The Approach to the Threatened Airway, with General Recommendations for Management



Presented by Davide Cattano, M.D., Ph.D.
Anesthesia Service Chief for Head and Neck Surgery
The University of Texas Medical School at Houston


Dear Colleagues,

It is my pleasure to offer for your attention and discussion the general guidelines for approaching the patients with the “threatened airway”. We have defined the threatened airway (TAW) as a clinical situation where a constant risk exists for the patient to develop a severe, acute upper airway obstruction.

The guidelines and protocols for dealing with airway emergencies are being actively developed in many anesthesiology departments. A Rapid Response team (or its equivalent) is usually requested at the bedside for urgent airway assessment in patients with acute airway compromise. These teams frequently have varying levels of expertise, and in many situations a further expert level of assessment and management becomes necessary.

A long-term focus of our group at the Memorial Hermann Hospital of The University of Texas Medical School (MHH-TMC) has been to identify a general set of interventions required for the patients with the partially obstructed airway, and especially those at risk for developing acute airway obstruction. Some of the clinical entities include the patients with laryngeal cancer, laryngeal edema, neck/submandibular abscesses, status post laser resection of the larynx and trachea, the patients with expanding neck hematoma (e.g. after anterior cervical discectomy/fusion, neck dissection, thyroidectomy), or any other situation where airway edema, trauma, or bleeding precipitate acute airway compromise.

Our group at the MHH-TMC felt that the set of focused recommendations would greatly help to properly and timely recognize such clinical situations, facilitate communication between the providers, and expedite safe and effective management of these patients under the optimal conditions, most commonly in the operating room (OR).

With time, our departmental group of experts has expanded to include inter-institutional consultants with substantial expertise in the field. The initial inter-institutional meetings and discussions occurred during the 2011 and 2012 Society for Airway Management (SAM) meetings, followed by further multiple exchanges and revisions, which have lead to the development of the document you are about to read.

The threatened airway guidelines/recommendations are presented for your perusal, comments, and, hopefully, enjoyment. We plan to produce a final revision based on the ensuing discussion, and are looking forward to SHANA endorsement of our efforts for implementing these guidelines in clinical practice.






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