LOWER AIRWAY INJURIES AND ANESTHESIA

Purpose: The perioperative management of lower airway injuries is a di fficult clinical problem. Since Sew reviews present the management of this injury from an anaesthetic perspective, we undertook a literature review of this topic. Sources: A computerized search of the National Library of Medicine database using tracheal or bronchial injury as key words produced 140 English language citations. An eight-year chart re view outlining our experience in an urban Canadian setting is also pre sented. Findings: The most frequent findings in patients with injury t o the lower airway are dyspnoea and surgical emphysema. Other findings include cough, haemoptysis, sucking neck or chest wounds, mediastinal emphysema or pneumothorax. Endoscopy with a fiberoptic scope is the t echnique of choice for diagnosis, airway management and as a preparato ry step in planning of the surgical repair. An airway technique employ ing direct vision is preferable to blind attempts during tracheal intu bation. The use of a double lumen endobronchial tube or selective endo bronchial intubation may be needed to achieve adequate pulmonary venti lation. A number of prospective randomized clinical trials comparing c onventional mechanical ventilation with high frequency jet ventilation in patients with acute lung injury have demonstrated no difference in effectiveness of ventilation or oxygenation. Conclusions: Patients wi th lower air-way injuries usually present when they are least expected and are a challenge to manage. The clinical presentation of a lower a irway injury may be overt or subtle. Resuscitation and anaesthetic man agement are directed towards control of the airway, maintenance of ade quate pulmonary ventilation and management of blood loss.