This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ho, A. M. H. Articles by Karmakar, M. K. Search for Related Content PubMed PubMed Citation Articles by Ho, A. M. H. Articles by Karmakar, M. K.

Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway

[Une obstruction totale des voies aériennes pendant une anesthésie locale chez un patient éveillé qui présentait déjà une obstruction respiratoire partielle]

From the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin; and the Oral and Maxillofacial Surgery Centre, St. Teresa Hospital, Kowloon, Hong Kong, China.

Address correspondence to: Dr. Anthony Ho, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PRC., Phone: 852-2632-2735; Fax: 852-2637-2422; E-mail: hoamh{at}cuhk.edu.hk

Purpose: To report a case of complete upper airway obstruction after topicalization with lidocaine in a completely conscious patient with partial upper airway obstruction.

Clinical features: A 69-yr-old man with a history of neck cancer and radiation presented for resection of recurrent neck tumour. No preoperative sedation was given. He had inspiratory and expiratory stridor but had no history of aspiration or swallowing problem. Phonation was distorted but effective. The surgeon was reluctant to perform an awake tracheostomy under local anesthesia. In preparation for a fibrescope-assisted orotracheal intubation, the non-sedated patient was given topical upper airway lidocaine during which he developed total airway obstruction and hypoxemia. He was immediately intubated with a fibrescope. His vocal cords were not edematous although the supraglottic structures appeared to be. The vocal cords were abducted and their movement was limited and not paradoxical. Tumour resection was uneventful upon successful tracheal intubation and general anesthesia. Tracheostomy at the end of the case was difficult, as expected. The patient tolerated the procedures and regained consciousness with no neurologic sequelae.

Conclusion: Dynamic airflow limitation associated with local anesthesia of the upper airway may lead to complete upper airway obstruction in a compromised airway. The main cause may be the loss of upper airway muscle tone, exacerbated by deep inspiration during panic.

This article has been cited by other articles:

				S. Darshane, P. Groom, and P. Charters Responsive Contingency Planning: a novel system for anticipated difficulty in airway management in dental abscess Br. J. Anaesth., December 1, 2007; 99(6): 898 - 905. [Abstract] [Full Text] [PDF]

				T. M. Cook, M. Asif, R. Sim, and J. Waldron Use of a ProSealTM laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway obstruction Br. J. Anaesth., October 1, 2005; 95(4): 554 - 557. [Abstract] [Full Text] [PDF]