Anaesthetic management of acute airway obstruction

Abstract

The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.

Keywords: airway obstruction; goitre; intratracheal; intubation.

Fig. 1

Chart shows airway management strategy for acute airway obstruction using a template for Plans A, B and C. Movement may take place from Plan A to Plan C depending on patient and operator factors (broken arrow). AFOI: awake fibreoptic intubation; CICV: cannot intubate, cannot ventilate; CPB: cardiopulmonary bypass.