Approaches to the anaesthetic management of the shared airway

  • Anil Patel

Student thesis: Doctoral Thesis


Traditional practice for maintaining an airway during anaesthesia is to place a tube through the larynx and into the trachea through which anaesthetic gases and oxygen keep the patient alive. During shared airway surgery on the larynx or trachea itself the presence of a tube may impair or make surgery impossible.
The presented work comprises a series of papers, research trials and commentary that describe the advantages and disadvantages of the various techniques that have been used for shared airway surgery.
The principles of shared airway surgery are described, including the influence of laser surgery on the technique selected, and the influence of temperature on the success of tracheal intubation.
Clinical application and laboratory investigations of various jet ventilation techniques are discussed. The influence of frequency, laryngoscope alignment and driving pressure on the efficiency of ventilation is described.
Management of the obstructed airway and the challenges posed during shared airway procedures are considered. The role of inhalational induction in these patients is challenged with research describing the improved ventilation following positive pressure ventilation in patients with severe laryngotracheal stenosis and stridor.
The introduction of Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) has improved shared and difficult airway management. For shared airway surgery, the advantages include no requirement for instrumentation of the airway and therefore no anaesthetic related trauma, a motionless surgical field for the surgeon and extended apnoea times in patients who may be difficult to visualise.
Future work will focus on the implementation of research data and new techniques into clinical practice
Date of Award2021
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorGraham Mills (Supervisor)

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