Anticipated Difficult Airway

Remember to consider – to get an idea of what you are dealing with.

Thoughts. Which of the following are anticipated to be difficult and what is the plan for each:

• Mask ventilation
• LMA insertion/use
• Endotracheal intubation
• Front of neck access

 

Options to consider:

• AFOI
• Inhalational induction vs IV induction
• Spontaneous vs controlled ventilation (+/- muscle relaxant)
• Mask ventilation with guedel + two person technique
• THRIVE
• Direct laryngoscopy
• Video laryngoscopy
• Asleep FOI
• Front of neck: surgical cricothyroidotomy by us vs ENT trache (awake?)

ENT tympanoplasty

Issues:
Middle ear surgery
Hypotensive anaesthesia
Facial nerve monitor

Anaesthesia:
Local anaesthesia block + opiod sparing analgesia
Anti-emetics
Avoid NMB
Remifentanil infusion
IPPV – LMA (flexi* or normal) or ETT

 

Tracheostomy get out of jail…

Top tip:
If it is difficult to re-intubate orally during a surgical tracheostomy, pass a bougie rostrally (upwards towards the head) through the tracheal opening, vocal cords and mouth then pass an ETT