The emergency surgical airway in children: what is the plan?

Tracheostomy is the most commonly performed (elective) surgical procedure in critically-ill patients. Compared with translaryngeal intubation, tracheostomy improves patient comfort, and leads to shorter length of intensive care unit and hospital stay. It relieves upper airway obstruction, protects the larynx and upper airway from damage, allows access to the lower airway for secretion removal, and provides a stable airway for patients requiring prolonged mechanical ventilation or oxygenation support. Timing of tracheostomy remains controversial and should be individualized; however, early tracheostomy (within 7 days) seems to be beneficial in certain patient populations (head injury, medically critically ill). The evolution of percutaneous techniques are rapidly reducing need for surgical tracheostomy and bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity. Cricothyrotomy is an emergency surgical airway used to save a life when all attempts at securing a patent airway fail and arrest is eminent. Techniques, timing, risks, benefits, as well as contraindications of the surgical airway in critically-ill patients are discussed in this chapter.

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Repeated Anesthetic Management for a Patient With Klippel-Feil Syndrome

Anesthesia Progress ◽

10.2344/0003-3006-61.3.103 ◽

2014 ◽

Vol 61 (3) ◽

pp. 103-106 ◽

Cited By ~ 4

Author(s):

Yuri Hase ◽

Nobuhito Kamekura ◽

Toshiaki Fujisawa ◽

Kazuaki Fukushima

Keyword(s):

Airway Management ◽

Cervical Vertebrae ◽

Anesthetic Management ◽

Preoperative Evaluation ◽

Fatal Outcome ◽

Laryngeal Edema ◽

Airway Control ◽

First Choice ◽

Surgical Airway ◽

Preoperative Examination

Abstract Klippel-Feil syndrome (KFS) is a rare disease characterized by a classic triad comprising a short neck, a low posterior hairline, and restricted motion of the neck due to fused cervical vertebrae. We report repeated anesthetic management for orthognathic surgeries for a KFS patient with micrognathia. Because KFS can be associated with a number of other anomalies, we therefore performed a careful preoperative evaluation to exclude them. The patient had an extremely small mandible, significant retrognathia, and severe limitation of cervical mobility due to cervical vertebral fusion. As difficult intubation was predicted, awake nasal endotracheal intubation with a fiberoptic bronchoscope was our first choice for gaining control of the patient's airway. Moreover, the possibility of respiratory distress due to postoperative laryngeal edema was considered because of the surgeries on the mandible. In the operating room, tracheotomy equipment was always kept ready if a perioperative surgical airway control was required. Three orthognathic surgeries and their associated anesthetics were completed without a fatal outcome, although once the patient was transferred to the intensive care unit for precautionary postoperative airway management and observation. Careful preoperative examination and preparation for difficult airway management are important for KFS patients with micrognathia.

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