Advanced upper airway obstruction in ENT surgery

Use of the McGrath video laryngoscope in awake patients

“…Management of such patients is achieved in a number of different ways, both awake and asleep. Awake fibreoptic intubation is not without complication [3, 4] and may be quite unpleasant for the patient with a narrowed airway; in fact, it is deemed unwise by some clinicians [5, 6], particularly in inexperienced hands. Awake tracheostomy is the other commonly used technique in this scenario, although none of these patients had such severe airway compromise that tracheostomy was clearly indicated (it was considered in one of the patients).…”

Special Considerations in Anesthesia for Laryngeal Cancer Surgery

“…Local anesthesia is difficult to achieve and may provoke laryngospasm, instrumentation may cause hemorrhage, and passage of the fibrescope itself may obstruct an already narrowed airway. 20…”

Maintaining oxygenation with high-flow nasal cannula during emergent awake surgical tracheostomy

“…1 Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency. 2 This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve.…”

“…However, this procedure is not devoid of risks, as it can result in bleeding, coughing, arrhythmias, increased patient distress, and deterioration of the clinical condition. 2 Rarely, other options can be considered, namely rigid bronchoscopy and femoral vessel cannulation for cardiopulmonary bypass. 2 Patients presenting with severe acute upper airway obstruction pose significant challenges to the anaesthetist.…”

“…2 Rarely, other options can be considered, namely rigid bronchoscopy and femoral vessel cannulation for cardiopulmonary bypass. 2 Patients presenting with severe acute upper airway obstruction pose significant challenges to the anaesthetist. High-flow nasal cannulation appears to be a safe and effective means to ensure oxygenation during placement of a surgical tracheostomy under local anaesthesia, with added physiological benefits.…”