A 40 year old patient with vocal cord polyps is scheduled for laser resection of the polyps. She is induced with general anesthesia and intubated with a 5.0 microlaryngeal tube. The table is turned 180 degrees and the sugeon begins. Halfway through the procedure, the surgeon yells "airway fire." There is a large air leak, and the patient cannot be ventilated with positive pressure. Smoke is coming out of the mouth.
Challenge: What's your next step in management?
Fahrenheit 451
ReplyDeleteIn an airway fire, ventilation must be stopped and the source of fire (ie. the endotracheal tube) must be removed. These actions remove the flame, retained heat, and oxygen-rich gas. Ventilation can then be maintained by mask and anesthesia by IV agents. Direct and rigid laryngoscopy can be used to assess the damage.
Source: Miller's Anesthesia, 7th ed.