Anaesthesia in XXXX and in the emergency room.

@entity1 @entity341 @entity26 @entity3652 @entity2898 @entity19271
AIMS: To review anaesthesia in @entity341 and in the emergency room, and to discuss guidelines for anaesthesia indication; pre-oxygenation; anaesthesia induction and drugs; airway management; anaesthesia maintenance and monitoring; side effects and training. METHODS: A literature search in the PubMed database was performed and 87 articles were included in this non-systematic review. CONCLUSIONS: For pre-oxygenation, high-flow @entity26 should be delivered with a tight-fitting face-mask provided with a reservoir. In haemodynamically unstable @entity1 , @entity3652 may be the induction agent of choice. The @entity2898 antagonist @entity19271 may have the potential to make @entity2898 a first-line neuromuscular blocking agent in emergency induction. An experienced health-care provider may consider prehospital anaesthesia induction. A moderately experienced health-care provider should optimise oxygenation, fasten hospital transfer and only try to intubate a @entity1 in extremis. If intubation fails twice, ventilation should be resumed with an alternative supra-glottic airway or a bag-valve-mask device. A lesser experienced health-care provider should completely refrain from intubation, optimise oxygenation, fasten hospital transfer and only in extremis ventilate with an alternative supra-glottic airway or a bag-valve-mask device. With an expected difficult airway, the @entity1 should be intubated awake. With an unexpected difficult airway, bag-valve-mask ventilation should be resumed and an alternative supra-glottic airway device inserted. Senior help should be called early. In a "can-not-ventilate, can-not-intubate" situation an alternative airway should be tried and if unsuccessful because of severe upper airway pathology, a surgical airway should be performed. Ventilation should be monitored continuously with capnography. Clinical training is important to increase airway management skills.
