Anestesia e Pesquisa Clínica
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Airway assessment, intraoperative challenges and clinical tips and tricks for Head-Neck Oncosurgery: Our experience

Shagun Bhatia Shah

Statement of the problem: It is alarming to note that 28% of all anaesthesia related deaths are secondary to cannot intubate, cannot ventilate (CICV) situations. Prime step in circumventing CICV is to detect potential problems with oxygenation and ventilation and maintaining airway patency. Airway assessment gives the diagnosis. Airway plan is the treatment. Anticipated difficult airway is not a race against time. We shall learn how to pause, plan, prepare and proceed to success.

Methodology: Nine core airway assessment considerations shall be addressed here, illustrated with pictures of real-life clinical situations 1.Any history of airway difficulties? 2.Any altered cardiorespiratory physiology? 3.Any impact of surgery on the airway? 4.Bag-mask ventilation difficulty? 5.SAD placement difficulty? 6.Intubation difficulty? 7. Infraglottic airway difficulty? 8.Risk of aspiration? 9.How easy will it be to extubate safely? Utility of ultrasonography in airway assessment shall be discussed. We shall see how fiberoptic bronchoscopy (FOB), though the gold standard, is not a blanket solution for all difficult airways. Case scenarios where potential CICV situations have been tackled with awake retrograde intubation, videolaryngoscopy and elective tracheostomy shall be described. Difficult airway in remote locations and the Vortex approach shall also be addressed.