Special Considerations in Anesthesia for Laryngeal Cancer Surgery .. Supraglottic laryngectomy offers the advantage of cure with preservation of speech for. Therefore tracheotomy was standard part of laryngectomy (usually under local anesthesia) to establish airway with general anesthesia. The anaesthetic considerations for head and neck cancer surgery are . this is physically impossible (e.g. the post-laryngectomy patient) or because oral.

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This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK.

Airway oedema can develop rapidly and is often precipitated by venous obstruction, posture change e. The need for advanced airway protection is to avoid airway obstruction due to haemorrhage or other surgical complication affecting the airway.

Extrapolation of these concepts to patients with head and neck cancer undergoing major resections and free-flap surgery lryngectomy help in improving outcomes.

Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

Enhanced recovery in colorectal resections: Other alternatives which allow a much less restricted field are: Anaesthedia situations can be very serious both because of the technical challenges posed and the limited time available for re-establishing the compromised airway. The anaesthetist will usually have information about the lesion e. Author information Copyright and License information Disclaimer. Anticipated complications include bleeding, tube obstruction and accidental decannulation.

Pre-treatment clinical assessment in head and neck cancer: Managing the emergency stridulous patient.

Sign In or Create an Account. Post laryngectomy patients can present for other types of surgery and a clear plan must be made for the management of such patients.

In the laryngectimy who presents with acute airway compromise the obvious option is to consider a tracheostomy under local anaesthesia.

An ERP can be formulated around the head and neck cancer patient’s overall journey. It may anaesthesiaa possible to de-bulk the tumour once intubation is achieved, but experienced practitioners need to be involved if this is to be attempted. Induction of anaesthesia If a patient is already at risk of airway obstruction due to tumour bulk, then it is probable that they will be at greater risk following induction of anaesthesia, whether intravenous or inhalational.

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Anaesthesia for total laryngectomy.

Analgesic requirements tend to be less than for body cavity surgery, but this will laryngectommy necessarily be the case in patients on moderate doses of opiates for pre-operative pain problems. Intensive Care Society, These equate to the need to protect from gravity-related pressure effects, thermal homeostasis, retention of urine and prolonged wake up time.

Currently there is widely diverse practice in terms of post-operative airway management of head and neck cancer patients. A guaranteed airway from pre-operative ward care through to safe discharge must be considered as an essential duty of care for any institution undertaking surgery of this nature. Enhanced recovery programmes ERP for head and neck cancer patients An ERP can be formulated around the head and neck cancer patient’s overall journey. In some institutions, ventilation is established prior to induction of general anaesthesia via temporary crico-thyroid or trans-tracheal access.

Anaesthesia for total laryngectomy.

While patients presenting for head and neck surgery may have co-existent problems that could make airway management difficult e. The Royal College of Anaesthetists, Br J Oral Maxillofac Surg ; Patel A, Nouraei SA. Pre-operative assessment Comorbidity and pre-operative assessment are considered elsewhere in the guidelines. Firstly a biopsy will be taken for tissue diagnosis and secondly the tumour bulk will be reduced so as to minimise any likelihood of obstruction.

Post-operative haemorrhage and oedema risks mean that tracheostomy remains an important consideration in extensive resections. For example, at one end of the spectrum almost all free-flap reconstructions are managed with temporary tracheostomy whereas elsewhere, overnight ventilation followed by extubation the following morning is the expected norm.

Length of operative procedure For lengthy operative procedures increased attention needs to be paid to the inevitable consequences of prolonged immobility, impaired homeostasis associated with general anaesthesia and the saturation of fatty tissue with anaesthetic agents.

Perioperative management of the elective laryngectomy. J Laryngol Otol ; Suppl S2: Ideally, any surgeon would wish to have an unrestricted view of the lesion to be operated on. Removal for tracheal tubes is the responsibility of the anaesthetist. Management of surgical complications Neck haematoma, flap failures, fistulas and airway management issues e.

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Tracheostomy is an intervention with its own risks including inadvertent decannulation and is also associated with increased hospital stay. It is unusual for any patient to be ventilated post-operatively.

Current practice has also been influenced by the introduction of many new anaesthwsia devices, very few of which have been reported in large series of head and neck cancer patients.

Anaemia, malnutrition, and alcohol dependency are modifiable preoperative risk factors. Cardiac monitoring was used regularly in only 9 per cent of UK units in an audit in Fir anaesthetic considerations World Health Organization WHO checklist All theatre staff are recommended to participate in this initiative to ensure that teams work effectively and that the right patients get the right surgical procedure they have consented to.

Dealing with any of these issues commonly requires senior and experienced staff and they will frequently resort to conventional oral intubation to secure the airway prior to re-establishing the compromised tracheostomy, but oral intubation may not be feasible either because this is physically impossible e. These alternatives tend to become more of a problem if the operative procedure is prolonged.

Oxford University Press is a department of the University of Oxford.

Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

Airway considerations While patients presenting for head and neck surgery may have co-existent problems that could make airway management difficult e.

All theatre staff are recommended to participate in this initiative to ensure that teams work effectively and that the right patients get the right surgical procedure they have consented to. Oxygenation Maintenance of oxygenation is fundamental to airway management and techniques that extend the apnoeic window allow more controlled, less hurried and more careful, gentle instrumentation.

For Permissions, please email: Neck haematomas can be particularly deceptive because any associated airway oedema bears little resemblance to the apparent severity of neck swelling. Close mobile search navigation Article navigation.