Upper Airway Instrumentation in Patients with Laryngeal Obstruction

Introduction: Ontogenetically the larynx is subdivided into supraglottis, glottis and subglottis. Difficult intubation requires the preparation of a preliminary plan for establishing ventilation of the patient if the intubation proves impossible. Aim: The aim of the study is to characterize the proposed various techniques for upper airway instrumentation in patients with laryngeal obstruction. Materials and methods: Clinical prospective cohort study including 120 patients undergoing laryngectomy in the Department of ENT Surgery; University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2012-2015, for determining the degree of laryngeal obstruction and depending on it, application of different techniques for upper airway instrumentation during the tracheostomy. The patients were subdivided into the following groups: Group 1 (n = 40): tracheostomy under local anesthesia with preservation of spontaneous breathing and oxygen administration through face mask; Group 2 (n = 40): tracheostomy under general anesthesia and ventilation through endotracheal tube; Group 3 (n = 40): tracheostomy under general anesthesia and ventilation through laryngeal mask. Results and discussion: Characterization of the anesthetic techniques during the tracheostomy: under local anesthesia with preservation of spontaneous breathing and oxygen administration through face mask, under general anesthesia and ventilation through endotracheal tube or ventilation through laryngeal mask and the anesthesia after intubation through the tracheostomy. Conclusion: Depending on the degree of laryngeal obstruction, different methods for upper airway instrumentation can be successfully used for upper airway instrumentation.