Upper airway diseases and airway management: a synopsis

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Stridor

Stridor, or noisy inspiration from turbulent gas flow in the upper airway, often is seen in airway obstruction, and always commands attention. Wherever possible, attempts should be made to immediately establish the cause of the stridor (eg, foreign body, vocal cord edema, tracheal compression by tumor, functional laryngeal dyskinesia, and so forth) [1].

The first issue of clinical concern in the setting is whether or not intubation is immediately necessary. If intubation can be delayed, a number

Diabetes and the airway

The link between diabetes mellitus and difficult laryngoscopy has been described only in recent years [2]. Approximately one third of long-term type diabetics (juvenile onset) present with laryngoscopic difficulties [3], [4]. This is a result, at least in part, of diabetic “stiff joint syndrome,” [5], [6] characterized by short stature, joint rigidity, and tight, waxy skin. The fourth and fifth proximal pharyngeal joints most commonly are involved. Patients with diabetic stiff joint syndrome

Airway polyps

Polyps may be found throughout the airway. Nasal polyps and polyps elsewhere in the airway can lead to partial or complete airway obstruction [45], [46]. Vocal cord granulomas and polyps may occur as a result of traumatic intubation, cord irritation from ETT movement or lubricant chemicals, or other causes. The problem occurs more frequently in women. Pedunculated granulomas or polyps detected after the investigation of hoarseness are usually removed surgically, as they can sometimes lead to

Mediastinal masses: some practical points

  • 1.

    Patient evaluation should center on the following clinical questions:

    • Is there SVC obstruction?

    • Is there tracheal compression?

    • Is the PA involved?

    • Is the heart involved?

  • 2.

    These questions must be investigated with the following tools:

    • Clinical presentation (signs, symptoms, and clinical findings). Note that the clinical presentation is the most important determinant of severity.

    • Chest radiogaph

    • CT scan of chest

    • Flow-volume loops (ideally, both sitting and supine)

  • 3.

    Signs and symptoms indicating airway

Tonsillitis and other tonsillar disorders [65,66]

Tonsillectomy surgery may be required in adults and children either because tonsillar hypertrophy is causing partial airway obstruction or because of the nuisance of repeated tonsillar infections. Less commonly, tonsillar malignancy may require radical craniofacial surgery, whereas occult hypertrophic tonsillar masses in completely asymptomatic individuals rarely may lead to fatal airway obstruction with the routine induction of general anaesthesia.

Airway considerations for general anaesthesia

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References (170)

  • J.M. Bernstein et al.

    Role of allergy in nasal polyposis: a review

    Otolaryngol Head Neck Surg

    (1995)
  • I. Hindle et al.

    The epidemiology of oral cancer

    Br J Oral Maxillofac Surg

    (1996)
  • K. Amaha et al.

    Major airway obstruction by mediastinal tumour. A case report

    Br J Anaesth

    (1973)
  • A.J. Piro et al.

    Mediastinal Hodgkin's disease: a possible danger for intubation anesthesia

    Int J Radiat Oncol Biol Phys

    (1976)
  • U.B.S. Prakash et al.

    Mediastinal mass and tracheal obstruction during general anesthesia

    Mayo Clin Proc

    (1988)
  • O.W. Hnatiuk et al.

    Spirometry in surgery for anterior mediastinal masses

    Chest

    (2001)
  • H. Breivik et al.

    Acute epiglottitis in children. Review of 27 patients

    Br J Anaesth

    (1978)
  • F.R. DiTirro et al.

    Acute epiglottitis: evolution of management in the community hospital

    Int J Pediatr Otorhinolaryngol

    (1984)
  • P.B. Fontanarosa et al.

    Adult epiglottitis

    J Emerg Med

    (1989)
  • U. Khilanani et al.

    Acute epiglottitis in adults

    Am J Med Sci

    (1984)
  • T.O. Stair et al.

    Adult supraglottitis

    Am J Emerg Med

    (1985)
  • W.A. Ames et al.

    Adult epiglottitis: an under-recognized, life-threatening condition

    Br J Anaesth

    (2000)
  • J.E. Greenberg et al.

