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The upper airway during anaesthesia
Journal article   Open access   Peer reviewed

The upper airway during anaesthesia

D.R. Hillman, P.R. Platt and P.R. Eastwood
British journal of anaesthesia : BJA, Vol.91(1), pp.31-39
2003
DOI: https://doi.org/10.1093/bja/aeg126
PMID: 12821563
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Abstract

airway, complications intubation tracheal difficult sleep sleep apnoea
Upper airway obstruction is common during both anaesthesia and sleep. Obstruction is caused by loss of muscle tone present in the awake state. The velopharynx, a particularly narrow segment, is especially predisposed to obstruction in both states. Patients with a tendency to upper airway obstruction during sleep are vulnerable during anaesthesia and sedation. Loss of wakefulness is compounded by depression of airway muscle activity by the agents, and depression of the ability to arouse, so they cannot respond adequately to asphyxia. Identifying the patient at risk is vital. Previous anaesthetic history and investigations of the upper airway are helpful, and a history of upper airway compromise during sleep (snoring, obstructive apnoeas) should be sought. Beyond these, risk identification is essentially a search for factors that narrow the airway. These include obesity, maxillary hypoplasia, mandibular retrusion, bulbar muscle weakness and specific obstructive lesions such as nasal obstruction or adenotonsillar hypertrophy. Such abnormalities not only increase vulnerability to upper airway obstruction during sleep or anaesthesia, but also make intubation difficult. While problems with airway maintenance may be obviated during anaesthesia by the use of aids such as the laryngeal mask airway (LMA†), identification of risk and caution are keys to management, and the airway should be secured before anaesthesia where doubt exists. If tracheal intubation is needed, spontaneous breathing until intubation is an important principle. Every anaesthetist should have in mind a plan for failed intubation or, worse, failed ventilation.

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Collaboration types
Domestic collaboration
Citation topics
1 Clinical & Life Sciences
1.235 Throat & Voice Disorders
1.235.847 Airway Management
Web Of Science research areas
Anesthesiology
ESI research areas
Clinical Medicine
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