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Perioperative Airway Management in Deep Neck Space Infections

Shoba K., 68/11B, GNT Road, Sembulivarum, Chennai-600067, Tamil Nadu, India. , C.B. Sridhar1 , Shoba K.2

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Indian Journal of Anesthesia and Analgesia 4(3):p 635-638, July - September 2017. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.14

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Abstract

Introduction: Airway management in deep neck infection are contraversial. In our study we retrospectively reviewed perioperative airway management methods practiced in the last 30 consecutive cases of deep neck infection. Materials and Methods: Inclusion criteria was deep neck space infection patients requiring surgical drainage under general anaesthesia. Exclusion criteria were small abscess managed medically and abscess drained under local anaesthesia. Patients were grouped into tracheostomy, fiberoptic intubation, blind nasal intubation and rigid laryngoscopic intubation. Results: In our study all 19 patients who had trismus were planned for fiberoptic intubation. It was successful in all 19 patients. Laryngoscopic intubation was attempted in 11 patients, 7 patients with good mouth opening and in 4 patients with severe stridor. However 2 patients in stridor who could not be intubated with laryngoscope, underwent emergency tracheostomy. In 6 patients tracheostomy was done along with incision and drainage for post-op airway management. Five patients were sent to intensive care unit with endotracheal tube, 3 out of this proceed to tracheostomy within 4 days. Rest of the patients were extubated immediately after surgery. Discussion: Fiberoptic intubation is a very safe airway management in trained hands when adequate time is available. Trial of rigid laryngoscopy can be given only with tracheostomy backup during emergency. Patients with advanced deep neck infection requiring post-operative airway are better managed with tracheostomy than with endotracheal tube. Conclusion: Fiberoptic intubation for general anaesthesia and tracheostomy for postoperative airway in advanced cases gave good results in our study.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.4317.14

Keywords

Deep Neck Infection; Fiberoptic Intubation; Tracheostomy; Airway.

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