ROLES OF THE ANESTHESIOLOGIST
Airway Management Consultation
In addition to the usual role in providing airway management during
the administration of an anesthetic, the anesthesiologist may be consulted as an
expert in airway management in settings outside the operating room. These consultations
may involve the provision of an acute airway or the management of problems that have
arisen in the patient requiring ongoing endotracheal intubation. Considerations
in the acute setting include a variety of clinical situations such as trauma, upper
airway obstruction, and medical conditions that must be specifically addressed to
provide optimal care. These intubations are particularly high risk because the patients
are often hemodynamically unstable.[67]
In the
patient requiring long-term endotracheal intubation, the issues of site of intubation,
leak-free ventilation, tube changes, laryngeal injury, and tracheostomy may be encountered.
[68]
Anesthesiologists may also be directly involved
in
performing percutaneous dilational tracheostomy or anesthetic and airway support
for the procedure in the intensive care unit. Acute and chromic settings require
a solid background in airway management principles and the ability to deal with unusual
and unpredictable problems in a relatively foreign environment. Two reviews address
these areas in detail.[69]
[70]
