BehindTheMedspeak: Noisy breathing sometimes trumps silence

As a rule I much prefer a perfect, silent airway when I'm controlling or assisting a patient's ventilation with a bag and mask during anesthesia and surgery.

There is one major exception: The case of someone whose airway is problematic and difficult to maintain, particularly an overweight or muscular patient.

In such cases, it's hard to know sometimes whether you're delivering oxygen to the lungs or stomach.

When that happens, it's comforting when each breath is accompanied by high-pitched wheezes or low-pitched growls or grinding sounds.

Why?

Because sound means gas is passing between the vocal cords, and the vocal cords are located at the top of the trachea.

That's real good news to me, that noise.

I can live with an imperfect airway — and more importantly, so will the patient.

Perfect the enemy of good.

Think like an anesthesiologist.