The gold standard for managing this situation was inhalational induction ( to avoid Airway loss) until the patient became deep enough to tolerate endotracheal intubation. This technique has been questioned recently because it is not as smooth as expected and on many occasions the situation is even more complicated and worsens in several ways. The suggested alternative is to put the patient to sleep and to administer long-acting muscle relaxant, so as to achieve an ideal situation for intubation, however, in case of losing the airway you should be able to perform an emergency FONA ( Front of the Neck access) using a scalpal, Bougie and a small endotracheal tube,
What is your opinion about the pros and cons of both approaches, do you have other suggestions?
In any way you will be able to use a fiberoptic laryngoscope and ready for alternative intubation such as emergency tracheastomy.
use a fiberoptic laryngoscope can help
Tracheostomy when
long-term mechanical ventilation (> 3 weeks)
- Acute upper airway obstructions that cause respiratory distress (stridor) and respiratory acidosis, e.g.:
- Infections (e.g., diphtheria, epiglottitis)
- Malignancy (e.g., larynx carcinoma)
- Hemorrhage
- Foreign body
- Oropharyngeal edema
or do Cricothyrotomy when cannot-intubate -cannot-ventilate' (CICV) scenario (if orotracheal intubation has failed or is contraindicated)
as
- Angioedema
- Foreign body in upper airway
- Severe oropharyngeal/nasal bleeding
- Severe maxillofacial trauma
I do not agree at all either with inhalation induction or with (?) iv induction and long-term myorelaxation in principle. The question is rather malposed. The level of obstruction is relevant. Complete obstruction means CA before R-CA as for the vagal response. This requires an ETT via CTY. An incomplete obstruction also needs to be appraised. If impending RCA and patient with critical signs you cannot use AFI and have to anesthetize the pt - staying in upright and with a prepared anterior neck and high oxygen flow by mask few cm from the mouth - with a ketamine bolus (induction within 1 min) and soon put him supine when anesthetized, continue the oxygenation with the mask applied to the mouth and attempt ETI after a quick look as to the obstruction i.e. if allows standard or smaller ETT, both prepared and at hand. If no joy then a CTY is the one. If the obstruction is such as to allow normal spontaneous breathing then you can consider AFI on an FBO with pt awake preoperatively, keeping ready for a CTY if things get worse or alternatively a SOT/OT
- Badges
- Science topic
- Similar topics
- Correction