Anesthesia & Airway Trauma

!!! A Mea Culpa !!!

Dr B A Harrison FRACP, FANZCA Department of Anesthesiology Mayo Clinic Florida harrison.barry@mayo.edu

Anesthesia & The Airway

Anesthesia

Airway Aims

Protect Access
< 5 hours short & > 5 hours long

Duration

Glottic

& Supra Glottic Oral, Nasal,Tracheostomy Non Difficult vs. Difficult

ASA Closed Claims Analysis

Metzner, J et al Best Pract & Res Clinical Anes 25:2011

Difficult Airways

Upper Airway
Injury

edema/laceration

Edema Lip, Tongue, Uvula

Foreign

body Laryngoscope - Light bulbs LTA kits, atomizers Teeth Throat Packs

John Adams Blog

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

Throat Packs

Pro

Aspiration
Lung Stomach N & V

Con

Sore throat Retained FB

Airway obstruction

Evidence

None Decreasing use

Outcome

A consistently clear view, enabling quick intubations.

Anesthesia & Larynx

Larynx

Complicated and delicate Voice = language

Difficult
Sore

>>> non difficult airways ETT = LMA

throat, hoarse voice, stridor, dyspnea

Adverse Laryngeal Effects Following Short General Anesthesia

Mendels EJ et al Arch Otolaryngol Head & Neck 138:2012

Vocal Cord Injuries

Hematoma

Mucosal

edema Granuloma

Mendels EJ et al Arch Otolaryngol Head & Neck 138:2012

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

Popat M et al Anaesthesia 2012;67:318-349

Thomas V et al JCT&VAnes 21:2007

VATS & DLETT

Surgical Airway & Difficult Intubation

 . . .a young man sustained a severely crushed chest in

a country motor vehicle accident . . . His gross respiratory insufficiency was managed at first by means of a tracheostomy with assisted ventilation. . . He was weaned off the respirator three weeks after the accident and soon discharged.

Three weeks later he was readmitted moribund from anoxia due to a tight stricture of the trachea for 4 cm below the previous stoma . . .
Trauma. . . had resulted in destruction of the full thickness of a segment of the trachea and its replacement within a month by a tight fibrous stricture. Gibson P Thorax 22:1967

The ICU Airway

Wain JC Chest Surg Clin N Amer 2003:13

Pervez Sultan et al AANA 21:2011

Minnich DJ et al Thoracic Surgical Clinics 17:2007

Nordin U et al Acta Otolaryngol Suppl 1977:345