Passagere Koniotomie im Airway-Management

Abstract

Extended tumors of the oral cavity, pharynx or larynx can severely compromise the performance of a necessary endotracheal intubation. Both transnasal fiberoptic intubation under spontaneous breathing as well as tracheotomy under local anesthesia require a great deal of cooperation from the awake patient. In cases with dyspnea due to a recurrent tumor the situation is much more difficult. These patients are often in a reduced general condition, show a lack of cooperation and often have postoperative or radiogenic scars of the pharyngeal and laryngeal structures. In response to these problems cricothyrotomy was performed in 16 selected patients under local anesthesia. Analgesia and sedation had been adapted to the needs of the individual patient. The cricothyrotomy was performed alternately by an anesthesiologist and an ENT surgeon. General anesthesia has been carried out immediately after secured ventilation and oxygenation had been determined. In all patients except one the airway was finally secured by tracheotomy and the larynx incision was closed in all cases. The possibility of conventional intubation was judged retrospectively by the anesthesiologist concerned and was found to be simple in one case and nearly impossible in 10 cases. There were no complications due to the surgical procedure apart from a brief episode of disturbance in wound healing and the potentially life-threatening situation of cannot ventilate-cannot intubate could be avoided. In selected cases with extended tumors of the upper airway, temporary cricothyrotomy is an effective and convenient procedure to secure the respiratory tract.