Airway Abscess & Infection 

 

 

Considerations 

 

  • Emergency with risk of aspiration & acute airway obstruction

  • Difficult intubation & BMV with potential for complete airway obstruction (life threatening emergency):

    • Difficult topicalization

    • Trismus

    • Distorted anatomy, tissue edema, immobile tissue

    • Copious secretions

  • Potential for airway soilage from abscess rupture 

  • Shared airway

  • Possible sepsis, pneumonia, mediastinitis & need for early goal directed therapy 

  • Risk factors & co-morbidities:

    • Adults: HIV, IV drug use, diabetes, head & neck malignancies, alcohol

    • Immunosuppression 

    • Pediatrics: upper respiratory tract infections

  • Potential for postoperative re-obstruction post extubation & disposition to ICU/high acuity unit 

 

 

Goals 

 

  • Consider pre-op abscess draining

  • Secure airway safely & effectively, always consider awake fiberoptic intubation (AFOI), surgical airway, ‘double set-up’ 

  • Manage sepsis with early goal directed therapy

  • Prevent abscess rupture & lung soilage

 

 

Conflicts 

 

  • Uncooperative pediatric patient vs. difficult airway

  • Full stomach & need for RSI vs. difficult airway

  • Full stomach & need for RSI plus need for deep plane of anesthesia vs. risk of hemodynamic instability (sepsis)

  • AFOI does not visualize ETT passing abscess & therefore potential to rupture it

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