Anesthetic and operative management of potential upper airway obstruction

Potential or actual supraglottic airway obstruction becomes critical when general anesthesia is begun. Four cases illustrated such obstruction, and the anesthetic and surgical management of each condition was critical. In carcinoma of the supraglottic larynx and in pharyngeal abscess, the unobstructed airway in the conscious patient became impossible to secure once general anesthesia was begun. Unappreciated pathological deformity prohibited endotracheal intubation, and anesthesia precipitated obstruction. In epiglottitis and peritonsillar abscess, the nature of the impending airway obstruction was appreciated, and the selection of a safe technique to secure the airway was made. Anesthetic and surgical management of potential supraglottic obstruction includes five options: (1) oral tracheal intubation by laryngoscopy while the patient is awake; (2) awake nasotracheal intubation; (3) inhalation induction by general anesthesia with intubation; (4) rapid induction with barbiturates and muscle relaxants with intubation; and (5) tracheostomy with local anesthesia.