Prospective Observational Study Of Perioperative Airway Management In Adult Patients With Central Airway Obstruction

Airway obstruction is a potentially life threatening condition with a wide variety of aetiologies that can lead to a number of complications ranging from respiratory failure, arrhythmias, cardiac arrest and even death.

In general, airway obstruction is broadly classified into upper airway obstruction which refers to the obstruction of air flow in the portion of the airway that extends from the nose till the trachea and therefore includes the nasopharynx and larynx. Central airway obstruction which refers to the obstruction of airflow in the trachea and mainstem bronchi. Lower airway obstruction refers to the obstruction distal to the mainstem bronchi.

Causes of central airway obstruction are typically classified as malignant or nonmalignant or in accordance to the location ie intraluminal or extraluminal or according to the nature of the obstruction ie dynamic (eg;tracheobronchomalacia) or fixed.

Management of central airway obstruction is complex and challenging. Management is usually individualised rather than protocolised. There are no clear guidelines regarding anaesthesia techniques for airway management. General anaesthesia with inhalational or intravenous techniques, with or without muscle relaxants or awake techniques for airway control may be used based on the type and degree of airway obstruction, experience of the anaesthesiologist and availability of equipment.

This prospective observational study is aimed at understanding the airway management practices and outcomes in patients with central airway obstruction undergoing anaesthesia in our institute.

The main objectives of the study is to

1)Assessment of the location, extent and nature of the obstruction based on radioimaging/fibreoptic nasoendoscopy, PFT and other modalities.

2)Assessment of the airway equipment used to secure the airway based on the location, extent, nature of the obstruction and other patient factors.

3)Assessment of the factors considered while planning the airway strategy (eg;awake or under GA).

4)Assess the impact of the proposed airway management in patient outcome.

The total study duration is 2 years.The total sample size is 200 patients.

All adult  patients in Tata Memorial Hospital,Parel with central airway obstruction undergoing anaesthesia in emergency and elective setting will be included in the study after taking an written informed consent.

Data will be collected in the Case Record Form. Details regarding patient characteristics, surgical procedure and anaesthesia details will be collected prospectively from the patients’ electronic and physical records. Details regarding airway management plan and its success, failure and complications will be captured.

Demographic data will be summarized with descriptive statistics. Continuous data will be represented as mean (Standard deviation), or Median (IQR) and categorical data will be reported in counts (percentage) respectively. The Shapiro-Wilk’s test will be used to check normality of each variable. Categorical data will be compared using chi square test such like Pearson’s chi square test and fisher’s exact test. Comparison of continuous data will be done by using t test or Mann Whitney U test.