**Immediate stridor**

*Special Considerations in Human Airway Management*

3. Ensure continuity of regular breathing and

adequate gas exchange

6. Ensure patient is awake, obeying commands with open eyes

7. Reversal of neuromuscular blocking

*Techniques to ease awake intubation in a difficult airway case.*

1. Patient in sit up Position 8. Ensure giving adequate analgesia

4. Insert bite block as rolled gauze 11. Ensure airway is patent 5. Airway suction 12. Continue giving oxygen

2. Give Oxygen 100% 9. Ensure the patient is cardiovascular stabile

10. Apply positive pressure, deflate cuff and remove tube

13. Transfer the patient with high flow oxygen and with

close observation and monitoring

**144**

**Extubation:**

**Figure 17.**

**Table 3.**

breathing normally. **Tracheostomy**

able to secure his airway.

oxygen and nebulized Epinephrine [13].

prevent coughing and facilitate a wake extubation.

then the ETT can be safely removed (**Figure 17**).

compromised or the patient cannot protect his airway [15].

**Staged extubation with airway exchange catheters (AECs)**

Patient with expected difficult airway, extubation preferred to be on the operating table with all needed equipment are available. Patients with some degree of laryngeal oedema after extubation they will benefit from the use of humidified

*(A) AEC introduced through the endotracheal tube. (B) AEC left inside trachea. (C) reintubation over the AEC.*

But in case of total airway obstruction this treatment is not effective and there is a great possibility for re-intubation. Remifentanil used at the end of surgery to

The AEC is usually used for patients known or suspected to have difficult airway, it is used to facilitate re-intubation if needed. The AEC (which is a long hollow boogie) introduced through the endotracheal tube (ETT) before extubation, and

In case the patient needs to be re-intubated, the AEC will be used as a guide for the ETT. The AEC can be left in place and tolerated for up to 72 H [14], but usually it is kept for few hours and removed after the patient is stable, fully awake and

Tracheostomy operation done within some of maxillofacial operations and in major head and neck operations where postoperatively the airway is expected to be

Usually the tracheostomy is temporary and patient can be weaned after healing of the wound, subsiding of the reactionary oedema and swelling and the patient is

Oedema from trauma to the airway is the most common cause for immediate stridor post extubation. This can be avoided by sitting the patient up, giving a dose of 8 mg Dexamethasone i.v. and also giving nebulized Epinephrine before extubation [17].

If the stridor persists and patient is deteriorating, you should examine the airway under anesthesia to rule out other causes as blood clot or retained throat pack.
