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Anesthesia
&
Airway Trauma
!!! A Mea Culpa !!!Dr B A Harrison FRACP, FANZCA
Department of AnesthesiologyMayo Clinic Florida
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Anesthesia & The Airway
Anesthesia Airway Aims
Protect
Access
Duration
< 5 hours short & > 5 hours long
Glottic & Supra GlotticOral, Nasal,Tracheostomy
Non Difficult vs. Difficult
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ASA Closed Claims Analysis
Metzner, J et al Best Pract & Res Clinical Anes 25:2011
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Difficult Airways
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Upper Airway
Injury edema/laceration
Edema Lip, Tongue, Uvula
Foreign body Laryngoscope - Light bulbs
LTA kits, atomizers
Teeth
Throat Packs
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John Adams Blog
http://www.anesthesiamyths.com/wp-content/uploads/2012/04/LMA.jpg -
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National Surgical Quality
Improvement Program
563,190 patients 2005-2008
1202 (0.2% = 1:500) airway injury Dental injury 26%
Laceration Lip laceration/hematoma 61% Tongue laceration 6%
Pharyngeal laceration 5%
Laryngeal laceration 2%
Multiple logistic modelling Mallampati III & IV
Age > 80 years
??? Satisfied???
Hua M et al Anesth Analg 114:2012
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http://www.supplierlist.com/prod_img/uamfind/161255_Mcintosh_Laryngoscopes.jpghttp://www.supplierlist.com/prod_img/uamfind/161259_Miller_Laryngoscopes.jpghttp://www.google.com/imgres?imgurl=http://www.ghorayeb.com/files/laryngoscopes.jpg&imgrefurl=http://www.ghorayeb.com/vocalcordpic.html&usg=__LfOvEKT7g7Y-Mo5P15WjfiCvB7Y=&h=1211&w=897&sz=164&hl=en&start=21&zoom=1&tbnid=KQQD3e0jI5nlYM:&tbnh=150&tbnw=111&ei=weBcULCPMYGDywHIwIDwDg&prev=/search%3Fq%3Dlaryngoscopes%26start%3D20%26um%3D1%26hl%3Den%26sa%3DN%26gbv%3D2%26tbm%3Disch&um=1&itbs=1 -
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Throat Packs
Pro Aspiration
Lung
Stomach N & V
Con Sore throat
Retained FB
Airway obstruction
Evidence None
Outcome Decreasing use
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A consistently clear view,
enabling quick intubations.
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Anesthesia & Larynx
Larynx
Complicated and delicate
Voice = language
Difficult >>> non difficult airways
ETT = LMA
Sore throat, hoarse voice, stridor, dyspnea
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Mendels EJ et al Arch Otolaryngol Head & Neck 138:2012
Adverse Laryngeal Effects Following
Short General Anesthesia
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Vocal Cord Injuries
Hematoma
Mucosal edema
Granuloma
Mendels EJ et al Arch Otolaryngol Head & Neck 138:2012
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BUT Airway Injury
7% of all ASA Closed Claims Database
Larynx most frequent
Vocal cord paralysis
Hematomas & granuloma
Arytenoid luxation
Prolonged intubation >short term
Domino KB et al Anesthesiology 91:1999
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Popat M et al Anaesthesia 2012;67:318-349
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Thomas V et al JCT&VAnes 21:2007
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VATS & DLETT
http://www.google.com/imgres?imgurl=http://www.equipmentexplained.com/images/physics_images/airway_images/ett_images/special_ett_images/double_lumen_closeup.jpg&imgrefurl=http://www.equipmentexplained.com/physics/airway/ett/endotracheal_tubes.html&usg=__Rsd6PREmSvcrfPWPnBkwxveBPX8=&h=800&w=800&sz=58&hl=en&start=15&zoom=1&tbnid=3qsmoNKX3UL23M:&tbnh=143&tbnw=143&ei=txpjUNu5HZTOyAGZ54CABw&prev=/search%3Fq%3Ddouble%2Blumen%2Bendotracheal%2Btube%26um%3D1%26hl%3Den%26gbv%3D2%26tbm%3Disch&um=1&itbs=1 -
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Surgical Airway & Difficult Intubation
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. . .a young man sustained a severely crushed chest ina country motor vehicle accident . . . His grossrespiratory insufficiency was managed at first by means
of a tracheostomy with assisted ventilation. . . He wasweaned off the respirator three weeks after the accidentand soon discharged.
Three weeks later he was readmitted
moribund from anoxia due to a tightstricture of the trachea for 4 cm below theprevious stoma . . .
Trauma. . . had resulted in destruction of the full
thickness of a segment of the trachea and itsreplacement within a month by a tight fibrous stricture.
Gibson P Thorax 22:1967
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The ICU Airway
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Wain JC Chest Surg Clin N Amer 2003:13
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Pervez Sultan et al AANA 21:2011
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Minnich DJ et al Thoracic Surgical Clinics 17:2007
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Nordin U et al Acta Otolaryngol Suppl 1977:345
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http://otorhinolarydoc.files.wordpress.com/2012/06/img_3339.jpg
