Lost Airway During Anesthesia Induction: Alternatives for Management

Abstract

Pediatric and adult patients with upper airway obstruction pose several challenges to the anesthesiologist and otolaryngologist--head and neck surgeon. The initiation of general anesthesia and endotracheal intubation may progress to complete life-threatening respiratory decompensation with failure to achieve endotracheal intubation or mask ventilation. Hurried invasive maneuvers such as large-bore needle tracheal entry and cricothyrotomy are recognized salvage techniques, but other modes of extratracheal ventilation are now possible before surgical airway procedures are required. The laryngeal mask airway and esophagotracheal Combitube (Kendall Sheridan Health Care Products Co., Argyle, NY) are described, with examples of their clinical application. The combined technique of anterior commissure laryngoscopy and intubation with the gum elastic bougie is the preferred alternative for achieving tracheal entry when extratracheal ventilation cannot be accomplished. An algorithm for joint management of the problem airway by anesthesiologist and otolaryngologist--head and neck surgeon is illustrated.

Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children

“…Children's preoperative distress is often augmented by the induction of anesthesia and can lead to complications and negative clinical outcomes (Fortier & Kain, 2015;Hayhoe, Pallett, Zani, & Trott, 2016). One such complication among children is airway management (Pawar, 2012;Soferman, Johnson, & Spencer, 1997). Children experiencing high levels of distress and crying during induction produce large amounts of secretions, increasing the risk of developing laryngospasms and subsequent oxygen desaturation (Langhan, Shabanova, Li, Bernstein, & Shapiro, 2015;Pawar, 2012).…”

Pediatric transtracheal and cricothyrotomy airway devices for emergency use: which are appropriate for infants and children?

“…Since these early efforts at securing an obstructed airway physicians have sought to develop the most rapid and safest method for performing this lifesaving maneuver. A tracheostomy may be semielective or performed as an emergency life-saving intervention (2)(3)(4)(5)(6)(7)(8)(9)(10). A surgical airway may be secured with a scalpel blade or other sharp device.…”

The humble bougie…forty years and still counting?

“…It is a key component of the ‘Plan A’ of the Difficult Airway Society (DAS) guidelines for management of the unanticipated difficult intubation . Several large series and reviews of intubation practice and airway management algorithms from Australia , the USA , Singapore and France also describe the bougie as the ‘most successful’, ‘effective’ and ‘commonly used’ device for management of the difficult airway. The reasons for its widespread and continued success over the years are easy to understand.…”