title: Anesthesia in prehospital emergencies and in the emergency department.
abstract: OBJECTIVE
  Recently, notable progress has been made in the field of anesthesia drugs and airway management.
  
  
  RESULTS
  Anesthesia in prehospital emergencies and in the emergency department is reviewed and guidelines are discussed.
  
  
  CONCLUSIONS
  Preoxygenation should be performed with high-flow oxygen delivered through a tight-fitting face mask with a reservoir. Ketamine may be the induction agent of choice in hemodynamically unstable patients. The rocuronium antagonist sugammadex may have the potential to make rocuronium a first-line neuromuscular blocking agent in emergency induction. Experienced healthcare providers may consider prehospital anesthesia induction. Moderately experienced healthcare providers should optimize oxygenation, hasten hospital transfer and only try to intubate a patient whose life is threatened. When intubation fails twice, ventilation should be performed with an alternative supraglottic airway or a bag-valve-mask device. Lesser experienced healthcare providers should completely refrain from intubation, optimize oxygenation, hasten hospital transfer and ventilate patients only in life-threatening circumstances with a supraglottic airway or a bag-valve-mask device. Senior help should be sought early. In a 'cannot ventilate-cannot intubate' situation, a supraglottic airway should be employed and, if ventilation is still unsuccessful, a surgical airway should be performed. Capnography should be used in every ventilated patient. Clinical practice is essential to retain anesthesia and airway management skills.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Braun
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Peter
authors.initials: P
authors.lastname: Paal
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D000777:Anesthetics / Q000009:adverse effects; D004632:Emergency Medical Services; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital; D006801:Humans; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic; D010102:Oxygen Inhalation Therapy; D012121:Respiration, Artificial
chemical_list: D000777:Anesthetics