Figure 10.

A process for minimising aerosol generation when managing patients with airway compromise due to laryngotracheal stenosis. Unless absolutely contraindicated due to impending airway obstruction, a pre-operative computed tomography (CT) scan must be performed and if available, virtual endoscopy views must be reconstructed (tinyurl.com/virtualendoscopy). The sequence of donning, draping and pre-oxygenation, along with available rescue manoeuvres have been adjusted to minimise aerosol generation. A rapid sequence induction dose of rocuronium is given in all cases to optimise laryngoscopy conditions with minimal apnoea time. Laryngoscopy is then performed to visualise the glottis and subglottis. The the Tritube® is then placed through the surgical laryngoscope. Therefore, the surgical laryngoscope needs to provide access to the glottis and subglotis and be of sufficient diameter to allow the Tritube to pass through it once it has been placed. An additional consideration is that the initial laryngoscopy must be performed in head-up position at the highest possible angle of inclination in order to reduce the speed of compression atelectasis development and early desaturation. The bottom images show the Tritube and the subglottis and the cervical trachea of a patient with Myer-Cotton grade 2 stenosis whose trachea has been intubated with the Tritube.