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Injury of airway during surgery — Clinical Guidelines

Overview

Injury to the airway during surgery can occur due to various complications such as dehiscence after tracheal resection, mechanical trauma, or procedural errors, necessitating urgent interventions and effective multidisciplinary communication. 1 2 4

Diagnosis

Clinical Presentation: Symptoms may include airway obstruction, respiratory distress, or signs of hypoxia.

Imaging: CT or bronchoscopy to assess extent of injury and anatomical changes.

Monitoring: Continuous pulse oximetry, capnography, and arterial blood gas analysis to evaluate ventilation status. 2 4

Management

Urgent Repair: Use of absorbable prosthetics for tracheal defects in cases of extensive ischemia or dehiscence. 1

Ventilation Management: Close collaboration between anesthesiologist and surgeon to maintain adequate ventilation during critical surgical maneuvers. 2

Preventive Measures: Application of positive end-expiratory pressure (PEEP) to reduce risk of laser-induced fires in PVC tracheal tubes during laser surgeries. 5

Special Populations

Elderly: Increased risk of complications due to comorbid conditions and tissue fragility; meticulous monitoring and communication are crucial. 4

Pediatrics: Smaller airway size necessitates specialized techniques and equipment; heightened vigilance for airway trauma is essential. 4

Key Recommendations

Employ absorbable prosthetics for urgent repair of extensive tracheal defects to avoid repeated surgical interventions. (Evidence: Moderate 1)

Ensure continuous and clear communication between anesthesiology and surgical teams to optimize patient ventilation and surgical outcomes. (Evidence: Expert opinion 2)

Utilize positive end-expiratory pressure (PEEP) to mitigate risks associated with laser use in airway surgeries involving PVC tracheal tubes. (Evidence: Moderate 5)

References

1 Mammana M, Comacchio GM, Bellini A, Rea F. Use of a reabsorbable patch as tracheal substitute in a complicated urgent tracheostomy. Interactive cardiovascular and thoracic surgery 2020. link 2 Shamji FM, Deslauriers J. Sharing the Airway: The Importance of Good Communication Between Anesthesiologist and Surgeon. Thoracic surgery clinics 2018. link 3 Lingard L, Regehr G, Espin S, Devito I, Whyte S, Buller D et al.. Perceptions of operating room tension across professions: building generalizable evidence and educational resources. Academic medicine : journal of the Association of American Medical Colleges 2005. link 4 Weber S. Traumatic complications of airway management. Anesthesiology clinics of North America 2002. link00014-7) 5 Pashayan AG, SanGiovanni C, Davis LE. Positive end-expiratory pressure lowers the risk of laser-induced polyvinylchloride tracheal-tube fires. Anesthesiology 1993. link

Injury of airway during surgery