Avoiding and Managing the Challenging Airway: The Team Approach

Tuesday, October 3, 2023

3:45 PM - 4:35 PM East Coast USA Time

Location: Ballroom A1

Moderator(s)

Rebecca J. Howell, MD

Associate Professor
University of Cincinnati
Cincinnati, OH, United States
Rebecca J. Howell, MD

Associate Professor
University of Cincinnati
Cincinnati, OH, United States

Panelist(s)

AM

Al Merati, MD

Professor and Chief
University of Washington
Seattle, WA, United States
AM

Al Merati, MD

Professor and Chief
University of Washington
Seattle, WA, United States
Alice Tang, MD

Assistant Professor
University of Cincinnati MedicalCenter/College of Medicine
Cincinnati, OH, United States
Alice Tang, MD

Assistant Professor
University of Cincinnati MedicalCenter/College of Medicine
Cincinnati, OH, United States
SB

Stuart R. Bertsch, MD

Associate Professor of Clinical Anesthesiology
University of Cincinnati
Cincinnati, OH, United States
SB

Stuart R. Bertsch, MD

Associate Professor of Clinical Anesthesiology
University of Cincinnati
Cincinnati, OH, United States

Disclosure(s):

Rebecca J. Howell, MD: No relevant relationships to disclose.

Al Merati, MD: No relevant relationships to disclose.

Alice Tang, MD: No relevant relationships to disclose.

Stuart R. Bertsch, MD: No relevant relationships to disclose.

PROGRAM DESCRIPTION: Shared airway management is fundamental to a successful operation in otolaryngologic surgery; how to communicate with your anesthesiologist to avoid unnecessary airway complications is imperative. Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) demonstrated that 39% of major airway complications involved an acute or chronic disease of the head, neck, or trachea. Assessment, planning, and communication between teams were identified as contributing influences. Of those requiring a surgical airway, poor planning of an airway strategy and failure to change routine plans were recognized factors. As otolaryngologists we face a unique relationship with our anesthesia colleagues in the shared airway. While in most circumstances, this is a smooth transition, when airway complications arise, they are serious, rapid, and we are asked to perform the surgical airway. Unique patient populations in otolaryngology include acute and chronic head and neck cancer, professional voice, glottic and subglottic stenosis, and OSA. Unique planning for airway management includes awake fiberoptic intubation, LMA, ETT choice, jet ventilation (supraglottic and subglottic), awake IV sedation, and sleep endoscopy. Induction and emergence of anesthesia are the critical check points for successful ENT surgery; improved preparation and communication between colleagues can make the climbing and descending smooth and avoid turbulence.

OUTCOME OBJECTIVE 1: 1. Identify unique patients at risk and critical members of the airway team.

OUTCOME OBJECTIVE 2: 2. Summarize pertinent medical history, goals of surgery, and early identification of the difficult intubation with anesthesia.

OUTCOME OBJECTIVE 3: 3. Describe the importance of induction, emergence, and recovery phases of anesthesia.

BACKGROUND STATEMENT: This is a 50% female panel with a dynamic group that worked well together last two years via both in-person and virtual symposia. Emergent airway management, this year we will include angioedema, which are both topics identified by the AAO.