ANZCA Bulletin June 2011 - Australian and New Zealand College of ...

Figure 1: a suggested algorithm for the acute management of an obstructing airway.
The patient’s preoperative
assessment by the anaesthetist revealed
that he was able to speak but had
some limitation of his mouth opening.
There was no stridor or drooling. The
anaesthetist performed an awake
fibreoptic intubation as a teaching
exercise for the anaesthetic trainee.
The anaesthetist felt that the patient’s
clinical condition was not an indication
for the awake fibreoptic intubation.
The fibreoptic view revealed a normal
appearance of the vocal cords.
The surgeons drained a right
submandibular and sublingual abscess.
Following the surgical procedure, the
anaesthetist examined the airway
with a laryngoscope and could see
his epiglottis and the posterior part of
his vocal cords. The anaesthetist was
confident that he could re-intubate
the patient if that was necessary. The
patient was extubated and transferred
to the recovery ward following the
surgery.
The anaesthetist reviewed the patient
in the recovery ward at approximately
5.30pm. At this time he was sitting
upright in his bed and the anaesthetist
asked him how he was going, to which
he responded “fine”. The patient on
direct questioning denied any pain.
Despite this, the records show that
the patient received 32 milligrams of
morphine in four milligram doses while
in the recovery ward. The patient did not
have any stridor. His tongue was slightly
swollen. The anaesthetist then asked the
consultant anaesthetist in charge of the
recovery ward to supervise the patient’s
care. She reviewed him and discharged
the patient to the general ward.
After arrival in the ward at 6.10pm
the nurse assisted the patient to have a
shower and changed his dressing. She
stated that he responded to her with yes
or no answers but did not converse. The
nursing observations were performed
immediately after the patient’s arrival
in the ward and then at 7pm and
8pm. These observations included
temperatures, oxygen saturations and
blood pressure. The nurse also said the
patient was alert and orientated at 8pm
and he was given some morphine for
pain relief.
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