Airway management

– maintenance of spontaneous ventilation
– patient will waken from anaesthesia rapidly if agent delivery stopped– inhalational induction slow in the presence of an obstructed airway
– apnoea may occur and patient may not waken
– mask ventilation then required and theoretical advantages of technique lost
– neuromuscular blocking agents may be required to aid ventilation
– laryngoscopy may cause trauma or fail
– may lead to can’t intubate, can’t ventilate (CICV) situationIntravenous induction with neuromuscular blockade– likely to facilitate mask ventilation
– abolishes laryngeal reflexes making tracheal intubation less traumatic– laryngoscopy may cause trauma or fail
– may lead to CICV situationAwake fibre-optic intubation– avoids general anaesthesia
– may be able to pass fibre-optic scope around a supraglottic lesion which may otherwise make mask ventilation difficult– complete airway obstruction may occur when used for glottic/subglottic lesions (‘cork in bottle’)
– local anaesthesia of the airway may be challenging, cause coughing and airway obstructionTracheostomy under local anaesthesia– avoids general anaesthesia– may be challenging in a patient with obstructed airway who may have difficulty lying flat and extending neckTrans-tracheal catheter/cricothyroidotomy under local anaesthesia– will allow jet ventilation in situation of CICV
– may be able to bypass infraglottic lesion with catheter– may be challenging to identify cricothyroid membrane
– jet ventilation may cause barotrauma