Challenges facing the anesthesiologist in the emergency department

Purpose of review: This review focuses on developments in airway management and concious sedation/analgesic techniques employed by anesthesiologists in the emergency department. Recent findings: Emergency medicine physicians routinely employ airway devices and techniques that were previously reserved for anesthesiologists. An understanding of the uses and limitations of these devices are essential for successful outcomes. Anesthesiologists responding to the emergency department may be faced with soiled or traumatized airways. The use of newer devices in cervical trauma and the difficult airway is reviewed. Consious sedation in the emergency department is also reviewed. There are no published recommendations demonstrating the advantage of specific agents for sedation in the emergency department. A wide variety of medications and techniques are currently being employed. Studies indicate that the incidence of adverse effects from these agents range from less than 1% to almost 30%. Various organizations have published guidelines detailing the appropriate protocols and equipment that must be present in the emergency department to monitor patients undergoing conscious sedation. These recommendations have not been universally implemented, and several recent studies suggest that a substantial number of emergency departments may have major deficiencies. Summary: The consultant anesthesiologist responding to a critical airway may face a variety of challenges, including traumatized or soiled airways, patients with cervical spine fractures, and patients who have undergone sedation techniques that may have progressed to deep and general anesthesia. Anesthesiologists may also face the challenge of responding to these emergent situations without all the equipment or adequately trained support staff necessary to handle those emergencies safely.