title: Urgent awake tracheotomy for impending airway obstruction.
abstract: OBJECTIVE
  Awake tracheotomy is performed for patients with impending airway obstruction. Few studies to date have addressed the issues surrounding awake tracheotomy. We sought to review the indications, complications, and outcome of awake tracheotomy for urgent airway control.
  
  
  METHODS
  We conducted a retrospective review of patients who underwent awake tracheotomy over a 4-year period from 2001 to 2004 at an urban tertiary medical center. Data were obtained from inpatient records and operative charts.
  
  
  RESULTS
  We obtained data on 54 men and 19 women, with a mean age of 61 years. The majority of patients presented with hoarseness, dyspnea, and stridor. Twenty patients had obstruction from head and neck cancers. Nonmalignant causes included deep neck infections (n = 18), bilateral vocal cord paralysis (n = 17), trauma (n = 9), and laryngeal edema (n = 6). Other causes include laryngeal cyst, subglottic stenosis, and vocal cord granuloma. Six (8.2%) patients experienced complications, including postoperative hemorrhage, pneumothorax, and chest and wound infections. There were no long-term complications or deaths.
  
  
  CONCLUSIONS
  Awake tracheotomy is efficacious and safe and has a low complication rate.
  
  
  CONCLUSIONS
  Awake tracheotomy should be performed for impending airway obstruction and in a timely manner before complete obstruction occurs.
authors.affiliation: Department of Otolaryngology, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore. yuen_a@yahoo.com.sg
authors.forename: Heng-Wai
authors.initials: HW
authors.lastname: Yuen
authors.forename: Andrew Heng-Chian
authors.initials: AH
authors.lastname: Loy
authors.forename: Shirish
authors.initials: S
authors.lastname: Johari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014140:Tracheotomy / Q000379:methods*; D014851:Wakefulness