Acute and chronic airway obstruction

Abstract

Abstract Acute airway obstruction can occur in a child with a previously normal airway, or with the acute exacerbation of a chronic problem. The narrow diameter of the infant airway makes it particularly susceptible to obstruction. Early recognition of the airway at risk is vital as respiratory reserve is limited and deterioration can be very rapid. Assessment is largely clinical, based on history and examination. Listen for stridor, croupy cough, hoarse voice and wheeze. Look for signs of increased work of breathing and hypoxia or hypercarbia. Acute causes of airway obstruction are often infective, such as croup, epiglottitis, bacterial tracheitis and abcess. Other causes include laryngeal foreign body, trauma and thermal injury. In some cases nebulised epinephrine and steroids will improve symptoms and ‘buy time' until experienced assistance arrives. Many causes of chronic airway obstruction are congenital, but subglottic trauma secondary to intubation can be a cause of stenosis. These infants may present as an emergency after an acute deterioration, but many require a general anaesthetic for planned investigation or airway surgery. Careful preoperative assessment is essential. It is easy to underestimate the degree of airway narrowing. Airway assessment in theatre requires examination during spontaneous respiration. Anaesthesia is usually maintained using inhalational agents with topical laryngeal anaesthesia. Commonly seen conditions include laryngomalacia, tracheomalacia, subglottic stenosis, laryngeal papillomas and cysts. Many are treated by resection or laser surgery, but tracheostomy may be needed to provide a safe airway.