Anaes · Subspecialty anaesthesia
Head and neck anaesthesia — ENT, dental, shared airway and eFONA
Also known as ENT anaesthesia · Shared airway anaesthesia · Emergency front-of-neck access · Dental anaesthesia · eFONA
Anaesthesia for ENT and dental surgery — the shared airway (preformed, reinforced, laser tubes), tubeless-field jet ventilation, airway fire, and emergency front-of-neck access (scalpel-bougie-tube vs cannula) in the CICO crisis.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Shared airway means 'no tube between you and the surgeon until secured' — plan together.
- NAP4 found over a third of major airway complications involved head, neck or tracheal pathology; the ENT list is a high-risk airway destination.
- Distorted or displaced larynx + secretions + stertor = secure the airway awake or surgically before induction.
- In the CICO crisis, DAS 2015 directs scalpel cricothyroidotomy without delay; time-to-oxygenation evidence favours cannula for speed and scalpel-bougie for reliability.
- Tubeless field means HFNO or jet ventilation via supraglottic catheter, not apnoea with intermittent face-mask.
Meet the patient
A 58-year-old with stridor and clubbed fingers is listed for microlaryngoscopy and biopsy of a glottic mass. The surgeon wants the tube out of the posterior field; you want a secure airway and a judged oxygenation strategy for what may be a paralysable, partially obstructed larynx. The wrong answer is to paralyse and hope. The right answer is to plan the shared airway before induction, and have the surgical airway open in the room.[3]
References9ShowHide
- [1]Cook TM, Woodall N, Frerk C, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth, 2011.PMID 21447488
- [2]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults Br J Anaesth, 2015.PMID 26556848
- [3]Bola S, Osuji J, Rivero-Bosch M, et al. Airway Management in Otolaryngology and Head and Neck Surgery: A Narrative Review of Current Techniques and Considerations. J Clin Med, 2025.PMID 40649091
- [4]Rees KA, O'Halloran LJ, Wawryk JB, et al. Time to oxygenation for cannula- and scalpel-based techniques for emergency front-of-neck access: a wet lab simulation using an ovine model. Anaesthesia, 2019.PMID 31165475
- [5]Zasso FB, Lait D, Siddiqui N, et al. Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study. CJEM, 2022.PMID 36346398
- [6]American Society of Anesthesiologists Task Force on Operating Room Fires Practice advisory for the prevention and management of operating room fires 2013.Source
- [8]Tom LW, Tsao F, Marsh RR Effect of anesthetic gas on middle ear fluid. Laryngoscope, 1994.PMID 8022245
- [9]Düzenli U, Bozan N, Turan M, et al. The Effect of Nitrous Oxide on the Outcomes of Underlay Tympanoplasty: A Prospective Study. Ear Nose Throat J, 2019.PMID 31035784
- [10]Athanassoglou V, Patel A, McGuire B, et al. Systematic review of benefits or harms of routine anaesthetist-inserted throat packs in adults Anaesthesia, 2018.PMID 29322502