Airway catastrophes.
OBJECTIVE
The article reviews the epidemiology of airway injuries, airway anatomy, techniques for airway management, helpful pharmacologic adjuncts and finally alternatives to airway manipulation.


RESULTS
Principles of airway management including the maintenance of spontaneous ventilation and careful and adequate preparation for an alternative plan will always be important. Advances in pharmacologic agents provide a safer, more controlled environment through which the patient's compromised airway can be controlled. Recent publications add to the evidence that alternative methods of oxygenation and ventilation such as cardiopulmonary bypass can be used successfully to treat patients with catastrophic airway injuries.


CONCLUSIONS
Trauma to the airway, either blunt or penetrating or iatrogenic, can result in significant patient morbidity and mortality. Although, relatively rare, if we practice long enough, each of us will encounter such a patient. The anesthesiologist must be familiar with airway anatomy and the location of injury for successful treatment. Along with airway injuries, associated injuries are common and often complicate definitive airway treatment. Modern anesthetic medications such as dexmedetomidine and proven techniques such as awake fiberoptic intubation can be used to safely treat these difficult patients. Alternative therapies such as cricothyroidotomy and cardiopulmonary bypass should be available if first-line therapies fail to secure an injured airway.
Abernathy
James H
JH
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425-9120, USA.
Reeves
Scott T
ST
D000771:Anesthesia, Intravenous / Q000295:instrumentation / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001999:Bronchoscopy / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D007649:Ketamine / Q000008:administration & dosage; D014132:Trachea / Q000033:anatomy & histology / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*; D014950:Wounds, Penetrating / Q000150:complications / Q000628:therapy*
D018686:Anesthetics, Intravenous; D020927:Dexmedetomidine; D007649:Ketamine