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Bleeding Airways

airway management airway trauma ent patient safety shared airway Jun 24, 2024

🌟 What and why? 🌟
A “bleeding airway” is a term used for urgent return to the operating theatre to manage bleeding from previous shared airway surgery. Common reasons include post-tonsillectomy or dental surgery.

🔍 Intraoperative considerations: 🔍
📍 Position: Supine with shoulder roll
⏱️ Duration: 30 mins
🌬️ Airway plan: It’s important to review the initial intubation records to identify any issues. Blood in the airway can obscure vision even with a videolaryngoscope. A rapid sequence induction is usually performed with a south-facing RAE tube and two suction devices available. The patient may not tolerate the supine position if there is considerable bleeding.

💡 Expert tips:
Blood loss may be underestimated due to swallowing of blood. Ensure fluid resuscitation +/- transfusion if required prior to anaesthesia.

🌟 Postoperative considerations: 🌟
💥 Pain: Mild-moderate depending on the reason for reoperation.
❗ Airway risks: If aspiration is suspected during the case, be vigilant for postoperative hypoxia and consider delaying extubation. Extubate awake in the operating theatre. Remain vigilant for laryngospasm, bleeding, and swelling.

🔄 Other:
A bleeding airway is a good reason to request assistance from a senior colleague!

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Ref: Turner, Grant, 'Ear, nose and throat surgery', in Rachel Freedman, and others (eds), Oxford Handbook of Anaesthesia, 5 edn, Oxford Medical Handbooks (Oxford, 2022; online edn, Oxford Academic, 1 Nov. 2021), accessed 13 June 2024.

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