UPPER AIRWAY OBSTRUCTION
Facilitator: Dr. Zephania Saitabau
University of Dodoma-College of
Health Sciences
Definition
Upper airway obstruction: This is obstruction at or
above the major carina
AETIOLOGY
Congenital.
a)Laryngeal web
b)Subglottic stenosis
c)Subglottic haemangioma
d)Bilateral choanal atresia
Inflammatory
a) Acute epiglottitis & retropharyngeal abscess
b) Acute laryngotracheobronchitis
c) Sarcoidosis
d) Laryngoscleroma
e) Laryngeal angioneurotic oedema
Neoplasms
Benign neoplasms
a) Laryngeal papillomas
b) Chodromas
c) Neurofibromas
d) Leomyomas
Malignant Neoplasms-Hypopharyngeal cancer,
Laryngeal cancer, Oropharyngeal cancer
Neurological
a) Bilateral abductor cord paralysis
b) Tetanus
c) Myasthenia gravis
d) Bulbar poliomyelitis
OTHER CAUSES
a) Trauma to the neck
b) Foreign bodies
c) Extrinsic obstruction
Thyroid tumours
Mediastinal tumours
DIAGNOSIS
• History
• Physical examination
Dyspnea
Inspiratory stridor
Cyanosis
Retraction ( suprasternal, intercostal, substernal.)
• Direct laryngoscopy
MANAGEMENT
• Depends on severity and nature of obstruction
In emergency
A large bore needle can be inserted in the cricothyroid
membrane or a cricothyrotomy may be done
Endotracheal intubation may be done-Epiglottitis.
Bronchoscopy is done for FBS
Tracheotomy.
TRACHEOSTOMY
• Definition: Is a surgical opening made in the anterior
wall of the trachea.
• Reduces anatomical dead space by 30-50%
INDICATIONS OF TRACHEOSTOMY
• Pulmonary toilet
• Relief upper airway obstruction
• An adjunct in major head and neck surgeries: provide
pathway for anesthetics in some head and neck
operations
• Prolonged intubation
• To Wean patients off ventilators
HISTORY OF TRACHEOSTOMY
• The first recorded tracheotomy was performed by Alexander
the great by a point of his sword to relief the airway of a
choking soldier.
• Before the 19th century it was very unpopular. The private
physician to George Washington advised against it.
Following which the president succumbed to acute
epiglottitis.
• In the 19th century it was performed to a convicted murderer
who survived to be hanged and became popular
TECHNIQUE OF TRACHEOSTOMY
• Whenever possible should be performed in theatre
under GA.
• Position: Supine with neck extended.
• Incision: Longitudinal: Dissection-easier.
Transverse: More cosmetic.
• Longitudinal incision is made from the cricoid cartilage
to the suprasternal notch
TRACHEOSTOMY DISSECTION
• Skin incision is made by no.10 scalpel Through skin
subcutaneous tissue, superficial fascia, platysma
muscle.
• Then cut deep cervical fascia, separate and retract the
strap muscles.
• The pre tracheal fascia is cut and the isthmus of the
thyroid retracted superiorly to expose the tracheal
rings
TRACHEAL INCISION
• The incision is made by no 11 scalpel.
• It is made between 2nd and 3rd tracheal rings.
• The incision edges are held apart by tracheal dilator.
• Tube is introduced and held in position by a tape.
• The wound is loosely tied to avoid subcutaneous
emphysema.
POSTOPERATIVE CARE
Essential requirements
• A spare tracheotomy tube to be kept near the patient
• Trained nurse or doctor should be available
• A bell should be provided for the patient as he can not
speak easily
• Suction and oxygen must be available
Contn….Postoperative Care
• Chest x-ray to rule out pneumothorax,
pneumomediastinum and ascertain position
• Clean inner tube regularly, to avoid condensation of
mucus.
• Don’t remove the tracheotomy tube before the stoma
is mature, i.e seven days.
• Do suction regularly under sterile conditions
COMPLICATIONS OF TRACHEOSTOMY
Immediate complications.
• Haemorrhage
• Pneumothorax and pneumomediastinum
• Subcutaneous emphysema
• Aspiration
• Tube malposition
• Tracheoesophageal fistula
• Recurrent laryngeal nerve paralysis.
• Apnea due to vagal stimulation and sudden removal of PaCO2
Instill lignocaine prior to insertion of the tube
Contn…..Complications
Late complications
• Secondary haemorrhage
• Tracheal cutaneous fistula
• Pulmonary infection
• Tracheomalacia
• Tracheostenosis
• Difficulty decanulation
THE END
