NDLI: Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway

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Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway

Content Provider	Taylor & Francis Online
Author	Pillay, Tk Hodgson, Re
Abstract	Background: This case report details the management of a patient with a threatened airway booked for an emergency awake tracheostomy but successfully managed with a percutaneous tracheostomy technique. The case illustrates the challenges of managing a severely compromised airway and presents an alternative technique for consideration that may obviate the requirement for a challenging surgical attempt to secure the airway.Methods: A 42-year-old male presented with a threatened airway as a consequence of complicated dental sepsis extending into the neck. Extensive head and neck swelling was assessed as severe enough to make bag-mask ventilation, direct laryngoscopy and rescue with a supraglottic airway (SGA) impossible. Critical narrowing of the pharynx, identified on CT scan, made fibre-optic intubation risky in terms of completely obstructing the airway during the attempt. The airway was secured by a percutaneous tracheostomy technique with local anaesthetic under ultrasound guidance with the patient awake and spontaneously breathing in the upright position.Results and conclusions: Tracheostomy is a potentially hazardous procedure. The distortion of anatomy as occurs in severe forms of sepsis may complicate surgical approaches, increasing time to securing the airway and increasing the time under stress for the patient (and the anaesthetist). This case report demonstrates the utility of the percutaneous tracheostomy technique under ultrasound guidance for securing the airway in such cases.
Starting Page	123
Ending Page	128
Page Count	6
File Format	PDF HTM / HTML
ISSN	22201181 22201173
DOI	10.1080/22201181.2017.1371916
Journal	Southern African Journal of Anaesthesia and Analgesia
Volume Number	23
Issue Number	5
Language	English
Publisher	Taylor & Francis
Publisher Date	2017-09-27
Access Restriction	Open
Subject Keyword	Airway management Anaesthesia Difficult airway Percutaneous tracheostomy Tracheostomy
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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