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Anesthetic and Operative Management of Potential Upper Airway Obstruction

Anesthetic and Operative Management of Potential Upper Airway Obstruction Abstract Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. In carcinoma of the supraglottic larynx and in pharyngeal abscess, the unobstructed airway in the conscious patient became impossible to secure once general anesthesia was begun. Unappreciated pathological deformity prohibited endotracheal intubation, and anesthesia precipitated obstruction. In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia. (Arch Otolaryngol 104:657-661, 1978) References 1. Gordon RA: Anesthetic management of patients with airway problems . Int Anesthesiol Clin 10:37-59, 1972.Crossref 2. Salem MR, Mathrubhutham M, Bennett EJ: Difficult intubations . N Engl J Med 295:879-881, 1976.Crossref 3. Meine FJ, Lorenzo RL, Lynch PF, et al: Pharyngeal distention associated with upper airway obstruction . Radiology 111:395-398, 1974.Crossref 4. Smith RM: Anesthesia for Infants and Children . St Louis, CV Mosby Co, 1968, p 365. 5. Meyers EF, Krupin B: Anesthetic management of emergency tonsillectomy and adenoidectomy in infections . Anesthesiology 42:490-491, 1975.Crossref 6. Schwartz HC, Bauer RA, Davis NJ, et al: Ludwig's angina: Use of fiberoptic laryngoscopy to avoid tracheostomy . J Oral Surg 32:608-611, 1974. 7. Proctor DF: High Airway Obstruction and Its Relief in Anesthesia and Otolaryngology . Baltimore, Williams & Wilkins Co, 1957, pp 208-225. 8. Schuller DE, Birck HG: The safety of intubation in croup and epiglottitis: An eight-year follow-up . Laryngoscopy 85:33-46, 1975.Crossref 9. Wilson RD, Putnam L, Phillips MT, et al: Anesthetic problems in surgery for varying levels of respiratory obstruction in infants and children . Anesth Analg 53:878-885, 1974.Crossref 10. Cohen SB, Scherz RG: Safe alternative to tracheostomy in acute epiglottitis . Am J Dis Child 129:136, 1975. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

Anesthetic and Operative Management of Potential Upper Airway Obstruction

Burtner, David D.; Goodman, Max
Archives of Otolaryngology , Volume 104 (11) – Nov 1, 1978
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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1978.00790110047012
Publisher site
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Abstract

Abstract Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. In carcinoma of the supraglottic larynx and in pharyngeal abscess, the unobstructed airway in the conscious patient became impossible to secure once general anesthesia was begun. Unappreciated pathological deformity prohibited endotracheal intubation, and anesthesia precipitated obstruction. In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia. (Arch Otolaryngol 104:657-661, 1978) References 1. Gordon RA: Anesthetic management of patients with airway problems . Int Anesthesiol Clin 10:37-59, 1972.Crossref 2. Salem MR, Mathrubhutham M, Bennett EJ: Difficult intubations . N Engl J Med 295:879-881, 1976.Crossref 3. Meine FJ, Lorenzo RL, Lynch PF, et al: Pharyngeal distention associated with upper airway obstruction . Radiology 111:395-398, 1974.Crossref 4. Smith RM: Anesthesia for Infants and Children . St Louis, CV Mosby Co, 1968, p 365. 5. Meyers EF, Krupin B: Anesthetic management of emergency tonsillectomy and adenoidectomy in infections . Anesthesiology 42:490-491, 1975.Crossref 6. Schwartz HC, Bauer RA, Davis NJ, et al: Ludwig's angina: Use of fiberoptic laryngoscopy to avoid tracheostomy . J Oral Surg 32:608-611, 1974. 7. Proctor DF: High Airway Obstruction and Its Relief in Anesthesia and Otolaryngology . Baltimore, Williams & Wilkins Co, 1957, pp 208-225. 8. Schuller DE, Birck HG: The safety of intubation in croup and epiglottitis: An eight-year follow-up . Laryngoscopy 85:33-46, 1975.Crossref 9. Wilson RD, Putnam L, Phillips MT, et al: Anesthetic problems in surgery for varying levels of respiratory obstruction in infants and children . Anesth Analg 53:878-885, 1974.Crossref 10. Cohen SB, Scherz RG: Safe alternative to tracheostomy in acute epiglottitis . Am J Dis Child 129:136, 1975.

Journal

Archives of Otolaryngology – American Medical Association

Published: Nov 1, 1978

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