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Airway catastrophes

Abernathy, James H III; Reeves, Scott T

Current Opinion in Anesthesiology: February 2010 - Volume 23 - Issue 1 - p 41–46
doi: 10.1097/ACO.0b013e328333b768
Thoracic anesthesia: Edited by Javier Campos

Purpose of review The article reviews the epidemiology of airway injuries, airway anatomy, techniques for airway management, helpful pharmacologic adjuncts and finally alternatives to airway manipulation.

Recent findings Principles of airway management including the maintenance of spontaneous ventilation and careful and adequate preparation for an alternative plan will always be important. Advances in pharmacologic agents provide a safer, more controlled environment through which the patient's compromised airway can be controlled. Recent publications add to the evidence that alternative methods of oxygenation and ventilation such as cardiopulmonary bypass can be used successfully to treat patients with catastrophic airway injuries.

Summary Trauma to the airway, either blunt or penetrating or iatrogenic, can result in significant patient morbidity and mortality. Although, relatively rare, if we practice long enough, each of us will encounter such a patient. The anesthesiologist must be familiar with airway anatomy and the location of injury for successful treatment. Along with airway injuries, associated injuries are common and often complicate definitive airway treatment. Modern anesthetic medications such as dexmedetomidine and proven techniques such as awake fiberoptic intubation can be used to safely treat these difficult patients. Alternative therapies such as cricothyroidotomy and cardiopulmonary bypass should be available if first-line therapies fail to secure an injured airway.

Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

Correspondence to Scott T. Reeves, MD, MBA, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite #301, MSC 912, Charleston, SC 29425-9120, USA Tel: +1 843 792 5699; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.