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Chapter 32 - The Bloody and Bleeding Airway

from Section 2 - Airway Management: Clinical Settings and Subspecialties

Published online by Cambridge University Press:  03 October 2020

Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

Bleeding in the upper airway is an important cause of airway-related death, even in young and otherwise healthy individuals. The estimated lifetime incidence of epistaxis is approximately 60%; post-tonsillectomy haemorrhage occurs in 6–15% of tonsillectomy cases; and bleeding following surgery for malignancy in the upper airway is one of the leading causes of requirement of an emergency front of neck airway. Pre-oxygenation may be difficult or impossible. Cornerstone techniques commonly employed to secure the airway, such as direct/videolaryngoscopy and flexible optical laryngoscopy, may be ineffective due to soiling of the hypopharynx – and the equipment – with blood. Supraglottic airway devices may be employed but are typically of limited efficacy due to the increased risk of aspiration and their potential interference with surgical access to the bleeding site in the hypopharynx, glottis and trachea. The clinician may thus be forced to use other, less familiar techniques and modify their approach to airway management, particularly if bleeding is profuse and/or conventional intubation and airway rescue techniques are predicted to be difficult. Cardiovascular compromise from blood loss may further complicate airway management and anaesthesia. We identify techniques and strategies that may be employed in this situation.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Abou-Madi, MN, Trop, D. (1989). Pulling versus guiding: a modification of retrograde guided intubation. Canadian Journal of Anaesthesia, 36, 336339.CrossRefGoogle ScholarPubMed
Ittrich, H, Bockhorn, M, Klose, H, Simon, M. (2017). The diagnosis and treatment of hemoptysis. Deutsches Arzteblatt International, 114, 371381.Google ScholarPubMed
Kristensen, MS, McGuire, B. (2020). Managing and securing the bleeding upper airway: a narrative review. Canadian Journal of Anaesthesia, 67, 128140.Google Scholar
Kristensen, MS, Fried, E, Biro, P. (2018). Infrared Red Intubation System (IRRIS) guided flexible videoscope assisted difficult airway management. Acta Anaesthesiologica Scandinavica, 62, 1925.Google Scholar
Windfuhr, JP, Schloendorff, G, Sesterhenn, AM, Prescher, A, Kremer, B. (2009). A devastating outcome after adenoidectomy and tonsillectomy: ideas for improved prevention and management. Otolaryngology–Head and Neck Surgery, 140, 191196.Google Scholar
Yang, SH, Wu, CY, Tseng, WH, et al. (2019). Nonintubated laryngomicrosurgery with transnasal humidified rapid-insufflation ventilatory exchange: a case series. Journal of the Formosan Medical Association, 118, 11381143.CrossRefGoogle ScholarPubMed

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