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Reviews of Educational Material  |   January 2008
Atlas of Airway Management: Techniques and Tools.
Author Notes
  • Loma Linda University School of Medicine, Loma Linda, California.
Article Information
Reviews of Educational Material / Airway Management
Reviews of Educational Material   |   January 2008
Atlas of Airway Management: Techniques and Tools.
Anesthesiology 1 2008, Vol.108, 174-175. doi:10.1097/01.anes.0000296303.91631.9e
Anesthesiology 1 2008, Vol.108, 174-175. doi:10.1097/01.anes.0000296303.91631.9e
Atlas of Airway Management: Techniques and Tools.  By Steven L. Orebaugh, M.D. Philadelphia, Lippincott Williams & Wilkins, 2006. Pages: 224. Price: $79.95.
Anesthesiologists rightly consider themselves the ultimate airway professionals. Because many books have been published on the subject, some brief and others exhaustive, one might enquire as to the need for yet another. Enter the new reference by Steven L. Orebaugh, M.D.: Atlas of Airway Management: Techniques and Tools  . Dr. Orebaugh, who has trained in Emergency Medicine, Critical Care, and Anesthesiology, intends this book to be an illustrative complement to previously published texts on the subject, with his intended audience those who are learning to manage airways.
The author undertakes a comprehensive discussion of airway management in a very visual manner. He includes a number of gross anatomy sketches recognizable from standard texts; a plethora of images obtained via  laryngoscopy, bronchoscopy, and computed tomography/magnetic resonance imaging scans; those obtained in the clinical setting; and (in what is probably the major strength of the book) literally hundreds of photographs of various airway devices and techniques demonstrated on cadaveric specimens. The most educational photos are those that show a cadaver in sagittal section with various airway devices in proper position.
The book is divided into 10 parts; each part contains one to seven chapters. Part I concerns itself with the routine airway management that we do on a regular basis, including mask ventilation, direct laryngoscopy, and the devices used in this setting. Also included are brief discussions on the pediatric airway and medications used in management of the airway. Part II is a treatise on the difficult airway. A chapter on the incidence and predictors of difficult airway management precedes a number of photos and drawings demonstrating the factors that may portend a difficult airway. Decision-making in airway management is also covered, including algorithms for managing difficult airways from the perspective of both Anesthesiology and Emergency Medicine.
Parts III–X are where the book really gets interesting. Here the author discusses virtually every device and technique that exists for airway management! These sections are arranged logically, which makes for easy reference. Devices and techniques discussed include those used for direct laryngoscopy (bougies and stylets), blind intubation strategies, lightwands and optical stylets, retrograde procedures, fiberoptic intubations (rigid and flexible), a superb section on emergency ventilation, and techniques that combine various devices (think fiberoptic scopes, laryngeal mask airways, combitubes, bougies, stylets, lightwands, and all manner of combinations of these). Finally, step-by-step photographic demonstrations of wire-guided (percutaneous) and open cricothyrotomy are presented. The latter is shown using the “poor man’s cricothyrotomy set,” consisting of a scalpel, hemostat, and an endotracheal tube, which can be used if a standard tray is not available. The book concludes with a complete index for quick reference.
Although the strength of this atlas is obviously the visual component, the author has also included valuable commentary along with each device or technique, which sets this book apart from others. The concept of a given device or technique is first discussed, followed by evidence from the literature as to its usage and efficacy (references are provided at the end of every chapter). Preparation for using the device or how to perform the procedure is spelled out, followed by a description of the procedure itself, which is extremely well illustrated with high-quality photographs. Each chapter concludes with bulleted lists detailing the practicality (including complexity and affordability), indications, contraindications, and complications associated with the device or technique.
Another strength of the book is its completeness. Were you ever curious (as I was) to know why that old prism is floating around in the bottom of your anesthesia cart, and how it was used? Turn to page 78 and find out. Has your attending been discussing wistfully how wonderful the Bullard laryngoscope was “back in the day,” and you have no clue what that is? Get up to speed by taking a look at Chapter 21. Is there a patient with a difficult airway rolling into your operating room? Take a quick look at Part X (Emergency Surgical Airways) for a review, just in case.
I have only a couple of minor points on which to quibble. Those who work with children on a regular basis would probably appreciate a larger section on the pediatric airway; however, to be fair, the author states this is beyond the scope of his book. In addition, an included DVD with video of the techniques discussed might be a valuable inclusion in future editions.
Although not many will sit down to read this book from start to finish, it is a fantastic reference for anyone who manages the airway for a living. Since receiving this book for review, I have been using it in my practice with medical students and beginning residents and as an adjunct to simulation training. I have seen medical students flounder with intubations, taken them aside, and shown them some choice photos in this book, then observed them succeed on the very next attempt. I am positive Dr. Orebaugh’s Atlas of Airway Management: Techniques and Tools  will thus find a ready application in the training of new practitioners. Although its primary audience is those just beginning to familiarize themselves with airway management and those who train them, it is also a valuable reference for all “ultimate airway professionals” to have nearby.
Loma Linda University School of Medicine, Loma Linda, California.