MANAGEMENT OF THE TRAUMATIZED AIRWAY

Abstract

The fundamental responsibility of the anaesthesiologist is to mamtam adequate gas exchange. In order to do this, the airway must be managed in such a way that it is almost contimtously patent. Failure to maintain a patent airway for more than a few minutes results in brain damage or death. Thus, it is not surprising that more than 85% of all respiratory-related closed malpractice claims involve a brain-damaged or dead patient. It is mandatory that a clinician responsible for airway management be familiar with the airway anatomy and how it pertains to intubation. [t should be remembered that the airway begins with the facial skeleton which is conventionally di,1ded into thirds; the frontal bone, the maxillae with the nasal bone and the mandible. The nasal passages communicate with the pharynx, larynx, and thence the trachea. The nasopharynx is delineated by the hard palate, separating it from the mouth and the soft palate separating it from the oropharynx. Airway trawna can be classified into incomplete or complete closure with either penetrating or blunt trauma. Clinical picture may be one of the following; hoarseness, stridor, bhmt or penetrating injury to the neck, cerebrospinal fluid rhinorrhea, subcutaneous emphysema, cervical spme instability, facial bone fractures, and/or a foreign body in the ai.tway. Injuries and fractures at different sites of the airway inClude; maxillo-facial fractures, mandibular fractures, panfacial fractures, or laryngeal and tracheal injuries. Airway traumas might be also related to anaesthetic practice, which are sometimes serious and may compromise the ai.tway.