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Pulmonary Disease

Answer 1
  1. Jaw thrust. Conscious sedation is widely used in a variety of procedures, including endoscopies and minor surgical procedures. Usual medications include benzodiazepines (eg, midazolam), which act as amnestics and anxiolytics, and opiates (eg, fentanyl), which provide pain relief. These medications not only suppress respiratory drive centrally but also lower the tone of pharyngeal structures.1 Although flumazenil and naloxone are reasonable options in this case, the first step should be a jaw thrust/chin lift maneuver to make the airway patent. The degree of difficulty in visualizing the tonsillar pillars, the soft palate, and the base of the uvula predicts difficulty with intubation.2

    1. Boushra NN. Anaesthetic management of patients with sleep apnoea syndrome [published erratum appears in Can J Anaesth 1996;43:1184]. Can J Anaesth 1996;43:599–616.

    2. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705–6

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