BARRY L. WENIG, MD, MPH; TIMOTHY B. MCDONALD, MD; RICHARD A. BERKOWITZ, MD; MARIA DECASTRO, MD; ANGELIQUE DANIELSON-COHEN, MD; GEORGE SMYRNIOTIS, MD

CHICAGO, ILLINOIS

Although the treatment of malignancies of the larynx and trachea falls within the realm of the otolaryngologist-head and neck surgeon, management of the airway overlaps to include the anesthesiologist. The inability to either intubate or perform a tracheotomy because of distal intratracheal lesions presents a harrowing challenge for both the surgeon and the anesthesiologist. While guidelines for airway management are currently unavailable to the otolaryngologist, the anesthesiologist can rely on the ASA Difficult Airway Algorithm. A review of the anesthesia literature points to only a handful of cases in which the ultimate method of airway management exceeded the end point of the algorithm. Two cases of malignancies that occluded the upper airway are presented. Standby femoral arterial-femoral venous bypass was employed to facilitate control of the airway in the event of complete occlusion during the induction of anesthesia or during an awake intubation. Standby cardiopulmonary bypass provides a backup for those occasions on which the end of the current airway algorithm has been met.