Initial measures are directed at preventing the tongue from falling backwards and obstructing the airway. The unconscious patient should be recovered in the lateral position with the jaw supported. Blood and secretions should be cleared by suction and supplemental oxygen given via a face mask. If upper airway obstruction develops the head should be tilted backwards and the jaw pushed forward by applying pressure behind the angle of the jaw. If this measure does not rapidly clear the airway then an oropharyngeal or nasopharyngeal airway should be inserted. Care should be taken on insertion of an oral airway as this may cause laryngospasm, coughing or vomiting in the waking patient and, if in doubt, a nasal airway should be passed. If this does not immediately rectify the situation then senior help should be sought and 100% oxygen administered via a tight fitting mask. Continuous positive airway pressure (CPAP) at this stage may help to open the airway or "break' the laryngospasm. However, in the presence of continued airway obstruction and falling oxygen saturation intravenous suxamethonium (1-2 mg/kg) should be given followed by manual ventilation with 100% oxygen and subsequent orotra cheal intubation. In the rare event when this is not possible the failed intubation drill should be followed. Extubation of the trachea should occur when the patient has regained full muscle power and is awake. An algorithm for airway management is shown in Figure PO.3.
Upper airway obstruction secondary to wound haematoma must be immediately treated. The surgeon and an experienced anaesthetist should be called, the airway supported, 100% oxygen administered and the trachea intubated. The wound stitches should be removed and the haematoma evacuated. It is important to remember that the airway anatomy may be grossly distorted and it may be impossible to intubate the trachea. In this situation, a surgical airway will be required
Post Operative Hypoxaemia
Hypoxaemia is defined as an arterial oxygen tension (PaO2) of less than 8 kPa. In the post operative period it occurs due to a combination of factors which are listed in Figure PO.4 (Mangat 1993). Prevention, early recognition and treatment are important because of the increased morbidity and mortality associated with this condition.
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