Internet Journal of Airway Management



Volume 6 (January 2010 to December 2011)


Zadrobilek E, Krasser K, Missaghi SM, Puchner W, Trimmel H, Genzwuerker H, Thierbach A, Greif R, Priebe HJ (for the Austrian Working Group for Airway Management). Recommendations of the Austrian Working Group for Airway Management: Airway Management in Patients Developing Hematomas after Neck Surgery

Preparatory Provisions



Hematoma formation developing after neck surgery is a potentially life-threatening complication and every efforts must be made to call for early help. Ready availablitity of the necessary equipment for emergency airway management, best accomplished by a dedicated difficult airway cart (2, 25), and the provision of qualified personnel are essential for successful management of these situations.  


An experienced surgeon must readily be available, particularly in emergency situations, and prepared to perform hematoma evacuation. This straightforward maneuver may be life-savening by acutely relieving upper airway obstruction and may facilitate laryngeal exposure during the subsequent tracheal intubation attempt. The surgeon should also be prepared to perform an emergency surgical cricothyrotomy or tracheotomy for airway access when attempts at oxygenation and ventilation of the patient fail. A respective agreed-upon management algorithm should exist in all surgical departments involved in neck surgery.


Preoxygenation by breathing oxygen through a face mask with airtight seal should be initiated early with the aim of optimizing oxygenation and delaying severe arterial desaturation during airway interventions. We emphasize that maintenance of oxygenation, particularly between tracheal intubation attempts, should be given the highest priority (23).



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