AB206. SOH22ABS238. Management of acute upper airway obstruction via surgical tracheostomy

Background: An Upper airway obstruction is a medical emergency that needs to be managed urgently to ensure patient oxygenation and prevent patient death. The difficult airway society describes various methods to obtain a front of neck access in short period of time in case a permanent airway cannot be secured. However, such method is not always practical due to factors such as patient anatomy, especially increased body mass index (BMI).

Methods: A fifty-six years old gentleman, with a past medical history of schizophrenia and very high BMI, presented to emergency department (ED) with shortness of breath, stridor and hoarseness following an episode of collapse earlier the same day. An attempt of fibre-optic intubation under light sedation in theatre room failed due to patient intolerance. The operating team moved to induce general anaesthesia with modified rapid sequence induction. Intubation was not possible despite obtaining sufficient view of the vocal cords with video laryngoscope. Ear-Nose and throat surgical team (ENT) proceeded with performing emergency tracheostomy while maintaining oxygenation via manual bag-mask ventilation. The surgical procedure took forty-five minutes.

Results: Tracheostomy insertion was successful and patient was transferred to ICU intubated and sedated. Subsequent imaging and biopsy investigations revealed the patient had squamous cell carcinoma of the larynx.

Conclusions: Practical challenges pertaining to anatomy, patient cooperation can significantly lengthen and complicate the task of obtaining a patent airway in emergency situation. In this case, operating conditions to perform a surgical tracheostomy were made available by providing adequate manual bag-mask patient ventilation and anaesthesia conditions.

Keywords: Airway obstruction; tracheostomy; carcinoma of the larynx; body mass index (BMI); intubation