Airway abscess & infection

Learning objectives

The consequences of airway infection and retropharyngeal abscess during intubation
Management of airway infection and retropharyngeal abscess

Upper respiratory or ear infections can lead to retropharyngeal abscess formation (collection of pus in the retropharyngeal space)
Tracheal intubation will be difficult due to distorted airway anatomy, edema, decreased mouth opening, and immobile tissue
Vocal cords can be difficult to visualize
A retropharyngeal abscess can rupture and aspiration of the content can occur during intubation
The induction of general anesthesia may precipitate complete airway closure

Upper airway infection	Retropharyngeal abscess
Cough Runny nose Sneezing Throat pain Fever	Severe sore throat Swollen lymph nodes Difficulty breathing Difficulty speaking Noisy breathing Severe headache Stiff neck Coughing Fever

Investigate the airway using an X-ray or CT-scan
Perform preoxygenation
Intubate using awake fiberoptic intubation
Consider a tracheostomy if endotracheal intubation is not possible
- Challenge: distorted anatomy affects the location of landmarks
Treat retropharyngeal abscess with broadspectrum IV antibiotics
Consider draining the abscess

Full stomach & need for rapid sequence induction (RSI) vs difficult airway
Full stomach & need for RSI plus need for deep level of anesthesia vs. risk of hemodynamic instability (sepsis)
Awake fiberoptic intubation does not visualize ETT passing abscess & therefore potential to rupture it