Anaesthesia in Upper Respiratory Obstruction.

The causes of upper respiratory obstruction are reviewed. The symptoms and signs are graded according to severity. It is stressed that cyanosis indicates very severe obstruction, and that stridor at rest is a very informative local sign of severe obstruction. In severe obstruction respiratory depressant drugs and atropine are contraindicated while helium may be helpful. When general anaesthesia is necessary in severely obstructed patients, the obstruction may first be bypassed by nasotracheal or orotracheal intubation, tracheostomy or bronchoscopy. Each of these can be performed with local anaesthesia. The value of blind nasal intubation in the conscious patient cannot be over-stressed. When tracheostomy is indicated it should be done early, as an elective procedure.