Guidelines for Complications of Cancer Treatment Vol VIII Part B

Obstruction can occur at the level of larynx, trachea or bronchidepending on site of tumor. When subjected to surgeryanaesthetist frequently encounters difficult intubation.Practice Guidelines for Management of the DifficultAirwayAn Updated Report by the American Society ofAnesthesiologists Task Force on Management of theDifficult AirwayAnesthesiology 2006; 104:847–64Definition- A difficult airway is defined as the clinical situationin which a conventionally trained anesthesiologist experiencesdifficulty with face mask ventilation of the upper airway,difficulty with tracheal intubation, or both. The difficult airwayrepresents a complex interaction between patient factors, theclinical setting, and the skills of the practitioner.1. Difficult face mask ventilation: (a) It is not possible forthe anesthesiologist to provide adequate face mask ventilationdue to one or more of the following problems: inadequatemask seal, excessive gas leak, or excessive resistance to theingress or egress of gas.(b) Signs of inadequate face mask ventilation include (but arenot limited to) absent or inadequate chest movement, absentor inadequate breath sounds, auscultatory signs of severeobstruction, cyanosis, gastric air entry or dilatation, decreasingor inadequate oxygen saturation (SpO2), absent or inadequateexhaled carbon dioxide, absent or inadequate spirometricmeasures of exhaled gas flow, and hemodynamic changesassociated with hypoxemia or hypercarbia (e.g., hypertension,tachycardia, arrhythmia).2. Difficult laryngoscopy: (a) It is not possible to visualizeany portion of the vocal cords after multiple attempts atconventional laryngoscopy.62