Chapter 19 - The lost airway

Summary

Loss of the airway is quite apparent once oxygen saturations begin to fall but identifying it before this happens gives more time for a definitive diagnosis to be made and for the correct course of action to be implemented. It is obviously preferable to maintain ventilation throughout a general anaesthetic rather than have to rescue a lost airway. An emergency situation only exists when all three routine methods of oxygenation (facemask, laryngeal mask and tracheal intubation) have failed. The cricothyroid membrane is the preferred site for emergency access to the trachea for oxygenation. There are three types of cricothyroidotomy: small cannula devices, large bore cannula devices, and surgical cricothyroidotomy. Accepting the diagnosis of a lost airway is a difficult mental process. The only thing that distinguishes the lost airway from other cases is that the anaesthetist's usual armamentarium of techniques does not restore ventilation.