AB192. SOH24AB_149. Emergent airway management in patients with subglottic lesions: a case series

Background: Subglottic lesions present a challenge for emergent airway management. Invariably, these patients present in extremis through the resuscitation room of an emergency department. We present a case series of the management of such lesions in a controlled fashion.

Case Description: We report two patients presenting Emergency with acute airway obstruction. The first is a medical student on Erasmus who presented with stridor, aphonia and dyspnoea, with a history of neonatal tracheo-oesophageal fistula repair. The second patient presented with inspiratory stridor and dysphonia, with a history of unexplained haemoptysis 3 months prior. Endoscopy in the resuscitation room noted obstructive subglottic lesions requiring urgent management in the operating theatre with close collaboration with senior anaesthetic colleagues. Close collaboration with consultant anaesthetic colleagues was paramount to the safe securing of the upper airway in both cases. Discussion with regards to fibreoptic awake intubation, standby ventilating bronchoscopy, and the option of front of neck access was discussed with the operative teams. Both patients underwent successful intubation and excision of subglottic lesions with coblation. Both recovered well and were successfully extubated following surgery. Histology confirmed squamous-lined mucosa with spongiosis, active inflammation and cytonuclear atypia in one, and a pyogenic granuloma with focal ulceration in the other.

Conclusions: Securing the upper airway in patients presenting with stridor due to subglottic masses requires immediate surgical planning and close collaboration with anaesthetic colleagues at a senior level. Coblation is a superb tool for excision and haemostasis of these lesions and the surgical site in a controlled manner.

Keywords: Airway; anaesthetics; coblation; stridor; subglottic lesion