الفهرس 
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Abstract
Summary
Providing anesthetic care to the patient with a difficult airway keenly interests anesthesiologists and is a situation that often provokes much anxiety and trepidation. However, dealing effectively and safely with these patients is a skill that all anesthesiologists should be familiar with and are expected to perform with competency. While there are many methods that may be used to provide anesthesia to the airway, descriptions of these methods tend to be widely scattered throughout various textbooks and journals, and the choice of which method to use is often based on limited information, such as institutional tradition and personal experience. Therefore, we will cover the neuroanatomy of the upper airway and then describe several techniques that can be used to provide airway anesthesia.
As airway assessment, investigation and management becomes increasingly refined, the search for a single, reliable predictor of the difficult airway continues. A number of bedside tests are available to the anesthetists wishing to make an assessment for features which might predict potential airway difficulties. However, unexpected airway problems can arise despite the ever-increasing array of assessment tools available to us. This should be borne in mind at all times. No one test can predict airway difficulties with a high degree of sensitivity or specificity, but a combination of tests may be helpful. Careful assessment of
Summary
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the airway and consideration of more than one factor is therefore recommended.
Three major neural pathways supply sensation to airway structures; Terminal branches of the ophthalmic and maxillary divisions of the trigeminal nerve supply the nasal cavity and turbinates, the oropharynx and posterior third of the tongue are supplied by the glossopharyngeal nerve and Branches of the vagus nerve innervate the epiglottis and more distal airway structures. The airway reflexes important for awake intubation are Gag reflex, Glottic closure reflex and cough reflex.
A calm and comfortable patient is much more likely to cooperate with the anesthesiologist during these procedures, thus making the process easier and more successful. Antisialogogues and vasoconstrictors for the nasal mucosa should be used before any airway instrumentation, in the absence of contraindications.
Topical anesthesia of the airway mucosa is generally accomplished by either some form of spraying of a local anesthetic solution onto the respiratory mucosa or by applying it directly to the mucosa itself. While nerve blocks are often more technically difficult to perform and generally carry a higher risk of complications (including bleeding, nerve damage, and intravascular injection) than the noninvasive methods, in experienced hands they are useful and provide excellent anesthesia and intubating conditions. There are 3 blocks are used to provide
Summary
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anesthesia to the upper airway: glossopharyngeal (oropharynx), superior laryngeal (larynx above the cords), and translaryngeal (larynx and trachea below the cords).
Current and potential applications of airway ultrasound including prediction of difficult airway evaluation of airway pathologies that may affect the choice of airway management prediction of size of endotracheal, endobronchial, and tracheostomy tubes airway related nerve blocks.