Emergent Surgical Airway Management in Bleeding Airway Tumor-Two Different Settings

Abstract

Expertise in surgical airway management is one of the key requirements in a difficult airway scenario. We describe two different surgical airway approaches in two similar scenarios of a bleeding airway. A 77-year-old man was proposed for an urgent femoral-popliteal bypass. During laryngoscopy, a friable vallecular tumor was recognized, resulting in a copious bleeding. After several unsuccessful attempts to establish a patent airway, a tracheostomy was performed in 10 minutes by a surgeon. A 43-year-old man with a known laryngeal epidermoid carcinoma, was admitted in the emergency room with an active bleeding airway, resulting in a ‘Can’t Intubate Can’t Oxygenate’ situation. A scalpel cricothyroidotomy was achieved in 45 seconds by an anaesthesiologist. In the presence of a difficult airway, the anesthesiologist must be prepared to establish an effective surgical airway in a timely fashion. Training in simulation scenarios is essential to improve these specific technical and nontechnical skills.