James talks to Dr Tim Suharto about postoperative airway concerns.
Summary Writer: Hayden Alicajic
Editor: Tim Suharto
Interviewee: Tim Suharto
Tim is a specialist anaesthetist and one of the supervisors of training at Nepean Hospital. He is involved in the anaesthetic education program and leads the Group for Anaesthetic Simulation (GAS), which delivers in-situ crisis scenarios involving critical care doctors and nurses. Tim is an instructor for the Nepean Difficult Airway course as well as the Nepean Can’t Intubate Can’t Oxygenate (CICO) workshop. He is a strong advocate for innovation in medical education and developing links between sub-specialties in medicine to enhance understanding and collaboration.
Tim’s clinical work encompasses both public and private practice with regular sessions in acute pain medicine, anaesthesia for orthopaedics, ENT, neurosurgery and interventional radiological procedures.
With Dr Tim Suharto, Staff Specialist Anaesthetist at Nepean Hospital, New South Wales, Australia
Tracheal intubation receives much attention, especially with regard to the difficult airway, however tracheal extubation and postoperative airway emergencies receive relatively little emphasis. A postoperative airway emergency is defined as derangement in physiological signs or symptoms attributed to the airway resulting in obstruction or impending obstruction. Events such as laryngospasm, aspiration, inadequate airway patency, or inadequate ventilatory drive can occur and frequently result in hypoxemia.
Any form of airway dysfunction, such as obstruction after tracheal extubation, is an immediate threat to patient safety. Significant airway compromise leads to a reduced minute ventilatory volumes and hypoxia. A differential diagnosis of acute postoperative obstruction of the upper airway after extubation is wide and includes: laryngospasm, relaxed airway muscles, soft tissue edema, cervical hematoma, vocal-cord paralysis, and vocal cord dysfunction.
You are on night shift and are called by nursing staff that are concerned about a 66-year-old female who is day 1 post thyroidectomy who is complaining of worsening pain at the surgical site. The nurses are concerned about the increased swelling of the neck.
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