Management of the obstructed upper airway

Progress in management of the obstructed airway

“…Opinions differ as some experts propose techniques that other experts find unacceptable and explicitly criticise [1][2][3]. There are advocates of inducing general anaesthesia by an inhalational route and avoiding neuromuscular blockade [4]; of inducing general anaesthesia by the intravenous route and using neuromuscular blockade [5]; of avoiding general anaesthesia altogether and securing an airway by an awake fibreoptic intubation technique [6,7]; of tracheostomy under local anaesthesia [8]; or of insertion of a transtracheal catheter under local anaesthesia [9]. The advocates of these various techniques claim that each respectively provides the best management and the range of choices can appear very confusing for the anaesthetist who is actually faced with a patient who has an obstructed airway.…”

“…Successfully used for mass lesions within the oral cavity or tongue base, where passing the fibrescope around the lesion may be possible in skilled hands [6,7], its role for advanced obstructing lesions within the glottis is more controversial, as the fibrescope has to pass through the small orifice of the obstructive mass with the risk of total airway occlusion [4].…”

“…The more significant the airway obstruction, the more likely this is to occur. Initial nasendoscopy to inspect the larynx has been advocated by skilled users of fibreoptic techniques, to assess if it is safe to continue with awake fibreoptic intubation or defer to an awake local anaesthetic tracheostomy [7].…”

Angina bullosa haemorrhagica presenting as acute upper airway obstruction

“…In disease processes where the obstructing lesion is likely to resolve over a few days, a surgical tracheostomy is often considered as a reserve procedure, provided that it can be carried out immediately if necessary. 11 In a moribund patient, cricothyrotomy and/or surgical tracheostomy may be needed immediately. Tracheostomy can, however, be technically dif®cult, particularly if a distressed patient is unable to cooperate.…”