Failed tracheostomy under local anaesthesia...plan B?
Severe stridor of recent onset is a challenge to deal with because of the lack of investigations on which to base the management plan. We describe a case of an elderly lady who presented to us with a short history of severe stridor. We encountered unanticipated difficulties with tracheostomy under local anaesthesia as the thyroid was replaced by a diffuse mass and the airway had to be secured by an awake fibre-optic intubation. Awake fibre-optic intubation is thought to be a relative contraindication in acute upper airway obstruction, but occasionally tracheostomy under local anaesthesia may not be possible and in experienced hands an awake fibre-optic intubation is a reasonable alternative.
Maiya
B
B
Department of Anaesthesia, Cambridge University Hospitals, Cambridge, UK.
Smith
H L
HL
D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D000772:Anesthesia, Local; D003657:Decision Making; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D016393:Lymphoma, B-Cell / Q000150:complications; D013964:Thyroid Neoplasms / Q000150:complications; D014139:Tracheostomy; D017211:Treatment Failure