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Airway Mass

airway mass ent patient safety shared airway teamwork tracheostomy Jun 24, 2024

The Fourth National Audit Project identified that an airway mass was a leading cause of death from failed airway management. An airway mass presents significant challenges for the anaesthetic team. Proper assessment and planning are crucial in keeping your patient safe. The common reasons for an airway mass are tumour, infection, and trauma.

Here’s what you need to know:

🌟 Preoperative 🌟
🔍 Assess the airway:
Remember our process for assessing difficult airways (Live Series 4). Your team needs to establish whether the patient needs an awake intubation, and if not, do you need any special equipment for intubation.

🖼️ Imaging:
Review the patient’s scans with your anaesthetist to establish airway compression, distortion, and any reason for difficult intubation.

💬 Communication and planning:
Communicate with the surgical team about their requirements for airway access and intentions for postoperative management (ICU, tracheostomy, etc).

🌟 Intraoperative 🌟
🌬️ Airway Management:
What is your team’s plan A and beyond? Does this patient need an awake intubation? Is your tube selection appropriate for the surgery and the patient’s postoperative destination? Do you need a video laryngoscope? Do you need the help of a colleague?

✅ Confirm and monitor airway position
Always confirm the tube position with end-tidal CO2. Monitor ventilation and end-tidal CO2 throughout the case.

🌟 Postoperative 🌟
Patients with an airway mass are at higher risk of obstruction or bleeding in the recovery room. Your team should discuss the need for transfer to the ICU.

✅ Build knowledge
✅ Improve safety

Ref: Cook, T. M., Woodall, N., Frerk, C., eds., 2011. Major complications of airway management in the United Kingdom: Report and findings. 4th ed. London: The Royal College of Anaesthetists.

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