Using Muscle Relaxant with LMA

Have you ever used muscle relaxant with LMA? Is muscle relaxant contraindicated with the use of LMA? We all know what is the answer in the textbook: the use of muscle relaxant in LMA case would not be supported. But recent studies have shown that the use of muscle relaxant with LMA cases are beneficial…

What Does the Airway Assessment Really Tell You?

Every time you see a patient in preop, you do your routine airway assessments to predict whether patient has an easy or difficult airway. Have you ever asked yourself  what the assessments really tell you and why some patients would have difficult airways based on your Mallampati score, neck circumference mouth opening or the protruding teeth? It…

Tips with Glidescope

Some of the students asked me the tips with the glidescope for the anterior airway when I was in clinical the other day. I remember I had struggled with the glidescope for the anterior airway when I first started using it. I had to do some research online to figure out how to get the…

Cricoid Pressure – Friend or Foe?

This is another dogma I feel overdue for discussion. This is one practice that was instilled in our training when we were students: trauma/NPO non-compliant would get RSI with CP.    Cricoid pressure was originally described by Sellick with the patient in a head down, tilted to the left position back in 1960’s. It was claimed that…

Are We Afraid of General Anesthesia for Cesarean Section?

Are we afraid of general anesthesia for cesarean section? I remember when I was in school, I learned from the lecture that there are 3 reasons for avoiding GA besides decreased patient’s satisfaction and sleepy baby with GA. They are (1) difficult airway management (2) increased risk for aspiration (3) increased risk for uterine atony. I…

Should We Ausculatate After Intubation?

Since I graduated from anesthesia school, I have given up the time-honored habit of routine chest auscultation after passing the tracheal tube through the glottis. This is another practice that we have been taught in school as one of the best ways to confirm tube placement. I still remembered the first time I was asked…

Ditch the Needle, Teach the Knife Part II

Dr. Larson, a well-known anesthesiologist at Stanford once stated that an emergency cricothyrotomy is much quicker, easier, safer and more effective than any needle-based technique. I can state with confidence that there is no place in emergency airway management for needle-based attempts to establish ventilation. As you all can tell, I love airway topics as…

Perpetuation of Three-Axis Alignment Theory and the Sniffing Position

We have read and been taught that sniffing position is the foundation for the difficult airway as placing the patient in the “sniffing position” facilitates aligning the three axes to visualize the larynx. Do you know that the THREE AXIS ALIGNMENT THEORY was proposed by Bannister and MacBeth in 1944. What they did was to take…

Should We Mask Ventilate Before Giving Muscle Relaxant?

Have you ever wondered whether we should mask ventilate before giving muscle relaxant? I know we were taught that we should attempt to mask ventilate first. But is this evidence based?  The answer is that this practice is really not evidence-based. There is a growing body of evidence suggesting that the NBD should be given…