Chapter 29 - Airway management with limited resources

Summary

This chapter discusses examples of airway management techniques which do not rely on expensive equipment. Ketamine anaesthesia with spontaneous breathing is a particularly useful anaesthetic for patients with facial burns requiring debridement and skin grafting. If the airway anatomy is abnormal and a difficult laryngoscopy under anaesthesia is anticipated, it is important to maintain spontaneous breathing until the airway is secure. In such cases one may consider laryngoscopy or insertion of a laryngeal mask airway (LMA) in the awake or lightly sedated patient. Many of the principles, such as adequate topical anaesthesia and the methods of guiding the tip of the tube into the larynx, are similar to blind nasal intubation. Retrograde intubation is preferred to tracheostomy if the cause of airway obstruction is likely to resolve in 72 hours and/or there is a fresh surgical incision in the neck or upper chest (sternotomy).