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 Google Scholar Google Scholar Articles by Beriault, M. Articles by Hui, A. Search for Related Content PubMed PubMed Citation Articles by Beriault, M. Articles by Hui, A.

Innovative airway management for peritonsillar abscess

[Contrôle novateur des voies aériennes dans un cas de phlegmon amygdalien]

Michael Beriault, MD^*, Jennifer Green, MD^* and Anita Hui, MD

^* From the Departments of Anesthesiology and
Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada.

Address correspondence to: Dr. Michael Beriault, Department of Anesthesiology, Foothills Medical Center, 1403-29^th St. N.W., Calgary Alberta T2N 2T9, Canada. Phone: 403-944-1430; Fax: 403-944-2425; E-mail: beriaul{at}telusplanet.net

Purpose: To describe innovative airway management in an adult with a peritonsillar abscess (quinsy) located atypically in the inferior pole of the palatine tonsil.

Clinical features: A 25-yr-old male was admitted for surgical drainage of a left-sided, inferior pole peritonsillar abscess. Previous attempts at intraoral needle and scalpel drainage with topical anesthesia in the emergency department had failed. He had an interdental distance of 1.5 cm and computed tomography imaging showed narrowing of the airway diameter to 8 mm and lateral displacement of the epiglottis. He gargled 10 mL 0.5% lidocaine in the sitting position. We advanced a 3.1-mm pediatric fibreoptic bronchoscope (FOB) through an orally inserted nasopharyngeal airway to identify the glottis and sprayed 0.5% lidocaine onto the airway mucosa. We replaced the airway with a reinforced 6.5-mm internal diameter tracheal tube (TT), advanced the FOB through it until its tip was just above the carina, and then advanced the TT into the trachea. After iv induction of general anesthesia, the surgeon performed a tonsillectomy and drained the neck abscess. Postoperative direct laryngoscopy revealed a markedly improved airway lumen and tracheal extubation over a Cook Airway Exchange Catheter^TM was uneventful. The patient was stable in the recovery room, and was discharged on the third postoperative day.

Conclusion: We present an innovative technique of fibreoptic intubation in an awake patient with an inferior pole peritonsillar abscess.