Adult Airway Management

Abstract

Adult Airway Management: Principles and Techniques, Rafael A. Ortega and Harold Arkoff. Norwood, MA: SilverPlatter Education, Inc., 1994, 250 pp, $175.00 individual, $495.00 library for a multimedia CD-ROM compact disc. Requirements: Windows PC--8 MB RAM, Microsoft Windows, version 3.1, hard disc with 4 MB free space, MS DOS 5.0 or later, MPC standard CD-ROM player, sound board, and speakers. Macintosh--8 MB RAM, system 7.0 or later, CD-ROM player, standard Mac color monitor, and Mac sound. This CD uses a multimedia approach demonstrating the equipment and techniques applied for airway management. It is designed for use with a personal computer by people with only basic computer skills. This CD covers a great deal of information in 17 chapters. Each chapter is minimal in text, is narrated well, and combines pictures, drawings, and video presentation. Similar to a textbook, the CD has a Table ofcontents consisting of 17 chapters with a total of 250 pages. Chapters vary in length from 2 to 47 pages. Chapters 1 and 2 discuss airway anatomy and evaluation of the airway. Chapter 3 jumps to causes and management of foreign body airway obstruction, followed by descriptions of endotracheal tubes and double-lumen tubes in Chapters 4 and 5. Adult Airway Management: Principles and Techniques includes a considerable amount of pediatric material, suggesting that a change in title might be less misleading. The airway is described from the nares to the carina. The bronchial anatomy was excluded. One of the factual errors was in the description of the four eminences in the aryepiglottic fold as being the arytenoids; later these are correctly noted to be the paired cuneiform and corniculate cartilages. The title of Chapter 12, "Translaryngeal Injection," would be better if changed to "Anesthesia and Analgesia of the Airway," as it describes different techniques of topical anesthesia and superior laryngeal and glossopharyngeal nerve blocks to abolish the pain, gag, and cough reflexes during awake oro-naso-tracheal intubation. Chapter 13, "What Is a Difficult Airway?" would also benefit from a title change and reorganization of the contents. This 47-page chapter devotes two pages to the American Society of Anesthesiologists algorithm for the difficult airway. The rest of the chapter describes various techniques applied to the management of the difficult airway. Six pages are devoted to the use of the esophageal obturator and esophageal-gastric tube airway, and four pages describes the Augustine guide, compared with three pages devoted to fiberoptic intubation, which includes description of the endoscopy mask and intubating airways. Chapter 15, "Extubation Criteria," not only covers the criteria applied for tracheal extubation, but also discusses extubation techniques, difficult extubation, complications of extubation, and prevention and treatment of complications during and after extubation. The usual textbook is intrinsically linear, with each chapter to be read straight through. Nonlinear books make excellent CDs, allowing searching and cross-referencing to be performed readily. The true multimedia approach should be multilevel and interactive, allowing each use of the CD to be a different experience, to access diverse but self-contained portions of information on each occasion. This CD on adult airway management goes only partway toward full use of the multimedia potential. The CD does include useful animation, film, and sound clips, but otherwise does not progress beyond being a commentary and slide show. In the next edition, the authors might consider the use of hypertext to explain difficult concepts or to hide less informative sections. Several of the links provided were imperfect in their execution and could be improved. In summary, the main menu is clear and gives good coverage of the CD's extensive contents. The optional use of video and sound clips allows the user additional insight not usually available in a book. The text is short and informative, each page designed to be self-contained. This is a good start for multimedia presentation of airway management. The authors are to be congratulated on their extensive review of this topic. Andranik Ovassapian, MD Colin Shanks, MD Department of Anesthesiology Northwestern University Medical School Anesthesiology Service V.A. Lakeside Medical Center Chicago, IL 60611