tilted position.
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
<bold>Figure 3. </bold>
Figure 3. 

Bag-valve-mask with reservoir. Top left: Tubing is connected to an oxygen source with 15 L/min supplied to the device and entering the reservoir bag while the ventilation bag is compressed. When the ventilation bag is released, it expands and oxygen within the reservoir is sucked into the ventilation bag filling it with oxygen for the next compression. In some models the reservoir bag is replaced with tubing that functions similarly. Ventilation bag sizes vary from approximately 250 mL for neonates to approximately 500 mL for children and approximately 1500 mL for adults. Top right: It is recommended that bag-valve-mask (BVM) resuscitation bags are equipped with manometers that monitor ventilation pressure. Bottom left and right: One- and two-person BVM ventilations illustrate the proper mask seal using the so-called C-E technique. The mask is sealed with the thumb and first finger forming a “C” configuration over the mask, and the remaining fingers (“E”) are placed under the mandible enhancing the seal and pulling the head into a tilted position.

Figure 4. ; Basic airway adjuncts.
Daniel E. Becker,
Morton B. Rosenberg, and
James C. Phero
<bold>Figure 4</bold> . 
Figure 4 . 

Basic airway adjuncts.

Figure 3; Hemoglobin Desaturation Following Apnea. All patients were preoxygenated prior to apnea following neuromuscular blockade. Normal adults remain well oxygenated for 8–9 minutes despite absence of ventilation. Obese patients and children have reduced functional residual capacity, so despite preoxygenation, commence significant desaturation within 3–4 minutes. In all cases, desaturation would have occurred far more rapidly had the functional residual capacity not been concentrated with oxygen by preoxygenation (adapted from Benumof JL7).
Daniel E. Becker and
Andrew B. Casabianca
Figure 3
Figure 3

Hemoglobin Desaturation Following Apnea. All patients were preoxygenated prior to apnea following neuromuscular blockade. Normal adults remain well oxygenated for 8–9 minutes despite absence of ventilation. Obese patients and children have reduced functional residual capacity, so despite preoxygenation, commence significant desaturation within 3–4 minutes. In all cases, desaturation would have occurred far more rapidly had the functional residual capacity not been concentrated with oxygen by preoxygenation (adapted from Benumof JL 7 ).

Alternative Transoral Application of Nasopharyngeal Airways
Robert MatsuiDDS, MSc,
Michelle WongDDS, MSc, and
Brian WatersDDS
Article Category: Research Article
Volume/Issue: Volume 67: Issue 1
Online Publication Date: Jan 01, 2020
DOI: 10.2344/anpr-66-03-04
Page Range: 39 – 44

; maxillary hypoplasia; macroglossia; nasal obstruction related to tonsillar, adenoid, lymphoid tissue hypertrophy, or nasal polyps; known unusual nasal anatomy; high risk of prolonged epistaxis (eg, patients on anticoagulants); or who demonstrate mouth-breathing behaviors during DS/GA, the NPA is often ineffective or contraindicated because of its inherent application through the nares and passage through the nasal cavity and nasopharynx. To address this concern, ventilation and the delivery of supplemental oxygenation in these particular patients undergoing dental