Recent advances in upper airway trauma management in adults & its relation to anesthesia

Abstract

Complications related to airway management in traumatized patients are common and, because of the importance and vulnerability of the ventilatory system, can be life threatening within a very short time. Therefore, airway management is perhaps the most vital component in the treatment of traumatized patients. Patients who have suffered major trauma can present the most complex airway management problems, especially in the prehospital setting. Because the treatment is time-critical, the evaluation of injuries is usually incomplete at the time airway management is undertaken. If the airway is injured, attempts to secure the airway by performing endotracheal intubation or insertion of other devices may cause even further injury. It is widely accepted that intensive preparation and training for the management of airway problems help to prevent and solve most reported complications. Airway management involves far more than just proficiency with tracheal intubation techniques. Clearly, several techniques are available, and the method chosen depends on the availability of equipment, the level of training and expertise, and the patient's specific injury. Traumatologists must understand the physiologic consequences and complications of the procedures and techniques and have knowledge of the anatomy and pathologic conditions of the airway and of methods of assessment. Perhaps most important of all, they must be able to recognize patients in whom airway management may be difficult and be able to formulate and implement alternative plans in various situations. Many times, difficult airways are not those that present obvious concerns in advance (and thus promote preemptive procedures and techniques) but rather those that look easy but are not. Difficult airways demand the confluence of all the skills, experience, training, knowledge, and innovation of advanced traumatologists.