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This chapter highlights a technique of airway evaluation which is readily available to the anesthesiologist, is minimally invasive, and may provide enough information to reduce the use of awake intubation by providing improved clinical information. Preoperative endoscopic airway examination (PEAE), uses the commonly available flexible intubation scope, and unlike use of the same instrument for awake intubation, requires minimal time and patient preparation because it is well tolerated by patients, mimicking an ordinary office ENT laryngoscopic examination. Patients presenting to the operating room under the care of an otolaryngologist for management (diagnostic or therapeutic) of an airway lesions have, in most cases, undergone a flexible endoscopy in the surgeon's office. PEAE may be performed in the preoperative clinic setting, holding area or operating room. Patients who present with invisible airway pathology (e.g. papillomas, supraglottic masses), which may compromise the clinician's ability to control the airway, can be more thoroughly assessed.
An airway fire is potentially deadly complication that may occur during tracheotomy surgery, during laser surgery and with a number of other procedures. This chapter discusses the prevention and management of airway fires. The anesthesiologist should keep the administered oxygen levels to the minimum needed when a significant potential for an airway fire is present. In general, cases of airway fire call for immediate removal of the endotracheal tube (ETT) and flooding of the field with saline. While this is a reasonable rule of thumb, it should also be noted that there are occasional patients where removal of the ETT would in all likelihood result in irreversible loss of the airway. Some authors have suggested that flooding the surgical site with carbon dioxide will help prevent airway fires during open tracheostomy using cautery.