    Upper airway obstruction secondary to acquired immunodeficiency syndrome-related Kaposi's sarcoma

    Chest

    (1985)
  • V. Renz et al.

    Functional laryngeal dyskinesia: an important cause of stridor

    J Laryngol Otol

    (2000)
  • H.H. Salzarulo et al.

    Diabetic “still joint syndrome” as a cause of difficult endotracheal intubation

    Anesthesiology

    (1986)
  • L. Eleborg et al.

    Are diabetic patients difficult to intubate?

    Acta Anaesthesiol Scand

    (1988)
  • K. Hogan et al.

    Difficult laryngoscopy and diabetes mellitus

    Anesth Analg

    (1988)
  • A. Grfic et al.

    Joint contracture in childhood diabetes

    N Engl J Med

    (1975)
  • J.R. Seibold

    Digital sclerosis in children with insulin-dependent diabetes mellitus

    Arthritis Rheum

    (1982)
  • B. Buckingham et al.

    Scleroderma-like syndrome and the non-enzymatic glycosylation of collagen in children with poorly controlled insulin dependent diabetes (IDDM)

    Pediatr Res

    (1981)
  • H. Nichol et al.

    Difficult laryngoscopy—the ‘anterior' larynx and the atlanto-occipital gap

    Br J Anaesth

    (1983)
  • E. Reissell et al.

    Predictability of difficult laryngoscopy in patients with long-term diabetes mellitus

    Anaesthesia

    (1990)
  • M. Chapple et al.

    Joint contractures and diabetic retinopathy

    Postgrad Med J

    (1983)
  • J.L. Nadal et al.

    The palm print as a sensitive predictor of difficult laryngoscopy in diabetics

    Acta Anaesthesiol Scand

    (1998)
  • V. Vani et al.

    The palm print as a sensitive predictor of difficult laryngoscopy in diabetics: a comparison with other airway evaluation indices

    J Postgrad Med

    (2000)
  • G.A. Bray et al.

    Obesity. Part 1. Pathogenesis

    West J Med

    (1988)
  • F.P. Buckley et al.

    Anaesthesia in the morbidly obese. A comparison of anaesthetic and analgesic regimes for upper abdominal surgery

    Anaesthesia

    (1983)
  • J.J. Lee et al.

    Airway maintenance in the morbidly obese

    Anesthesiol Rev

    (1980)
  • M.L. Norton et al.

    Evaluating the patient with a difficult airway for anesthesia

    Otolaryngol Clin North Am

    (1990)
  • R.W. Baughn et al.

    Volume and pH of gastric juice in obese patients

    Anesthesiology

    (1975)
  • S.K. Kallar et al.

    Potential risks and preventive measures for pulmomary aspiration: New concepts in preoperative fasting

    Anesth Analg

    (1993)
  • M. Bengtsson et al.

    Cricoarytenoid arthritis–a cause of upper airway obstruction in the rheumatoid arthritis patient

    Intensive Care Med

    (1998)
  • L. Brazeau-Lamontagne et al.

    Cricoarytenoiditis: CT assessment in rheumatoid arthritis

    Radiology

    (1986)
  • D. Funk et al.

    Rheumatoid arthritis of the cricoarytenoid joints: an airway hazard

    Anesth Analg

    (1975)
  • A. Geterud et al.

    Laryngeal involvement in rheumatoid arthritis

    Acta Otolaryngol

    (1991)
  • A. Geterud et al.

    Severe airway obstruction caused by laryngeal rheumatoid arthritis

    J Rheumatol

    (1986)
  • D.F. McGeehan et al.

    Life-threatening stridor presenting in a patient with rheumatoid involvement of the larynx

    Arch Emerg Med

    (1989)
  • C.L. Vassallo

    Rheumatoid arthritis of the cricoarytenoid joints: cause of upper airway obstruction

    Arch Intern Med

    (1966)
  • P. Hakala et al.

    Intubation difficulties in patients with rheumatoid arthritis. A retrospective analysis

    Acta Anaesthesiol Scand

    (1998)
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    This article is modified from an earlier review published in Anesthesiology Clinics of North America. DJ Doyle, R Arellano. Medical Conditions With Airway Implications. The Difficult Airway II. WB Saunders; September 1995.

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